In The News

AHRQ’s EvidenceNOW Initiative Estimates Heart Health Needs in Primary Care

AHRQ’s EvidenceNow, an initiative that supports smaller primary care practices’ efforts to improve heart health, has found that participating practices regularly provide evidence-based care while recognizing the potential to improve on one or more of the heart health clinical services known as the ABCS: Aspirin use for high-risk individuals, Blood pressure control, Cholesterol management, and Smoking cessation counseling. EvidenceNOW provides support services typically not available to smaller primary care practices to help them improve the care they deliver. Baseline data from more than 1,000 primary care practices participating in EvidenceNOW indicate that while an average of more than 50 percent of patients are receiving each of the ABCS services, many practices have not yet reached the EvidenceNOW goal of 70 percent.

Read more in a new AHRQ Views blog post by the Agency’s Chief Medical Officer David Meyers, M.D.

NIH consortium takes aim at vascular disease-linked cognitive impairment and dementia

02/22/2017 03:00 PM EST

MarkVCID brings team science approach to small vessel disease biomarkers in the brain.

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Health Policy and Clinical Practice in the New Era of Quality

Abstract

April 27th, 2016 executive notice by the US Department of Health and Human Services issued key provisions to the Medicare Access and Summary CHIP Reauthorization Act of 2015, (MACRA). MACRA replaced the 1997 Sustainable Growth Rate formula for determining Medicare reimbursement. MACRA provides a new approach in Medicare reimbursement based on value and quality care. MACRA legislation is guided by the Quality Payment Program, directing two paths for Medicare reimbursement: The Merit-based Incentive Payment System (MIPS), or the Advanced Alternative Payment Model (APM). Nurse Practitioners, require knowledge and information to prepare for MIPS and APM to begin January 1, 2017.

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February is American Heart Month

Heart disease is the leading cause of death for men and women in the United States. February is American Heart Month, a great time for health care providers to share the facts about heart health with their patients, especially those who may be at high risk of heart attacks.

AHRQ has fact sheets for primary care health professionals to help their high-risk patients adopt the ABCS of heart disease prevention: Aspirin use by high-risk individuals, control their Blood pressure, lower their Cholesterol, and quit Smoking.

To download these free materials go to: Aspirin Use, Control Blood Pressure, Lower Cholesterol, and Quit Smoking.

Native Americans Turning the Tide Against Diabetes

By: Judy Sarasohn, HHS (Public Affairs)

The tribal elder at Fort Berthold Reservation in western North Dakota had struggled with his diabetes for years. His blood glucose level was about twice what's considered normal, his blood pressure was dangerously high, and he was overweight.

His health care provider talked to him about the need to address his diabetes and he was included in the tribal clinic's diabetes registry, so they wouldn't lose track of him. But he just didn't take the steps necessary to manage his condition. Until one day, it apparently clicked.

Jared Eagle, Director of the Indian Health Service's Special Diabetes Program for Indians (SPDI) at the reservation in New Town, said the man finally started taking advantage of the resources and care provided through the clinic. He started walking more; lost 20 to 30 pounds; and reduced his blood glucose and blood pressure levels.

"You can see him walking every day. He's walking his dog every day, even in the winter," Eagle said.

The story of this elder of the Mandan, Hidatsa and Arikara Nation (also known as the Three Affiliated Tribes) reflects the significant progress being made in Indian Country where Native Americans have a greater chance of having diabetes and kidney failure resulting from diabetes than any other U.S. racial or ethnic group, according to the Centers for Disease Control and Prevention. Nonetheless, the CDC also reported recently that kidney failure among Native Americans dropped by 54 percent between 1996 and 2013, the fastest rate for any racial or ethnic group in the U.S.

READ MORE: Native Americans Turning the Tide Against Diabetes

Study finds premature death rates diverge in the United States by race and ethnicity

Premature death rates have declined in the United States among Hispanics, blacks, and Asian/Pacific Islanders (APIs) — in line with trends in Canada and the United Kingdom — but increased among whites and American Indian/Alaska Natives (AI/ANs), according to a comprehensive study of premature death rates for the entire U.S. population from 1999 to 2014. This divergence was reported by researchers at the National Cancer Institute (NCI), and colleagues at the National Institute on Drug Abuse (NIDA), both part of the National Institutes of Health, and the University of New Mexico College of Nursing. The findings appeared Jan. 25, 2017, in The Lancet.

