HEIP stands for hospital efficiency improvement program. It is a legal contract outlining specific initiatives where physician-driven variance can be improved across specialties and departments. For organizations with a...HEIP stands for hospital efficiency improvement program. It is a legal contract outlining specific initiatives where physician-driven variance can be improved across specialties and departments. For organizations with a good strategy to reduce care variation, a HEIP can provide the jolt of incentive that generates real improvement.
For those who doubt the importance of transparency in price and quality to free the market, you just have to look behind the public curtain and observe the fierceness with which the opponents of transparency are trying t...For those who doubt the importance of transparency in price and quality to free the market, you just have to look behind the public curtain and observe the fierceness with which the opponents of transparency are trying to keep consumers in the dark.
And that means full scope of practice as primary care providers. Medical societies hate the idea and think that nurse practitioners need to be tethered securely to a physician office in order to ensure top-notch care. Nu...And that means full scope of practice as primary care providers. Medical societies hate the idea and think that nurse practitioners need to be tethered securely to a physician office in order to ensure top-notch care. Nurse practitioners counter that they can help shore up primary care.
Patient-reported outcomes measures (PROMs) use a patient's response to questions to measure health status. If they're going to catch on payers will need to incentivize use. So far, that's not happening. But clinicians wh...Patient-reported outcomes measures (PROMs) use a patient's response to questions to measure health status. If they're going to catch on payers will need to incentivize use. So far, that's not happening. But clinicians who use PROMs for clinical decision making might be providing a valuable service.
The United States is the world's biggest spender on health care by far. And what do we get for it? Not as much as we should. Our quality shortcomings are not for lack of knowledge: Stakeholders know what to do to close t...The United States is the world's biggest spender on health care by far. And what do we get for it? Not as much as we should. Our quality shortcomings are not for lack of knowledge: Stakeholders know what to do to close these gaps. So why aren't they doing it?
UNLABELLED: The pay-for-value movement could justify rewarding-and punishing-doctors based on quality scores. PROBLEM: Hardly anyone likes the current ways quality is measured, especially physicians. Few believe that Med...UNLABELLED: The pay-for-value movement could justify rewarding-and punishing-doctors based on quality scores. PROBLEM: Hardly anyone likes the current ways quality is measured, especially physicians. Few believe that Medicare's Merit-based Incentive Payment System (MIPS) will clear things up. In fact, it might cause more confusion.
With accumulators, the value of any copay assistance cards or coupons does not count toward out-of-pocket medicine costs that are applied toward deductibles. It's a cost-shifting tool that's facing pushback from patients...With accumulators, the value of any copay assistance cards or coupons does not count toward out-of-pocket medicine costs that are applied toward deductibles. It's a cost-shifting tool that's facing pushback from patients, providers, and others saying that accumulators will hurt public health.
Sanofi and Regeneron's Dupixent (dupilumab)-which is already approved for atopic dermatitis-has an FDA action date of October 20 for its asthma indication. It will join Nucala, (mepolizumab), Cinqair (reslizumab), and Fa...Sanofi and Regeneron's Dupixent (dupilumab)-which is already approved for atopic dermatitis-has an FDA action date of October 20 for its asthma indication. It will join Nucala, (mepolizumab), Cinqair (reslizumab), and Fasenra (benralizumab) as a monoclonal antibody approved as a treatment for the type 2 inflammation phenotype in severe asthma.
For 169 ACOs, time is up to take on downside risk. This group-30% of all of those in the Medicare Shared Savings Program (MSSP)-are Track 1, upside risk-only ACOs and are nearing the end of their contracts with CMS.For 169 ACOs, time is up to take on downside risk. This group-30% of all of those in the Medicare Shared Savings Program (MSSP)-are Track 1, upside risk-only ACOs and are nearing the end of their contracts with CMS.
The National Guidelines Clearinghouse might be making a comeback. It's been contracted out to the ECRI Institute, a not-for-profit organization that conducts medical safety research. ECRI plans to have a version of the c...The National Guidelines Clearinghouse might be making a comeback. It's been contracted out to the ECRI Institute, a not-for-profit organization that conducts medical safety research. ECRI plans to have a version of the clearinghouse website up and running anytime soon, with plans for a full relaunch in 2019.
Integrated care models can foster the kind of collaboration that's needed to treat complex, multifaceted problems like chronic pain. They are among our best hopes for an alternative to the overuse of prescription painkil...Integrated care models can foster the kind of collaboration that's needed to treat complex, multifaceted problems like chronic pain. They are among our best hopes for an alternative to the overuse of prescription painkillers that has caused so much suffering and early death.
