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Dartmouth-Hitchcock health care system is leaving the very program its researchers developed: the ACO, the The New York Times reports. "It's hard to achieve savings if, like Dartmouth, you are a low-cost provider to begin with. ... [I]t's sad that we could not make it work here," says Dr. Elliott Fisher, director of the Dartmouth Institute for Health Policy and Clinical Practice. Dartmouth's health system did save money, but not enough to avoid penalties. "We would have loved to stay in the federal program, but it was just not sustainable," says Dr. Robert Greene of Dartmouth-Hitchcock. (The New York Times)


Premiums for employer-based health insurance are holding stable; family plan costs grew 3 percent. That was due, in part, to employers shifting costs to workers through increased deductibles, which have grown nearly six times as fast as wages. Kaiser Health News offers a roundup of the coverage. (Kaiser Health News)

Last week's Census Bureau report offered mostly good news, including a 1.3 percent reduction in the number of uninsured and a 5.2 percent increase in household income. But CBS News notes that one finding isn't so cheery: the Supplemental Poverty Measure. It suggests that health care cost still push millions into poverty. When medical expenses--premiums, drugs and co-pays and other uncovered medical costs--are included, 3.5 percent more people are defined as living in poverty in 2015 than the official statistics show. (CBS News)
 

Despite a concerted national investment in electronic medical records, most people's records remain scattered among various health care providers' offices, and many are available only on paper if they are available at all, experts say. The notion of a single file containing "medical records" (be they Hillary Clinton's, Donald Trump's or yours) is a fiction. Medical records are "in bits and pieces, in doctors' filing cabinets, hospital records departments, and in hard-to-access computers." (The New York Times)
 
Innovation & Transformation  
Clinical pharmacists, authorized as advanced practice providers who can write prescriptions, constitute a rapidly expanding workforce at the Veterans Health Administration. A recent piece in the American Journal of Health-System Pharmacy provides an overview. VHA clinical pharmacists had more than 5 million patient care encounters and generated 1.9 million prescriptions in FY2015. A multidimensional approach has proven successful in expanding clinical pharmacy practice throughout the VHA system. "Clinical pharmacists with an SOP ... play a key role as advanced practice providers, helping to improve access to high-quality chronic disease and medication management for the nation's veterans." (AJHP)

Trust, privacy, collaboration, inclusion, consistency, engagement, seamlessness and giving consumers what they want will make mHealth appealing to patients, according to research from Deloitte. "As more healthcare moves to self-care, consumers will likely demand easy-to-use platforms, high-quality care and secure health and personal information," Deloitte researchers concluded in their 2016 Survey of US Health Care Consumers. (mHealth Intelligence; survey)
 
Consumers & Providers
The Triple Aim is morphing into the Quadruple Aim, adding provider satisfaction to the other goals: improving the patient experience of care, improving the health of populations and reducing the per capita cost of health care. It makes sense, Danielle Miller, PHD(c), MSN, RNC-OB, writes in a Health IT Outcomes column, because clinician burnout may prevent the achievement of the Triple Aim. The key to achieving both aims? Health IT. One potential solution, she says, is "a fully integrated health system ...that allows for health information exchange and interoperability." (Health IT Outcomes)
 
 
Why aren't primary care physicians using telehealth? They aren't reimbursed for it, according to research published in the Journal of the American Board of Family Medicine, based on a survey conducted by the American Academy of Family Practitioners. Overall, the AAFP study reported only 15 percent of family care physicians surveyed in 2014 had used telehealth during the previous year. The most frequent users are HMOs and FQHCs, where reimbursements are more likely to be tied to reduced hospitalizations. (mHealth Intelligence; Journal of the American Board of Family Medicine)
Although EHR technology has improved patient safety and team-based health care, nurses, like their physician colleagues, are not satisfied, according to a recent survey from the Adventist University of Health Sciences. The survey questioned nurses about their opinions of EHR technology and how it has fit into their clinical workflows. Overwhelmingly, nurse respondents had negative views, with 92 percent reporting dissatisfaction in 2014. (EHR Intelligence)
 
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New & Noted   
HIT users, developers disconnected: The pace of innovation in health IT continues to lag. According to a NEJM Perspective piece, one fundamental--and largely unaddressed--barrier to innovation is the disconnect between health IT developers and users. (New England Journal of Medicine)
Gray

Strange bedfellows, good cause: Gun shop owners and public health workers in Colorado are skipping past the politics and working together to reduce suicides involving firearms. (Kaiser Health News)

Oregon, Oracle settle: The Cover Oregon debacle is over. Oregon has settled for more than $100 million, which includes cash payments to the state, as well as a six-year license agreement for products and services. Oregon originally demanded more than $6 billion in damages, accusing Oracle executives of fraud, filing false claims and racketeering. (Oregon Public Radio)
 
Multi-media 
In an interview with Medscape, Kaiser Permanente CEO Bernard Tyson talked about how technology is making "taking care of ourselves cooler" and predicted that, one day, most visits will be virtual. (Medscape)
 
MarketVoices...quotes worth reading
     
There is no way that I can go all over the world if every time I need something I have to physically be at a location. I have a relationship with my doctor and with her medical care team. I can be anywhere around the world. I can simply send an email to my doctor, say I am wondering if this is okay, and get a message back within a day. That is a convenience for me; it's a different relationship with my doctor. She knows me very well and the trust is there. In our view, the technology cannot substitute for trust. When I have a relationship, everything else is built on that.-- Kaiser Permanente CEO Bernard Tyson on the value of virtual care, in Medscape.


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Wednesday, September 21, 2016