Value-based payment has produced little value. It needs a time-out

“The concept of value-based payment became widespread among U.S. health policymakers and analysts during the 2000s. It collectively refers to interventions that offer doctors and hospitals financial incentives that, in theory, induce them to improve both components of health-care value — cost and quality — without generating the hostility provoked by managed care insurance companies during the HMO [health maintenance organization] backlash of the late 1990s. [The Center for Medicare and Medicaid Innovation reviewed 54 models of value-based payment. Only four were certified to be expanded:] The Home Health Value-based Purchasing Model demonstration cut Medicare spending by 1% with mixed … Read More

FDA rule would facilitate prescription-to-OTC switches but nix a third class of drugs

“The proposed rule would establish an Additional Condition for Nonprescription Use [ACNU] category for prescription products the FDA says consumers currently can’t appropriately self-select and use without a prescription. This is somewhat analogous to the Risk Evaluation and Mitigation Strategies, which allow certain prescription drugs with potential safety issues to be approved for patients with additional requirements for use, such as verifying a negative pregnancy test for a drug that can cause birth defects or requiring a monthly lab test before the drug can be dispensed. With an ACNU, a drug company must meet several FDA-approved conditions to ensure that … Read More

The Telehealth Era is Just Beginning: More gains in quality, affordability, and accessibility are on the way

“Having analyzed health outcomes data from the independent National Committee for Quality Assurance, health plan member satisfaction surveys from J.D. Power, and internal data from our own organizations, we are confident that full implementation of five opportunities would improve clinical quality nationwide by 20%, increase access to care by 20%, and reduce health care spending by 15% to 20%. Reduce Expensive and Unnecessary Trips to the ER Reverse America’s Chronic-Disease Crisis – For members of large multispecialty medical groups such as Kaiser Permanente [KP], high blood pressure is a much more manageable problem [outside of KP, control rates hover around … Read More

Checklists work well for complicated health care problems. But they don’t work to solve complex ones, like pandemics

Excerpt – In 2001, I developed a checklist for health care workers to reduce infections from catheters, tubes that are widely used to deliver fluids and critical medicines to people who have been hospitalized. At the time, catheter infections resulted in approximately 31,000 deaths a year in the U.S, putting it in the top 15 leading causes of death. The checklist included measures such as washing hands and wearing masks. When tested at Johns Hopkins, where I worked at the time, and then adopted in Michigan, and overseen by a diligent nursing staff, use of the checklist eliminated almost all … Read More

Preventing Delayed and Missed Care by Applying Artificial Intelligence to Trigger Radiology Imaging Follow-up

“[..] artificial intelligence (AI) is well suited to the detection and reporting of follow-up recommendations because of the large volume of imaging studies requiring screening and the relatively standardized language employed by radiologists in preparing reports. Natural language processing (NLP) methods, including text pattern-matching and traditional machine-learning techniques, have been developed for this task. In this article, we use the term traditional machine learning to refer to all machine-learning methods that are not deep learning, and these terms will be defined in detail in the sections that follow. More recently, novel deep-learning methods for NLP have shown great promise for … Read More

Experiences of Health Centers in Implementing Telehealth Visits for Underserved Patients During the COVID-19 Pandemic

“Before the pandemic, most health centers did not offer telehealth visits for primary care or behavioral health, in large part because of reimbursement policy. In spring 2020, dramatic policy changes removed many of the restrictions on telehealth delivery, and health centers responded by standing up large telehealth programs. This sudden and dramatic change in health care delivery posed numerous challenges. Health centers had to quickly make changes to technology, workflows, and staffing to accommodate telehealth visits. To support health centers in these efforts, the California Health Care Foundation established the Connected Care Accelerator (CCA) program, a quality improvement initiative that … Read More

Learning from Real-World Implementation of Daily Home-Based Symptom Monitoring in Patients with Cancer

“Routine use of home-based symptom monitoring and management using electronic patient-reported outcomes (ePRO) to improve care delivery is on the horizon. Randomized clinical trials demonstrate that use of patient-reported symptoms can have marked impact on patient outcomes, including minimizing symptom burden, enhancing quality of life, reducing hospitalizations, increasing time receiving cancer treatments, and, in some studies, improving survival. [..] few health systems have successfully, fully integrated ePRO. [..] In the study by Daly and colleagues, the authors begin to tackle an important question of frequency of assessment administration in ePRO. This study used daily symptom assessment in contrast to the … Read More

Dr. Venture Capital: Insurance companies are supposed to cover high-quality care for patients. What happens when they dabble in investing?

“The insurance companies [Cigna and Kaiser Permanente] provided Ginger with access to millions of potential users. After its financial investments in Ginger, Cigna began offering no-cost access to Ginger’s behavioral health services in order to improve customers’ overall health and well-being, according to leadership from both organizations. Yes, it is possible that those customers will benefit from the platform. But given that Ginger’s valuation grew in multiples around the same time—at least in part because of the massive influx of customers from Cigna and Kaiser—it’s reasonable to suggest that the insurance company was double dipping. By sending its customers to … Read More

Remote Postdischarge Treatment of Patients With Acute Myocardial Infarction by Allied Health Care Practitioners vs Standard Care: The IMMACULATE Randomized Clinical Trial

“β-Blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARBs) are beneficial after AMI [acute myocardial infarction], and adjustment of these medications to moderate to high doses is recommended in the setting of reduced LV ejection fraction (LVEF) or heart failure. Initiation and adjustment of these medications can be challenging during hospitalization, particularly among patients with borderline or low systemic blood pressure because of an emphasis on shortening length of stay and the challenges in organizing frequent face-to-face visits early after discharge. Telemedicine has enabled the transition from face-to-face care and is set to play a key role in the post–coronavirus disease-19 … Read More

The Treatment of Patients With Unbearable Suffering—The Slippery Slope Is Real

“Physician-assisted death (PAD) is now legal in 9 US states and the District of Columbia and is under consideration in 17 more. Legalization generally follows ballot, as opposed to legislative, initiatives in the setting of extensive marketing efforts by advocacy groups focused on convincing the public that they face a future of unbearable suffering if PAD is not available. Whereas fear of unbearable suffering at the end of life is a commonly expressed concern, most Americans should be able to expect reliable and expert relief of suffering as a result of medical advances in geriatrics and palliative care. The fact … Read More