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Cathy Hostettler, DNP isn’t in EMS, but her indirect exposure to the industry over the years meant that teaming up with MedStar’s Mobile Integrated Healthcare program was an easy choice. The decision to do her Doctor of Nursing Practice dissertation research on MedStar’s Heart Failure Readmission Avoidance Program reflects the growing trend of collaboration across disciplines within the pre-hospital setting.

Hostettler ‘s retrospective research aimed to evaluate the MedStar program’s effect on readmission rates, costs of care and overall health status of enrollees who entered from October 2013 to September 2015. A total of 114 patients were originally included in the program, however 20 were unenrolled or died prior to completion and therefore were not included in subsequent analyses.

The median readmissions rate for heart failure patients across the United States is 23 percent, meaning that 22 patients in the program should have been readmitted within the first 30 days. In reality, only 18 patients were readmitted in that time frame, resulting in a rate of 19.1 percent and an almost $20,000 cost savings.

This cost savings were offset by higher than expected emergency department utilization. In fact, while the 94 enrollees were only expected to use the emergency department seven times in the first 30 days, they made a total of 53 visits for a cost of just over $56,000.

Hostettler hypothesizes that this higher than expected emergency department utilization rate was due to an initial underestimation that did not accurately reflect geographic patterns of emergency department use. She also expects that the number was confounded by enrollees who should have been jointly classified as high utilizers.

The health status of enrollees was measured using the EuroQol-5D-eL survey which provides a score of 0-100 based on patient responses to questions within five dimensions. Enrollees that graduated from the program saw an increase in their health status scores in all dimensions. There was one exception to this improvement, in which a subset of the enrollees saw a slight increase in feelings of depression and anxiety.

I asked Hostettler a series of questions on her decision to do research within EMS. Her responses have been edited for length and clarity.

COUNTS: AS A NURSE, WHY DID YOU DECIDE TO LOOK AT MIH/CP?
Hostettler: My experience with EMS goes back to my days as a staff ED nurse in an inner city, tertiary care hospital. A friend told me about the community paramedic concept. My knee-jerk response was that home visit nurses fulfill that role and paramedics need not apply. He persisted and helped me understand that home visit nurses are not usually available 24 hours a day and their agencies may not accept uninsured patients.

From my experience in the ED, I knew that patients in need often do not call their doctors, much less their home visit nurses when they need help; they call EMS. Because of this I realized that EMS was a very logical place for this intervention.

HOW DID YOU GET CONNECTED TO MEDSTAR?
MedStar is one of the premier implementers of mobile integrated health care. Since my project was for my doctoral program, I wanted to be able to narrow it down pretty well so that I could finish it and graduate in a reasonable period of time. MedStar’s Heart Failure Readmission Avoidance Program was much further developed than any of the others I did find, so I chose to study MedStar’s program as a possible prototype or basis on which other programs might be modelled.

Doug Hooten, Matt Zavadsky and Daniel Ebbett of MedStar were incredibly generous with their knowledge and data. Without them I would not have been able to do this project.

WHY DID YOU USE PDSA AS THE QUALITY IMPROVEMENT MODEL?
Because of the retrospective nature of my project, I was really looking at the success of the program, not at the philosophy of the program. As such, my project was more of a quality improvement project and the Plan-Do-Study-Act model is specific to quality improvement projects.

WHAT WAS THE EASIEST PART ABOUT RESEARCHING SUCH A NEW MODEL OF CARE?
The easiest part about researching this new model of care was the openness and transparency of MedStar.

WHAT WAS THE HARDEST PART ABOUT RESEARCHING SUCH A NEW MODEL OF CARE?
There is a lot of information available about mobile integrated health care, but very little of it is scientifically studied. Most of the more scientific studies are from the United Kingdom and some from Australia, New Zealand and Canada. A lot of the research I did to prepare for this project involved reading anecdotal reports. While these are great to read, they often do not help us understand what part of the intervention was useful and measure how useful it was.

The MIH-CP Performance Measurement project will be an incredible repository of information from across the country that will allow programs to benchmark their data against others and will provide documentation of measurable outcomes for programs.

WHAT DO YOU THINK THE MOST SIGNIFICANT FINDING FROM THIS RESEARCH PROJECT IS?
Mobile integrated health care programs are community-specific. They must address a community’s needs. The purse strings on health care are tightening. We are all called to do more with less. The EMS system is the way many patients access health care. For those who use EMS as their primary method of accessing health care, it is only logical that the EMS providers are perfectly positioned to help educate and link these patients to appropriate resources for continuity of care.

