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GTMRx News Brief

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15Mar 22

News Brief | March 8, 2022 | The big honking problem: The cost of employer health plans

Practice Transformation Pharmacist-led patient care services + PGX = success, study finds A large implementation of a pharmacogenomics-enriched CMM program led to a reduction of roughly $7,000 per patient for participating Medicare Advantage enrollees. It also led to a positive shift in health care resource utilization away from acute care toward primary care. The program focused on participants in the Teachers’ Retirement System of the State of Kentucky. “The observed reduced costs, meaningful shifts in the patterns of patient healthcare…

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08Mar 22

News Brief | March 8, 2022 | The big honking problem: The cost of employer health plans

Practice Transformation RAND: Volume-based payments still dominate Most physicians employed in group practices owned by health systems are paid primarily based on the volume of care they provide, according to findings published in JAMA Health Forum. In these practices, volume-based compensation was the most common type of base pay for more than 80% of primary care physicians and for more than 90% of specialists. “The results of this cross-sectional study suggest that PCPs and specialists despite receiving value-based reimbursement incentives from…

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01Mar 22

News Brief | March 1, 2022 | A path forward? PBM as fiduciary

Practice Transformation A path forward? PBMs as a fiduciary PBMs could provide employers with the transparency they need into employee drug prices and help them save money. How? By agreeing to serve as a fiduciary, writes David A. McKay who spent 20 years representing self-funded plans in audits and litigation against PBMs. “By agreeing to serve as a fiduciary, a PBM can commit to putting the employer’s best interests ahead of the PBM’s profits when negotiating with pharmacies and drug manufacturers and…

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22Feb 22

News Brief | February 22, 2022 | AMA survey: Prior authorizations hurts patients, increases doctor’s burden

Practice Transformation Primary care a hot property for private equity Private investors, retailers and health insurers are pumping billions into primary care ventures, Bloomberg reports: “A medical profession once defined by solo offices and small partnerships is now dominated by corporate practices and hospital-owned clinics.” US companies focused on primary care raised about $16 billion from investors in 2021, according to an article in the New England Journal of Medicine’s Catalyst. That’s more than four times the amount invested in 2020. The article includes interviews…

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15Feb 22

News Brief | February 15, 2022 | Staffing shortage top hospital CEO challenge

Practice Transformation Electronic exchange closer to reality After several COVID-related delays, the ONC has set a Dec. 31 deadline for the health care industry to support apps that store records electronically, such as Apple Health. This is part of the 21st Century Cures Act, and it works both ways: Health IT developers will need standardized APIs and FHIR technology to support data exchange and interoperability, and providers will be expected to use APIs and FHIR technology. Patients won’t be required to use apps, but medical offices…

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08Feb 22

News Brief | February 8, 2022 | For VBP success, CMS must consider market dynamics

Practice Transformation Address depression to correct misinformation? People who experience depressive symptoms may be more receptive to misinformation related to COVID-19 vaccines, according to research published in JAMA Network Open. “This survey study found that individuals with moderate or greater depressive symptoms were more likely to endorse vaccine-related misinformation,” according to researchers. “[B]y addressing the extremely high levels of depression in this country during COVID, we might decrease people’s susceptibility to misinformation,” says lead author Roy H. Perlis, MD, MSc,…

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01Feb 22

News Brief | February 1, 2022 | Gene variant may protect against severe COVID-19

Practice Transformation Lessons from COVID: Curbing antibiotic overuse From April to December 2020, antibiotic prescriptions for children declined by 73% compared with the same months in 2019 for primary care practices in the Philadelphia region, according to research published in Pediatrics. Antibiotic prescriptions for respiratory tract infections (RTI) saw an even steeper decline. This suggest reducing viral RTI transmission through social distancing and masking corresponds with a reduction in antibiotic prescribing, according to the researchers. “Because many antibiotic prescriptions related to…

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25Jan 22

News Brief | January 25, 2022 | Lack of PCPs associated with wastefulness

Practice Transformation 360x wants to close the care coordination loop To enable care coordination, data exchange must be a closed loop, MedAllies’ Holly Miller, MD, MBA, FHIMSS, explains. That’s the goal of 360X, an ONC-backed to build data standards that enable coordinated and streamlined care between PCPs and specialists. The 360X referral process is a full circle, and the primary care staff will know immediately if the patient's been declined so they can find another specialist. Integrating the Healthcare Enterprise…

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18Jan 22

News Brief | January 18, 2022 | Inconsistent messaging hurts COVID effort

Practice Transformation RAND: Biosimilars could save $38.4B Biosimilar drugs could drive down prices for expensive medicines, saving an $38.4 billion, according to a new RAND Corporation study published in the American Journal of Managed Care. The number could be higher with higher biosimilar use. Most of the expected savings would come from downward pressure on the brand-name biologics they compete with, rather than lower biosimilar prices. The estimated savings are lower than two other recent assessments. The new analysis uses more recent…

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11Jan 22

News Brief | January 11, 2022 | Pharmacists play key collaborative role with MDs in PGx

Practice Transformation Sustained team-based approach reduces burnout A team-based approach to primary care reduces clinician burnout, according to research published in the Annals of Family Medicine. In 2016, Stanford Health Care’s primary care clinic in Santa Clara launched Primary Care 2.0, a team-based model. It has proven beneficial for patients and physicians —but only when the model is sustained. “The Primary Care 2.0 model of enhanced team-based primary care demonstrates team development is a plausible key to protect against burnout, but…

