Week of June 6 – 10, 2016


Health Care IT, Leadership and Management 
Located in the east San Francisco Bay area, Contra Costa County has a population of approximately 1 million.  But the same data shows that while the median household income is $78,187, the per capita income is $38,106.  How one health system addressed 2,000 patients’ social needs in 2 years.

How can health care organizations sustain improvements in safety, effectiveness, and efficiency of patient care? According to the new IHI White Paper, Sustaining Improvement, the key is to focus on the daily work of frontline managers, supported by a high-performance management system that prescribes standard tasks and responsibilities for managers at all levels of the organization.  Sustaining Improvement,

The goal of this article is to provide an overview of the use of health IT in behavioral health and to describe some unique challenges experienced in that domain.  Behavioral Health Information Technology: From Chaos to Clarity (abstract),

We are in the Age of Authenticity, where “be yourself” is the defining advice in life, love and career.  But for most people, “be yourself” is actually terrible advice.  Unless You’re Oprah, ‘Be Yourself’ Is Terrible Advice,

Effective CEOs must be more than just friendly, according to this HBR article; they must be highly decisive, as CEOs with that trait are 12 times more likely to get strong performance scores from their respective boards.  HBR, The Dangers of Hiring a Nice CEO,

ACA Implementation
In this column for WSJ Think Tank, Drew Altman discusses Republican and Democratic health reform objectives, and why GOP proposals and the Affordable Care Act are better understood as policies with very different goals, trade-offs and consequences.  The Fundamentally Different Goals of the Affordable Care Act and Republican ‘Replacement’ Plans,

In a new Commonwealth Fund issue brief, Sherry Glied of NYU and Adam Striar of Manatt Health Solutions report that the Cadillac tax will likely be more progressive than prior analyses have suggested, while reducing total health spending only modestly.  Looking Under the Hood of the Cadillac Tax,

CMS released a final rule Monday that aims to strengthen incentives for ACOs in the Medicare Shared Savings Program.  Acting Administrator Andy Slavitt said they will “encourage more physicians to improve patient care by joining ACOs, while also refining how the program measures success, so that current participants are better rewarded for quality.”  CMS issues final rule for Medicare Shared Savings Program ACOs: 5 takeaways,

Sixty-one percent of people who have used health insurance obtained through the Affordable Care Act (ACA) are getting care they previously could not access or afford, according to new Commonwealth Fund survey findings.  Americans’ Experiences with ACA Marketplace and Medicaid Coverage: Access to Care and Satisfaction,

Residents of Medicaid expansion states are more likely to have insurance and thus more likely to have a usual source of care; they are less likely to have unmet health care needs or problems paying medical bills. But there are further benefits of Medicaid expansion.  Beyond the Reduction in Uncompensated Care: Medicaid Expansion Is Having a Positive Impact on Safety Net Hospitals and Clinics,

Short term insurance policies, which do not qualify as coverage under the Affordable Care Act and put consumers at risk of a tax penalty, can siphon healthy people away from the online marketplaces because they are generally less expensive.  HHS Announces Plans To Curtail Consumers’ Use Of Short-Term Insurance Policies,

Many states are using Section 1115 waivers to expand eligibility for Medicaid.  Wisconsin’s 2014 BadgerCare demonstration is testing the effect of reducing, rather than expanding, eligibility.  Wisconsin’s waiver, approved by CMS, lowers Medicaid income cutoffs and moves some beneficiaries into the marketplace. Wisconsin’s 1115 Medicaid Demonstration: What Will Policymakers Learn?


A new study out in Scientific Reports finds that more and more young people have early stage ear damage. Hearing tests run on 170 students between ages 11 and 17 found that nearly 25 percent have persistent tinnitus, or a buzzing or ringing in the ears.  Scientific Reports,  

Crispr describes a series of DNA sequences discovered in microbes, part of a system to defend against attacking viruses. Microbes make thousands of forms of Crispr, most of which are just starting to be investigated by scientists. If they can be harnessed, some may bring changes to medicine that we can barely imagine.  NY Times,

In the United States, the transition from volume to value dominates discussions of health care reform. While shared decision making might help patients determine whether to get care, transparency in procedure- and hospital-specific value measures would help them determine where to get care.  Milbank Quarterly,

There is another story about prescription drugs that should get attention. It doesn’t involve a sleazy entrepreneur or a breakthrough drug that costs more than a luxury car. It is not even a new story.  Milbank Quarterly,

Despite opposition from the pharmaceutical industry, Vermont late last week became the first state in the country to require drug makers to justify price hikes for medicines.  STAT,

Drug monitoring databases show promise in curbing certain opioid prescriptions. States that launched a monitoring program saw a 30 percent drop in the rate of Schedule II opioid prescriptions in the next decade, according to a new analysis of 24 states published in Health Affairs.  Health Affairs (abstract),

Some type 2 diabetic patients are being overtreated, and that might actually be increasing their risk of dangerously low blood sugar, finds new research in JAMA Internal Medicine.