Declining rates of premature death (i.e., deaths among 25- to 64-year-olds) among Hispanics, blacks, and APIs were due mainly to fewer deaths from cancer, heart disease, and HIV over the time period of the study. The decline reflects successes in public health efforts to reduce tobacco use and medical advances to improve diagnosis and treatment. Whites also experienced fewer premature deaths from cancer and, for most ages, fewer deaths from heart disease over the study period. Despite these substantial improvements, overall premature death rates still remained higher for black men and women than for whites.

In contrast, overall premature death rates for whites and AI/ANs were driven up by dramatic increases in deaths from accidents (primarily drug overdoses), as well as suicide and liver disease. Among 25- to 30-year-old whites and AI/ANs, the investigators observed increases in death rates as high as 2 percent to 5 percent per year, comparable to those increases observed at the height of the U.S. AIDS epidemic.

"The results of our study suggest that, in addition to continued efforts against cancer, heart disease, and HIV, there is an urgent need for aggressive actions targeting emerging causes of death, namely drug overdoses, suicide, and liver disease," said Meredith Shiels, Ph.D., M.H.S., Division of Cancer Epidemiology and Genetics (DCEG), NCI, lead author of the study.

"Death at any age is devastating for those left behind, but premature death is especially so, in particular for children and parents," emphasized Amy Berrington, D.Phil., also of DCEG and senior author of the study. "We focused on premature deaths because, as Sir Richard Doll, the eminent epidemiologist and my mentor, observed: 'Death in old age is inevitable, but death before old age is not.' Our study can be used to target prevention and surveillance efforts to help those groups in greatest need."

The study findings were based on death certificate data collected by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.

New Issue Brief Guides Advance Care Planning Conversations

In January 2016, the Centers for Medicare & Medicaid Services issued a final rule reimbursing physicians and other providers for discussing advanced care planning with patients and their families. However, studies show that nearly two-thirds of physicians feel inadequately trained to engage in end-of-life counseling. A new issue brief from National Quality Partners (NQP) helps healthcare providers better navigate these conversations through the lens of six key preferences of high-quality, person-centered advanced illness care.

NQP’s Advanced Illness Care Action Team—which includes more than 25 patient advocates, physicians, hospital systems, and other stakeholders from the public and private sectors—identified purpose and connection, physical comfort, emotional and psychological well-being, family and caregiver support, financial security, and peaceful death and dying as key preferences of individuals with advanced illness. By placing individuals at the center as the guiding North Star of all healthcare decisions, this initiative calls on the nation to transform advanced illness care and to engage patients, families, and caregivers as true partners in care planning.

Download the issue brief now to explore these key preferences in depth, along with snapshots of organizations that have embraced one or more of these preferences. Register for NQP’s March 15 webinar to delve into case studies demonstrating how physicians, nursing homes, and home health agencies can integrate these preferences into existing quality efforts.

CMS Finalizes New Medicare and Medicaid Home Health Care Rules and Beneficiary Protections

The Centers for Medicare & Medicaid Services (CMS) today finalized rules governing home health agencies that will improve the quality of health care services for Medicare and Medicaid patients and strengthen patients’ rights. These Medicare and Medicaid Conditions of Participation are the minimum health and safety standards a home health agency must meet in order to participate in the Medicare and Medicaid programs.

Home health care allows patients to receive needed health care services within the comfort and safety of their own homes. Patients receive coordinated services ranging from skilled nursing to physical therapy to medical social services, all under the direction of their physician. Currently, there are more than 5 million Medicare and Medicaid beneficiaries receiving home health care from nearly 12,600 Medicare and Medicaid-participating home health agencies nationwide.