IF PEOPLE WANT TO LEARN MORE ABOUT WHAT YOU’RE WORKING WHERE SHOULD THEY LOOK?
I am hoping to present this at a national EMS conference soon. You can also read the full paper below.

WHAT ADVICE WOULD YOU GIVE TO A PROVIDER ATTEMPTING TO DO THEIR OWN RESEARCH?
I have five suggestions for EMS providers attempting research.

1. CHOOSE A TOPIC THAT INTERESTS YOU.
You are going to be working on this for a while, so make it something you are passionate about.

2. START WITH A SIMPLE PROJECT.
Sometimes you need to take baby steps in order to get to the destination. A quality improvement study is a great place to start and PDSA is a great tool for evaluating an intervention.

3. GET A MENTOR WHO IS EXPERIENCED WITH RESEARCH.
Formal research is a new world for most of us. The background research that must be done before trying to design a project is necessary and a good mentor will be able to help guide you to make sure you study what you want to study and how to study it.

4. FIND PEOPLE WHO AREN’T IN HEALTH CARE TO EDIT AND REVIEW.
The litmus test for understanding comes from whether or not someone with no exposure to the topic can understand what you are trying to say.

5. SHARE YOUR FINDINGS.
When you invest so much time and effort into creating a good project, you must share it with others. Sharing helps others with their work as well. Sharing more formal research helps others design their projects, benchmark their results against yours and replicate your study for reliability and validity.

Mobile Integrated Health Care: A program to reduce readmissions for heart failure

To view current outcome reports from MedStar’s MIH program visit http://www.medstar911.org/mobile-healthcare-programs

As President Donald Trump on Tuesday renewed his pledge to remake the nation’s healthcare system, GOP lawmakers are continuing to look for ways to build a coalition strong enough to repeal and replace the Affordable Care Act.

The latest salvo is a compromise idea being floated by Reps. Mark Meadows (R-N.C.) and Tom MacArthur (R-N.J.), which was first reported by Politico. While the draft amendment would retain the ACA’s provision that insurers cover 10 essential benefits, states would be able to seek a waiver to do away with that requirement. The draft amendment also aims to retool how premiums are set. Under the ACA, insurers calculate premiums using a community rating, which is intended to bring down costs for sicker members. Here too, the draft amendment would allow states to seek a waiver, freeing insurers to go back to using an individual rating system to set premiums.

The draft amendment, which hasn’t been vetted by GOP leadership, is an attempt to appease the conservative Freedom Caucus, which thwarted earlier efforts to vote on the American Health Care Act. At press time, it was unclear when a new draft of the AHCA would be available or if votes will occur next week, as has been reported.

“We’ve consistently said that everyone should be covered, and that guaranteed coverage for everyone, including those with pre-existing conditions, must be coupled with continuous coverage provisions to help keep premiums affordable for everyone,” said Kristine Grow, a spokesperson for America’s Health Insurance Plans, adding that the group does not have a formal position on the draft amendment.

This latest chatter about AHCA doesn’t seem to advance the ball very far, especially in regards to efforts to curtail Medicaid expansion, says industry analyst Paul Keckley.

“This will be the fourth iteration of the bill,” he said. “But there’s a point at which the 16 GOP governors who expanded Medicaid will say, ‘If you whack my funding, we are going to have a problem.’ Even if you give states more latitude on some of these issues, you can’t put Medicaid into a free fall.”

Tom Nickels, executive vice president of government relations and public policy at the American Hospital Association, said lawmakers need to move away from a construct that jeopardizes coverage for 24 million Americans who have benefited from the ACA’s insurance provisions.

He and Keckley also noted that stabilizing the individual insurance market should be a priority. The AHA, AHIP and several other organizations last week sent a letter to the president urging action on funding for cost sharing reductions.

Original article can be accessed here.

Chicago’s Fire Department has only half as many ambulances as it has fire vehicles, but it gets 20 times more medical calls than fire calls these days.

Let’s say you think you’re having a stroke and you call 911 for an ambulance.

In a lot of cities across the country there’s a good chance that a fire truck — with a full fire crew including a paramedic — will race to your door.

But that doesn’t mean they can deliver the emergency care you might need.

