Intensive care management of a complex Medicaid population: a randomized evaluation.

Objectives: Care management programs are employed by providers and payers to support high-risk patients and affect cost and utilization, with varied implementation. This study sought to evaluate the impact of an intensive care management program on utilization and cost among those with highest cost (top 5%) and highest utilization in a Medicaid accountable care organization (ACO) population.

Study Design: Randomized controlled quality improvement trial of intensive care management, provided by a nonprofit care management vendor, for Medicaid ACO patients at 2 academic centers.

Putting the puzzle pieces together: Adapting a population health infrastructure to Medicaid risk.

As Accountable Care Organizations (ACOs) become more common within state Medicaid programs, health systems are increasingly facing the challenge of developing a population health approach for this population. This case report considers how health systems with a mature population health infrastructure evolve, adapt, and expand programs to take on Medicaid risk and better serve the Medicaid population. Four key implementation lessons were garnered from Partners HealthCare's experience that may be relevant for organizations undergoing similar transformations: 1) A significant portion of a health system's existing population health strategy can be applied to the Medicaid risk population; 2) Leveraging existing population health infrastructure can assist in adapting and adding programs; 3) Additional attention needs to be paid to behavioral health, substance use, and social determinants of health needs across existing and new programing; 4) Patients need to be engaged outside of the traditional primary care setting, including in the emergency department, and through home and community based care.

What Do High-Risk Patients Value? Perspectives on a Care Management Program.

Background: There is growing interest in coordinating care for high-risk patients through care management programs despite inconsistent results on cost reduction. Early evidence suggests patient-centered benefits, but we know little about how participants engage with the programs and what aspects they value.

Objective: To explore care management program participants' awareness and perceived utility of program offerings.

Bending The Spending Curve By Altering Care Delivery Patterns: The Role Of Care Management Within A Pioneer ACO.

Accountable care organizations (ACOs) appear to lower medical spending, but there is little information on how they do so. We examined the impact of patient participation in a Pioneer ACO and its care management program on rates of emergency department (ED) visits and hospitalizations and on Medicare spending. We used data for the period 2009-14, exploiting naturally staggered program entry to create concurrent controls to help isolate the program effects.

Substantial Physician Turnover And Beneficiary 'Churn' In A Large Medicare Pioneer ACO.

Alternative payment models, such as accountable care organizations (ACOs), attempt to stimulate improvements in care delivery by better alignment of payer and provider incentives. However, limited attention has been paid to the physicians who actually deliver the care. In a large Medicare Pioneer ACO, we found that the number of beneficiaries per physician was low (median of seventy beneficiaries per physician, or less than 5 percent of a typical panel).

Development and Implementation of a Collaborative Team Care Model for Effective Insulin Use in an Academic Medical Center Primary Care Network.

Improving glycemic control across a primary care diabetes population is challenging. This article describes the development, implementation, and outcomes of the Diabetes Care Collaborative Model (DCCM), a collaborative team care process focused on promoting effective insulin use targeting patients with hyperglycemia in a patient-centered medical home model. After a pilot, the DCCM was implemented in 18 primary care practices affiliated with an academic medical center.

Patient Population Loss At A Large Pioneer Accountable Care Organization And Implications For Refining The Program.

There is an ongoing move toward payment models that hold providers increasingly accountable for the care of their patients. The success of these new models depends in part on the stability of patient populations. We investigated the amount of population turnover in a large Medicare Pioneer accountable care organization (ACO) in the period 2012-14.

Impact of rapid screening for discontinuation of methicillin-resistant Staphylococcus aureus contact precautions.

Background: A history of methicillin-resistant Staphylococcus aureus (MRSA) is a determinant of inpatient bed assignment.

Methods: We assessed outcomes associated with rapid testing and discontinuation of MRSA contact precautions (CP) in a prospective cohort study of polymerase chain reaction (PCR)-based screening in the Emergency Department (ED) of Massachusetts General Hospital. Eligible patients had a history of MRSA and were assessed and enrolled if documented off antibiotics with activity against MRSA and screened for nasal colonization (subject visit).

Communicate, don't litigate: The Schwartz Center Connections Program.

Little is known about effective educational approaches intended to reduce malpractice risk by improving communication with patients and among multidisciplinary teams in outpatient settings in order to prevent diagnostic delays and errors. This article discusses a prospective, controlled educational intervention that aimed to open lines of communication among teams in two disciplines: identifying how and why communication lapses occur between disciplines and with patients, and articulating strategies to avert them.

A controlled trial of population management: diabetes mellitus: putting evidence into practice (DM-PEP).

Objective: Population-level strategies to organize and deliver care may improve diabetes management. We conducted a multiclinic controlled trial of population management in patients with type 2 diabetes.

Research Design And Methods: We created diabetic patient registries (n = 3,079) for four primary care clinics within a single academic health center.

Are research ethics standards satisfied in pediatric journal publications?

Background: The requirements for institutional review board (IRB) review and informed consent (IC) for research involving human subjects have existed for more than 2 decades. Although many studies document them poorly, most published research undergoes IRB review and has IC procedures. Less is known about research published in pediatric journals, and how child health research is determined to be exempt.