At-home hemoglobin A1c testing during COVID-19 improved glycemic control.

Objectives: COVID-19 has exacerbated barriers to routine testing for chronic disease management. This study investigates whether a home hemoglobin A1c (HbA1c) test kit intervention increases frequency of HbA1c testing and leads to changes in HbA1c 6 months post testing and whether self-reinforcement education improves maintenance of HbA1c testing.

Study Design: Retrospective analysis of a randomized, controlled quality improvement intervention among members with type 2 diabetes (T2D) in a large commercial health plan.

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.

Optimizing vaccine distribution via mobile clinics: a case study on COVID-19 vaccine distribution to long-term care facilities.

Background: People living in clustered communities with health comorbidities are highly vulnerable to COVID-19 infection. Rapid vaccination of vulnerable populations is critical to reducing fatalities and mitigating strain on healthcare systems. We present a case study on COVID-19 vaccine distribution via mobile vans to residents/staff of 47,907 long-term care facilities (LTCFs) across the United States that relied on algorithms to optimize vaccine distribution.

Incidence and Estimated Vaccine Effectiveness Against Symptomatic SARS-CoV-2 Infection Among Persons Tested in US Retail Locations, May 1 to August 7, 2021.

This case-control study evaluates the estimated vaccine effectiveness against infection changes over time to help inform public health policy and clinical practices.

Association Between Cost-Saving Prescription Policy Changes and Adherence to Chronic Disease Medications: an Observational Study.

Background: Pharmacy benefit design is one tool for improving access and adherence to medications for the management of chronic disease.

Objective: We assessed the effects of pharmacy benefit design programs, including a change in pharmacy benefit manager (PBM), institution of a prescription out-of-pocket maximum, and a mandated switch to 90 days' medication supply, on adherence to chronic disease medications over time.

Design: We used a difference-in-differences design to assess changes in adherence to chronic disease medications after the transition to new prescription policies.

Health systems as venture capital investors in digital health: 2011-2019.

Provider health systems as venture capital investors in digital health are uniquely positioned in the industry. Little is known about the volume or characteristics of their investments and how these compare to other investors. From 2011 to 2019, we found that health systems made 184 investments in 105 companies.

Enhancing employer coverage of smoking cessation treatment: A randomized trial of the Partners in Helping You Quit (PiHQ) program.

The workplace is a key channel for delivering tobacco cessation treatment to a population. Employers can provide workplace-based programs and/or financial incentives such as health insurance benefits that cover the cost of treatment accessed outside the workplace. Little is known about the effect of combining these strategies.

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.

Development of an electronic health record-based chronic kidney disease registry to promote population health management.

Background: Electronic health record (EHR) based chronic kidney disease (CKD) registries are central to population health strategies to improve CKD care. In 2015, Partners Healthcare System (PHS), encompassing multiple academic and community hospitals and outpatient care facilities in Massachusetts, developed an EHR-based CKD registry to identify opportunities for quality improvement, defined as improvement on both process measures and outcomes measures associated with clinical care.

Methods: Patients are included in the registry based on the following criteria: 1) two estimated glomerular filtration rate (eGFR) results < 60 ml/min/1.

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).

The evolving role of subspecialties in population health management and new healthcare delivery models.

New healthcare delivery models, including accountable care organizations (ACOs) and patient-centered medical homes, emphasize a more robust role for primary care. However, it is less clear how the roles and responsibilities of subspecialists should change as we enter a new paradigm of alternative payment models. Health systems seeking to better manage population health and control costs will need a clearer understanding of how best to incorporate subspecialty practitioners: What is a subspecialist's role? How does it vary by subspecialty? How should they be compensated? We argue that subspecialist compensation in ACOs and other new care delivery models should recognize the range of ways in which specialists can provide value to patients across a population-which varies depending on the provider's role in a patient's care.

Ten Years, Forty Decision Aids, And Thousands Of Patient Uses: Shared Decision Making At Massachusetts General Hospital.

Shared decision making is a core component of population health strategies aimed at improving patient engagement. Massachusetts General Hospital's integration of shared decision making into practice has focused on the following three elements: developing a culture receptive to, and health care providers skilled in, shared decision making conversations; using patient decision aids to help inform and engage patients; and providing infrastructure and resources to support the implementation of shared decision making in practice. In the period 2005-15, more than 900 clinicians and other staff members were trained in shared decision making, and more than 28,000 orders for one of about forty patient decision aids were placed to support informed patient-centered decisions.

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.

HIV and obstetric complications and fetal outcomes in Vellore, India.

Antenatal prevalence is more than 1% in parts of India, yet little is known about the complications and fetal outcomes in this region. We reviewed the records of 23,386 women who delivered at the Christian Medical College Hospital in Vellore, India from 2000 through 2002. HIV-infected women were more likely than HIV-uninfected women to have pregnancy-induced hypertension, anaemia, breech presentations, stillborn babies and fetal deaths.

Adverse effects of highly active antiretroviral therapy in developing countries.

Recent increases in access to highly active antiretroviral therapy (HAART) have made the management of drug toxicities an increasingly crucial component of human immunodeficiency virus (HIV) care in developing countries. The spectrum of adverse effects related to HAART in developing countries may differ from that in developed countries because of the high prevalence of conditions such as anemia, malnutrition, and tuberculosis and frequent initial presentation with advanced HIV disease. The severity of adverse effects may vary as a result of host genetics and diagnostic delays attributable to inadequate laboratory monitoring.

The changing natural history of HIV disease: before and after the introduction of generic antiretroviral therapy in southern India.

The number of individuals seeking treatment for infection with human immunodeficiency virus increased as the cost of highly active antiretroviral therapy (HAART) decreased 20-fold after the introduction of generic HAART in India in the year 2000. The incidence of tuberculosis and opportunistic infections decreased to <2 cases per 100 person-years. Death rates decreased from 25 to 5 deaths per 100 person-years between 1997 and 2003.