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In January 2018, Congress passed the “Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act,” amending the Social Security Act (SSA) in order to provide prevention, recovery, and treatment, among other things, for persons with opioid use disorder (OUD). The U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) released an informational bulletin that provides guidance for implementation of the Act on August 5, 2019, addressing Section 1004 of the SUPPORT Act. The bulletin reviews the requirement that states implement changes to their Medicaid Drug Utilization Review (DUR) process to include minimum opioid standards within their fee-for-service (FFS) and managed care programs. This article reviews the need for strategies to address OUD in the United States and outlines the information provided by CMS to assist states in meeting the Medicaid DUR requirements of the SUPPORT Act. Read More →
A recent study found that people living with asthma are not using their inhalers correctly. One of the doctors involved in that study explains how mHealth can help patients and providers follow the rules. Read More →
As children grow and develop, they experience a number of emotional reactions that they know are different or even negative feelings, but they haven’t the experience to understand what they are dealing with. However, they will let us know when something is wrong even when they aren’t entirely sure of what it is. Read More →
Until recently, efforts to improve the health of Americans have focused on expanding access to quality medical care. Yet there is a growing recognition that medical care alone cannot address what actually makes us sick. Increasing health care costs and worsening life expectancy are the results of a frayed social safety net, economic and housing instability, racism and other forms of discrimination, educational disparities, inadequate nutrition, and risks within the physical environment. These factors affect our health long before the health care system ever gets involved. Read More →
From readmissions to no-shows, factors like addiction and food insecurity have an impact on billing, collections, and the bottom line. Read More →
Managed care organizations (MCOs) are on the leading edge of efforts to strike a better balance between health and social service expenditures, a recent article in JAMA says. Read More →
Medicare Advantage enrollment and spending are expected to surge over the next decade, until more than 4 in 10 beneficiaries are in the program by 2028. Read More →
It’s no secret that physicians are bogged down by EHRs. Now, the federal government says it has some solutions. A new draft strategy issued by the Department of Health and Human Services (HHS) on Wednesday details three overarching goals to reduce clinician burden revolving around entering information into the EHRs, meeting regulatory requirements and improving EHR ease of use. In several recommendations, the agency vowed to continue is work stripping down regulations and working with the industry to find solutions to growing problems. Read More →
We are excited to announce Amazon Comprehend Medical, a new HIPAA-eligible machine learning service that allows developers to process unstructured medical text and identify information such as patient diagnosis, treatments, dosages, symptoms and signs, and more. Comprehend Medical helps health care providers, insurers, researchers, and clinical trial investigators as well as health care IT, biotech, and pharmaceutical companies to improve clinical decision support, streamline revenue cycle and clinical trials management, and better address data privacy and protected health information (PHI) requirements. Read More →
The insurer is teaming up with the physician-led value-based care organization to serve Medicare Advantage patients in southern and central California. Read More →
When they're sick, Americans seem to know what they want: antibiotics. And if they don't get them, their doctors' reputations may suffer. Read More →
Budget hawks worry that rather than replace comparatively expensive in-person visits, extra telemedicine billings would add to them. Read More →
Cutting out the middlemen, Walmart, General Motors and other companies are experimenting with new models for health coverage. Read More →
Survey finds overemphasis on physical health and treatment compared to underlying components of health such as diet and environmental factors. Read More →
Nearly 12% of Takotsubo Syndrome patients are readmitted to a hospital within 30 days of an inpatient stay, recent research shows. Read More →
Bellin Health shares how the health system achieved the top composite quality score in the first performance year of Next Generation ACO. Read More →
New research shows a significant increase in emergency department violence, but there are strategies to address the problem. Read More →
By focusing on public health instead of incarceration, the country has stopped an opioid epidemic. Psychologists are playing a key role in this dramatic turnaround. Read More →
The key to helping hospital physicians and quality leaders build an effective clinical analytics program and leverage performance improvement. Read More →
The U.S. Senate passed its amendment to H.R. 6, the Opioid Crisis Response Act of 2018, on Monday in a 99-1 vote to address the United States’ ongoing opioid addiction epidemic. The bipartisan bill package contains proposals from 72 senators and work from five Senate committees: banking, commerce, finance, health, and judiciary. Read More →
For Kristin Cox, MD, an internist and a program director at Newton-Wellesley Hospital in Massachusetts, the real value comes from the fresh eyes.
