“Pennsylvania’s ‘Super-Utilizers’ of hospital care” – A Pennsylvania Health Care Cost Containment Council report
The Pennsylvania Health Care Containment Council (PHC4) Research Brief indicates that the “number of super-utilizers has dropped between 2012 and 2016.” The graphic above is from the Research Brief which is downloadable here.
“‘Super-utilizer’ has been used to describe patients who have repeated inpatient hospital stays or who make frequent trips to hospital emergency rooms – often across different hospitals or health systems. The result is a high health care costs that might have been prevented through early intervention and collaborative care.”
“A nurse conducts a foot exam on a diabetic patient in Oak Hill, W.Va.” – SOURCE: Robert Wood Johnson Foundation article: “Treating Super Utilizers in Rural Pennsylvania.”
“NO EXCUSES: HEALTHCARE” | The Skimm cracks “open the Skimm’tionary to give you some key healthcare terms to know.”
If you’re perplexed, ferhoodled, scratching your head or just plain confused by the verbiage of health care words and phrases, then the Skimm’tionary will be a terrific resource for you.
It’s produced by The Skimm, a terrific website that “that gives you everything you need to know to start your day. We break down what’s going on in the world with fresh editorial content. We’ll meet you in your inbox M-F, bright and early. The Daily Skimm leaves our hands–keyboard at 6am ET.”
Bruce Mead-e, 63, who has advanced lung cancer, stands in the garden at his home in Georgetown, Del. Over four years, he has undergone two major surgeries, multiple rounds of radiation and chemotherapy. (Eileen Blass for Kaiser Health News)
by Liz Szabo
“In the past four years, Bruce Mead-e has undergone two major surgeries, multiple rounds of radiation and chemotherapy to treat his lung cancer.
“Yet in all that time, doctors never told him or his husband whether the cancer was curable — or likely to take Mead-e’s life.
“‘We haven’t asked about cure or how much time I have,’ said Mead-e, 63, of Georgetown, Del., in a May interview. ‘We haven’t asked, and he hasn’t offered. I guess we have our heads in the sand.’
“At a time when expensive new cancer treatments are proliferating rapidly, patients such as Mead-e have more therapy choices than ever before. Yet patients like him are largely kept in the dark because their doctors either can’t or won’t communicate clearly. Many patients compound the problem by avoiding news they don’t want to hear.”
The Centers for Medicare & Medicaid Services (CMS) seeks public input on reducing the regulatory burdens of the Patient Protection and Affordable Care Act (ACA)
The Centers for Medicare & Medicaid Services (CMS) has issued a Request for Information (RFI) seeking recommendations and input from the public on how to create a more flexible, streamlined approach to the regulatory structure of the individual and small group markets. The goal is to identify and eliminate or change regulations that are outdated, unnecessary, or ineffective; impose costs that exceed benefits; or create inconsistencies that otherwise interfere with regulatory reform initiatives and policies.
The Department of Health and Human Services (HHS) is looking for feedback on regulations under the ACA to determine whether each rule advances or impedes priorities for stabilizing the individual and small group health insurance markets; empowers patients and promotes consumer choice; enhances affordability; and returns regulatory authority to the states. Regulations under review include Essential Health Benefits and Actuarial Value, among others.
Feedback can include providing input to improve rules, maintain rules, change rules, remove rules, and more. Some areas for specific requested feedback, include:
- Empowering patients and promoting consumer choice. What activities would best inform consumers and help them choose a plan that best meets their needs?
- Enhancing affordability. What steps can HHS take to enhance the affordability of coverage for individual consumers and small businesses?
- Protecting individual independence. How can HHS enhance the opportunities of older adults and people with disabilities to participate in their communities and access the supports they need?
Aging and disability community-based organizations and other groups may wish to provide feedback for these populations and their caregivers and/or family members.
The RFI will be open for public comment for 30 days.
by Elly YuEvan Nodvin, seen here in his Atlanta-area apartment, uses services that are covered by Medicaid. – Elly Yu/WABE
“Several decades ago, Evan Nodvin’s life probably would have looked quite different.
“Nodvin has his own apartment just outside Atlanta, in Sandy Springs, Ga., which he shares with a roommate, and a job at a local community fitness center. He also has Down syndrome.
“‘I give out towels, and put weights away, and make sure people are safe,’ the 38-year-old says.
“To get to and from work, Nodvin relies on rides from people who are hired to help him. He also has a counselor to help him do daily chores like grocery shopping, cleaning and cooking.
“‘My favorite thing to cook on Wednesdays — I like to cook turkey patties once a week,’ he says. ‘And on Thursdays I make fish, and other days, I make other good stuff like spaghetti.’”