“Our priority is to ensure that Medicare and Medicaid beneficiaries who receive health services at home get the highest level of patient-centered care from home health agencies,” said Kate Goodrich, MD, CMS Chief Medical Officer and Director of the Center for Clinical Standards and Quality for CMS. “Today’s announcement is the first update in many years to Medicare and Medicaid home health agency rules and reflects current best practices for in-home care, based on recommendations from stakeholders and medical evidence.”

These changes are an integral part of CMS’ overall effort to improve the quality of care furnished through the Medicare and Medicaid programs, while streamlining requirements for providers. The final rule includes:

  • A comprehensive patient rights condition of participation that clearly enumerates the rights of home health agency patients and the steps that must be taken to assure those rights.
  • An expanded comprehensive patient assessment requirement that focuses on all aspects of patient wellbeing.
  • A requirement that assures that patients and caregivers have written information about upcoming visits, medication instructions, treatments administered, instructions for care that the patient and caregivers perform, and the name and contact information of a home health agency clinical manager.
  • A requirement for an integrated communication system that ensures that patient needs are identified and addressed, care is coordinated among all disciplines, and that there is active communication between the home health agency and the patient’s physician(s).
  • A requirement for a data-driven, agency-wide quality assessment and performance improvement (QAPI) program that continually evaluates and improves agency care for all patients at all times.
  • A new infection prevention and control requirement that focuses on the use of standard infection control practices, and patient/caregiver education and teaching.
  • A streamlined skilled professional services requirement that focuses on appropriate patient care activities and supervision across all disciplines.
  • An expanded patient care coordination requirement that makes a licensed clinician responsible for all patient care services, such as coordinating referrals and assuring that plans of care meet each patient’s needs at all times.
  • Revisions to simplify the organizational structure of home health agencies while continuing to allow parent agencies and their branches.
  • New personnel qualifications for home health agency administrators and clinical managers.

The final rule can be viewed at the Federal Register website at: https://www.federalregister.gov/public-inspection/current

New Analysis: Uninsured rate for Americans with pre-existing conditions dropped sharply when major Affordable Care Act reforms were first implemented

Without ACA protections, more than half of non-elderly Americans could face discrimination in health care

Since the Affordable Care Act (ACA) became law, millions of Americans no longer face coverage denials, higher costs, or coverage carve outs because of their medical histories. A new analysis from the U.S. Department of Health and Human Services provides a first look at what happened to uninsured rates for Americans with pre-existing health conditions when the ACA's major insurance market reforms took effect in 2014. It finds that, between 2010 and 2014, the share of Americans with pre-existing conditions who went without health insurance all year fell by 22 percent, meaning 3.6 million fewer people with pre-existing conditions went uninsured.

While data for individuals with pre-existing conditions are available only through 2014, the uninsured rate for all Americans has fallen by an additional 22 percent through mid-2016, and Americans with pre-existing conditions have likely seen similar additional gains.

"Today, thanks to Affordable Care Act protections, the uninsured rate is at its lowest level in history and millions of Americans with pre-existing conditions like asthma or cancer no longer have to worry about being denied coverage because of their medical history," said HHS Secretary Sylvia M. Burwell. "This is clear and measurable progress, and we shouldn't turn the clock back to a time when people were denied coverage."

The new analysis estimates that 51 percent of non-elderly Americans, or 133 million people, have a pre-existing health condition under the definition insurers used for underwriting purposes before the ACA. Among the most common pre-existing conditions are: high blood pressure (46 million people); behavioral health disorders (45 million people); asthma or chronic lung disease (34 million people); heart conditions or heart disease (16 million people); diabetes (13 million people); and cancer (11 million people). Because the likelihood of having a pre-existing condition increases with age, the ACA's protections are especially important to middle-aged and older Americans. Up to 84 percent of Americans between age 55 and 64, and up to 75 percent of Americans between age 45 and 54 have a pre-existing condition that could have been the basis for insurer discrimination prior to 2014.