“Residents are in a perfect position to evaluate the systems we’re using,” she says. “They see best practices, what works, and what doesn’t work. They see every department on days, nights, and weekends. They see every aspect of the hospital.”
And seeing those things can lead to improvements — improvements in systems within the hospital, improvements within care teams, and, most importantly, improvements for patients. Those improvements are central to a unique QI-themed training program for residents at Newton-Wellesley. Read More →
A healthcare collaborative in San Diego achieved a 22% reduction in heart attack hospitalization rates compared to an 8% reduction in the rest of California, research published this week says.
The collaborative—Be There San Diego—launched in 2011. The 22% reduction in heart attack hospitalization rates was attained from 2011 to 2014, avoiding about 3,800 hospitalizations and attaining an estimated $86 million in savings. Read More →
Seventeen health systems in 21 states are collaborating to identify, develop, and scale financially sustainable digital solutions to improve healthcare for the 75 million Americans on Medicaid.
The Medicaid Transformation Project will focus on critical challenges facing vulnerable populations across the country, including behavioral health, women and infant care, substance use disorder, and avoidable emergency department visits. Read More →
A Google study released this month finds that customer experience is the primary reason consumers choose to travel with a particular brand. Easy-to-use websites and online reviews are second and third.
What does this have to do with healthcare? Quite a bit, according to experts in customer experience, a field that is becoming increasingly important to health systems. Thanks to new ways to gather and organize data, health systems now have actionable information to improve patient experience, often in real time. These processes are enhanced by technology that uses natural language processing to detect patterns in that data. Read More →
The focus on behavioral health is surfacing in pediatric facility design. As this traditionally underserved area of healthcare grows, providers are boosting their mental health services by hiring more specialists, building more private rooms, integrating more play areas, and weaving more soothing, nature-related elements into the design. Read More →
Addressing the problem of professional burnout has become a pressing topic in psychiatry as we all try to achieve a work-life balance that is satisfying, enriching, and sustainable. This month’s author, John Kern, M.D., found that working as the consulting psychiatrist for a collaborative care program helped stave off burnout and allowed him to reach his clinical and personal goals. Read More →
A significant number of Medicaid beneficiaries — one in five — have a behavioral health diagnosis (mental health and/or substance use disorder). However, many of these individuals are served in fragmented systems of care with little to no coordination across providers, often resulting in poor health care quality and high costs. Read More →
The National Committee for Quality Assurance (NCQA) is proud to announce NCQA’s eMeasure testing laboratory is now approved by the Office of the National Coordinator for Health Information Technology (ONC). As an ONC-Authorized Testing Lab (ONC-ATL), NCQA can perform health IT tests as part of the ONC Health IT Certification program.
NCQA is the only approved alternative to this government-based electronic quality measure testing procedure. With this approval, health IT and data vendors can use the NCQA generated test decks for two certifications; ONC HIT Certification for use in reporting electronic clinical quality measures (eCQMs) to CMS for the Quality Payment Program; as well as NCQA eMeasure certification for use in NCQA’s recognition for Patient-Centered Medical Home (PCMH) and as a standard supplemental dataset in support of HEDIS reporting. Read More →
Collaborating with public health and community organizations to foster informed decision-making can help Medicaid entities better address the social determinants of health (SDOHs), says new guidance issued by the National Quality Forum (NQF).
An expert panel assembled by NQF found that Medicaid programs are well positioned to positively impact food insecurity and housing-related SDOH among their beneficiary populations, but only if they work closely with other organizations in their communities. Read More →