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21Dec 21

News Brief | December 21, 2021 | Report: Vaccines averted 1.1M COVID deaths

Practice Transformation ACP, YouTube join forces to battle disinformation The American College of Physicians is partnering with YouTube to create new educational content to help combat health misinformation about the COVID-19 virus, vaccination and treatments. The videos will focus on communication strategies for clinicians as well as providing proactive, trusted information in the clinicians’ voice. In addition, ACP is developing video content for the public to answer their questions about vaccines with trusted information from physicians. (ACP announcement) Sub generic…

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14Dec 21

News Brief | December 14, 2021 | Millenson: Enough with the secret analytics

Practice Transformation Millenson: Enough with the secret analytics Medicare Advantage plans secretly analyze members’ detailed information ranging from their credit scores and shopping habits to how they vote, writes Michael Millenson, president of Health Quality Advisors. “The use of what’s obliquely termed consumer data is increasingly common not only by health plans but also by health systems and others who have an economic interest in controlling costs.” It needs to stop: “Let me be clear: Secret analysis of information about…

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07Dec 21

News Brief | December 7, 2021 | Study calls for optimization, deprescribing

Practice Transformation More MA plans to take on SDOH  More Medicare Advantage plans will offer supplemental benefits that address social determinants of health such as meals, nutrition and transportation—at $0 premium, according to analysis by Avalere Health. For 2022, meal delivery was the most common benefit, with 68% of plans offering the benefit. The second most popular was transportation services with 39%, followed by nutrition at 30% and in-home support services with 11%. (Avalere analysis; Fierce Healthcare) More doctors spend time…

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30Nov 21

News Brief | November 30, 2021 | Telehealth may hinder identification of drug misuse

Practice Transformation Telehealth may hinder identification of drug misuse Most of physicians (67%) fear they missed signs of drug misuse during the pandemic, according to a new Health Trends report from Quest. Telehealth may be a culprit: 75% said telehealth visits limit the ability to determine if patients are at risk for or are already misusing prescription drugs. Moreover, 91% of physicians said they feel confident they can recognize the signs of prescription drug misuse during in-office interactions with patients, but only…

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23Nov 21

News Brief | November 23, 2021 | Forrester: Burnout, turnover will lead to medication errors in 2022

Practice Transformation Forrester: Burnout, turnover will lead to medication errors in 2022 In 2022, clinician turnover and burnout will contribute to “irreversible patient impacts” such as adverse drug reactions due to medication errors, increasing the risk of illness and mortality among patients, according to a report from Forrester research. Fierce Healthcare shared several other predictions from the report. Among them: Health disparities will disproportionately hurt rural Americans, and 60% of virtual visits will relate to mental health. (FierceHealthcare) Opinion: We must support…

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16Nov 21

News Brief | November 16, 2021 | Patient safety a casualty of COVID-19

Practice Transformation Doctors still the go-to source for all ages The generational divide may not be as wide as one would expect when it comes to health information, according to CMI Media Group’s Media Vitals annual report. Consumers of all ages put more trust in health websites than in the past. Branded websites saw the biggest trust gains across all age groups, especially among millennials. The doctor’s office, however, remains the go-to source for health information across all age groups. However, older…

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09Nov 21

News Brief | November 9, 2021 | Diagnostic errors costly, deadly and preventable

Practice Transformation Primary care access helped reduce risk of COVID infection, death Counties with greater primary care access, more robust public health and fewer social vulnerabilities had fewer COVID-19 infections and deaths, according to a report from the Primary Care Collaborative and Robert Graham Center. “As we emerge from the current pandemic and re-imagine and rebuild primary care, we also need to look at other factors, such as investment in public health and community-based services,” PCC President and CEO Ann…

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02Nov 21

News Brief | November 2, 2021 | National employer group launches PBM

Practice Transformation Nurses feel stressed, worthless, insolated and—surprise—undervalued More than half of nurses working in critical care said they were "not emotionally healthy," according to the latest COVID-19 survey on mental health and wellness conducted by the American Nurses Foundation. Three quarters of nurses across all roles said they felt "stressed," and 10% said they felt "worthless." Among nurses of all types, nearly half said they felt "undervalued," 20% reported increased alcohol consumption, 5% reported feeling isolated, 4% reported increased…

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26Oct 21

News Brief | October 26, 2021 | Talking to health insurers costs billions

Practice Transformation Mandatory virtual visits: Innovation or fragmentation? New, often lower-cost, plans capitalize on the convenience of telemedicine—and patients’ growing familiarity with it. In fact, some insurers now require initial telehealth visits for non-emergency primary care. But consumers should weigh costs and care options before enrolling in a “virtual-first” plan, warns Kaiser Health News. Most insurers doing this rely on contracted physicians, mental health therapists and other staff members. Moreover, some may permit an in-person visit only if their virtual doctor,…

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19Oct 21

News Brief | October 19, 2021 | Needed: A more comprehensive approach to medication management

Practice Transformation CMM lets pharmacists demonstrate value Opportunities abound for pharmacists to participate in comprehensive medication management to demonstrate their value and achieve savings and reimbursements for their practices, Pharmacy Practice News report. It then provides insights on how to implement and execute CMM. Among the advice: Track pharmacoeconomic data; for example, look at where less expensive medications were available and whether patients accepted the recommendation for the cheaper drug. Track disease metrics—e.g., whether a patient with diabetes reduced their A1c levels…

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