Care Transformation Center Blog
The insights, tools, and resources you need to take on population health management
by Darby Sullivan and Tomi Ogundimu June 14, 2018
Last week, Virginia became the 33rd state to expand Medicaid under the Affordable Care Act, covering an additional 400,000 low-income residents. Expansion didn't come easy: After five years of effort, lawmakers were only able to pass the bill with a work requirement provision, making Virginia one of five states—joining Arkansas, Indiana, Kentucky, and Michigan—to add controversial work requirements to the entitlement. Introducing these provisions can negatively impact around 1.7 million beneficiaries, including those currently working blue-collar jobs.
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by Clare Wirth, Tomi Ogundimu, Darby Sullivan June 12, 2018
One of the core strategies of driving ROI in risk-based contracts includes reducing unnecessary utilization by trading high-cost care for lower-cost services. For this shift to occur, patients must have access to a consistent source of care—but data show that many vulnerable populations do not. With 25% of low-income patients missing or rescheduling appointments, providers need to have a clear sense of the root cause of primary care underutilization. In our research, we found three reasons why inactivated patients may not make it to their appointments:
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by Rebecca Tyrrell and Colleen Keenan June 7, 2018
Although recent evidence suggests that opioid prescribing volumes are on the decline, experts agree that nationally we are still vastly overprescribing and suffering the consequences. Every day, nearly 115 Americans die from an opioid overdose.
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Rebecca Tyrrell June 5, 2018
For years, experts have cited poor care transitions as a major contributor to waste and less-than-optimal clinical outcomes. So while efforts to improve the post-discharge process and prevent readmissions aren't new, the urgency to improve is growing, given increased regulatory scrutiny, financial penalties, and enhanced data transparency and accountability measures.
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by Laurie Sprung and BJ Millar May 31, 2018
Across the past several years, health systems have invested in early-stage value-based care capabilities. Across the country, organizations have committed substantial time and resources to assemble and deploy value-based care assets, typically with the aim of gaining market share through risk contracts and improving outcomes through aligned incentives.
But many organizations have seen little material benefit to date. Market share gains have been underwhelming, and securing enough lives at risk to meaningfully change outcomes still seems like a distant goal for many.
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by Anjana Sreedhar and Gina Lohr May 29, 2018
A recent report calculated that specialty pharmaceuticals are a $180 billion national market with more than 10% annual growth. Many health systems are investing in their own specialty pharmacy capabilities to better coordinate patient care, manage drug costs, and generate revenue for the system. In fact, provider-owned specialty pharmacies are the fastest-growing category of accredited specialty pharmacy locations.
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by Tomi Ogundimu and Abby Burns May 24, 2018
It's no secret that financial hardship significantly impacts a patient's ability and willingness to seek treatment and to follow care regimens. As a result, lower income is tied to worse health outcomes and utilization patterns. For example, low-income patients are up to 44% more likely to experience 30-day hospital readmissions compared with higher-income individuals.
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by Tomi Ogundimu and Darby Sullivan May 22, 2018
"[Doctors] can give you advice, like, 'Here's the kind of medicine you need.' But they don't really know how it works in the real world." Summed in just two sentences, a patient from the University of Pennsylvania Health System succinctly encapsulates the disconnect between health care professionals and at-risk patients who have difficulty effectively self-managing their conditions. For patients dealing with a range of non-clinical barriers to health—from unemployment to food deserts—clinical care isn't enough to improve long-term health outcomes and care utilization.
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