In “How Doctors Die,” a powerful essay that went viral in 2011, a physician described how his colleagues meet the end: They go gently. A new study reveals a sobering truth: Doctors die just like the rest of us.  Journal of the American Geriatrics Society,

In an effort to get or keep a good performance rating from the federal government, transplant centers have been labeling some patients “too sick to transplant” and dropping from the waitlist some who may been viable candidates, the researchers found.  Journal of the American College of Surgeons (abstract),

Latinos who’ve recently arrived in the U.S. often have poor access to health care, mental health treatment in particular. UNC Charlotte is among several universities trying to change that.  Kaiser,

The FDA said Monday that over-the-counter antacid products, commonly taken for heartburn and upset stomach, that contain aspirin can cause “serious bleeding.” The Charlotte Observer,

Vice President Biden on Monday announced the launch of a first-of-its kind, open-access cancer database to allow researchers to better understand the disease and develop more effective treatments. The Genomic Data Commons, a part of the National Cancer Institute, contains the raw genomic and clinical data for 12,000 patients.  The Washington Post,

Citing misrepresentations and broken promises, the New York State attorney general’s office is seeking to prevent the purchase of two nursing centers by a company that was involved in transactions that put a Manhattan nursing home in the hands of luxury condominium developers.  NY Times,  

One of the most successful research enterprises funded by the NIH, the Clinical Research Center (CRC) program, is dying, its highly productive life cut short with virtually no discussion in the scientific community.  Journal of Clinical Investigation, 

Many more babies die in the United States than you might think. In 2014, more than 23,000 infants died in their first year of life, or about six for every 1,000 born. According to the Centers for Disease Control and Prevention, 25 other industrialized nations do better than the United States at keeping babies alive.  NY Times,

Researchers found no improvement in 30-day mortality rates for several conditions after the data began appearing on CMS’s Hospital Compare website, according to a study published in the Annals in Internal Medicine (abstract).

A new guide is offering primary care practices practical guidance and a flexible framework to increase their ability to serve patients with depression, anxiety, and other common mental health issues.  United Hospital Fund,  

In this nationally representative survey of adults in the United States, the age-adjusted prevalence of obesity in 2013-2014 was 35.0% among men and 40.4% among women.  JAMA,  

This NAM workshop explored the intersection of health literacy and precision medicine through a number of topics, but its impetus was the Precision Medicine Initiative (PMI). The PMI is a multiyear effort launched in 2016, led by the White House to advance the practice of precision medicine.  Read the workshop brief,

The U.S. Food and Drug Administration finalized its efforts to streamline the process used by physicians to request expanded access, often called “compassionate use,” to investigational drugs and biologics for their patients.  FDA,

Early evidence suggests that the Affordable Care Act is working in one important respect, according to researchers at the Federal Reserve Bank of New York. Analysts found a big difference between indebtedness trends in states that embraced the Medicaid expansion versus the ones that did not. Bloomberg,  

British scientists announced that they developed a blood test that can accurately predict whether you’ll respond to the conventional, commonly prescribed antidepressants on the market.  International Journal of Neuropsychopharmacology

Microsoft scientists have demonstrated that by analyzing large samples of search engine queries they may in some cases be able to identify internet users who are suffering from pancreatic cancer, even before they have received a diagnosis of the disease.  NY Times,  

Stephen Klasko, MD, president and CEO of Thomas Jefferson University and Jefferson Health, wrote a new book, We Can Fix Healthcare Now.   Here are the 12 Disruptors outlined in the book.  Becker’s,

High-cost, high-need Medicare and Medicaid beneficiaries face a host of challenges when interacting with the healthcare system, but certain policy changes could improve care for these patients, according to a new fact sheet from the National Coalition on Health Care (NCHC).   

There are more than 500 quality measures related to behavioral health, but only 5 percent are used in quality-reporting programs. This study provides an overview of current measures of behavioral health, identifies priorities for measure development, and outlines the most significant challenges.  Commonwealth Fund and Health Affairs,

The idea is to create implants the size of a grain of rice, or even smaller, that can be bolted directly onto nerves to treat diseases, augmenting or replacing drugs.  the project is a long-odds bet that Glaxo is virtually alone in making among its Big Pharma peers. It has started a $50 million venture fund for bioelectronics.  Bloomberg,  

Rates of syphilis have trended steadily upward since 2000, and the CDC’s syphilis elimination efforts officially ended as of December 2013.  JAMA,

The battle to contain and ultimately defeat the Ebola epidemic of 2014–2015 has been vividly described. Yet more than 11,000 people died, and local economies were brought to a halt. The battle was won, but at immense cost,  NEJM Perspective,

The U.S. Food and Drug Administration said on Thursday it, along with international authorities, has formally sought to suspend 4,402 websites that illegally sell potentially dangerous, counterfeit or unapproved prescription drugs to U.S. consumers.  Reuters,

Much uncertainty remains about how best to collect and utilize patient data and perspective in ways that satisfy the needs of all the parties involved. But many influential entities have made patient engagement part of their culture in an effort to fundamentally improve the R&D process. Science Translational Medicine,


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