Care Transformation Center Blog

The insights, tools, and resources you need to take on population health management

Medicaid work requirements are becoming law—here's how providers can help maximize coverage for at-risk populations

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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Get at the root cause of your primary care access problem. It may not be what you think.

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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5 steps to rein in unwarranted opioid prescribing

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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Don't miss these 5 opportunities to reduce readmissions

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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Think again about where to find value in your value-based care assets

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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Don't overthink your specialty pharmacy strategy. Get 2 keys to incremental success.

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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Patients are struggling to make ends meet. Here's how Boston Medical Center put $3M back in their patients' pockets.

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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Penn's IMPaCT program cracked the code of deploying community health workers—and you can, too

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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