Patient sharing arrangements are important to effective care coordination but it is not known how these relationships are related to the organizational boundaries of physicians’ practices. This paper examined the extent to which different types of organizational affiliations between physicians affect the number of patients they have in common. The work found that physicians at the same practice site and/or in the same medical group were significantly more likely to share patients, while simply being in the same insurance contracting network did not increase the probability of sharing patients. Findings provide insight into the role of organizational affiliations in the construction of patient care teams.
This analysis of diagnostic imaging claims in Massachusetts reveals negligible growth in use and a decline in spending for these services, mainly due to falling payments per claim for most imaging modalities. While per-resident use of MRIs, ultrasound and x-rays rose over the study period, there were very large reductions in the use of CT scans and nuclear medicine claims.
With support from a NIHCM Foundation Journalism Grant, the Center for Investigative Reporting will produce an investigative series on fraud in the worker’s compensation system.
The Center for Investigative Reporting uncovers that the number of opiates prescribed at the Tomah VA hospital in Wisconsin more than quintupled between 2004 and 2012, even as the number of veterans seeking care at the hospital declined.
A NIHCM Foundation Journalism Grant is supporting the public engagement campaign for the To Err is Human documentary to raise awareness of medical errors—now the third leading cause of death in the U.S.—and efforts to improve patient safety.
Reveal's Aaron Glantz reports on the widespread consequences of the overprescription of opiates to veterans being cared for at the Tomah VA in Wisconsin.
New Hampshire Public Radio's health and science reporter Jack Rodolico and Reveal's Laura Starechecski (formerly at NPR) team up to unveil 40 years of abuse and neglect of people with traumatic brain injuries and severe disabilities at specialty rehabs across the US.
This paper demonstrates how machine learning techniques can be applied to data from electronic health records to predict mortality for patients initiating chemotherapy. The model’s predictions performed better than mortality estimates derived from randomized trials of specific treatment regimens. The work holds promise for possible adoption in clinical settings as a tool that can improve shared decision making about chemotherapy initiation.
In this essay, Steven Lieberman reviews the ACO landscape in both the public and private sectors and examines the major obstacles confronting these emerging organizations.
This webinar explored what’s behind the disturbingly high U.S. maternal mortality rates, looking for solutions in California, a state that has become a national leader in efforts to reduce deaths and improve pregnancy outcomes.
This NIHCM-funded study used data from Virginia’s largest Medicaid managed care plan to evaluate the effects of integrated case management on health service use, cost, racial disparities, and goal setting and accomplishment. By examining various subgroups of enrollees and differential impacts according to the type of case management used, the work is providing insights into the effective design of case management interventions for the Medicaid population.
Catherine Sager and her production team have been awarded the 5th Annual Television and Radio Journalism Award for the documentary "Autism: Coming of Age." This documentary, produced by Veritech Corporation, sponsored by MassMutual and distributed by American Public Television, provides a look inside the lives of three adults with autism, offering insights on the challenges people with autism face as they transition into adulthood and age out of the public education system.
This brief highlights strategies for public and private collaboration around education and payment reforms to put an end to unnecessary and dangerous early deliveries.
The racial disparities in health service use among Medicaid beneficiaries with similar coverage have been well established. A study led by Gloria Bazzoli and colleagues and supported by a NIHCM research grant finds that integrated case management (ICM) reduces these racial disparities in the use of both primary care and emergency care. This one-page Research Insights reviews the key takeaways from the published Medical Care Research and Review article.
This webinar, hosted by USC Annenberg's Center for Health Journalism with support from NIHCM Foundation, gave an overview to end of life care, examined the issues around end-of-life care as well as insights for journalists on spurring more conversations about how we approach death in America.
The number of cancer survivors in the U.S. is projected to grow by 31 percent in just a decade, and while rapid scientific advances are increasing survival, they’re also adding cost and complexity to treatment decisions. This webinar explored new ways to deliver and pay for cancer care.
This NIHCM-sponsored research shows that in markets where the supply of orthopedists is more concentrated private payers pay higher prices for knee replacement surgery.
This fact sheet highlights how the BlueCross BlueShield of Tennessee Health Foundation has developed partnerships with innovative organizations that are making headway in improving maternal and infant health.
