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Population Health Management

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https://www.readbyqxmd.com/read/29437537/impact-of-comprehensive-medication-management-on-hospital-readmission-rates
#1
Holly Budlong, Amanda Brummel, Adam Rhodes, Hannah Nici
In 2012, the Fairview Health System implemented a formal care transitions process that included referrals to outpatient services provided by medication therapy management (MTM) pharmacists, among other clinical services. This analysis evaluates the impact of the MTM-provided comprehensive medication management (CMM) service on readmission rates. Retrospective electronic medical record (EMR) data were used to identify hospital admissions between December 1, 2012, and July 31, 2015. Thirty- and 60-day readmission rates were calculated in both a CMM and comparator cohort...
February 13, 2018: Population Health Management
https://www.readbyqxmd.com/read/29437531/improving-population-health-among-uninsured-patients-with-diabetes
#2
Michele H Talley, Shea Polancich, Jason B Williamson, Jennifer S Frank, William Curry, John F Russell, Cynthia Selleck
Diabetes is a leading cause of morbidity and mortality; prevalence of diabetes is especially high in the southeastern United States among minority populations and those from lower socioeconomic sectors without access to health care services. The purpose of this project was to evaluate the clinical and financial outcomes of a nurse-led, interprofessional collaborative practice model that provides care coordination and transitional care for uninsured patients with diabetes. Data for this study were collected and evaluated from medical records of patients seen at the Providing Access to Health Care (PATH) Clinic between August 1, 2015, through May 30, 2017...
February 13, 2018: Population Health Management
https://www.readbyqxmd.com/read/29393829/low-wage-workers-and-health-benefits-use-are-we-missing-an-opportunity
#3
Bruce W Sherman, Carol Addy
No abstract text is available yet for this article.
February 2, 2018: Population Health Management
https://www.readbyqxmd.com/read/29393824/strategic-review-process-for-an-accountable-care-organization-and-emerging-accountable-care-best-practices
#4
Sarah J Conway, Sarah Himmelrich, Scott A Feeser, John A Flynn, Steven J Kravet, Jennifer Bailey, Lindsay C Hebert, Susan H Donovan, Sarah G Kachur, Patricia M C Brown, William A Baumgartner, Scott A Berkowitz
Accountable Care Organizations (ACOs), like other care entities, must be strategic about which initiatives they support in the quest for higher value. This article reviews the current strategic planning process for the Johns Hopkins Medicine Alliance for Patients (JMAP), a Medicare Shared Savings Program Track 1 ACO. It reviews the 3 focus areas for the 2017 strategic review process - (1) optimizing care coordination for complex, at-risk patients, (2) post-acute care, and (3) specialty care integration - reviewing cost savings and quality improvement opportunities, associated best practices from the literature, and opportunities to leverage and advance existing ACO and health system efforts in each area...
February 2, 2018: Population Health Management
https://www.readbyqxmd.com/read/29393807/health-care-service-use-among-elderly-seasonal-migrators
#5
Molly Moore Jeffery, Julian Wolfson, Sarah K Meier, Bryan E Dowd, Jean M Abraham, Robert L Kane
Elderly seasonal migrators share time between homes in different states, presenting challenges for care coordination and patient attribution methods. Medicare has prioritized alternative payment models, putting health care providers at risk for quality and value of services delivered to their attributed patients, regardless of the location of care. Little research is available to guide providers and payers on the service use of seasonal migrators. The authors use claims data on fee-for-service (FFS) Medicare beneficiaries' locations throughout the year to (1) identify seasonal migrators and (2) describe the care they receive in each seasonal home, focusing on primary care and emergency department (ED) visits and the relationships between the two...
February 2, 2018: Population Health Management
https://www.readbyqxmd.com/read/29393804/the-hungry-cancer-patient-a-case-of-money-ill-spent
#6
Allison Zibelli
No abstract text is available yet for this article.
February 2, 2018: Population Health Management
https://www.readbyqxmd.com/read/29298402/public-reporting-of-primary-care-clinic-quality-accounting-for-sociodemographic-factors-in-risk-adjustment-and-performance-comparison
#7
Douglas R Wholey, Michael Finch, Rob Kreiger, David Reeves
Performance measurement and public reporting are increasingly being used to compare clinic performance. Intended consequences include quality improvement, value-based payment, and consumer choice. Unintended consequences include reducing access for riskier patients and inappropriately labeling some clinics as poor performers, resulting in tampering with stable care processes. Two analytic steps are used to maximize intended and minimize unintended consequences. First, risk adjustment is used to reduce the impact of factors outside providers' control...