In Chicago, like many cities, the fire department oversees both firefighters and paramedics who work on ambulances.

When a medical call comes in, dispatchers usually prefer to send ambulances. But there are half as many of those as there are fire trucks. And fire department spokesman Larry Langford says those ambulances can be super busy.

“They’ll hit the street at 7 o’clock in the morning and may not come back to the firehouse at all until 7 o’clock the next morning,” he says.

Meanwhile, fire trucks are often much less busy and parked in firehouses, just minutes away from any given emergency.

So the 911 dispatchers make a choice.

A Chicago Fire Department ambulance and firetruck respond to a call in 2016.
Arvell Dorsey Jr./Flickr

“They save valuable time by sending the closest vehicle, which is usually a fire truck that has at least one paramedic and a lot of equipment on it,” Langford says.

That sounds logical until you ask why Chicago’s fire department still has twice as many fire trucks as ambulances, especially when the department gets 20 times more medical calls than fire calls.

Getting answers can be difficult. That has a lot to do with the political power of fire departments and their unions — and the challenge of trying to change that.

Chicago’s not alone in facing these challenges. Most cities are seeing big drops in fire calls and big jumps in medical calls. But few are really reforming their departments to meet this changing emergency landscape.

Portland State researcher Phil Keisling thinks that’s a mistake. He looked at why fire departments don’t just admit that they’re mostly medical services these days.

“And I keep getting answers that are really not a whole lot more than, ‘Well, that’s the way we’ve always done it,’ ” he says. Keisling says that’s not a good answer “in a world that has limited resources and you want to try to optimize the resources you’ve got.”

As more cities see the drawbacks of using giant firetrucks for medical issues, they’re facing calls for reform. That’s what Misty Bruckner found when she researched the problem at the Public Policy Center at Wichita State. While she didn’t find agreement on everything, she said there was some consensus.

“I think everybody can agree that the ladder truck responding to someone who may have a sprained ankle is not the best use of our public resources,” she says.

Langford disagrees. And he thinks people shouldn’t get so hung up on what kind of vehicle arrives. He’s even got a catch phrase for it: “Don’t look at the conveyance. Look at the care.”

Catchy or not, the conveyance can matter. Fire trucks aren’t equipped to take you to the hospital. Only ambulances are.

And this transport part can be crucial, according to veteran Chicago paramedic Rich Raney.

“When you get a stroke patient or a trauma patient, the most important thing is that they be transported to the hospital as quickly as possible,” he says. “As they say with stroke patients, time is brain, basically.”

Each city runs its emergency services differently, so solutions are going to vary. In Chicago, for example, paramedics want more ambulances and staffing.

New York and Wichita recently started deploying medics in SUVs for less urgent calls. And Washington, D.C., is trying something called nurse triage lines. They let callers talk through their problems with a nurse on the phone. But Keisling says some proposals should also look at moving resources from large firefighting staffs.

“And it’s not anti-firefighter, it’s not anti-union, and it’s not anti-government,” he says. “It’s just, why aren’t we taking limited resources and deploying them in a smarter way?”

While there’s no agreement on exactly what that smarter way is going to be, most agree it doesn’t involve sending a fire truck to treat someone with heartburn.

Monica Eng is a reporter with NPR member station WBEZ. You can follow her @monicaeng.

Original article can be accessed here.

Millions of Americans take an ambulance trip every year; others get rides from willing friends or, tempting fate, drive themselves.

But in recent years a new trend has arisen: Instead of an ambulance, some sick people are hailing an emergency Uber.

Though firm numbers are hard to come by, drivers for Uber and Lyft say it happens with some regularity.
In an online chatroom for Uber drivers, dozens of posters share experiences with passengers who hail a ride with bloody cuts, asthma, anaphylaxis, or broken bones.

The trend, experts say, is driven by a few key factors. Ride-hailing services are cheaper and more predictable than ambulance services. And it allows riders to choose the hospital they’re taken to. But emergency Uber and Lyft rides come with significant risks — to drivers, to patients, and potentially to the companies themselves.

‘There’s definitely a liability’

Francis Piekut, who drives for Uber and Lyft, recalled a passenger who requested a pickup at a Boston-area Starbucks last year. When Piekut arrived, he discovered it wasn’t a typical fare. “They were burned and wanted to go the emergency room,” he said. He treated the situation like any other ride, he said, dropping his passenger off at the hospital and not asking any questions. “I don’t know how bad it was, but I knew they were in pain really bad.