Marshall Allen and Alex Richards have been awarded the 17th Annual Health Care Print Journalism Award in the General Circulation category for their Las Vegas Sun series "Do No Harm: Hospital Care in Las Vegas." This investigation revealed the dangers patients in the Las Vegas-area have unknowingly encountered in delivery rooms, surgical suites and intensive care units, including thousands of cases of deadly infections, injury, and death associated with stays in Las Vegas hospitals.
With Medicaid expanding to cover more low-income adults, some Medicaid programs are experimenting with integrated case management (ICM) to help these patients address their specific medical, social and behavioral needs. A study led by Gloria Bazzoli and supported by a NIHCM research grant finds that ICM can decrease health service use by high-risk patients and lower spending for low-risk patients. This one-page Research Insights reviews the key takeaways from the published Medical Care article.
As part of the work to investigate ways to identify primary care patients who are at high risk, this analysis explored the predictive power of asking physicians whether they would be surprised if the patient died in the next 12 months. Though this question in isolation failed to identify the majority of patients who subsequently died in that time frame, physician predictions were more strongly associated with 1-year mortality than other known correlates such as patient age and comorbidities, suggesting that incorporating this physician judgement into more advanced predictive algorithms may be a fruitful direction for future research.
In this video, Dr. Aaron Carroll explains how abuse of prescription opioids can lead to addiction and explores the impact of opioid abuse and addiction on Americans and our health care system. This video is part of a Healthcare Triage series on opioids supported by a NIHCM Journalism grant.
With support from a NIHCM Foundation Journalism Grant, Healthcare Triage produced an online video series on the use of opioids in the U.S., including their legitimate use in medicine and their immediate and long-term health impacts.
In this video, Dr. Aaron Carroll reviews the treatment options available to those addicted or dependent on opioids. He also highlights the importance of efforts to prevent addiction, such as the Blue Cross Blue Shield of Massachusetts program to curb overprescription of opioids. This video is part of a Healthcare Triage series on opioids supported by a NIHCM Journalism grant.
In this video, Dr. Aaron Carroll explores the evolution of opioids to treat pain, tracing the history of a growing epidemic as opioid medications became more powerful leading to our current crisis of addiction and overdose deaths. This video is part of a Healthcare Triage series on opioids supported by a NIHCM Journalism grant.
In this video, Dr. Aaron Carroll explains the science behind how opioids relieve pain in the human body. This video is part of a Healthcare Triage series on opioids supported by a NIHCM Journalism grant.
This methodological paper investigates the strengths and weaknesses of data sources that might be used to study hospital ownership of physician practices. Focusing on the two most promising sources, from SK&A and the American Hospital Association, the authors document differences in estimates arising from each source and discuss likely reasons for the differences, concluding that a researcher's choice of data source and measure of integration will depend on the research question under study.
Dr. Laurence Baker and his colleagues, with support from NIHCM research grants, have produced a series of papers examining the relationship between provider market power and private prices in a variety of scenarios. This Research Insights highlights the key takeaways from four published papers.
This NIHCM-funded study is investigating how referral patterns are influenced both by the ownership structures of physician groups and hospitals and by limited-network insurance plans. Findings have the potential to inform regulatory policy on hospital and physician group mergers and on network adequacy.
This Research Insights summarizes findings from a study showing that a patient is more likely to choose a hospital that owns her doctor’s practice - even if the costs are higher and the quality lower than at other local hospitals.
The brief provides recommendations and tools for health care providers to identify and treat maternal depression and shares opportunities for health plans to promote a comprehensive approach to early identification and treatment of maternal depression.
An increasing number of Americans are living with serious and chronic illness—20% of Medicare beneficiaries now have five or more chronic conditions and two-thirds of Medicare spending goes to cover their care. Palliative care, which offers personalized, coordinated treatment for patients with serious illness, has been shown to reduce health care spending while improving quality of life.
This issue brief explores how oral health practices and utilization of dental care among pregnant women may affect a woman’s overall health, her birth outcome, and the oral health of her children.
In this essay, Dr. Meier argues that widening the reach of palliative care could increase value in the health care system.
