Viewpoint
Ellen Harrison
CMS continues to push on measuring and reporting information from the consumer perspective for Medicare Advantage and Part D contracts. Others will follow, and we can expect more emphasis on member-reported outcomes and experience measures across all lines of business.
Massachusetts plans scored highest. Other New England states in the top 10 included Rhode Island (ranked second), Maine (third), New Hampshire (sixth), and Vermont (eighth). The Midwest states were also well represented in the top 10 with Wisconsin (fourth), Minnesota (fifth), and Iowa (10th) making the cut.
What Works
Sarah Kwon
Community health workers liaise between underserved populations and clinicians, help patients and resources to manage disease, and provide health education, informal counseling, and social support. Interest in community health workers is shifting away from narrowly focused intervention on a single disease toward care coordination of multiple chronic conditions.
News Wire
Meanwhile, primary care office visits to nurse practitioners and physician assistants skyrocketed 129% during the same period.
Health insurers worry that a flush hospital industry that spends more on direct-to-consumer ads might get the upper hand in negotiations.
The disease management company promises to lower the A1C levels of diabetes patients, or health plans won’t have to pay for the program.
Agency researchers scramble to find the cause of a virus that’s affected about 160 children.
Combination of Experimental Drug and Checkpoint Inhibitors Fight Tumor Cells
What Works
Robert Calandra
The caveat: Joint replacements might be a sweet spot for bundled payments. They might not work as well for other episodes of care.
What Works
Sarah Kwon
The caveats: They may need to be part of larger programs to be effective. And smoking rates have fallen but remain stubbornly high among people without privilege.
What Works
Jan Greene
The caveats: Most of the evidence involves routine care. It is uncertain whether nurse practitioners will be willing to work in rural areas to fill the primary care void.
CURRENT ISSUE November 2018

Winning Moves in Health Care

Sure, we learn from our mistakes. But we also learn from our successes. Managed Care this month looks at almost a dozen developments in health care that can be called victories although, as with everything in the industry they can’t be called complete victories. That’s why we added some caveats to our topics.

For instance, palliative care improves quality of life and symptoms. Caveat: It is difficult to study. The strongest evidence is for palliative care in hospitals.

Antiviral drugs have made hepatitis C eminently treatable. Caveat: Though prices are now falling the high cost still means many who might benefit don’t have access to the medications.

Nurse practitioners provide quality primary care at a lower cost than physicians. Caveat: Most of the evidence involves routine care.

Still, mostly success stories for a change. What’s not to like?

UPCOMING MEETINGS
Scottsdale, AZ
January 28-29, 2019
What Works
Michael D. Dalzell
The caveats: P4P programs don’t have a great track record, and avoiding risky patients may prove to be an unintended consequence.
What Works
Frank Diamond
The caveats: About 40,000 Americans are newly infected every year. And HIV infection is still among the top 10 leading causes of death among Americans between the ages of 25 and 44.
What Works
Jan Greene
The caveats: It is difficult to study. The strongest evidence is for palliative care in hospitals.
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