“I didn’t mind it,” Piekut added, saying that he would do it again. “I was already there, and I know the ambulance costs a lot.”

But that sentiment isn’t universal. Some riders have reported being turned down for an emergency ride.

On the web forum, some drivers shared stories of refusing passengers who looked like they needed emergency medical care. They cited reasons like not wanting to get blood on their car seats, or to be stuck with a dead body in their car.

One Boston-area driver for both Uber and Lyft, who requested not to be named for fear of hurting his business, recounted the story of a group of three people who hailed him last year. “The women tell me their friend is not feeling well, and they want me to take them to the emergency room,” he said. “I told them no and to just call 911. I have to respect the rules of the road; I can’t speed like an ambulance.

“And there’s definitely a liability thing,” the driver added. “If anything happened to the guy, it’s definitely on me and the insurance I have to carry.”

Officially Uber agrees that riders should call local police or emergency medical services for emergencies.

“It’s important to note that Uber is not a substitute for law enforcement or medical professionals,” said Uber spokesperson Brooke Anderson by email. “In the event of any medical emergency, we encourage people to call 911.”

Still, despite that official stance, the company does occasionally honor drivers on its website for providing emergency transport.

Emergency departments respond
A motivating factor for patients can be cost. The price of an ambulance ride to the hospital can range from $600 to $1000, according to the Department of Health and Human Services, while ride-hailing would rarely hit three figures.

Moreover, with ride-hailing, customers know the cost of a trip before they book it. Ambulance services, by contrast, send bills long after they are used, and often the final amount is unknown until the bill is received.

And using Uber or Lyft also lets users choose the hospital, said Chandra Steele, who wrote about taking Uber to the emergency room last summer in PC Magazine. Her medical emergency was severe bleeding, and she knew where she wanted to go.

“My brother was a doctor at the hospital I wanted, but ambulances have to follow certain protocols,” she said.
“Ambulances just take you to the closest hospital, which wasn’t the one I wanted to go to.”

And some emergency departments are even beginning to embrace the idea. Last summer, Washington, D.C., city officials began studying the use of ride-hailing to respond to what they describe as “non-emergency, low-acuity” calls, which accounted for nearly half the city’s 911 calls in 2015, according to a report released in February.

“In our research, we found that many of these calls did not require an ambulance,” said District of Columbia Fire and Emergency Medical Services Department spokesperson Doug Buchanan. In fact, he added, it would be better if more people used ride-hailing services instead of an ambulance. “We would love our residents to take that initiative,” he said.

Operators would route medical emergency calls to triage nurses, who would then determine whether the situation calls for an ambulance, a ride-hailing service, or something else altogether. It’s unclear whether drivers would get any special training for transporting such passengers.

The program is part of the mayor’s budget which will be voted on next month.

Dr. Mark Plaster, an emergency room physician in Baltimore, concurs that trips to the ER can vary greatly in severity — and that the transport options should as well.

“I would hope that no one who needed truly urgent medical attention would take an Uber,” he said. “If you need medical care en route, a private car is a bad idea, because you won’t have the personnel or equipment to treat you.”

He is not completely against the idea, however.

“Rideshares don’t take ambulances out of service, and not everybody coming into the ER is in a dire situation,” he said.
“And the ambulance can be expensive.”

“I don’t care how they get there,” he added. “Just get there.”

Original article can be accessed here.

CHICAGO — Massive disruptions are ahead in health care, including blowing up the fee-for-service model and making care more affordable, Bernard Tyson, chairman and CEO of Oakland, Calif.-based Kaiser Permanente, told attendees at the American College of Healthcare Executives’ 2017 Congress on Healthcare Leadership on Tuesday.

Tyson challenged ACHE members to use their “firepower” to take health care to the next level and to invest in a system that provides something better than “episodic care after something has gone wrong.” This includes early diagnosis and treatment and helping patients with the behavior modification needed to manage chronic conditions.

“This is on our collective watch,” Tyson said. “We need to turn up the volume [about moving] from a sick-based system to a health-based system.”

Tyson noted that he was a supporter of the Affordable Care Act and was applauded when he said that it does not meet his definition of “disaster,” even though some politicians describe it as such.

