The best way to help physicians improve is to let other physicians show them the way, according to a study in the Joint Commission Journal on Quality and Safety. “Peer messengers… appropriately supported with ongoing training, high-quality data, and evidence of positive outcomes, are willing to intervene with colleagues over an extended period of time,” the study states. “The physician peer messenger process reduces patient complaints....”

Those patient complaints are the foundation of the study “An Intervention Model That Promotes Accountability: Peer Messengers and Patient/Family Complaints.”

Complaints were used in this study to identify underperforming doctors. At a time when patients face more choice and greater financial burden, the researchers say, “Patients and their families are well positioned to partner with health care organizations to help identify unsafe and dissatisfying behaviors and performance.”

The complaints fell into to six categories: communication, concern for the patient, care and treatment, access and availability, environment, and billing.

The study, conducted by researchers at Vanderbilt University Medical Center from 2005 to 2009, involved training 178 physician messengers on the best ways to discuss problems with 373 peers who were considered at high risk of dissatisfactory or unsafe performance.

The physicians worked for seven academic and nine other medical centers in the United States. About 25,000 were either employed or associated in some other manner with the institutions.

The messenger physicians received eight hours of training on how to conduct interventions, emphasizing that messengers “share data in a respectful, nonpunitive, nonjudgmental, and nondirective fashion.”

Most of the high-risk physicians (97%) accepted the feedback in a professional manner, and 64% were what the researchers called responders, that is, physicians who improved by at least 15%. The doctors whose scores worsened (17%) or remained unchanged were called “nonresponders.”

“Responders were more often physicians practicing in medicine and surgery than emergency medicine physicians, had longer organizational tenures, and engaged in lengthier first-time intervention meetings with messengers,” the study states. The overall mean and median percentage of reductions in patient complaints were 50% and 80% respectively. Not surprisingly, perhaps, one of the motivations for changing was fear of being sued.

Though highlighting the study’s success, the authors also note that the problem might in fact be much worse because “many persons fear lodging a complaint about their physician’s practice” and “unsolicited complaints surely represent the tip of an iceberg that may be 20 to 50 times the number of reports.”

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

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The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.