Care managers can quickly assess clinical complexity and monitor members climbing the cost and risk curve if they are armed with up-to-date information about a member's medical and behavioral diagnoses, prescription medi...Care managers can quickly assess clinical complexity and monitor members climbing the cost and risk curve if they are armed with up-to-date information about a member's medical and behavioral diagnoses, prescription medications, physician office visits, emergency room visits, and hospitalizations.
But the adoption of new technology is rarely smooth; learning curves create jagged edges. The gee-whiz factor of technology can easily get ahead of true utility and effectiveness. And, of course, there's the expense. Hos...But the adoption of new technology is rarely smooth; learning curves create jagged edges. The gee-whiz factor of technology can easily get ahead of true utility and effectiveness. And, of course, there's the expense. Hospitals and other providers need to be ready to plow millions in new machines.
Given the startling statistic that the rate of women dying of pregnancy-and childbirth-related complications in the United States is increasing, it seems logical that the U.S. health system would focus on improving outco...Given the startling statistic that the rate of women dying of pregnancy-and childbirth-related complications in the United States is increasing, it seems logical that the U.S. health system would focus on improving outcomes in this area of care. But not all health plans address this disparity in health care delivery.
In a last-minute filing, the attorney general elected not to defend the health care law. The legal arguments in Texas v. Azar hinge on severability and legislative intent. While Texas seeks an injunction to block enforce...In a last-minute filing, the attorney general elected not to defend the health care law. The legal arguments in Texas v. Azar hinge on severability and legislative intent. While Texas seeks an injunction to block enforcement of the ACA beyond January 1 next year, the Justice Department is seeking a declaratory judgment.
The Healthcare Effectiveness Data and Information Set (HEDIS) is used by health plans to measure and report on quality and performance. This study evaluated the appropriateness of the prescription drug compliance step fo...The Healthcare Effectiveness Data and Information Set (HEDIS) is used by health plans to measure and report on quality and performance. This study evaluated the appropriateness of the prescription drug compliance step for the Medical Attention for Nephropathy quality measure for patients with diabetes. Data from national commercial claims for 28,348,363 persons were reviewed. The study applied the standard HEDIS specifications for compliance in medical attention for nephropathy for diabetic patients. Evaluation of the third and final process (evidence of angiotensin-converting enzyme [ACE] inhibitors or angiotensin II receptor blockers [ARBs]) found that the addition of this step contributed 14% to 16% of the numerator, bringing the final rate to the >80% range. Yet, presence of a prescription for an ACE inhibitor or ARB did not confirm microalbuminuria. Only 1% of the persons satisfying Step 3 had evidence of microalbuminuria in years prior and none in the reporting year. Use of these medications does not obviate the need for a nephropathy screening in diabetics. Inclusion of these medications as numerator compliance leads to overreporting and may contribute to underscreening of a population at risk.
At telehealth walk-in centers, patients get care at the touch of a screen. They were able to choose from a long list of board-certified physicians for their virtual visit. Medical devices such as thermometers and blood p...At telehealth walk-in centers, patients get care at the touch of a screen. They were able to choose from a long list of board-certified physicians for their virtual visit. Medical devices such as thermometers and blood pressure cuffs are also on hand.
Many diabetes patients can use peritoneal dialysis, which allows them to self-administer dialysis at home. But researchers and kidney specialists say there are many obstacles in the way: a lack of doctors and nurses with...Many diabetes patients can use peritoneal dialysis, which allows them to self-administer dialysis at home. But researchers and kidney specialists say there are many obstacles in the way: a lack of doctors and nurses with training in how to instruct patients, the sunk costs of existing dialysis clinics, and the reluctance of patients and their families.
Some companies are starting to challenge the hegemony of PBMs by trying go around them. Some of them contact Vivio Health, which says it can get employers the lowest cost for health care's current bête noire: specialty d...Some companies are starting to challenge the hegemony of PBMs by trying go around them. Some of them contact Vivio Health, which says it can get employers the lowest cost for health care's current bête noire: specialty drug prices.
Harvard Pilgrim Health Plan offers some beneficiaries an app that allows them to stay in contact with the health plan's nurse practitioners. It seems tailored-made for patients with chronic conditions, but it can be appl...Harvard Pilgrim Health Plan offers some beneficiaries an app that allows them to stay in contact with the health plan's nurse practitioners. It seems tailored-made for patients with chronic conditions, but it can be applied to almost everything a person might need to go to the hospital for.