This NIHCM-funded study will apply state-of-the-art machine learning techniques to electronic health record data to develop predictive models that: (1) identify patients at high risk of becoming high users, and (2) predict which patients are likely to achieve better health outcomes and/or lower health care utilization in response to high-risk care management (HRCM). Results will contribute to more effective and efficient HRCM programs, helping to provide better care at lower cost.
The current generation of children may be the first in U.S. history to live shorter, sicker lives than their parents. Already, more than half of Americans have at least one chronic disease. The majority of these conditions are preventable, but the scale of the problem necessitates interventions beyond the walls of the doctor’s office.
This brief highlights several of these efforts and outlines strategic opportunities for health plan foundations to have even greater impact in the future.
This NIHCM-sponsored research documents significantly higher private prices for a range of surgical and medical procedures and specialties in markets with higher concentration of physician practices.
Nearly half of all U.S. counties lack a practicing OB-GYN, and the shortage is expected to grow, with projections showing as many as 8,800 fewer OB-GYNs practicing than will be needed in 2020. This webinar explored what’s driving shortages and share promising solutions.
In this essay, John Iglehart surveys the landscape for nurse practitioners, noting the latest developments in the scope of practice debate and showing where the tide might be turning.
Nearly half of adults who died by suicide visited a primary care physician within a month before their deaths, according to an influential study. Primary care is on the front lines facing behavioral health crises like suicide and opioid abuse, yet studies show that primary care providers often lack the time and resources to treat mental health and substance use disorders. This webinar explored ways to bridge the gap between primary care and behavioral health care.
This fact sheet lays out barriers to HPV vaccination and highlights strategies health plans can use to improve uptake of the vaccines.
Living in poverty can have serious health consequences. Lower-income Americans are at higher risk of developing chronic diseases, and providers report challenges ensuring compliance with treatment guidelines when their patients have limited resources.
Less than one in five patients reports having seen information comparing prices and quality across health plans or providers, and the burden of health care spending continues to mount. This webinar highlighted strategies to guide consumers toward high-value health care.
With the epidemic of prescription painkiller abuse and related increase in heroin dependence, the health system is facing an alarming rise in neonatal abstinence syndrome (NAS). NAS afflicts newborns exposed to drugs, most commonly opioids, while in utero. These infants may experience withdrawal symptoms like vomiting, weight loss, hypersensitivity to light and sound, seizures, and potential long-term developmental effects.
A NIHCM Foundation Journalism grant supports the development of an interactive, multi-media project to educate the public on antimicrobial resistance, including the extent of the problem, the potential solutions and the need for policy to address the crisis.
In this essay, Michael Millenson identifies three distinct ways of thinking about patient-centered care—ethically, economically and clinically—noting that these perspectives both compliment and conflict with one another.
In this fact sheet, NIHCM Foundation highlights how health plans and health plan foundations support text4baby and suggests ways plans and foundations can partner with state and local governments and community organizations.
Most children’s health system experience is limited to the pediatrician’s office, but those with chronic or complex medical needs often deal with care that is fragmented, duplicative and crisis-driven. This leads to stress on families and wasteful utilization
This study continues earlier research also funded by NIHCM examining how physician practice consolidation affects care delivery, spending and quality for Medicare patients and PPO prices for the privately insured. Results are expected to inform policy discussions about provider consolidation and market power.
This NIHCM-funded study is exploring physician practice patterns for cancer services that tend to be overused in order to understand whether overuse is pervasive across the medical decisions of individual physicians or more limited to specific services. Results will inform efforts to reduce overuse.
Building on prior NIHCM-funded research documenting significant persistence in individual physicians’ use of inappropriate cancer services, this study will examine the overuse of non-recommended services for patients with advanced cancer, where patient preferences might be expected play a larger role than physician practice patterns. Results will inform efforts to reduce overuse of low-value services.
This podcast profiles Sharon Begley, senior science writer at STAT, the new life sciences publication of The Boston Globe. With a long career in journalism, including stints at Reuters, Newsweek, and The Wall Street Journal, she discusses why reporting on science is more difficult than ever for journalists and how she has reported on the cancer screening debate throughout her career.
In this podcast, Teri Roberts, a patient advocate and blogger, discusses questionable news coverage announcing a new migraine treatment, which turned out to be an approach that had never been studied in migraines.