January 3, 2018: Population Health Management
https://www.readbyqxmd.com/read/29240530/mobile-integrated-healthcare-intervention-and-impact-analysis-with-a-medicare-advantage-population
#8
Brooke Roeper, Jonathan Mocko, Lanty M O'Connor, Jiaquan Zhou, Daniel Castillo, Eric H Beck
Mobile Integrated Healthcare (MIH) is a patient-centered, innovative delivery model offering on-demand, needs-based care and preventive services, delivered in the patient's home or mobile environment. An interprofessional MIH clinical team delivered a care coordination program for a Medicare Advantage Preferred Provider Organization that was risk assigned prior to intervention to target the highest risk members. Using claims and eligibility data, 6 months of pre-program experience and 6 months of program-influenced experience from the intervention cohort was compared to a propensity score-matched comparison cohort to measure impact...
December 14, 2017: Population Health Management
https://www.readbyqxmd.com/read/29232531/key-elements-of-a-population-based-approach-to-improving-birth-outcomes
#9
Marian Bihrle Johnson, Jeffrey Rakover, Kedar Mate
No abstract text is available yet for this article.
December 12, 2017: Population Health Management
https://www.readbyqxmd.com/read/29232528/upmc-s-population-health-management-strategy-a-road-map-to-high-value-health-care
#10
Marion McGowan, Donna J Keyser, Suzanne Kinsky, Ellen Beckjord, Rosanne DeGrazia, William Shrank
No abstract text is available yet for this article.
December 12, 2017: Population Health Management
https://www.readbyqxmd.com/read/29211661/evaluation-of-a-clinical-pharmacist-led-multidisciplinary-antidepressant-telemonitoring-service-in-the-primary-care-setting
#11
Shubha Bhat, Miranda E Kroehl, Katy E Trinkley, Zeta Chow, Lauren J Heath, Sarah J Billups, Danielle F Loeb
Guidelines recommend patient follow-up within 2 weeks of antidepressant initiation or uptitration to minimize treatment discontinuation and suicidal ideation risks; however, time constraints and lack of systematic processes remain barriers in primary care. A pharmacist-led multidisciplinary telemonitoring service aimed to address these barriers. This was a retrospective, observational study of adults with depression initiated or uptitrated on an antidepressant between May and October 2016. Outcomes included the proportion of eligible patients successfully contacted, adherence, adverse effects, suicidal ideations, and pharmacist interventions...
December 6, 2017: Population Health Management
https://www.readbyqxmd.com/read/29211632/an-employer-health-incentive-plan-for-advance-care-planning-and-goal-aligned-care
#12
Matthew J Gonzales, Jeff Dobro, Katy Guilfoile, Keegan Fisher, Ira Byock
One strategy to promote workforce well-being has been health incentive plans, in which a company's insured employees are offered compensation for completing a particular health-related activity. In 2015, Providence Health & Services adopted an Advance Care Planning (ACP) activity as a 2015-2016 health incentive option. More than 51,000 employees and their insured relatives chose the ACP incentive option. More than 80% rated the experience as helpful or very helpful. A high proportion (95%) of employees responded that they had someone they trusted who could make medical care decisions for them, yet only 23% had completed an advance directive, and even fewer (11%) had shared the document with their health care provider...
December 6, 2017: Population Health Management
https://www.readbyqxmd.com/read/29211631/how-to-measure-population-health-an-exploration-toward-an-integration-of-valid-and-reliable-instruments
#13
Roy J P Hendrikx, Marieke D Spreeuwenberg, Hanneke W Drewes, Dirk Ruwaard, Caroline A Baan
Population health management initiatives are introduced to transform health and community services by implementing interventions that combine various services and address the continuum of health and well-being of populations. Insight is required into a population's health to evaluate implementation of these initiatives. This study aims to determine the performance of commonly used instruments for measuring a population's experienced health and explores the assessed concepts of population health. Survey-based Short Form 12, version 2 (SF12, health status), Patient Activation Measure 13 (PAM13), and Kessler 10 (K10, psychological distress) data of 3120 respondents was used...
December 6, 2017: Population Health Management
https://www.readbyqxmd.com/read/29211623/quality-of-care-improves-for-patients-with-diabetes-in-medicare-shared-savings-accountable-care-organizations-organizational-characteristics-associated-with-performance
#14
Taressa K Fraze, Valerie A Lewis, Emily Tierney, Carrie H Colla
Accountable care organizations (ACOs), a primary care-centric delivery and payment model, aim to promote integrated population health, which may improve care for those with chronic conditions such as diabetes. Research has shown that, overall, the ACO model is effective at reducing costs, but there is substantial variation in how effective different types of ACOs are at impacting costs and improving care delivery. This study examines how ACO organizational characteristics - such as composition, staffing, care management, and experiences with health reform - were associated with quality of care delivered to patients with diabetes...
