Improving the delivery and financing of health care services in the U.S. can be a muddy endeavor. But a number of developments in September offered a clearer view of what needs to be done to meet the Triple Aim's objectives of improving patient experience, improving population health and reducing health care spending.

Alternative Delivery Models

$685 Million earmarked by HHS for new Transforming Clinical Practice Initiative

The $685 million goes to 39 national and regional health networks that will use the money to change the way more than 140,000 clinicians provide care to patients, according to HHS' Sept. 29 announcement. Projects include the development of electronic tools to improve communication between clinicians and patients, providing health coaches to patients with chronic medical illnesses and the centralization of clinical outcome data to facilitate quality improvement efforts. The thread running through all the projects is the desire to exchange actionable information electronically among their participants. In the near future, that capability will become the baseline competency required of all health care stakeholders.

78% of ACOs ranked “access to data” as a top challenge

In a survey of accountable care organizations by the eHealth Initiative, three of the top five operational challenges cited by 69 ACOs surveyed were information-related. “Access to data outside my organization/network” topped the list, mentioned by 78 percent of the ACO respondents. Second was “data integration” at 62 percent. Fourth at 38 percent was “cost of new health information technology.” The eHealth Initiative released the results of its annual ACO survey as part of a Sept. 8 webinar.

Electronic Health Records

5 main challenges remain to achieve interoperability

According to a 29-page report issued by the Government Accountability Office last month there are five major challenges that need to be overcome to achieve interoperability among all EHR systems. The challenges to be overcome, in no particular rank order, per the GAO are: Insufficient health data standards; variation in state privacy laws; difficulty in matching patients' health records; costs related to interoperability; and lack of trust among stakeholders. The report is based on extensive interviews with representatives from 18 organizations working on various aspects of health IT interoperability, including the CommonWell Health Alliance.

75.5% of hospitals have adopted at least a basic EHR system

The Robert Wood Johnson Foundation's annual report, Health Information Technology in the United States 2015 (2015, September 18) says that 78% of hospitals that had adopted at least a basic EHR system by the end of 2014. That's a 16.6 percentage point jump in one year alone over 2013's basic-level EHR hospital adoption rate of 58.9 percent. Although that's an enviable increase in just one year, it means that nearly a quarter of the nation's hospital began this year without a basic EHR system. That will need to change to achieve true health IT interoperability among the nation's hospitals.

20 recommendations for reducing misdiagnoses

The Institute of Medicine has outlined 20 recommendations to reduce the rate of misdiagnoses that jeopardize the safety of patient care provided in the U.S. The recommendations are delineated in the IOM's latest patient safety tome, Improving Diagnosis in Health Care (2015, September 22). In the 346-page report found on, the IOM said misdiagnoses contribute to 10 percent of all patient deaths and that most people “will experience at least one diagnostic error in their lifetime.” Among the IOM's 20 recommendations to reverse the situation are several targeted at health IT. Specifically, the IOM said health IT used in the diagnostic process should: Demonstrate usability; incorporate human factors; integrate measurement capability; fit well within clinical workflow; provide clinical decision support; and facilitate the timely flow of information among patients and health care professionals. If you're a health care provider, those are the features you should be looking for in your EHR systems.

1.9% reduction in low-value health care services

The reduction in the number of low-value health care services provided to Medicare patients by Medicare Pioneer ACOs in their first year of operation was measured at 1.9%. Researchers looked at whether the participating providers in Pioneer ACOs cut back on any of 31 health care services to beneficiaries that offered minimal clinical value based on the beneficiaries' health status. And they did, according to their findings published Sept. 21 in the Journal of the American Medical Association. The volume of low-value services dipped 1.9 percent, and the spending on low-value services dropped 4.5 percent. The results show that providers, when properly incented, can eliminate unnecessary care without any adverse impact on patient outcomes.

Patient Access and Engagement

165,000 health apps now available

According to a recent report from the IMS Institute for Healthcare Informatics, Patient Adoption of mHealth (2015, September 17), there are now hundreds of thousands of mobile health applications available for download to consumers from Apple and Google. That's nearly four times the number of mobile health apps found by the IMS Institute two years ago in its first report on the topic. Of the 165,000 apps identified in the new report, 26,864 were true mobile health apps, which the group defined as those focused on overall wellness like diet and exercise and those focused on disease management like medication reminders. The report said one in 10 true mobile health apps now can connect to a device or sensor, enabling collection and transmission of health data.

91% of patients found texts helpful for managing health

Researchers sent four text messages per week for six months to 352 people with heart disease. The messages were lifestyle reminders on diet, exercise, tobacco use and medication adherence. They didn't send any text messages to a peer group of 358 people with heart disease. After six months, the texted patients lowered their cholesterol, lowered their blood pressure, lost more weight, exercised more and reduced smoking more than patients who didn't get phone reminders. Some 91 percent of texted patients said the messages were useful in helping them maintain a heart healthier lifestyle. The study, Effect of Lifestyle-Focused Text Messaging on Risk Factor Modification in Patients With Coronary Heart Disease (2015, September 22) appeared in the Journal of the American Medical Association. This demonstrates that technology doesn't have to be complex to improve patient engagement.

17.6 Million new covered lives

As a result of the Patient Protection and Affordable Care Act, which took effect in 2010, there are reportedly 17.6 million adults in the U.S. who have gained health insurance coverage. This data is from HHS Secretary Sylvia Burwell, Secretary Burwell previews third Open Enrollment (2015, September 22). Of those, 15.3 million obtained coverage through state health insurance exchanges, and another 2.3 million were young adults who were able to stay on their parents' health insurance plan.

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