Tyson told of how he met with President Donald Trump and said the president listened intently and asked “great” questions. Tyson didn’t dwell on the American Health Care Act, the GOP’s repeal-and-replace legislation, but told ACHE members that it was up to them to “pick up the pieces and move forward.”

“It looks like the Affordable Care Act will have another day,” Tyson said. “My hope is that, with whatever we come up with in Round 2, we don’t lose ground.”

He described the ACA as a “great step forward” in providing care to the working poor, and Tyson pledged to work toward further reducing health care disparities.

This means everyone having access to the health care system’s “front door,” Tyson said.

The future of health care also involves addressing the social determinants of health and recognizing that a person’s family history, personal behavior and where they live can have more influence on their well-being than anything that can be provided in a hospital or physician’s office, he added.

Tyson closed by recalling his own short hospitalization and how fortunate he was that he didn’t have to ask, “Am I going to be broke after this?”

Gina Calder, vice president of ambulatory services for Yale New Haven’s Bridgeport (Conn.) Hospital, said she was glad to hear Tyson speak to audience members about their collective responsibility to the country and their communities to provide care that is accessible to everyone.

“It doesn’t stop at our front door,” Calder said.

She also noted that value-based care “is here to stay.” In reference to Tyson’s comment about blowing up fee for service, Calder said, “I’m not sure that’s something we can avoid.”

Being reimbursed for outcomes allows organizations to invest in things like information-technology systems that provide data on what strategies produce the best outcomes, Calder said.

One recurring problem payers and providers grapple with is 30-day readmissions, and the financial penalties associated with them. To help address this issue, and improve patient outcomes, more organizations are turning to community paramedic (CP) programs that enlist the services of EMS teams to answer calls and offer short-term interventions that help divert patients away from emergency departments and funnel them back into appropriate care channels.

Kevin McGinnis, MPS, program manager of Community Paramedicine-Mobile Integrated Healthcare and Rural Emergency Care for the National Association of State EMS Officials, says community paramedicine got its roots in the late 1990s in the Northeast United States and Canada but didn’t come to prominence until the mid-2000s. There are roughly 170 documented CP programs nationwide.

“We can start to help the health system affect savings where others in the traditional healthcare system can’t because we’re in the community 24/7 and we’re used to being in patients’ homes,” McGinnis says. Data suggests CP programs are effective in reducing repeat ED admissions and 30-day hospital readmissions, he adds. “… This is one small solution that the healthcare system can invoke.”

Diversion tactics
CP programs work by allowing EMS personnel to answer emergency calls and assess patients’ needs to determine whether less-costly, more beneficial interventions are appropriate. Patients may need a quick fix for low blood glucose and a referral to an endocrinologist, for example. “They can take care of the issue right then and refer the patient for primary care at a future date. Or they can refer patient to a higher level of care more immediately,” McGinnis says. “It’s very powerful. It’s that triage force. You don’t want triage being done in the ED, you want to come out in front of the ED to do that.”

CP programs are also offering additional services. Dan Swayze, DrPH, MBA, MEMS, vice president and chief operating officer of the Center for Emergency Medicine of Western Pennsylvania, Inc., says that while community programs vary from state to state, most utilize the services of community paramedics for areas within their scope of practice where there are gaps in traditional care, such as for patients without insurance who don’t qualify for home health nurse visits. “Some home nursing agencies are actually contracting with CP services to supplement their care, to help reduce the likelihood their patients will be readmitted to the hospital,” Swayze says.

CP programs are also helping bridge the gap between health and human services, he says. They can provide patient navigation and patient advocacy services for patients who can’t get them on their own or who need help finding the right program.

“Our CPs often accompany patients to their providers’ visits so we can reinforce and translate the next steps in ways the patient will understand when they get back home,” Swayze says. “Once we address the underlying social determinant issues facing the patient, we find that their dependence on 911 and the local emergency department goes down drastically. It’s much more effective to have a paramedic call these patients than it is to continue to react as we have traditionally done.”

He adds that more CP programs are coming from hospitals that operate their own ambulance service. “The medics are already FTEs in the healthcare system and hospital administrators are beginning to realize it’s more cost effective to deploy the medics to the patient based on their predictive and risk stratifications models rather than waiting for the patient to call 911,” he says.