This podcast covers the lack of evidence behind many news releases, using the example of a University of Maryland news release claiming that special chocolate milk helped football players with concussions. Schwitzer illustrates how news stories sometimes mirror press releases and can cause emotional harm to consumers by providing false hope for cures that aren't backed up with evidence.
Gary Schwitzer interviews Ajay Puri to discuss ShowMoreSpine, a social media campaign to address overdiagnosis of osteoporosis, with an eye on changing clinical guidelines.
In this podcast, Gary Schwitzer interviews Christie Aschwanden, the lead writer for science at FiveThirtyEight and a health columnist for The Washington Post. They discuss the gap between public messaging and data and the need for a push for more evidence-based health care reporting.
This webinar, co-hosted by NIHCM Foundation and the Association of Maternal and Child Health Programs with support from the Maternal and Child Health Bureau, explored ways to connect women to dental coverage and care during pregnancy, including the impact of the ACA on dental insurance options; strategies to integrate dental screenings and referrals into prenatal care; and efforts to educate pregnant women on dental care.
ProPublica analyzed government inspection reports and found that, between 2011 and 2014, at least 165 nursing home residents were hospitalized or died after errors involving Coumadin or its generic version, warfarin. Following the report, CMS called for more state health department scrutiny of nursing home errors involving the blood thinner.
This issue brief reviews the legal protections in place to ensure confidential care delivery for adolescents and young adults and the effect of privacy and confidentiality concerns on the use of health services.
With support from a NIHCM Foundation Journalism Grant, the Center for Investigative Reporting continues its public health and safety reporting, which combines data analysis, cutting-edge technology and storytelling to arm citizens with information on health care services in their communities.
This briefing in Washington, DC, featured forward-thinking leaders whose expertise spans the public and private sectors to share insights on how to foster innovation and build a brighter future for health care in America.
Cheryl Clark has been awarded the 21st Annual Trade Journalism Award for her report “Sepsis Success” in HealthLeaders. Her research explores the problem of sepsis—a potentially fatal, expensive and preventable illness—in U.S. hospitals, digging into practical solutions hospitals can use to improve rapid diagnosis and treatment.
This NIHCM-sponsored research showed that when physicians are in practices that are owned by a hospital, their patients are more likely to be admitted to that hospital than to other hospitals, even if its costs are higher and its quality is lower.
This Capitol Hill briefing brought together leaders who have served in Democratic and Republican Administrations, led and advised major health care companies, and spurred improvements in health policy for many decades. They shared their insights on the outlook for health policy post-election and their experiences spearheading the transformation of health care payment and delivery.
This health policy briefing on Capitol Hill brought together top health care leaders with diverse business and policy expertise.
In this essay, Dr. Peter Shin presents highlights from his study of how community health centers are faring post-ACA, including the challenges of operating in states that chose not to expand Medicaid coverage. Shin also notes that critical federal funding could be in jeopardy after 2017 unless Congress takes action.
This NIHCM-funded study is using data from the Massachusetts All Payer Claims Database to describe referral patterns across the state and to evaluate the impact of global payments on referrals and spending. Results are expected to inform the development of ACOs and other delivery/payment system innovations.
Concerns are mounting about the capacity of the primary care workforce to meet the demands of an influx of newly insured individuals in 2014 and the complex needs of an aging population. However, the changes in payment and delivery models that are gaining momentum across the country could provide natural opportunities to address critical workforce challenges.
Telemedicine is booming, fueled by promises of consumer convenience and better access for the underserved. Nearly half of employers will offer telehealth benefits this year. Yet the use of virtual visits continues to be limited by state licensure requirements, reimbursement issues, and concerns about quality and patient safety. How can health care embrace this transformative technology while also protecting patients?
This briefing brought top public- and private-sector health care leaders and policy experts to Capitol Hill to share their unique perspectives on efforts to drive value in health care.
This Washington, DC briefing on Capitol Hill featured experts from policy, business and academia sharing their insights on how to improve health outcomes for Americans while managing the cost of care.
Allison Lipitz-Snyderman and colleagues have shed new light on why cancer patients receive non-recommended care. Their study, supported by a NIHCM research grant, finds that use of low-value services is driven by physician preference, with little influence from the particular characteristics of a given patient.
This Research Insights summarizes findings from a new study showing that hospital market power drives higher negotiated prices for privately insured patients.