Enhancing Quality of Care and Reducing Costs Through a New Collaboration

The Mount Sinai Health System has entered into an agreement with Empire BlueCross BlueShield that is designed to enhance quality of care and help individuals maintain healthy habits, all while reducing the cost of care. Empire is the largest health insurer in New York State.

Under the innovative agreement, which became effective January 1, 2015, Mount Sinai will manage all aspects of care for Empire’s 48,000 commercial and Medicare members who are attributed to the Health System. This includes coordinating all medical treatment, closely monitoring the patient between physician visits, and ensuring that appropriate follow-up care is received. Patients with chronic or complex conditions will receive individualized care plans tailored to their specific needs. Read more

Big Data Treasure Trove From Routine Medical Checkups

A Wall Street Journal article noted: “Researchers are analyzing pools of patient information collected from routine checkups to help doctors better diagnose their patients. This type of data is easier to mine thanks to the rise in electronic health records that contain information collected in regular doctor visits.”

“Big data generally refers to information that is too large—terabytes to petabytes or even exabytes of memory—to process with older standards of processing power. Researchers say it is important to do additional studies beyond data mining to learn more.” Read more

Health Care Teams Demand Nurses with Doctorate Degrees

A Press of Atlantic City article noted: “ When open enrollment for the Health Insurance Marketplaces closed earlier this year, more than 7.1 million Americans had signed up for health insurance coverage. As millions of new patients continue to gain access to insurance under the Affordable Care Act, industry leaders are facing the challenge of providing quality care while meeting the needs of an aging population and patients with more chronic health issues. One emerging solution is the concept of ‘care teams’ that more closely engage health care professionals from all disciplines.” Read more

For Better Treatment, Doctors and Patients Share the Decisions

An NPR story noted: “Many of us get confused by claims of how much the risk of a heart attack, for example, might be reduced by taking medicine for it. And doctors can get confused, too.”

“Just ask Karen Sepucha. She runs the Health Decisions Sciences Center at Boston’s Massachusetts General Hospital. A few years ago she surveyed primary care physicians, and asked how confident they were in their ability to talk about numbers and probabilities with patients. ‘What we found surprised us a little bit,’ Sepucha says. ‘Only about 20 percent of the physicians said they were very comfortable using numbers and explaining probabilities to patients.’” Read more

Scale of Medical Decisions Shifts to Offer Varied Balances of Power

A Los Angeles Times article noted: “Patients never used to worry about making healthcare decisions. They didn’t have to. Their doctors made just about all of their decisions for them. Everyone simply assumed that doctors knew what was best.”

“But that paternalistic view of doctors as know-it-alls has gone by the board, says Dr. Clarence Braddock, vice dean for education at the David Geffen School of Medicine at UCLA. “Now doctors are seen as the experts on medical information and choices,” he explains, “but patients are seen as the experts on what those choices mean in their own lives.” Read more

Clashing Visions on Medical Care Practice Prove to Be Hurdle

A Modern Healthcare article noted: “Clashing visions of how physicians should practice medicine in the 21st century bubble beneath the surface of nearly every controversial issue in delivery system reform. On the one side is ….a ‘last-century perspective. It reflects a time when patient outcomes were considered unmeasurable and when the idea of team care meant everyone following the orders of whichever physician was in charge.’”

“This approach put heroic practitioners at the center of the diagnosis, treatment and healing process. It posited that the best therapy for any patient should be discerned and delivered by someone with years of training and experience and, hopefully, a personal relationship with the individual in need of care.” Read more

Fee-for-Service Thwarts Value-Based Care’s Intention

A Modern Healthcare article noted: ”Society wants the healthcare system to improve the population’s overall health while caring for the sick at a lower overall cost. The term of art is providing value-based care. Yet system leaders are stuck with a reimbursement system that still rewards volume through fee-for-service medicine.”

“Those differing approaches to providing healthcare—actually, only value-based care can truly be called healthcare since fee-for-service medicine is more properly called sick care—present providers with two diametrically opposed incentive schemes.” Read more

Chemo Costs in U.S. Driven Higher by Shift to Hospital Outpatient Facilities

A Kaiser Health News article noted: “The price of cancer drugs has doubled in the past decade, with the average brand-name cancer drug in the U.S. costing $10,000 for a month’s supply, up from $5,000 in 2003, according to a new report by IMS Institute for Healthcare Informatics, a health information, services and technology company.”

“And those are just average prices; some drugs may cost as much as $30,000 a month.In Europe, where governments negotiate for national discounts, the list prices of cancer drugs are at least 20 to 40 percent lower than in the U.S., the report found.” Read more

Hospitals’ Purchase of Doctors Leads to Higher Prices, Spending, Study Finds

A Kaiser Health News article noted: “A new study gives ammunition to what health economists and health insurers have argued for years: When hospitals buy physician practices, the result is usually higher hospital prices and increased spending by privately insured patients.”

“The study, published … in the journal Health Affairs, was based on an analysis of 2.1 million hospital claims from workers of self-insured employers between 2001 and 2007.  The analysis by Stanford University researchers found prices were most likely to increase when hospitals bought physician practices, as opposed to hospitals forming looser contractual relationships with physicians.” Read more