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Assessing Provider Partnerships For Accountable Care Organizations

ACOs need to provide comprehensive care management across a spectrum of provider specialties. To do this, they need a framework for evaluating potential partners that will help risk-bearing providers establish the partnerships that will enable them to achieve their goals.

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The CVS Effect on American Health Insurance

Once they have the right platforms in place, insurers can layer on predictive analytics, digital medical records, and other innovations that promise to make health care costs more manageable—and in the process make health insurers more competitive with the likes of CVS and maybe, eventually, Amazon.

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Is CAR-T Really Putting Us On Road to Gene Therapy?

Some say gene editing platforms like CRISPR are a truer version of gene therapy because they are designed to home in on a particular genomic location.

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Prior Authorization: Do Insurers Pay Bonuses for Denying New-Drug Requests?

A MedPage Today blog post suggests that they do. Industry veterans say they’re unaware of bonuses for denials but agree prior auth processes should be more transparent.

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Harvard Pilgrim’s Patrick Cahill Tries To Make Sense of It All

The 40-year-old has to guide one of the health insurer’s regional markets as the ACA continues to evolve. His course? Keep strengthening ties with providers.

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Purchasers to Insurers: Standardize Your ACO Measures

Building on a similar effort in California, Catalyst for Payment Reform is proposing a standardized set of 50 ACO measures. Some of the country’s largest purchasers are taking it to their health plans.

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Real-World Evidence Not Quite Believable Enough 

In theory, this approach could help untangle some knotty cost and quality concerns about medications as they move from clinical trials and into clinical use. But there’s that credibility issue.

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Management Partnerships (‘ACO Enablers’) Are Pervasive Part of ACOs

In theory, ACOs are groups of providers that band together to lower the cost of health while maintaining its quality by using various tools in the value-based care (aka population health) toolkit: care coordination, data analytics, avoidance of low-value services. But a study published in this month’s…
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A 12-step Program for American Health Care

Ezekiel J. Emanuel’s Prescription for the Future is true to its title and proposes a five- to 10-year agenda for transforming expensive, wasteful American health care into a system that delivers high-value care. This is a qualitative book based on case studies that identify and systematize how to improve quality, patient experience, and cost.

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Diabetes Costs Employers $20B in Unplanned Sick Days

That’s thanks to about 57 million unplanned sick days for workers. The prevalence of diabetes in the adult population grew from 10.6% in 2008 to 11.6% in 2016. It was at 11.5% for the first nine months of 2017.

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Interoperability of Electronic Health Records: A Physician-Driven Redesign

The document “Feature and Function Recommendations To Optimize Clinician Usability of Direct Interoperability To Enhance Patient Care” offers recommendations from the clinician point of view. Widespread adoption of even a few of these recommendations by designers and vendors would greatly enhance care.

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Health Care Resource Use and Costs Pre- and Post-Treatment Initiation With Linaclotide: Retrospective Analyses of a U.S. Insured Population

As expected, pharmacy costs increased with the introduction of this new treatment in a market dominated by over-the-counter and generic treatments. On the other hand, outpatient GI-related and irritable bowel disease health care resource use and costs substantially decreased among commercial and Medicare patients following linaclotide treatment initiation.

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Three Flavors of Oral Health Care

Training primary care physicians to identify and treat oral health problems will go a long way toward integrating care for those problems with general medical care, according to a study in the Journal of the American Board of Family Medicine.

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A Tall Order From a Cautionary Tale

Mistreated is a comprehensive and brilliant analysis of American health care by Robert Pearl, the CEO of the Kaiser Permanente Medical Group. The book’s subtitle aptly summarizes the author’s point of view: “Why We think We’re Getting Good Treatment–and Why We’re Usually Wrong.”

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Hospital Deaths From Opioids Soar

Morality rates for inpatient hospitalizations for opioid abuse quadrupled between 2000 and 2014, according to a study in Health Affairs. The mortality rates increased from 0.43% before 2000 to 2.02% in 2014. In 2016, 15,000 Americans died from heroin overdoses and 20,000 others died from overdoses from synthetic opioids.

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