January, 2017 vol. 3 - In This Issue:
This week's digest includes an array of topics but there is a common thread: the next phase of healthcare reform requires a focus on science and the patient to achieve smart policy change.  Whether we're talking about value-based benefit design or preserving the last bastion of our antimicrobial arsenal, real-world evidence about outcomes and impact on patients needs to be the gold standard.

Repeal and Replace Obamacare: What Could It Mean?

Donald Trump's pledge to "repeal and replace Obamacare" was one of his biggest crowd pleasers. It's been noted, of course, that "repeal and replacing" is easier said than done, and indeed the President-elect has already begun to fudge. But moving forward on his broad replacement themes-expanding health savings accounts (HSAs) and state flexibility-could lead to some surprising and intriguing reforms.

Where Health Conversations Should Start and End: the Patient

Nearly every day, it seems, the research world brings us new, high-tech treatments for diseases once thought incurable. But with these advances comes the unavoidable question of cost: Just what are "fair" prices for these new drugs or treatments - and how do manufacturers, insurers, doctors and patients find that middle ground, with all their varying interests?

Under- and Overuse Are Global Healthcare Problems

The overuse of health services is old news. In the U.S., the problem emerges in the form of variations in practice patterns and overdiagnoses. Here, underuse usually falls under the heading of access.

In both cases, efforts are underway to expand coverage and discourage the use of low-value services.

The Missing Ingredient In Quality Measurement

An elderly man with cancer waited two hours for a scheduled outpatient cystoscopy. When the nurse finally called him in, he asked if the clinic had a patient information sheet that explained the procedure. "Of course we do-I'll get you one," she replied, only to return five minutes later saying she couldn't find one. The man asked if the clinic had a quality assurance committee, and the nurse said yes, but no one paid attention to it. 

"Tell the committee Donabedian said they have a problem," he replied.

At Federally Funded Health Centers, Medicaid Expansion Was Associated With Improved Quality Of Care

In 2014 many uninsured, low-income nonelderly adults gained access to health insurance in states that expanded Medicaid eligibility under the Affordable Care Act. Federally funded community health centers were likely to be particularly affected by this expansion because many of their patients were uninsured and low income. We used a difference-in-differences approach to compare changes among 1,057 such centers in expansion versus nonexpansion states from 2011 to 2014, in terms of their patients' insurance coverage, the number of patients they served, and the quality of care they provided. This analysis suggests that states' decisions about Medicaid expansion have important consequences for health center patients, with expansion improving treatment and outcomes of chronic disease and bolstering the use of recommended preventive services.

Scientists Have Found a Way to Reverse Antibiotic Resistance

When Alexander Fleming discovered penicillin in 1928, it was one of the world's first true antibiotics to ever be successful in eliminating infectious disease. Since then, antibiotics have been essential to preventing avoidable deaths.

But a troubling reality faces us all. Throughout all of Earth's evolutionary history, multicellular organisms have continually changed and adapted. But unicellular bacteria evolve so quickly, that a majority are now resistant to a wide array of antibiotics. The problem of antibiotic resistance is so serious, that the  United Nations placed it at crisis level along with HIV.

Passion + Quality = Change That Matters
I embrace the powerful opportunities in our evolving health care landscape. I founded Momentum Health Strategies to be a catalyst for change through continuous learning, diverse engagement and thoughtful policy and practice initiatives. I deliver innovative, strategic thinking and a passion for improving the patient experience. My personal drive and dedication to high-quality results will help you navigate the competitive terrain you face and convert your vision to action.

Momentum Health Strategies

Jennifer L Bright, MPA
(703) 628 - 0534