Financial drivers
Matt Zavadsky is director of public affairs for MedStar Mobile Healthcare, a governmental agency that is the regional 911 EMS provider for 15 Texas cities, including Fort Worth. MedStar also operates a CP program. Zavadsky says EMS teams have traditionally only been paid for transporting patients to the hospital or ED, with no reimbursement for patients treated on the scene without transport. “So we transport them to pay our employees and that’s just silly,” Zavadsky says.

Now, hospitals and payers are using incentives from the ACA earned through lower ED admissions and hospital readmissions to change the reimbursement structure. “Any health system migrating to a population health strategy has to recognize that all their efforts can be thwarted by the patient with a quick call to 911. As systems consider how best to transition to value-based care, they should take a serious look at their local EMS agencies as partners in the process,” Swayze says.

MedStar is paid primarily for 911 ambulance service, Zavadsky says. It also is paid for CP services. Hospitals and other agencies, such as an IPA, pay an enrollment fee for the enrollment. It also receives per member per month payment from hospice agencies. Third party payers are negotiating with the cost savings plan, though it was not yet in effect at press time, says Zavadsky.

Filling an unmet need
Zavadsky says that patients who are surveyed after hospital stays say they only understand their discharge instructions 40% of the time. They may have questions that only come up after they leave the hospital, then forget by their next appointment. These things that can lead to ED visits and readmissions.

“It’s not that they want to be noncompliant, it’s just that they don’t know any other way to be. Nobody has the time to sit with that patient in an area that’s comfortable for that patient and explain,” says Zavadsky. “We’ve put 3,000 to 5,000 patients through these [CP programs] and 80% of what we’re doing with these patients isn’t clinical. It’s educational.”

Zavadsky says his agency has tracked 475 patients using the CP mobile healthcare services for 24 months and found that EMS calls were reduced by about 55% in patients enrolled in the CP program. That translates to an estimated $8 million cost savings to health systems thanks to the change in the patient’s utilization of services. That estimate, Zavadsky says, is based on ED facility payments and Medicare cost savings and isn’t inclusive of additional costs for lab work or specialist care.

Original article can be accessed here.

Misunderstanding about the role of the Agency for Healthcare Research and Quality within the federal government may lead to its demise.

The agency is the lead federal agency involved with improving safety and quality of the nation’s healthcare system, and it develops the tools and data needed to help providers and consumers make informed health decisions. It has played a critical role in funding research devoted to health IT.

But the agency’s independent status may be coming to an end if President Donald Trump’s proposed budget is approved. The administration wants to merge it with the National Institute of Health (NIH), which also faces a $5.8 billion cut in funding.

AHRQ takes a hard look at healthcare costs and makes sure medical practice is evidence-based and not motivated by financial interests. But Republicans argue the agency’s work is duplicative and wasteful, noted STAT.

In defense of the administration’s consolidation plan, Health and Human Services Secretary Tom Price said during a budget hearing Wednesday the changes would improve efficiency while continuing to fulfill the agency’s mission.

But supporters of AHRQ believe that lawmakers don’t completely understand the role of the agency and that the proposal is short-sighted, according to STAT. The agency looks at the effectiveness of healthcare practices, such as identifying strategies to reduce medical errors and hospital-acquired conditions.

Lisa Simpson, chief executive of Academy Health, a healthcare research organization, told the publication that although it is well-known and respected within the scientific community, AHRQ lacks the visibility of larger agencies like the Centers for Disease Control and Prevention and the NIH.

“When you think about how many taxpayer dollars are spent to pay for healthcare under any scenario—Medicare, Medicaid, CHIP—to not invest a tiny amount of money to understand how to improve the quality of care seems so ill-advised and shortsighted,” Simpson told STAT.

And though the proposal is a threat to the agency’s future, it could be beneficial if it’s reorganized under the right conditions, wrote Andrew Bindman, M.D., in a blog post for Health Affairs. Bindman is a professor of medicine, epidemiology & biostatistics, and an affiliated faculty member within the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco.

Perhaps, he said, the AHRQ could lead efforts on how to prioritize the allocation of resources for practice-based research and implementation science available through the NIH and other federal investments.

Original article can be accessed here.

The current healthcare landscape is ever-changing, complex, fragmented and a thousand other adjectives. From cybersecurity to quality, policy changes to rising drug costs, there are myriad issues in the industry that are worth addressing.

For physicians, the complicated healthcare environment is only exacerbated by the country’s current insurance system.

A recent LinkedIn survey found 48 percent of physicians support a single-payer healthcare system, according to a post by LinkedIn’s healthcare news editor Beth Kutscher.

