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Care Delivery


Trained community or lay health workers (LHW) helped a rural hospital in Kentucky lowered its 30-day readmission rates among a high-risk population by almost 48 percent, according to a study published in Health Education Research.

Anthem has been criticized and even sued over policies in several states where it won’t pay for emergency room visits it later determines to be unnecessary. The insurer has now softened those restrictions, but American College of Emergency Physicians (ACEP) said the changes don’t go far enough.

Purdue Pharma, best known for making and selling OxyContin, announced Feb. 10 that it will stop marketing opioid drugs to physicians. The company also stated it will lay off half of its sales force, with the remaining staff of 200 focusing on other medications.

Medicaid patients face a host of challenges in accessing care, with reliable, timely transportation often being a major consideration. A recently published study, though, showed rates of missed primary care appointments were unaffected when Medicaid patients were offered free ridesharing services.

Some 11.8 million people signed up for coverage through the Affordable Care Act (ACA)’s insurance exchanges for 2018, down from 12.2 million the year before. Considering changes that were expected to depress enrollment—like HHS shortening the open enrollment period for and cutting its advertising budget by 90 percent—signups “remained generally stable,” according to a report from the National Academy for State Health Policy (NASHP).


Recent Headlines

AMA: Almost half of older physicians have been sued

In a trio of reports, the American Medical Association (AMA) attacked what it called a “broken” medical liability system, finding that getting sued isn’t uncommon for physicians and can cost tens of thousands of dollars even if a case is dismissed.

All-payer hospital program in Maryland saved money—but didn’t change utilization

In 2014, Maryland adopted an all-payer, global budget program for most of its hospitals, making a fixed payment to facilities for services provided in inpatient, outpatient and emergency departments. In its first two years, the concept contained costs, but didn’t appear to change utilization by patients.

Next Generation ACO grows to 58 participants in 2018

Seventeen more accountable care organizations (ACOs) have joined CMS’s Next Generation ACO model, the most advanced and high-risk available to ACOs in Medicare.

Nonprofit hospitals creating new generic drug company

Intermountain Healthcare, Ascension Health, SSM Health and Trinity Health announced they’ll create their own not-for-profit generic drug company, called Project RX, with the goal of increasing pharmaceutical competition and making “essential generic medications more available and more affordable.”

Longer lives for diabetics come with ‘high price tag’ for healthcare system

Older diabetic patients are living longer as they and their physicians get better at managing the condition, but with longer lifespans comes additional years of incurring higher healthcare expenditures than non-diabetics.

3.2 million more people were uninsured in 2017

The number of Americans without health insurance saw its biggest increase in nine years in 2017, rising 1.3 percentage points from the year prior, representing an estimated 3.2 million more people being uninsured.

$850K gene therapy for blindness is overpriced

According to an analysis from the Institute for Clinical and Economic Research, the price tag for a new medicine which treats a genetic form of childhood blindness should be at least 75 percent lower based on its cost effectiveness.

Tax-exempt hospitals haven’t greatly increased community benefit spending

Despite hopes the Affordable Care Act (ACA) would spur additional investments into community health initiatives by nonprofit hospitals, little changed between 2010 and 2014, with tax-exempt hospitals only increasing their average spending for all community benefits by 0.5 percentage points.

Women outpace men in med school enrollment for 1st time

Of the more than 21,000 newly enrolled students in medical schools in 2017, 50.7 percent were women—the first time the Association of American Medical Colleges (AAMC) has recorded a female majority in medical school enrollment.

AAFP’s alternative payment model gets thumbs up from advisory committee

Physician-Focused Payment Model Technical Advisory Committee (PTAC) will recommend a primary care-focused alternative payment model developed by the American Academy of Family Physicians (AAFP) be tested by HHS.