December 6, 2017: Population Health Management
https://www.readbyqxmd.com/read/29189107/the-psychology-behind-population-health-management
#15
Scott Guerin, Richard G Stefanacci
No abstract text is available yet for this article.
November 30, 2017: Population Health Management
https://www.readbyqxmd.com/read/29251548/rural-aging-in-america-proceedings-of-the-2017-connectivity-summit
#16
Alexis Skoufalos, Janice L Clarke, Dana Rose Ellis, Vicki L Shepard, Elizabeth Y Rula
Rural Aging in America: Proceedings of the 2017 Connectivity Summit Alexis Skoufalos, EdD, Janice L. Clarke, RN, BBA, Dana Rose Ellis, BA, Vicki L. Shepard, MSW, MPA, and Elizabeth Y. Rula, PhD Editorial: Creating a Movement to Transform Rural Aging David B. Nash, MD, MBA, with Donato J. Tramuto, and Joseph F. Coughlin, PhD   S-3 Introduction   S-4 Summit Proceedings   S-5 Roundtable 1: The Power of Community - Enabling Social Connections and Access to Health Resources Through Community-Based Programs   S-5 Roundtable 2: Technology and Rural Health: Innovative Solutions to Bridge the Distance, Improve Care, and Deliver Programs   S-7 Roundtable 3: An Integrated Experience: The Exponential Potential of a Collaborative Approach to Rural Aging   S-8 General Discussion and Recommendations   S-8 Post-Summit Debriefing   S-9 Strategy and objectives   S-9 6-12 month action plan   S-9 Conclusion   S-9...
December 2017: Population Health Management
https://www.readbyqxmd.com/read/28384076/ehealth-literacy-patient-engagement-in-identifying-strategies-to-encourage-use-of-patient-portals-among-older-adults
#17
Eboni G Price-Haywood, Jewel Harden-Barrios, Robin Ulep, Qingyang Luo
Innovations in chronic disease management are growing rapidly as advancements in technology broaden the scope of tools. Older adults are less likely to be willing or able to use patient portals or smartphone apps for health-related tasks. The authors conducted a cross-sectional survey of older adults (ages ≥50) with hypertension or diabetes to examine relationships between portal usage, interest in health-tracking tools, and eHealth literacy, and to solicit practical solutions to encourage technology adoption...
December 2017: Population Health Management
https://www.readbyqxmd.com/read/29161521/lessons-from-the-camden-coalition-of-healthcare-providers-first-medicaid-shared-savings-performance-evaluation
#18
Aaron Truchil, Natasha Dravid, Stephen Singer, Zachary Martinez, Teagan Kuruna, Scott Waulters
Accountable Care Organizations (ACOs) aim to reduce health care costs while improving patient outcomes. Camden Coalition of Healthcare Providers' (Camden Coalition) work already aligned with this aim before receiving state approval to operate a certified Medicaid ACO in New Jersey. Upon its formation, the Camden Coalition ACO partnered with UnitedHealthcare and, through state legislation, Rutgers Center for State Health Policy (CSHP) was established as its external evaluator. In evaluating the Camden Coalition ACO, Rutgers CSHP built on the Medicare Shared Savings model, but modified it based on the understanding that the Medicaid population differs from the Medicare population...
November 21, 2017: Population Health Management
https://www.readbyqxmd.com/read/29148921/a-predictive-model-for-readmissions-among-medicare-patients-in-a-california-hospital
#19
Ian Duncan, Nhan Huynh
Predictive models for hospital readmission rates are in high demand because of the Centers for Medicare & Medicaid Services (CMS) Hospital Readmission Reduction Program (HRRP). The LACE index is one of the most popular predictive tools among hospitals in the United States. The LACE index is a simple tool with 4 parameters: Length of stay, Acuity of admission, Comorbidity, and Emergency visits in the previous 6 months. The authors applied logistic regression to develop a predictive model for a medium-sized not-for-profit community hospital in California using patient-level data with more specific patient information (including 13 explanatory variables)...
November 17, 2017: Population Health Management
https://www.readbyqxmd.com/read/29140764/framework-for-a-population-based-surveillance-program-for-hepatocellular-cancer
#20
Manisha Verma
No abstract text is available yet for this article.
November 15, 2017: Population Health Management
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