“Not just for the poor: The crucial role of Medicaid in America’s health care system” – The Conversation
by Simon Haeder
“Nurse Jane Kern administers medicine to patient Lexi Gerkin in Brentwood, New Hampshire. Lexi is one of thousands of severely disabled or ill children covered by Medicaid, regardless of family income.” Charles Krupa/AP
“Despite many assertions to the contrary, Senate leaders are now saying they want to vote on the replacement bill for Obamacare before the month is out.
“Front and center is the planned transformation of America’s Medicaid program, which covers 20 percent of Americans and provides the backbone of America’s health care system.
“As a professor of public policy, I have written extensively about the American health care system and the Affordable Care Act.
“Living in West Virginia, perhaps the nation’s poorest state, I have also seen the benefits of the ACA’s Medicaid expansion since 2014.
“To understand how the ACHA’s proposed changes to Medicaid would affect people and our health care system, let’s look more closely at the program.”
Click here to read this Conversation article in its entirety.
“1 in 3 People in Medicare is Now in Medicare Advantage, With Enrollment Still Concentrated Among a Handful of Insurers” – Kaiser Family Foundation
“For the first time, 1 in every 3 people with Medicare is enrolled in Medicare Advantage, the private Medicare plans that have played an increasingly large role in the Medicare program over the past decade, according to a new analysis from the Kaiser Family Foundation.
“Medicare Advantage enrollment has more than tripled since 2004, reaching 19 million, or 33 percent of enrollees, in 2017, the analysis shows. That milestone is up from 17.6 million beneficiaries (31% ) in 2016, and 11.1 million beneficiaries (24%) in 2010, the year in which Congress reduced payments to Medicare Advantage plans as part of the Affordable Care Act. The Congressional Budget Office has projected that enrollment in Medicare Advantage will continue to rise, reaching 41 percent of all beneficiaries by 2026.
“Medicare Advantage enrollment continues to be highly concentrated among a handful of insurers, both nationally and in local markets, the new analysis shows. UnitedHealthcare and Humana together account for 41 percent of enrollment in 2017, for instance, and in 17 states one company has more than half of all Medicare Advantage enrollment – an indicator that these markets may not be very competitive. (Antitrust concerns – in Medicare Advantage and other insurance markets – scuttled recent proposed mergers between Humana and Aetna and Anthem and Cigna.)
“The new analysis, Medicare Advantage 2017 Spotlight: Enrollment Market Update, examines trends in this market, including premiums and cost sharing; enrollment and market penetration at the state- and large metropolitan county-level; Medicare Advantage enrollment by firm nationally; and market share of the top three Medicare Advantage firms by state.”
“Today, health systems operate on a spectrum of how involved patients are in the delivery of their care. On one end, traditional providers inform patients of their options, make a recommendation, and proceed to deliver care to a relatively passive patient. On the other, patients and their families are engaged in conversations with care teams, discussing goals and creating care plans together — with patients taking a more active role in the decision-making process. Over the past 20 years, health care as a whole has been moving toward the patient-centered care-end of the spectrum. What’s the next step? Care that is truly delivered by patients themselves. A few health systems are blazing this frontier. Judging from the early results, other provider organizations should seriously consider following suit.
“Patient-administered care occurs when providers … ”
Diane Archer, justcareusa.org, writes: “It’s hard enough to be in the hospital. Most of us can think only of getting out as quickly as possible. But, leaving the hospital can have its own set of risks if you’re not prepared. So, before you or someone you love leaves, here are seven things that you should do:”
Click on the graphic above to download the booklet, Discharge Planning.
“Discharging patients from the hospital is a complex process that is fraught with challenges, and involves over 35 million hospital discharges annually in the United States. Among Medicare patients, almost 20 percent who are discharged from a hospital are readmitted within 30 days, and the cost of unplanned readmissions is 15 to 20 billion dollars annually. Preventing avoidable readmissions has the potential to profoundly improve both the quality of life for patients and the financial wellbeing of health care systems.
“Researchers in the field of Transitions of Care evaluate the effectiveness of various approaches to improve the discharge process. One classification scheme to categorize these interventions is to consider them as: pre-discharge interventions (patient education, discharge planning, medication reconciliation, scheduling a follow-up appointment); post-discharge interventions (follow-up phone call, communication with ambulatory provider, home visits); and bridging interventions (transition coaches, patient-centered discharge instructions, clinician continuity between inpatient and outpatient settings).
“This topic presents an overview of the discharge process, determination of the appropriate next site of care, and review of interventions to reduce the likelihood of unplanned readmissions and adverse events after discharge. Much of the discussion relates to structures of care available in the United States; there is significant variability in the availability of services and types of facilities across geographic areas.”
Continue reading this article, click here to read “Hospital discharge and readmission” at UpToDate.com.