Assessing a behavioral nudge on healthcare leaders' intentions to implement evidence-based practices.

Importance: Leaders of healthcare organizations play a key role in developing, prioritizing, and implementing plans to adopt new evidence-based practices. This study examined whether a letter with peer comparison data and social norms messaging impacted healthcare leaders' decision to access a website with resources to support evidence-based practice adoption.

Methods: Pragmatic, parallel-group, randomized controlled trial completed from December 2019 -June 2020.

"I would love to see these big institutions… throwing their weight around": qualitative findings regarding health and social sector collaborations to address community-level socioeconomic adversity.

Background: Health and social sector organizations are increasingly working together to mitigate socioeconomic adversity within their communities. We sought to learn about the motivations, experiences, and perspectives of organizations engaged in these collaborations.

Methods: We conducted semi-structured, 60-minute interviews with 34 leaders from 25 health and social sector organizations between January-April 2021.

Addressing Social Needs in Clinical Settings: Early Lessons from Accountable Health Communities.

The Centers for Medicare and Medicaid Services recently adopted quality metrics that require hospitals to screen for health-related social risks. The hope is that these requirements will encourage health care organizations to refer patients with social needs to community resources and, as possible, offer navigation services. This approach-screening, referrals, and navigation-is based, in part, on the Accountable Health Communities (AHC) model.

Essential not Supplemental: Medicare Advantage Members' Use of Non-Emergency Medical Transportation (NEMT).

Background: Over five million people in the USA miss or delay medical care because of a lack of transportation. Transportation barriers are especially relevant to Medicare Advantage (MA) health plan enrollees, who are more likely to live with multiple chronic conditions and experience mobility challenges. Non-Emergency Medical Transportation (NEMT) helps to address transportation gaps by providing rides to and from routine medical care (for example, medical appointments, laboratory tests, and pharmacy visits) and has been added as a supplemental benefit to some MA health plans.

"Because There's Experts That Do That": Lessons Learned by Health Care Organizations When Partnering with Community Organizations.

Background: Health care organizations' partnerships with community-based organizations (CBOs) are increasingly viewed as key to improving patients' social needs (e.g., food, housing, and economic insecurity).

Racial-Ethnic Composition of Primary Care Practices and Comprehensive Primary Care Plus Initiative Participation.

Background: It remains unclear whether the racial-ethnic composition or the socioeconomic profiles of eligible primary care practices better explain practice participation in the Centers for Medicare and Medicaid Services' (CMS) Comprehensive Primary Care Plus (CPC+) program.

Objective: To examine whether practices serving high proportions of Black or Latino Medicare fee-for-service (FFS) beneficiaries were less likely to participate in CPC+ in 2021 compared to practices serving lower proportions of these populations.

Design: 2019 IQVIA OneKey data on practice characteristics was linked with 2018 CMS claims data and 2021 CMS CPC+ participation data.

"Beyond Just a Supplement": Administrators' Visions for the Future of Virtual Primary Care Services.

Purpose: The COVID-19 pandemic resulted in unprecedented adoption and implementation of virtual primary care services, and little is known about whether and how virtual care services will be provided after the pandemic ends. We aim to identify how administrators at health care organizations perceive the future of virtual primary care services.

Methods: In March-April of 2021, we conducted semistructured qualitative phone interviews with administrators at 17 health care organizations that ranged from multi-state nonfederal delivery systems to single-site primary care practices.

"More than just giving them a piece of paper": Interviews with Primary Care on Social Needs Referrals to Community-Based Organizations.

Background: Primary care practices are responding to calls to incorporate patients' social risk factors, such as housing, food, and economic insecurity, into clinical care. Healthcare likely relies on the expertise and resources of community-based organizations to improve patients' social conditions, yet little is known about the referral process.

Objective: To characterize referrals to community-based organizations by primary care practices.

Configuration and Delivery of Primary Care in Rural and Urban Settings.

Background: There are concerns about the capacity of rural primary care due to potential workforce shortages and patients with disproportionately more clinical and socioeconomic risks. Little research examines the configuration and delivery of primary care along the spectrum of rurality.

Objective: Compare structure, capabilities, and payment reform participation of isolated, small town, micropolitan, and metropolitan physician practices, and the characteristics and utilization of their Medicare beneficiaries.

A Missed Opportunity? How Health Care Organizations Engage Primary Care Clinicians in Formal Social Care Efforts.

Health care organizations increasingly recognize the impact of social needs on health outcomes. As organizations develop and scale efforts to address social needs, little is known about the optimal role for clinicians in providing social care. In this study, the authors aimed to understand how health care organizations involve clinicians in formal social care efforts.

"It's Not Just the Right Thing . . . It's a Survival Tactic": Disentangling Leaders' Motivations and Worries on Social Care.

Health care organizations face growing pressure to improve their patients' social conditions, such as housing, food, and economic insecurity. Little is known about the motivations and concerns of health care organizations when implementing activities aimed at improving patients' social conditions. We used semi-structured interviews with 29 health care organizations to explore their motivations and tensions around social care.

Resource Brokering: Efforts to Assist Patients With Housing, Transportation, and Economic Needs in Primary Care Settings.

