Ten new industry developments provide useful guidance to health care providers that are re-tooling their delivery models in response to the latest advances in information and medical technologies and the latest innovations in the way payers reimburse them for care. Here's our recap of the insights providers need to know to maintain and create business value.
Accountable Care Organizations
Study says Medicare ACOs find savings harder to come by in second year of participation
The 220 provider organizations that joined the Medicare Shared Savings Program as ACOs in 2012 and 2013 were able to cut spending on Medicare patients more in their first year as an ACO than in their second, according to a study by researchers from the Harvard Medical School published in the New England Journal of Medicine. The study said the ACOs trimmed average annual per beneficiary spending in 2012 by 1.4 percent to $9,942, or $144 per beneficiary. In 2013, however, they were able to trim only another $3 per beneficiary. The biggest drivers of savings were reductions in spending on inpatient hospital care and post-acute care, specifically care provided by skilled-nursing facilities. The researchers suggested that the ACOs that joined in 2013 versus those that joined in 2012 had “less advanced systems for managing care” to keep patients out of the hospital or nursing home.
Bigger Medicare ACO savings seen from managing patients with multiple chronic medical conditions
A second study on Medicare ACO performance suggested that participating providers can find the greatest savings from deftly managing the care of beneficiaries suffering from multiple chronic medical conditions. The study, which was published in the Journal of the American Medical Association, compared per beneficiary per quarter spending on generally healthy Medicare patients who were moved into ACOs with spending on Medicare enrollees with at least three chronic medical conditions who were moved into ACOs. Researchers from the Dartmouth Institute for Health Policy and Clinical Practice found that total spending on healthy Medicare patients dropped by $34 per beneficiary per quarter in 2013 after they joined an ACO. By comparison, total spending on “clinically vulnerable” Medicare patients dropped by $114 per beneficiary per quarter in 2013 after they joined an ACO. Keeping Medicare patients with multiple chronic medical conditions out of the hospital, out of the emergency room and out of a skilled-nursing facility drove the bigger savings.
EHR Adoption and Use
Hospitals near universal adoption of “certified” EHR systems, according to the ONC
The percentage of U.S. hospitals that have installed “certified” EHR systems topped 96 percent last year, said a report from HHS's Office of the National Coordinator for Health Information Technology. That's up from 72 percent in 2011, the ONC said. A certified EHR is one that “meets the technological capability, functionality and security requirements adopted by HHS,” the report said, including the “capability to securely work with other certified EHR systems to share information.”
Barriers remain that inhibit hospitals from using certified EHRs to electronically share patient data
A second report from the ONC said hospitals are making progress toward sharing patient information electronically with other unaffiliated providers, but significant barriers remain that inhibit universal interoperability. The second report said 26 percent of U.S. hospitals were using all four dimensions of interoperability in 2015, up from 23 percent in 2014. Those four dimensions are: finding, sending, sharing and integrating patient information electronically via their EHR systems. The most frequently cited technical barrier was the inability of another provider's EHR system to receive data, and the most frequently cited operational barrier was a cumbersome workflow to send data.
Study suggests lifestyle and behavior changes can reduce cancer cases by as much as one-third
Researchers from the Harvard Medical School compared the cancer incidence rates and cancer mortality rates of about 136,000 health care professionals -- 21 percent who lived a low-risk, healthy lifestyle and 79 percent who lived a high-risk, unhealthy lifestyle. The researchers, who published their results in JAMA Oncology, defined a person as low risk if he or she didn't smoke, consumed little or no alcohol, wasn't overweight and exercised regularly. Everyone else was high-risk. High-risk women had cancer incidence rates and cancer mortality rates that were 25 percent and 48 percent higher, respectively, than low-risk women in the study. High-risk men in the study had cancer incidence rates and cancer mortality rates that were 33 percent and 44 percent higher, respectively, than low-risk men in the study. The results led the researchers to conclude that “primary prevention should remain a priority for cancer control.”
Overall adult obesity rate closing in on 40%, according to latest CDC data
Some 37.7 percent of U.S. adults were obese in 2013-2014, according to the latest data from the Centers for Disease Control and Prevention published in the Journal of the American Medical Association. The CDC defines obesity as an adult with a Body Mass Index of 30.0 or higher. Some 40.4 percent of women were obese in 2013-2014 compared with 35.0 percent of men, the CDC said.
Less than 7% of adults engage in behaviors that prevent chronic disease
Research published by the CDC in the journal Preventing Chronic Disease found that fewer than 7 in 100 adults regularly engaged in five health-related behaviors in 2013 that help prevent chronic medical illnesses. The five behaviors are: not smoking; exercising regularly; consuming little or no alcohol; maintaining a normal body weight; and getting enough sleep. Of the nearly 400,000 adults age 21 or older surveyed in 2013, only 6.3 percent said they engaged in all five behaviors. Some 24.3 percent cited four; 35.4 percent cited three; 24.3 percent cited two; 8.4 percent cited one; and 1.4 percent didn't do any. “Collaborative efforts in health care systems, communities, work sites and schools can promote all five behaviors and produce population-wide changes, especially among the socioeconomically disadvantaged,” the researchers concluded.
Genetic data from nearly 15,000 cancer patients already available in new NIH data base
The National Institutes of Health's National Cancer Institute launched a new data base through which cancer care researchers and clinicians can share and study the genetic profiles of patients diagnosed with cancer. The data based, called the Genomic Data Commons, kicked off with the genetic profiles of nearly 15,000 patients suffering from one or more of 38 different types of cancer. “These datasets will lead to a much deeper understanding of which therapies are most effective for individual cancer patients,” the NIH said in a prepared statement, calling the GDC a “core component” of the federal government's National Cancer Moonshot program and the Precision Medicine Initiative.
Fifty-eight oncology practices sign on to ASCO's data initiative to share patient treatment outcomes
In a parallel effort to use advanced data analytics to improve the care of cancer patients, the American Society of Clinical Oncology announced that 58 oncology practices in 39 states have joined the group's CancerLinQ Big data initiative. Through CancerLinQ, which began development in November 2013, oncology practices can share the de-identified medical records of their cancer patients. Participating clinicians can access the database to compare their treatment plans and outcomes with their peers and with accepted clinical protocol guidelines.
Collecting and protecting patient information used in precision medicine Big Data initiatives
The success of medical researchers, clinicians and other providers in using advanced data analytics in precision medicine or any other type of data-driven clinical decision-making process starts with the data themselves. That means having the ability to collect the right information and the ability to protect the privacy and security of that information. Three groups have offered up guidance to providers on how to do both. The Precision Medicine Task Force of the Health IT Standards Committee, which advises HHS' Office of the National Coordinator for Health Information Technology on health IT policy, released recommendations to bolster the collection of patient data via EHRs and non-EHR sources for precision medicine purposes, including patients' medication histories, lab results and claims. The FDA issued draft guidance on how to tap EHR data for use in clinical trials. And the White House issued a framework for protecting the security of patient data used in its Precision Medicine Initiative.