Today's analysis confirms that the ACA's insurance market reforms are having a major impact on coverage for Americans with pre-existing conditions. After passage of the Affordable Care Act, uninsured rates declined by almost 20 percent or more among non-elderly Americans with high blood pressure, behavioral health disorders, asthma or chronic lung disease, and osteoarthritis.

The analysis also sheds light on proposals that would restrict pre-existing condition protections to people who meet standards for continuous coverage, rather than protecting anyone who signs up during an annual open enrollment period. The analysis finds that tens of millions of people with pre-existing conditions go uninsured for at least short spells due to job changes, other life transitions, or periods of financial difficulty. In the two-year period beginning in 2013, almost one third of people (44 million) with pre-existing conditions went uninsured for at least one month.

The Affordable Care Act achieved dramatic improvements in coverage for people with pre-existing conditions through three fundamental reforms: first, requiring insurance companies to cover people with pre-existing conditions; second, providing financial assistance linked to premiums and income to help make coverage more affordable; and third, by requiring all Americans to get coverage if they can afford it. Prior to the Affordable Care Act, states that tried to protect people with pre-existing conditions without other measures such as financial assistance and an individual responsibility requirement saw premiums skyrocket as not enough healthy people entered the risk pool. Under the Affordable Care Act, the number of people in the individual market has grown, and most HealthCare.gov enrollees can select a plan for less than $75 per month in premiums.

To read today's report, visit: https://aspe.hhs.gov/pdf-report/health-insurance-coverage-americans-pre-existing-conditions-impact-affordable-care-act

Transforming Health Care Delivery through the CMS Innovation Center: Better Care, Healthier People, and Smarter Spending

We have made great progress in recent years on reforming our system into one that delivers better quality of care for patients and pays for care in a smarter way, including investing more in prevention and primary care.

Before 2010, there had been only modest efforts to improve care and reduce costs. Medicare – the country's largest health care insurance program – was largely paying for health services based on volume – where providers were paid for every service they ordered or performed – which didn't necessarily improve the health of beneficiaries or preserve the program for future generations. To improve our health care system, the largest payer of health care stepped up to partner with providers, doctors and other clinicians, states, private payers, consumers, and others to spur innovation. The market and people in communities across the nation have responded this initiative in extraordinary ways and delivered better care to patients.

This has been the mission of the Center for Medicare and Medicaid Innovation (CMS Innovation Center), to align incentives, partner with others to improve the health system, and implement best practices for coordinating patient care. Since opening its doors in late 2010, the CMS Innovation Center has worked tirelessly to enhance the quality of health care delivered while not increasing costs for Medicare, Medicaid, and Children's Health Insurance Program (CHIP) beneficiaries. The CMS Innovation Center takes locally-driven approaches – approaches from doctors and other health care partners providing care to patients every day – and gives them the platform to be tested through a collaborative process.

Today, based on the successful work of the CMS Innovation Center and countless public and private sector partners, we can now say that health care delivery system reform addressing both quality and cost has become part of the fabric of Medicare, Medicaid, and the health care sector nationwide. According to a new report to Congress prepared by the CMS Innovation Center:

  • Over 30 new payment models have been launched over the past six years.
  • Investments in electronic medical records and a data and analytics infrastructure are sparking a new set of innovative companies.
  • The CMS Innovation Center's portfolio of models has attracted participation from a broad array of health care providers, states, payers, and other partners. An estimated 18 million individuals, including CMS beneficiaries and individuals with private insurance included in multi-payer models, have been impacted by, have received care, or will soon be receiving care furnished by more than 207,000 health care providers participating in CMS Innovation Center payment and service delivery models and initiatives. These models are delivering care to people in every state across the nation.
  • Medicare exceeded – earlier than predicted – the goal to tie more than 30 percent of fee-for-service payments by the end of 2016 through alternative payment models to quality and cost metrics. Medicare is on pace to reach 50 percent by the end of 2018.

