Attributes Common to Programs That Successfully Treat High-Need, High-Cost Individuals
Gerard F. Anderson, et al. in AJMC
“Interesting research meta-analysis on what is working to treat high-cost patients. Many of the findings are no-brainers, but some our eye openers, e.g., call centers are in-effective as they do not have an established relationship with the patient. Could this be a leading factor as to why all those payer-sponsored DM programs failed? Certainly a contributor.” – John
‘No Matter Where’ brings health information exchange to big screen
Neil Versel in MedCity News
“Not a fan of holiday blockbusters? You could do worse than check out “No Matter Where,” a 77-minute film that aims to explain health information exchange in layman’s terms. The film, screened at the recent American Medical Informatics Association symposium, traces the starts and stops of HIE over the last decade. With more than two-thirds of Americans expecting their records to be readily available to medical professionals over the Internet, the film presents a stark reminder of the distance between expectation and reality.” – Brian E.
Clinician-Led Stewardship To Curb Medical Excess
Dan Morgan in Health Affairs
“Overuse of imaging, often in response to clinical uncertainty, has many of the same clinical and financial downsides as overuse of antibiotics. This article talks about how the idea of medical stewardship – better clinical guidelines in plain English — could help reduce overuse not only of imaging but also of a variety of interventions with significant variability of application and outcome.” – Brian M.
MIT offshoot set to launch health app reviews
Marc Iskowitz in Medical Marketing and Media
“One of the biggest criticisms of consumer health apps is that no one verifies their clinical efficacy. The average consumer has no idea whether an app is truly effective or merely bloatware. MIT’s Hacking Medicine Institute, working with Harvard University clinicians, intends to launch consumer health tech reviews by the end of the year. The organization says it’s well positioned to review apps specifically because it’s “a group of hackers” and not a medical institution. Here’s hoping it fares better than Happtique.” – Brian E.
UnitedHealth Group May Leave Obamacare Exchanges By 2017
Bruce Japsen in Forbes
“This headline – that United Health Group may leave the exchanges with their individual commercial product in 2017 due to underperformance – turned numerous heads yesterday from Wall Street to Silicon Valley. To some extent this is just growing pains for the industry – Oscar faced similar trouble in year one of their experiment in NY. One has to wonder what the market will look like in five years if the bigger players decide to bow out.” – Naveen
Former hospital CFO, two surgeons, charged in $600 million healthcare billing fraud
Dan Morgan in Health Affairs
“With all the talk of narrow networks and referral management, this article points to a darker side of referral management – fraud. To what extent do the newer referral management solutions entering the market track such fraudulent practices is hard to say. To date, in the briefings we have had with such vendors, the issue has not been addressed.” – John
Twitter Streams Fuel Big Data Approaches to Health Forecasting
Bridget M. Kuehn in JAMA
“There’s obviously a lot of noise on social media, but research increasingly shows that Twitter in particular can be an effective tool for health forecasting. The willingness of Twitter users to say just about anything can predict disease outbreaks, spot the spread of food-borne illness, or identify subjects engaged in opioid abuse. There are obviously limitations to this type of forecasting, especially given the types of people who tend to use social media, but the timeliness of tweets can provide more timely assessments that traditional research methods.” – Brian E.
California’s 3 largest health insurers among few to show Obamacare profit in 2014
Chad Terhune in La Times
“Click on this article to find out more about the payers who made money last year and will have to turn some of it over so CMS can pay those who did not make money under the risk corridors rule. California insurers did OK and, as the article indicates, not everyone is happy about that. They blame the profits on a variety of reasons which make for an interesting read.” – Brian M.
This state scrapped fee-for-service last year. Here’s how it’s doing now.
Advisory Board Daily Briefing
“The Value-Based Reimbursements (VBR) activity in Maryland over the last two years has started turning many heads, and rightfully so. After last month’s progress update in the New England Journal, we learned of a few notable accomplishments, including but not limited to: Getting all hospitals in the state to agree to operate on global budgets within 6 months; lowering the state’s health care growth rate per capita to just 1.47% (two full percentage points lower than the state’s GDP growth rate), and even decreasing the state’s total per capita hospital cost growth to the tune of saving CMS $116M in just one year. Moreover, these efforts have improved quality, as measured by decreases in rate of hospital readmissions and preventable conditions. In the year ahead we hope to learn more about the specific strategies and technologies that hospitals have used to drive this groundbreaking progress.” – Naveen