“It was a surprising number,” Kutscher told MedCity in a phone interview.

Another 32 percent of respondents were opposed to the idea of a single-payer system and 21 percent said they didn’t know.

The survey, which was part of a larger LinkedIn survey, was conducted between February 7 and February 19. A total of 511 United States physicians responded, 449 of whom are currently practicing. The participants, who come from various specialties, were selected at random. All the respondents noted in their profile that they have an MD degree, Kutscher said.

Why do almost half of the surveyed physicians favor a single-payer system? Some pointed to patients who move from provider to provider through the years.

“There was also a strong human rights theme that came out of the survey,” Kutscher said.

Other respondents noted the inconvenience of negotiating with numerous insurance companies. This frustration was fairly common. Fifty-four percent of physicians claimed they spent time negotiating with insurers. “It’s notable that more than half are actually doing it themselves,” Kutscher said. On average, they spent about four hours per week doing so. “That’s time out of their day. If all patients were in a single platform, [physicians] wouldn’t have to worry about these things,” Kutscher added.

Additionally, 64 percent of respondents said they’ve put new measures into place to ensure payment from patients with high-deductible health plans. Thirty-three percent said they offer payment plans, while 26 percent demand upfront payment. Another 19 percent said they bring on additional team members such as financial counselors to ensure timely payment from HDHP patients.

What about the 32 percent of respondents who said they oppose a single-payer system? Many said they think it could cut down competition or suppress innovation initiatives. Other opposers said they “fear it would give the government too much power over reimbursement rates or that they mistrust the government’s ability to create a viable single-payer system,” according to Kutcher’s post.

The statistics from LinkedIn’s survey show physicians are varied in their opinions about what should happen next in the U.S. healthcare system. But given last week’s AHCA failure, it looks like we’re staying where we are for right now.

Original article can be accessed here.

While Congress continues to hash out the details of a GOP bill to repeal and replace the Affordable Care Act, leading public health experts say the debate fails to address the actual challenges to American health and healthcare and will have a limited impact on the health of the population.

The National Academy of Medicine (NAM) has released a new discussion paper (PDF) that goes beyond the debates over insurance coverage and creates eight policy directions that are essential to advance American health, healthcare and scientific progress.

The publication is part of NAM’s Vital Directions for Health and Health Care Initiative, which called together more than 150 leading experts 18 months ago to examine ongoing healthcare problems, including high costs, disparities in health and the burden of chronic illness and disability.

The report was written by a bipartisan steering committee, which included Mike Leavitt, former governor of Utah and former secretary of the Department of Health & Human Services; Mark McClellan, former commissioner of the Food and Drug Administration; and Tom Daschle, former Senate majority leader.

“In the midst of all this debate, we cannot afford to lose focus on the ultimate goal of achieving better health for all, for an effective healthcare system that not only helps people prevent and treat their ailments but also helps every American to reach their best health and well-being,” Victor J. Dzau, M.D., co-chair of the committee and the president of NAM, said Tuesday during a conference to unveil the findings.

To achieve this goal, McClellan said the report identifies four priority actions to advance a more efficient and patient-focused health system, as well as four infrastructure needs to support the system.

Priority actions
Pay for value: One of the recurring themes in the 19 papers released as part of the report is the problem with the nation’s fragmented payment system. The report describes the need to align payments with outcomes and results and focus on activities that deliver the best outcome for patients at the lowest costs. To advance value-based care, policy reforms must drive healthcare payment and innovation providing incentives for outcomes and value, help clinicians develop the core competencies required for new payment models and remove barriers to integration of social services with medical services.

Empower people: Healthcare needs to be more democratic, McClellan said. The report calls on policy reforms to encourage clinicians to work with patients and families to ensure the care they provide matches the individual’s goals, work to improve health literacy and communicate in a way that is more understandable to patients, promote effective telehealth tools, and ensure patients have access and ownership of their personal information.

Activate and support communities: In most cases, health is determined by where patients live, what they are exposed to and who they spend time with, according to McClellan. Therefore, the report recommends strategies to support stronger, healthier communities, such as investing in local leadership and infrastructure for public health initiatives, expanding community-based strategies that target high-need individuals, such as patient-centered medical homes, and utilizing resources at the local level to customize and scale community health innovations.

