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 has approved 360X specifications for specialty referrals and for ambulatory/acute transfers to skilled nursing facilities, EHR Intelligence reports. 360X specifications use the Direct Standard. (EHR Intelligence)
Lack of PCPs associated with wastefulness
Health systems with fewer primary care physicians were associated with performing more wasteful health care services, according to findings published in JAMA Health Forum. Overall, the cross-sectional study of 676 US health care systems found that those overusing health care had more beds, fewer primary care physicians, more physician practice groups, were more likely to be investor owned and were less likely to include a major teaching hospital. Integrated health care delivery systems were found to provide more high-value services. Organizations in highly competitive markets were associated with overusing low-value care. (JAMA Health Forum; Health Exec)
Blumenthal: Private sector can save primary care
“No modern health care system can function without the equivalent of what the family doctor provides. The United States has failed to offer it. Perhaps corporate America can come to the rescue, make a profit, maintain quality, and sustain a vital national service,” David Blumenthal, MD, president of the Commonwealth Fund, writes in the Harvard Business Review. He identifies three potential strategies: Use primary care as a loss leader for their main business; make fee-for-service primary care more profitable by increasing its productivity; apply a capitation model and assume the financial risk of the cost of care. (Harvard Business Review)
Evidence & Innovation
Genetics and unexplained child death
Mutations in genes associated with cardiac and seizure disorders appear to be linked to sudden unexplained deaths in young children and may explain nearly 9% of such cases, according to research published in Proceedings of the National Academy of Sciences. The findings suggest that such mutations pose “significant genetic risk factors for childhood sudden unexplained death and that their identification may lead to medical intervention that ultimately saves lives.” (Medscape)
Policy Solutions
CMS leaders outline vision for Medicare
“Medicare can contribute to the meaningful, sustainable changes necessary in our health system to put the person at the center of care, CMS leaders Chiquita Brooks-LaSure, Elizabeth Fowler and Meena Seshamani write in a post for Health Affairs Forefront. Their goals for Medicare mirror those for CMS: “Advance health equity; expand access to affordable coverage and care; drive high quality, person-centered care; and promote affordability and the sustainability of the Medicare trust funds.” The piece focuses on how they are “furthering these goals and available opportunities to better align and partner across the health care system.” (Health Affairs Forefront)
Lown’s Shkreli Awards recognize “innovative profiteers”
The Lown Institute announced its 2021 Shkreli Awards for “worst examples of profiteering and dysfunction in healthcare.” Many relate to drug pricing. Coming in at number nine: pharma companies use of “charitable giving” to increase sales of pricy drugs. Humana is suing Biogen and Teva for allegedly arranging copay assistance through charities to which they donated to boost sales of their pricey multiple sclerosis drugs. These drugs cost Medicare up to $80,000 per year, with copays as high as $6,500. Federal law prohibits drug companies from paying copays for Medicare patients, as this is considered a kickback. (Lown Institute)
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In Case You Missed It!
GTMRx sponsoring Health Care Value Week
January 24 – 28, 2022
Health Care Value Week will feature opportunities for interested stakeholders to participate in meaningful dialogue with health care executives and policymakers in the Administration and Congress through virtual events and social media.
GTMRx will host a panel on Value-based Strategies: A Better Way to Manage Medications with speakers Katherine H. Capps, GTMRx executive director, Steven Chen, PharmD, MHS, GTMRx distinguished fellow, associate dean for clinical affairs at USC School of Pharmacy, and Michael Hochman, MD, MPH, CEO of Healthcare in Action,
SCAN Group. This session will take place on January 24, 2021 from 3:00pm -3:30pm EST as part of Monday’s Special Edition of the Virtual Value-Based Payment Summit event.
More information and registration for Health Care Value Week can be found here.
You can register for the Virtual Value-Based Payments Summit: Update on CMS/CMMI Payment Reform Initiatives here.
GTMRx Workgroup Update | Employer Advisory Taskforce
On January 20, 2022 from 3:00-4:00pm EST, Matt Baki, Sr. Vice President, Strategic Accounts, Tria Health spoke to the GTMRx Employer Advisory Taskforce. Baki’s presentation focused on determining optimal patients for medication management services using claims and/or other clinically sourced data. In addition, he discussed integral components in sourcing medication management services and expected returns within an employers as health plan sponsor lens.
SEE THE EVIDENCE | The Outcomes of Implementing and Integrating Comprehensive Medication Management in Team-Based Care: A Review of the Evidence on Quality, Access and Costs
Learn about the peer-reviewed evidence showcasing the value of CMM, through improvements in access to care, provider work life, outcomes and patient satisfaction as well as a reduction in costs. These findings, updated in December 2021, outline the CMM team-based care process that can be implemented in a variety of health care systems to ensure positive patient outcomes.
SEE THE GUIDANCE | The Integration of Telehealth Delivery within a Comprehensive Medication Management Practice
Considering the advantages of telehealth and the future direction of health care, it is no longer a question of if telehealth needs to be implemented into practice; rather, it is a question of how to integrate telehealth and CMM services. Core to a plan is a patient care team that works together to achieve a goal of enhancing patient-centered care and medication optimization. Outlined are essential steps to integrating telehealth services and CMM practice: define what telehealth means for your practice, secure stakeholders, develop a team, equipment and software needs; assess costs and financial stability, educate staff, patients and caregivers, develop a workflow, measure health care outcomes and meet with your team regularly.
SEE THE GUIDANCE | Value Framework for Providing CMM in Telehealth
The escalation of telehealth has shed light on the opportunities that exist to increase patient access to care through virtual visits that extend beyond the traditional in-office visit. Included as an opportunity for telehealth is comprehensive medication management (CMM). This value framework, intended for health care team members, payers for health care services and health care policy makers, proposes a guide for providing CMM services via telehealth. Although obstacles to telehealth delivery of CMM exist, the benefits to providers, patients and payers outweigh the barriers. For sustainability of telehealth and CMM provided via telehealth, effort from multiple stakeholders is needed to address the challenges that exist.
Join us to be part of meaningful change
Irma, like many others, struggles as a result of our current trial-and-error approach to medication. That is why we advocate for a new, comprehensive approach to medication use and prescribing. As a non-profit 501(c)(3) and 501(c)(4) organization, the GTMRx Institute and Foundation relies on funding from our supporting members. We ask that you consider becoming a Supporting Signing Member so we can continue to provide relevant, timely resources to get the medications right!
If you’re interested in supporting the Institute or Foundation at a higher level, please contact us. Your dollars will bring about meaningful change for people like Irma.
AmazonSmile is an easy way for 0.5% of your qualified purchases go to the GTMRx Foundation at no cost to you. And signing up is simple—go to smile.amazon.com and select “Get the Medications Right Foundation” as your charity of choice. If you prefer to directly donate instead, you can do so here.
Adding the foundation on AmazonSmile will help us continue to provide no cost educational webinars, issue briefs, weekly news briefs and promote the need for transformation of our current system of medication use through social media campaigns.