Purpose: Clinicians and policy makers are exploring the role of primary care in improving patients' social conditions, yet little research examines strategies used in clinical settings to assist patients with social needs.

Methods: Study used semistructured interviews with leaders and frontline staff at 29 diverse health care organizations with active programs used to address patients' social needs. Interviews focused on how organizations develop and implement case management-style programs to assist patients with social needs including staffing, assistance intensity, and use of referrals to community-based organizations (CBOs).

The Role of Value-Based Payment in Promoting Innovation to Address Social Risks: A Cross-Sectional Study of Social Risk Screening by US Physicians.

Unlabelled: Policy Points One of the most important possibilities of value-based payment is its potential to spur innovation in upstream prevention, such as attention to social needs that lead to poor health. Screening patients for social risks such as housing instability and food insecurity represents an early step physician practices can take to address social needs. At present, adoption of social risk screening by physician practices is linked with having high innovation capacity and focusing on low-income populations, but not exposure to value-based payment.

Translating Evidence into Practice: ACOs' Use of Care Plans for Patients with Complex Health Needs.

Background: Care plans are an evidence-based strategy, encouraged by the Centers for Medicare and Medicaid Services, and are used to manage the care of patients with complex health needs that have been shown to lead to lower hospital costs and improved patient outcomes. Providers participating in payment reform, such as accountable care organizations, may be more likely to adopt care plans to manage complex patients.

Objective: To understand how Medicare accountable care organizations (ACOs) use care plans to manage patients with complex clinical needs.

Role of Nurse Practitioners in Caring for Patients With Complex Health Needs.

Objective: The objective of this study was to estimate trends in the percentage of Medicare beneficiaries cared for by nurse practitioners from 2012 to 2017, to characterize beneficiaries cared for by nurse practitioners in 2017, and to examine how the percentage of beneficiaries cared for by nurse practitioners varies by practice characteristics.

Design: An observational study of 2012-2017 Medicare fee-for-service beneficiaries' ambulatory visits. We computed the percentage of beneficiaries with 1 or more ambulatory visits from nurse practitioners and the percentage of beneficiaries receiving the plurality of their ambulatory visits from a nurse practitioner versus a physician (ie, predominant provider).

Financial Integration's Impact On Care Delivery And Payment Reforms: A Survey Of Hospitals And Physician Practices.

Health systems continue to grow in size. Financial integration-the ownership of hospitals or physician practices-often has anticompetitive effects that contribute to the higher prices for health care seen in the US. To determine whether the potential harms of financial integration are counterbalanced by improvements in quality, we surveyed nationally representative samples of hospitals ( = 739) and physician practices ( = 2,189), stratified according to whether they were independent or were owned by complex systems, simple systems, or medical groups.

Association of Organizational Factors and Physician Practices' Participation in Alternative Payment Models.

Importance: Consolidation among physician practices and between hospitals and physician practices has accelerated in the past decade, resulting in higher prices in commercial markets. The resulting integration of health care across clinicians and participation in alternative payment models (APMs), which aim to improve quality while constraining spending, are cited as reasons for consolidation, but little is known about the association between integration and APM participation.

Objective: To examine the association of organizational characteristics, ownership, and integration with intensity of participation in APMs among physician practices.

The CMS State Innovation Models Initiative and Improved Health Information Technology and Care Management Capabilities of Physician Practices.

The Centers for Medicare and Medicaid Services' (CMS) State Innovation Models (SIMs) initiative funded 17 states to implement health care payment and delivery system reforms to improve health system performance. Whether SIM improved health information technology (HIT) and care management capabilities of physician practices, however, remains unclear. National surveys of physician practices ( = 2,722) from 2012 to 2013 and 2017 to 2018 were linked.

Prevalence of Screening for Food Insecurity, Housing Instability, Utility Needs, Transportation Needs, and Interpersonal Violence by US Physician Practices and Hospitals.

Importance: Social needs, including food, housing, utilities, transportation, and experience with interpersonal violence, are linked to health outcomes. Identifying patients with unmet social needs is a necessary first step to addressing these needs, yet little is known about the prevalence of screening.

Objective: To characterize screening for social needs by physician practices and hospitals.

'Eyes In The Home': ACOs Use Home Visits To Improve Care Management, Identify Needs, And Reduce Hospital Use.

Home visits are used for a variety of services and patient populations. We used national survey data from physician practices and accountable care organizations (ACOs), paired with qualitative interviews, to learn about home visiting programs. ACO practices were more likely to report using care transitions home visits than non-ACO practices were.

Comparison of Populations Served in Hospital Service Areas With and Without Comprehensive Primary Care Plus Medical Homes.

Importance: Little is known about the types of primary care practices that have chosen to participate in the Comprehensive Primary Care Plus (CPC+) program or about how participation could affect disparities.

Objective: To describe practices that joined the CPC+ model and compare hospital service areas with and without CPC+ practices.

Design, Setting, And Participants: This comparative cross-sectional study identified 2647 CPC+ practices in round 1 (from January 1, 2017; round 1 is ongoing through 2021).