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Contributing Voices
Edie Castello

Technology in health care is in danger of going the way of the home exercise bike: Lots of potential, not enough use — and less-than-optimal results.

Take data analytics, for example. With more health care organizations than ever before using electronic health records, we’re finally getting what we have been asking for: A plethora of really good data that could inform decision making. In 2011, data from the U.S. health care system reached 150 exabytes. As growth continues, big data for U.S. health care will soon reach the zettabyte (1021 gigabytes) scale and ...

Contributing Voices
John Marcille

Anyone who spends much time talking with me knows that one of my concerns, and not just as an editor, is the misuse of language by people in health care. Yes, I have a list of examples, and I might share that in a future essay. Today, we'll consider just one problem.

Contributing Voices
Norman S. Ryan, MD

As if the worsening diabetes epidemic were not enough to worry about, this chronic condition also increases risk for complications like heart disease, stroke, and kidney failure. This is a major challenge for health plans managing the care of a growing population of Medicaid members, who tend to overutilize emergency rooms for routine or non-urgent care.

While preventive and disease management programs are helping improve outcomes for people with diabetes and other chronic conditions, more must be done beyond just phone outreach to adequately engage Medicaid members. For instance, the single mother with young children and no car doesn’t need a call to remind her of an A1C test; she needs help resolving socioeconomic barriers like lack of transportation or child care.

Contributing Voices
Peter Wehrwein

Three more organizations have exited CMS’s Pioneer accountable care organization (ACO) program, leaving just 19 of the original 32 participants in the fold for the elite program’s third year.

The Franciscan Alliance in Indianapolis, the Genesys Physician Hospital Organization in Flint, Mich., and the Renaissance Health Network in Wayne, Pa., in the southeastern part of the state, are leaving the Pioneer program, according to a list posted on the CMS website this afternoon.

Sharp Healthcare in San Diego had announced in August that it was dropping out.

Contributing Voices
Peter Wehrwein

Maybe, just maybe, accountable care organizations (ACOs) are the best bet for hitting the health care exacta of controlling costs and improving the quality of care.

Figures released by CMS on September 16 showed that the 23 organizations in the elite Pioneer program and 220 in the Shared Savings program produced over $372 million in savings while earning $445 million in shared savings payments.

Contributing Voices
Paul Terry

Though hospitals were the slow adopters of EHRs, most are now fully engaged in trying to satisfy the federal requirement for “meaningful use” of an EHR thanks to CMS financial incentives. Still, as much as acceptance of the complex requirements needed to earn incentives is now a given with three fourths of health systems achieving stage 1 requirements, my discussions with providers from around the country leaves me observing that the intense focus on the details behind satisfying requirements has obscured the greater health policy picture.

Contributing Voices
Edie Castello

The United States spends considerable money on health care. Unfortunately, the clinical return on investment has been coming up short for years, according to Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally, an oft-cited Commonwealth Fund study.

Contributing Voices
Krishna R. Patel, PharmD, RPh
Formulary Restrictions Blow Medication Adherence

If you haven’t already heard about the negative impact of formulary restrictions on adherence, well here it is. With mixed messages regarding formulary restrictions’ impact on patients, a recently published systematic literature review, published by Happe, et al., sought to get to the bottom this.

Contributing Voices
Paul E. Terry, PhD and David Anderson, PhD, LP

Paul E. Terry, PhD

David Anderson

David Anderson, PhD, LP

We’ve known Michael O’Donnell, the publisher and editor in chief of the American Journal of Health Promotion, for 30 years. He is not prone to hyperbole. So he got our attention when he recently wrote that he had just published “the most extensive and well-conceived review conducted to date” on the financial impact of workplace health promotion.

He calls the paper “one of the best reviews ever conducted on any topic in workplace health promotion.” The study by Siyan Baxter and colleagues shows how the quality of the research methodologies used in the 51 interventions examined in their final analysis affected the magnitudes of the ROI’s reported. An archived webinar that summarizes the study findings is available free on this page at the  American Journal of Health Promotion.

Studies vary

There is a time-honored belief among health services researchers that the more rigorous the methodology, the smaller the size of the differences between groups will be. This is precisely what Baxter and colleagues found with respect to return on investment, which they calculated as ROI = (benefits – program costs) / program costs rather than the more typical approach of reporting ROI as the ratio of benefits to costs, i.e., ROI = benefits : costs. Nevertheless, Baxter, who is a PhD candidate in medical research at Australia’s University of Tasmania, found ROIs averaging 0.26 ($1.26 per dollar invested) in the 18 high-quality studies and –0.22 ($0.78 per dollar invested) in 12 studies using the most rigorous methodology, namely, the randomized controlled trial (RCT). For the 43 less rigorous studies of moderate or low quality, Baxter found ROIs averaging 1.79 (i.e., benefits of $2.79 per dollar invested), which is consistent with the oft cited ROI of 3:1 reported in a recent review by Harvard Economist Katherine Baicker and her colleagues.

Contributing Voices
Norman S. Ryan, MD

Next year is a big year for Medicare Advantage plans. In 2015, they will not receive bonuses unless they have a 4-star rating or above. Many health plans are feeling under pressure right now, and may even feel a little disgruntled, as their businesses could really take a hit next year if they fall even slightly below 4.

One way to view this challenge that may take the edge off the pain is that the CMS Five Star Quality Rating System for Medicare Advantage Plans is not just about being able to stay or earn a spot in the Medicare Advantage program. Taking steps to improve ratings can help Medicare Advantage plans and other health plans hoping to enter the program achieve the Triple Aim and move them even closer to getting the business results they really want.

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