From Laggard To Leader: Why Health Care In The United States Is Failing, And How To Fix It.

Health care in the United States is among the most technologically advanced in the world, but it is largely failing to meet the needs of the nation. The US can claim international excellence in important areas of care, such as cancer treatment, and it leads the world in biomedical innovation and building a well-prepared and dedicated clinical workforce. The Affordable Care Act was a major step forward in expanding access to health care in the US.

Tracing value from social determinant solutions.

We develop and illustrate a framework to trace value from social determinants of health (SDOH) interventions across 4 dimensions: health, cost and quality, engagement, and equity. To provide context, we begin by estimating the societal value lost to premature deaths from homelessness and food insecurity, using recent longitudinal methods that offer greater precision. We then apply the value tracing framework to 2 example interventions: permanent supportive housing for chronically homeless people and medically tailored meals for dual eligibles.

Insights From Implementation Of A Community-Based Model For Collaborative Public Good Investing.

Communities across the United States are looking for ways to reduce health inequities. Improving the social determinants of health (SDOH) is one fruitful pathway. In prior work we developed a financing model to incentivize and coordinate joint SDOH investments among local stakeholders, called the Collaborative Approach to Public Good Investments (CAPGI).

The EvidenceNOW Practice Support Initiative: The Heart of Virginia Healthcare.

Purpose: HHS' Million Hearts campaign focused the delivery system on ABCS clinical quality measures (appropriate Aspirin use, Blood pressure control, Cholesterol control, and Smoking cessation counseling). AHRQ's Evidence Now project funded 7 collaboratives to test different ways to improve performance and outcomes on ABCS within small primary care practices. The Heart of Virginia Health care (HVH) collaborative designed 1 of the approaches in Evidence Now.

Burnout among Primary Care Providers and Staff: Evaluating the Association with Practice Adaptive Reserve and Individual Behaviors.

Background: Workplace burnout among healthcare professionals is a critical public health concern. Few studies have examined organizational and individual factors associated with burnout across healthcare professional groups.

Objective: The purpose of this study was to examine the association between practice adaptive reserve (PAR) and individual behavioural response to change and burnout among healthcare professionals in primary care.

COVID-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center.

Dealing with the COVID-19 coronavirus requires a coordinated transnational effort. We propose a 2-stage state-led effort that utilizes community health workers (CHWs). We spell out what is beginning to occur in states to control and suppress COVID-19.

Indicators of Workplace Burnout Among Physicians, Advanced Practice Clinicians, and Staff in Small to Medium-Sized Primary Care Practices.

Background: The rising prevalence of burnout among physicians and other healthcare professionals has become a major concern in the United States. Identifying indicators of burnout could help reduce negative consequences such as turnover, loss of productivity, and adverse health behaviors. The goal of this study was to examine whether individual behaviors and attitudes towards major disruptive change has an effect on workplace burnout.

Care Experiences of Patients with Multiple Chronic Conditions in a Payer-Based Patient-Centered Medical Home.

Individuals with multiple chronic health conditions require additional support and medical services, incur higher health care costs, and often have a higher risk of hospitalization. The goal of this study was to examine care experiences of patients with multiple chronic conditions in the CareFirst patient-centered medical home (PCMH). The study used a repeated cross-sectional research design and included 1308 adult CareFirst plan members with multiple chronic conditions.

A Qualitative Analysis of Implementing EvidenceNOW to Improve Cardiovascular Care.

Purpose: The Heart of Virginia Health care (HVH) was a regional cooperative under the EvidenceNOW initiative to assist primary care practices in implementing evidence-based cardiovascular care and building capacity for quality improvement. The HVH implementation team included individuals from multiple universities, quality improvement organizations, and consulting firms. The goal of this study was to understand HVH team member viewpoints on the challenges, strengths, and lessons learned in each phase of the project.

Provider Experiences with a Payer-Based PCMH Program.

Background: The patient-centered medical home (PCMH) is an enhanced primary care model that aims to improve quality of care. Over the past several years, the PCMH model has been adopted by Medicare and private payers, which offer financial resources and technical assistance to participating practices. However, few studies have examined provider experiences and perspectives on the adoption of payer-based PCMH models in different practice settings.

Quality of Care and Preventive Screening Use in the CareFirst Patient-Centered Medical Home Program.

Despite their value, comprehensive diabetes care and screening for common cancers remain underutilized. We examined the association between participation in a patient-centered medical home (PCMH) program with strong financial incentives and receipt of preventive care in the first 5 years after program launch. Using multivariate regression analysis, we compared outcomes for adults under the care of participating primary care providers (PCPs) with adults under the care of nonparticipating PCPs.

Effect of Practice Ownership on Work Environment, Learning Culture, Psychological Safety, and Burnout.

Purpose: Physicians have joined larger groups and hospital systems in the face of multiple environmental challenges. We examine whether there are differences across practice ownership in self-reported work environment, a practice culture of learning, psychological safety, and burnout.

Methods: Using cross-sectional data from staff surveys of small and medium-size practices that participated in EvidenceNOW in Virginia, we tested for differences in work environment, culture of learning, psychological safety, and burnout by practice type.

Primary Care Practices' Abilities And Challenges In Using Electronic Health Record Data For Quality Improvement.

Federal value-based payment programs require primary care practices to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate. To determine whether EHRs produce reports adequate to the task, we examined survey responses from 1,492 practices across twelve states, supplemented with qualitative data. Meaningful-use participation, which requires the use of a federally certified EHR, was associated with the ability to generate reports-but the reports did not necessarily support quality improvement initiatives.

Medical Home Implementation in Small Primary Care Practices: Provider Perspectives.

Background: CareFirst BlueCross BlueShield of Maryland implemented a voluntary patient-centered medical home (PCMH) program in 2011 that did not require formal certification to participate. This study assessed attitudes and awareness of PCMH programs among participating providers in Maryland and Northern Virginia.

Methods: This qualitative study used information from 13 focus groups.

The CareFirst Patient-Centered Medical Home Program: Cost and Utilization Effects in Its First Three Years.

Background: Enhanced primary care models have diffused slowly and shown uneven results. Because their structural features are costly and challenging for small practices to implement, they offer modest rewards for improved performance, and improvement takes time.

Objective: To test whether a patient-centered medical home (PCMH) model that significantly rewarded cost savings and accommodated small primary care practices was associated with lower spending, fewer hospital admissions, and fewer emergency room visits.

Ebola crisis of 2014: are current strategies enough to meet the long-run challenges ahead?

The outbreak of the Ebola virus disease (EVD) in 2014 mobilized international efforts to contain a global health crisis. The emergence of the deadly virus in the United States and Europe among health care workers intensified fears of a worldwide epidemic. Market incentives for pharmaceutical firms to allocate their research and development resources toward Ebola treatments were weak because the limited number of EVD cases were previously confined to rural areas of West Africa.

Government intervention in health care markets is practical, necessary, and morally sound.

This essay makes the affirmative case for health reform by expounding on three fundamental points: (1) one moral case for expanding access to coverage and care to all is grounded in scriptural concepts of community and mutual obligation which continue to inform the American pursuit of justice; (2) the structure of PPACA springs from an appreciation of and approach to channeling market forces that was developed and proposed by a coalition of moderate and conservative Republican U.S. senators almost 20 years ago; (3) the most humane path to a better and more sustainable health system lies in implementing (and amending where appropriate) PPACA as fast and fully as we can.