The Innovation Center has partnered with Medicare, Medicaid, and private health plans in the commercial market on new models of care and innovation. And, a number of exciting initiatives will be coming to more beneficiaries over the next few years:

  • The Medicare Diabetes Prevention Program expanded model, set to begin in 2018, will pay for services to prevent the onset of diabetes to all eligible Medicare beneficiaries, improving their health and that of the Medicare program both now and in the future. This is important because we estimate that Medicare spent $42 billion in 2016 on fee-for-service, non-dual eligible, over age 65 beneficiaries with diabetes.
  • Three new payment models—the Acute Myocardial Infarction Model, the Coronary Artery Bypass Graft Model, and the Cardiac Rehabilitation Incentive Payment Model—will support clinicians in providing care to patients who receive treatment for heart attacks, heart surgery to bypass blocked coronary arteries, or cardiac rehabilitation.
  • Through the Comprehensive Primary Care Plus Model, primary care doctors can care for their patients the way they think will deliver the best outcomes, and they'll get paid for achieving results and improving care.
  • One new payment model—the Surgical Hip and Femur Fracture Treatment Model—will support clinicians in providing care to patients who undergo surgery after a hip or femur fracture beyond hip replacement. In addition, we finalized updates to the Comprehensive Care for Joint Replacement Model, which began in April 2016.
  • The Accountable Health Communities Model, beginning in 2017, will test whether increased awareness of and access to services addressing health-related social needs will impact total health care costs and improve health and quality of care for Medicare and Medicaid beneficiaries in selected communities. This model will address a critical gap between clinical care and community services in the current delivery system.
  • Thirty-eight states and territories are engaged in the State Innovation Models initiative where they are testing their own best ideas to improve health, quality of care, and lower costs. Additionally, Vermont and Maryland have entered into global payment arrangements to improve care for the whole state's population.
  • And, already, investments in patient safety from the CMS Innovation Center, including through the Partnership for Patients, have contributed to an estimated 125,000 lives saved, over 3 million infections and adverse events avoided, and $28 billion in savings. We expect to see these numbers and savings continue to grow in the coming years.

These exciting approaches are the result of careful design, thorough and rigorous evaluation, and close collaboration with patients, doctors, and other stakeholders to achieve real, measurable, and significant results in improving health and lowering spending. CMS conducts an independent evaluation of every CMS Innovation Center model and releases those findings publicly. These reports provide stakeholders with information on the impact of the model as a whole on health care expenditures and utilization, beneficiary and health care provider experiences with care, and, where feasible, health outcomes. The reports also often provide site-specific results.

Using the CMS Innovation Center to advance better, smarter health care has become even more important over time. Since the passage of the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the CMS Innovation Center has been instrumental to its implementation. The Quality Payment Program, which implements provisions of MACRA, includes a five percent incentive payment for physicians and other clinicians sufficiently participating in Advanced Alternative Payment Models. The CMS Innovation Center is the mechanism to create new Advanced Alternative Payment Models in the future. In fact, the CMS Innovation Center has recently announced more than five new or re-opened opportunities for clinicians to join Advanced Alternative Payment Models. CMS expects 125,000 to 250,000 clinicians to be participating in Advanced Alternative Payment Models by 2018. The CMS Innovation Center looks forward to partnering with doctors, clinicians, patients, and others on new models.

The CMS Innovation Center continues to work on behalf of current and future Medicare, Medicaid, and CHIP beneficiaries. After more than six years, the health care system is objectively safer while making Medicare more financially secure for future generations. Such significant progress is possible because we have worked with Congress and stakeholders to listen, adapt, and advance proven ideas. Our work in developing and expanding new payment models will continue to be guided by the following core principles:

  • Supporting innovative payment and service delivery models with strong potential to improve health care quality and lower costs.
  • Engaging with and listening to consumers, providers, and other stakeholders allowing for open and transparent dialogue, including through the appropriate use of notice-and-comment rulemaking and ombudsmen.
  • Evaluating results based on appropriately scoped and sized demonstrations and advancing best practices based on their impact on quality and cost.

Together we can continue to strive to achieve better care, healthier people, and smarter spending.

To read more detail of the accomplishments of the CMS Innovation Center, read the most recent biennial report to Congress on the Innovation Center website: https://innovation.cms.gov/Files/reports/rtc-2016.pdf