Week of November 29-December 5, 2015


Strategy and the Health Care Marketplace
From their inception, Medicare and Medicaid have been shaped and guided by health services research (HSR) and its people.  As administrator of the Centers for Medicare and Medicaid Services (CMS) from 2010 to 2011, I saw productive contributions of HSR to CMS policy, regulation, and operations every day. That is a track record to be proud of. But there are gaps, some big ones, and a re-chartered agenda for HSR could help boost American health care to its next and needed levels of performance. Donald M. Berwick writing in the Milbank Quarterly, Health Services Research, Medicare, And Medicaid: A Deep Bow And A Rechartered Agenda,

Healthcare leaders are under pressure to improve performance as rapidly as possible in an environment of great ambiguity. The colossal shifts taking place in the industry require urgent action and more new ways of approaching complex issues that may affect quality, safety and reimbursement.
The volume-to-value journey: Guidelines for the new C-Suite,

How can organizations that are working to improve health outcomes incorporate innovation into their work? How can they get the most out of the investments they are making in innovation? In this post, Institute for Healthcare Improvement (IHI) Senior Vice President for Innovation Kedar Mate, MD, and IHI Senior Research Associate Mara Laderman, MSPH, explain that successful health care delivery innovation requires disciplined processes rather than divine inspiration or vast resources.
Innovation Is No Lightning Strike: How to Maximize the Value of Your New Ideas,

We are increasingly aware of the tremendous geographical variation in health care—in utilization, prices, and the growing role of local market power that arises from consolidation. The idea behind the Healthy Marketplace Index, supported by the Robert Wood Johnson Foundation (RWJF), was to come up with timely measures that reflected important attributes of health care markets—such as prices, efficiency, and provider consolidation.
How Do You Measure The Health Of Health Care Markets?

In 2010, the Agency for Healthcare Research and Quality awarded 14 Transforming Primary Care Practice (TPC) grants to conduct retrospective evaluations of successfully implemented or ongoing patient-centered medical home (PCMH) transformation efforts in primary care settings. The findings and lessons learned from the TPC grants may be useful for practices and health care systems that are considering primary care transformation.
Findings from the AHRQ Transforming Primary Care Grant Initiative: A Synthesis Report, 

Many health care organizations today are striving to deliver better patient outcomes at lower cost and to be rewarded for accomplishing both. Most have begun this journey with pilot projects to obtain valid measures of outcomes and cost for one or two medical conditions.  To accelerate the dissemination and adoption of this value agenda for many more medical conditions, leaders should now consider establishing a new central office to oversee the creation of all the capabilities and information for such initiatives.
Healthcare Providers Need a Value Management Office,

More and more health care organizations are beginning to track their performance on outcomes – and they’re finding that getting started isn’t easy.  Measuring outcomes requires redesigned workflows, enhanced coordination across departments, and investment in new resources.  Above all, it requires strong resolve and adept leadership.
What Healthcare Leaders Need to do to Improve Value for Patients,

ACA Implementation
Thousands of Americans are again searching for health insurance after losing it for 2016. That’s because health cooperatives — large, low-cost insurers set up as part of Obamacare — are folding in a dozen states.
A Tale Of Two Obamacare Co-Op Insurers: One Standing, One Falling, 

Rural providers face different challenges than urban and suburban providers, making it difficult for many to achieve typical measures of quality, the National Quality Forum (NQF) noted in a new report. As a result, a number of federal quality initiatives exclude rural providers because of their low patient numbers or how they are paid.
Rural Health Final Report,

With the recent governors’ elections in  Kentucky and Louisiana refocusing attention on state Medicaid expansion decisions, a newly updated issue brief from the Kaiser Family Foundation provides an overview of the waivers obtained by six states – Arkansas, Iowa, Michigan, Indiana, New Hampshire and Montana — that are pursuing alternative Medicaid expansions under the Affordable Care Act.
The ACA and Medicaid Expansion Waivers,

An estimated 17 million uninsured have been covered by the Affordable Care Act. As that number grows in the coming years, it could have political implications: How will the newly insured behave at the ballot box? Will they vote? Will they become a Democratic constituency? The ACA may be an issue in the 2016 elections, but the newly insured are unlikely to become an important electoral factor themselves.
What’s the Political Power of Those Newly Insured Under Obamacare?,

Forty-five percent of the silver-level PPO plans coming to the market for the first time in 2016 provide no annual cap for policyholders’ out-of-network costs, an analysis by the Robert Wood Johnson Foundation finds. Not having a cap could lead to tens of thousands of dollars in bills for patients who are hospitalized or treated by providers who are not part of the plan’s network.
This Year’s Model: PPOs In 2016 Offer Less Out-Of-Network Coverage,

The CMS finalized a rule to permanently boost funding that helps states upgrade the technology that allows people to enroll in Medicaid. Nearly a quarter of states are looking to modernize their aging, often very state-specific systems, many of which have experienced the stress of Medicaid expansion under the Affordable Care Act.
CMS finalizes rule giving $3 billion to states for Medicaid system upgrades,

A report released this week by the Centers for Medicare and Medicaid Services (CMS) shows that annual health care spending increased 5.3 percent in 2014, up from 2.9 percent in 2013. In a new blog post, The Commonwealth Fund’s Sara R. Collins and David Blumenthal, M.D., explain that the increase resulted in part from 8.7 million Americans gaining insurance under the Affordable Care Act, as well as rapid growth in prescription drug spending.
New U.S. Health Care Spending Estimates Reflect ACA Coverage Expansions and Higher Drug Costs,


Little headway in attracting more Hispanics to ACA health coverage. The Washington Post
Diabetes prevention becomes lucrative growth industry, MarketPlace Healthcare,  
Oklahoma hospital will not charge homecoming crash victims for ER treatment. Reuters,
Saving Lives and Saving Money: Hospital-Acquired Conditions Update, Agency for Healthcare Research & Quality (AHRQ)
Why the U.S. Pays More than Other Countries for Drugs, The Wall Street Journal 
Community Paramedicine Can Improve Your Hospital’s Standing, Ease ED Burden.  Hospital and Health Networks, 
What Patients Need to Remember after Leaving the Hospital, WSJ, 
Physicians and burnout: It’s getting worse, MAYO CLINIC, 
Valuing the Invaluable: 2015 Update Undeniable Progress, but Big Gaps Remain,AARP Public Policy Institute, 
IBM’s Watson using data to transform health care, Chicago Tribune 
Medicare Rules Reshape Hospital Admissions, WSJ, 



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