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Diagnosis in 'Digital India' (Opinion)
Divvy Upadhyay, Additional Authors
Misdiagnosis is likely to be one of the bigger health-care safety challenges facing India and solutions are not simple or obvious. While resource-rich nations are still evaluating how to reduce misdiagnosis, the conversation needs to start in low and middle income countries in order to prepare doctors and the health-care policymakers of tomorrow. As we have learnt, even a single misdiagnosis — such as in the case of Ebola in Dallas — can have widespread public health consequences. The new Indian government preparing its new health policy agenda can recognize the role low-cost health IT innovations could play in improving diagnostic accuracy, including many that would be useful for rural India.
CHIPRA Mandated Evaluation of the Children's Health Insurance Program: Final Findings (Research Report)
Genevieve M. Kenney, Lisa Clemans-Cope, Ian Hill, Stacey McMorrow, Jennifer M. Haley, Timothy Waidmann, Sarah Benatar, Matthew Buettgens, Victoria Lynch, Nathaniel Anderson, Additional Authors
This report presents findings from an evaluation of CHIP mandated by CHIPRA and patterned after an earlier evaluation. Some of the evaluation findings are at the national level, while others focus on the 10 states selected for more intensive study: Alabama, California, Florida, Louisiana, Michigan, New York, Ohio, Texas, Utah, and Virginia. The evaluation included a large survey conducted in 2012 of CHIP enrollees and disenrollees in the 10 states, and Medicaid enrollees and disenrollees in three of these states. It also included case studies conducted in each of the 10 survey states in 2012 and a national telephone survey of CHIP administrators conducted in early 2013.
Ebola US Patient Zero: Lessons on Misdiagnosis and Effective Use Of Electronic Health Records (Article)
Divvy Upadhyay, Additional Authors
On September 30th, 2014, the US Centers for Disease Control and Prevention (CDC) confirmed the first travel-associated case of US Ebola in Dallas, TX. The events surrounding the care of this first case of Ebola in the US uncovered one of the biggest vulnerabilities of outpatient medicine – misdiagnosis. The case also illustrated how the use of electronic health records (EHRs) can become a potential barrier to making a correct or timely diagnosis. In this paper, we analyze the case, discuss several missed opportunities and outline key challenges facing diagnostic decision-making in EHR-enabled health care. Until recently, diagnostic errors have not received the respect and attention they deserve and have only now begun to find a possible place on the policy agenda.
Structuring Payment to Medical Homes After the Affordable Care Act (Article)
Robert A. Berenson, Additional Authors
The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. With the passage of the Affordable Care Act, the Accountable Care Organization (ACO) has emerged as a model of delivery system reform, and while there is theoretical alignment between the PCMH and ACOs, the discussion of physician payment within each model has remained distinct. Here we compare payment for medical homes with that for accountable care organizations, consider opportunities for integration, and discuss implications for policy makers and payers considering ACO models.
Development of a Model for the Valuation of Work Relative Value Units: Objective Service Time Task Status Report (Press Release)
Stephen Zuckerman, Robert A. Berenson, Additional Authors
This pilot project is part of the Centers for Medicare & Medicaid Services' efforts to address potentially misvalued services in the Medicare Physician Fee Schedule. It aims to develop a validation process for the fee schedule's relative value units for physician or nonphysician practitioner work. One of the project's key elements is the development of objective time estimates based on data from several physician practices, health systems, or other entities. This status report describes that task, including selection of services to be studied, identification and engagement of data collection sites, and development of data collection protocols and tools.
Strategies in 4 Safety-Net Hospitals to Adapt to the ACA (Research Brief)
Teresa A. Coughlin, Sharon K. Long, Rebecca Peters, Additional Authors
Safety-net hospitals have long played an essential role in the US health care system. The Affordable Care Act fundamentally changes the health care landscape and safety-net hospitals need to make major changes to compete. This report examines four safety-net hospitals to learn how they are preparing for health reform. While hospitals were employing strategies with different intensities, we found that the study hospitals had implemented an array of financial strategies focused on tapping Medicaid revenues. They also adopted delivery systems reforms, particularly ones related to developing community-based partners, and implemented changes in hospital leadership and management structure as well as efforts to better align physician incentives with hospitals and altering the culture of patient care to be more responsive to the shifting market.
Primary Care Access for New Patients on the Eve of Health Care Reform (Article)
Genevieve M. Kenney, Douglas A. Wissoker, Additional Authors
This study uses a simulated patient approach to assess appointment availability and wait times for new primary care appointments in late 2012/early 2013 by insurance status and state. Although most primary care physicians are accepting new patients, access varies widely across states and insurance status. Outreach programs are needed, not only to help patients enroll but also to identify practices accepting new patients within each plan's network. Tracking new patient appointment availability over time can inform policies designed to strengthen primary care capacity and enhance the effectiveness of the coverage expansions with the Patient Protection and Affordable Care Act.
New Evidence On The Affordable Care Act: Coverage Impacts Of Early Medicaid Expansions (Article)
Genevieve M. Kenney, Additional Authors
The Affordable Care Act expands Medicaid in 2014 to millions of low-income adults in states that choose to participate in the expansion. Since 2010 California, Connecticut, Minnesota, and Washington, D.C., have expanded coverage earlier to a portion of low-income childless adults. Using administrative records, the authors document that the ramp-up of enrollment was gradual over time in California, Connecticut, and D.C. Survey data on the two earliest expansions show strong evidence of increased Medicaid coverage in Connecticut and positive but weaker evidence of increased coverage in D.C. Medicaid enrollment rates were highest among people with health-related limitations. In Connecticut, evidence of some crowd-out of private coverage as well as a positive spillover effect on Medicaid enrollment among previously eligible parents was found.
Risk-Based Managed Care in Kentucky: A Second Year Implementation Report and Assessment of Beneficiary Perceptions (Research Report)
Ashley Palmer, Embry M. Howell, Genevieve M. Kenney, Additional Authors
This report summarizes findings from a qualitative assessment of implementation of Kentucky Medicaid managed care. It provides an update on the implementation issues identified in our year one report based on 18 stakeholder interviews and document review, and incorporates information obtained in ten focus groups across the state to provide insights about beneficiary experiences and their perceptions of changes to care. We find that many implementation issues identified in our year one report have stabilized over time. Focus group participants report few problems gaining access to health care services, though access to prescription drugs and behavioral health services remain areas of concern.
Nine States' Use of Collaboratives to Improve Children's Health Care Quality in Medicaid and CHIP (Article)
Kelly J. Devers, Additional Authors
We examine quality improvement (QI) collaboratives in 9 states participating in the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program. In addition to developing patient-centered medical home (PCMH) capability, some states use collaboratives to familiarize practices with CMS's Initial Core Set of Children's Health Care Quality Measures, practice-level quality measurement, and improving QI knowledge and skills. All states supplement the collaboratives with practice facilitation; the majority utilized practice-level parent engagement, but only 4 used workforce augmentation. Overall, practice staff highly valued aspects of the collaboratives and supplemental strategies but also reported a variety of challenges.