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Industry News
More than 1,600 hospitals earned bonuses in 2017 under the Hospital Value-Based Purchasing program, but that's 200 fewer than were distributed this year. The program affects roughly 3,000 hospitals, which are penalized or rewarded based on how well they perform on certain quality measures. The results are "somewhat concerning," said Francois de Brantes, executive director of the Health Care Incentives Improvement Institute. He cited two reasons: Fewer hospitals are being rewarded, and hospitals' lack of movement in rankings. (Modern Healthcare )


New data sets from the Robert Wood Johnson Foundation offer a treasure trove of information for wonks, geeks and researchers. HIX Compare includes data on premiums, deductibles and out-of-pocket maximums, as well as cost-sharing requirements for physician visits, prescription drugs, emergency department services and inpatient and outpatient visits. According to RWJF, this is the only nationally comprehensive public dataset that includes information on all plans offered in the public health insurance exchanges.( RWJF )

Although Republicans still don't have the votes to abolish the Affordable Care Act, they could largely dismantle it on a procedural level, according to Kaiser Health News, which offers a roundup of election-related news. Modern Healthcare reports that the election results most likely mean "an end to the expansion of Medicaid to the 19 states that have not yet implemented it, and puts the expansion in the other 31 states in serious jeopardy." But it also notes that not all conservatives agree with how to address certain health care policy issues, including making insurance affordable. (Kaiser Health News roundup; Modern Healthcare)
 
Innovation & Transformation    
Humana is using artificial intelligence to identify negative member experiences in real-time--this, according to the company, will help enhance the ability of call center personnel to empathize with consumers. As members call in to its customer service centers, Humana's AI tool listens for signals of consumer frustration and delivers instant feedback that allows the representative to alter his or her strategy while on the phone. ( FierceHealthcare )

Health Resources and Services Administration announced a $2.3 million grant for "The Complex Patient in the Primary Care Medical Home." The grantee: Dr. Allen Perkins is professor and chair of family medicine at University of South Alabama College of Medicine and a family medicine physician with USA Physicians Group. The award is to help establish an inter-professional training environment focused on population health and improving care for complex patients. "Through the incorporation of the enhanced use of data, population metrics, mental health access and team-based care we will be able to provide better care at lower costs to patients," Perkins said. ( Med School Water Cooler )

A team-based approach is important for creating a successful practice, family physician Bruce Bagley, MD, told attendees at the Medical Group Management Association's annual conference. About 30 percent of what family physicians do daily could be done by other staff; using a team-based model would optimize patient outcomes. T he balance of power is shifting in medical practices because physicians no longer control all the information, Bagley said. But, he added, "We're still operating on the 'hero model' where the doctor is the source of all information." ( Diagnostic Imaging )
Consumers & Providers
Health plan enrollees who are given the opportunity to shop around for health care will seek less expensive options even if it won't have an impact on their out-of-pocket costs, according to research published in  JAMA Internal Medicine. "Patients who viewed price estimates prior to having their procedure chose healthcare facilities with lower relative price estimates than other patients for imaging services and sleep studies." ( Fierce Healthcare ; JAMA Internal Medicine )
 
 
Cigna, Aetna and UnitedHealth have all trimmed commissions to insurance brokers, motivating some brokers to step back from the exchanges when open enrollment begins this week. That could be a hurdle for consumers who normally would seek help from brokers in navigating the complexities of insurance coverage. (Kaiser Health News )
The Personal Care Services program, which exceeded $14.5 billion in FY2014, is rife with financial scams, some of which threaten patient safety, according to a recent report from the Office of Inspector General at the Department of Health and Human Services. The Medicaid program sends non-medical assistants to elderly and disabled peoples' homes. "This type of industry is ripe for fraud," says Lynne Keilman-Cruz of Alaska's Department of Health and Social Services. The risks increase because the care takes place out of view in people's homes, and because neglected patients may not advocate for their own care. ( OIG report Kaiser Health News )
New & Noted   
Depression contributes to nonadherence:  Diabetes-related distress and depression symptom severity are risk factors for medication nonadherence in type 2 diabetes, according to research published in   Diabetes Care. ( Diabetes Care )
Gray

Docs say EHRs impair productivity:  Seventy percent of physicians surveyed say EHRs reduce their productivity, and three out of four believe EHRs increase practice costs, outweighing any efficiency savings. (Deloitte )

UnitedHealthcare launches NexusACO:  UnitedHealthcare is launching a nationally branded ACO product designed to attract large self-funded employers in 15 markets. NexusACO already has a dozen employers signed on for 2017, the company reports. (Forbes )
 
Multi-media  
Kevin Quinn, MA, describes eight basic payment methods that are applicable across all types of health care: per time period; beneficiary; recipient; episode; day; service; dollar of cost; or dollar of charges. He explains these methods are more specific than common terms, such as capitation, fee for service, global payment and cost reimbursement. They also correspond to the division of financial risk between payer and provider, with each method reflecting a risk factor within the health care spending identity. (Annals of Internal Medicine; video )
 
MarketVoices...quotes worth reading
 
"A healthcare company has to have empathy and compassion."--Geeta Wilson, Humana's director of customer experience, quoted in FierceHealthcare

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Wednesday, November 9, 2016