Connect care: McClellan said the final action involves creating principles and standards for end-to-end interoperability, which involves making necessary regulatory and infrastructure changes for clinical data accessibility and use, and identifying information technology and data strategies to support continuous learning.
Essential infrastructure needs
To drive these actions, the report calls for different infrastructure needs, such as:

Measure what matters most: This means a consistent set of core measures must be developed. The report calls on HHS to identify a lead organization for each of the 15 core measures, and ongoing investment in improving performance measurement.

Modernize skills: The country must invest in and train the healthcare workforce to manage increasingly complex patients and populations. This will require reforms in healthcare training and education.

Accelerate real-world evidence: There is much promise in the potential to analyze large amounts of health-related data from actual patient care. But the report says progress has been hampered by technical, regulatory and cultural barriers. Policy reform must draw on real-word evidence to advance continuously learning clinical research, create incentives and standards that foster a culture of data sharing, and partner with patients and family to support evidence generation and sharing of information.

Advance science: To advance the pace of innovation, policies must invest in scientific innovation, support collaboration among government, academia and industry scientists, and streamline regulatory processes.

Article can be accessed here.

Health systems and insurers are actively seeking out technologies and innovations that drive change in the healthcare system, many focusing on solutions that make healthcare a more seamless experience for people to access and navigate. Given that healthcare represents 17.8 percent of the U.S. economy, health plan investment in innovative startups that create efficiencies and enable better patient outcomes should continue for the foreseeable future.

However, while investments are being made, many health plans are challenged to launch and scale commercial partnerships with these innovators after the closing dinner. Some are stuck in a health plan’s procurement spin cycle, or unable to grow beyond an initial pilot, all of which can be a life-or-death challenge for a startup company, only adding to the underlying investment risks.

For health plans’ strategic investment programs to mature, they must resolve the challenge of bringing innovations to scale for the benefit of broader membership.
Ultimately, the burden falls to entrepreneurs to decide where to invest their time and limited resources. I have observed decades worth of partnerships, many of which have not lived up to expectations.

Entrepreneurs should consider the following when evaluating potential strategic partners and investors to increase their chances of success:

Do they have a long-term vision?
Every company has their mission on their website, but is their business structured to support their vision? Not all health plans are aligned with their often transformative-sounding mission statements, and their annual business objectives are not always driving toward marketplace disruption. Entrepreneurs should really examine whether the plan and its leaders are incentivized to implement innovations – or just keep doing what they do.

Right room, wrong people
Time and time again entrepreneurs make agreements with health plans to fund a pilot, the teams get to work, and as the pilot wraps up, no long-term agreements are made. At times technology and time spent are wasted, and entrepreneurs are left scratching their heads.

To ensure a long-term partnership, entrepreneurs must ensure they’ve established direct relationships with a cross-functional team inside the health plan — including an executive sponsor (with real budget and decision-making authority) and leaders from other business units touched by the startup’s technology. Ensuring these key players are making decisions, and offering input from the start will lead to successful partnerships.

Adapt. And then adapt again.
Every health plan has their own processes and systems. Some require procurement approvals in advance, others after some work has been accomplished. Some parties may require roundtables and constant check-ins, while there are organizations that want progress reports at the end of each quarter. In every aspect of health care, no size fits all.

Entrepreneurs must be nimble and adapt to each plans’ internal processes and requirements.

Are they tire kickers?
Not every health plan has deep experience in partnering with startups – and it is clear that few of us get it right the first few times. There are many lessons for organizations to learn about aligning incentives, driving project budgets, making systems integrate and data sharing easier. Entrepreneurs must examine the plan’s track records: Do they stick it out for the long term, or are they tire kickers? Can they execute on the partnership once they make the investment? If entrepreneurs find stage-agnostic portfolios with a track record of long-term investment commitments, chances are the plan is in it for the long term, and not looking to kick the small guys to the curb.

Healthcare is a mess, and the industry has many problems and needs. Smart entrepreneurs have no shortage of opportunities to create billion dollar companies. However, if companies choose to use partnerships to speed their growth and development, entrepreneurs must always keep in mind that the wrong partner can smother them with attention, bury them in the process, and ultimately freeze them in pilot mode. Many strategic investors are looking for ways to facilitate these partnerships to run more efficiently and allow for better functioning. Startups and entrepreneurs, let us know what you are experiencing, what’s working well, and what’s not, in the market.

Original article can be accessed here.