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The U.S. health care system remains among the least efficient in the world, ranking 50th among 55 countries in 2014, according to the Bloomberg Health-Care Efficiency Index. The index assesses life expectancy, health care spending per capita and relative spending as a share of GDP. The U.S. has ranked near the bottom of the index since its inception in 2012. That's because the system "tends to be more fragmented, less organized and coordinated, and that's likely to lead to inefficiency," says Paul Ginsburg, a director of the Center for Health Policy at the Brookings Institution. (Bloomberg)

A Government Accountability Office report finds that the administration mismanaged a three-year transitional reinsurance program that pays eligible issuers. The goal: Stabilize health insurance premiums and encourage issuer participation in the exchanges. The GAO says some money that was paid to insurers should have gone to the Treasury. The administration defended its interpretation of the law, but the finding bolsters Republican complaints that administration officials bent the law as problems arose carrying out its complex provisions, the Associated Press reports. (AP; GAO report)
UnitedHealth Group and the University of California Health system joined forces to create an ACO that will be offered to large, self-funded employers statewide. The agreement also calls for expanded research into patient data. UnitedHealth will open a research lab that offers UC-system researchers access to a huge national database of patient records. David Kraus, chief contracting and clinical strategy officer for the UC Health system, tells Kaiser Health News that UC and UnitedHealth want to learn from past ACO mistakes and offer a centralized approach that can tap into real-time data. (Kaiser Health News)
Innovation & Transformation  
Some types of wine grapes grow only in very specific locales and nowhere else. The concept is "terroir," and in a Health Affairs Blog post, Drs. Jeff Goldsmith and Lawton Burns suggest the same applies to health care. "[O]ne finds repeatedly that some forms of organization that prosper in one part of the country fail to thrive in others." Among the examples they offer is Kaiser Permanente, which thrives in Oregon and California, but has struggled in some other locations. (Health Affairs Blog)

Melissa Perrell Phipps's 2010 cancer diagnosis changed her life--and her career. Phipps--then assistant general counsel for Novant Health in N.C.--planned to revamp the system's approach to advance directives. Instead, Novant President and CEO Carl Amato empowered her to create a plan to transform end-of-life care. It's been a multi-year effort, she tells HealthLeaders Media. Among the changes: "trying to shift our culture so the right questions are asked much earlier, and focusing on patient goals rather than asking nonclinical people questions about specific medical treatments that they don't really understand at a time when they're stressed or scared." (HealthLeaders Media)
St. Jude Children's Research Hospital received a six-year, $4.4 million grant from the National Heart, Lung, and Blood Institute for an app. "Our goal with this project is to use a mobile health application to help 15-year-old and older patients in the Memphis and wider areas manage sickle cell. This is crucial since at this time in their lives they often have less access to health care providers and comprehensive sickle cell programs, which greatly impacts their quality of life," says Dr. Jan Hankins of the St. Jude hematology department. (Memphis Business Journal)
Consumers & Providers
Nearly 20 years ago, Dr. Lars Aanning lied under oath during a medical malpractice trial because the culture amongst doctors is you don't squeal on each other, he tells ProPublica. "Pressure is the prevailing attitude of the medical profession. The professional societies like the AMA and the American College of Surgeons say you should be a patient advocate at all times. But that goes out the window because here you are, banding together with your peers. Because if you don't, you'll be like a man without a country." (ProPublica)
Working as partners, insurers and physicians can improve care delivery. Researchers from Rice University studying Cigna's Collaborative Accountable Care initiative in a large multi-clinic practice reported a 5.7 percent reduction in spending. "With improved patient data...plus additional nursing support within the practice for follow-up, physicians can readily focus on delivering care quickly and efficiently," explains Rice's Vivian Ho, PhD. (Rice announcement; American Journal of Managed Care)
Hospices are seriously understaffed, according to new research from Health Affairs. Guidelines recommend that hospitals have a physician, an advanced practice or registered nurse, a social worker and chaplain on the palliative care team, but only 25 percent of participating programs met that standard based on funded positions; when unfunded positions were included, only 39 percent of programs met the standard. (Health Affairs)
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New & Noted   
Public option still on table: California Insurance Commissioner Dave Jones said last month he thinks a public option should be strongly considered in his state. National Democrats are also reviving the idea after many insurers started pulling out of the individual insurance markets. But critics warn it would lead to a full government-run system, and insurers are steadfastly opposed. (Kaiser Health News)

Obamacare update: More insurers announce plans to leave ACA exchanges, Utah announces rate increases and Kansas finalizes plan choices. (Kaiser Health News)

Unreported epidemic: Thousands of Californians die each year from hospital-acquired infections, but the state does not track those deaths. And unlike most other states, it does not require hospitals to report when patients are sickened by "superbugs." Across the country, an epidemic of hospital-acquired infections is going unreported, scientists say. (LA Times)
A NEJM Perspective piece calls for better sharing of patient-level data from clinical trials, arguing that it can improve not only the quality of research, but enhance the understanding of disease and treatment. "We believe the clinical research enterprise needs to come together to build on what exists and create a simple one-stop shop for clinical trial data sharing." In an accompanying audio interview, Dr. Jeffrey Drazen discusses the future of sharing clinical trial data. (NEJM)
MarketVoices...quotes worth reading
"To paraphrase the famous line from the movie Cool Hand Luke, 'What we have here is failure to replicate.' Absent a respect for local and non-economic factors, we will continue the wasteful practice of sowing our policy seeds on barren ground."--Drs. Jeff Goldsmith and Lawton Burns in a Health Affairs Blog post

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Wednesday, October 5, 2016