A review of The Commonwealth Fund‘s top five reports of 2014 offers some important clues on how to address quality of care issues on a local regional and international level. A report that placed the US healthcare system dead last behind Canada and nine European countries emerged as the top publication on the Commonwealth Fund’s website this year. The surveys and reports touched on social needs, health insurance coverage and elements of successful care management programs for high need, high cost patients.
1. One of the things that earned the U.S. a low score in the Mirror Mirror report was the lack of a single payer system. The U.S. performed strongest in delivering preventive care and patient-centered care and wait time for specialists. The U.S. scored worst on criteria such as having a high infant mortality rate, based on stats from 2010, access to care, efficiency. One thing that most of these reports skip over is that the countries the U.S. compared with are inevitably smaller and much less diverse than the U.S.
2. A state scorecard comparison of health system performance placed Minnesota, Massachusetts, New Hampshire, Vermont, and Hawaii at the top but found widespread variations in care quality across the country. Most states had improved in areas such as immunizations for children, safe prescribing of medications for the elderly, patient-centered care in the hospital, avoidable hospital admissions and readmissions, and cancer-related deaths, according to the report. Affordability of care and coverage were the biggest source of concern. The report, which relied on data from 2011-2012 explained these trends could be the impact of the recession.
When Investment Rhymes with Canada
Canada has a proud history of achievement in the areas of science and technology, and the field of biomanufacturing and life sciences is no exception.
3. An assessment of health insurance coverage following the first open enrollment period found that 9.5 million fewer adults lacked insurance. The uninsured rate for people ages 19 to 64 fell from 20 percent in July-to-September 2013 to 15 percent from April-to-June 2014. The numbers were helped by states that expanded Medicaid. It also found that 60 percent of newly insured adults saw a doctor, went to a hospital or paid for a prescription.
4. Social needs were the focus of one report that looked at factors that contribute to things like asthma and diabetes such as access to healthy food and housing, income, education. The push to penalize hospitals for readmissions has led some hospitals to try a different approach. One group, Health Leads, works with hospitals to connect patients with local resources that can support some of their needs.
5. A look at ingredients for successful care management programs for high need and high cost patients assessed 18 programs such as Aetna’s Medicare Advantage Provider Collaboration, Geisinger Proven Patient Navigator and state programs. It showed how each of them defined a complex patient. It also highlighted areas where they had successfully lowered readmission, cost of care, quality of care and improved provider and patient experiences. It drew attention to common elements that have helped these programs work.
It emphasized the need to build a trusting relationship with patients and families along with primary care providers and staff. It noted that one way care managers approach this is direct communication or “warm handoffs” from their primary care physicians. Some care managers accompany patients to their primary care visits. A care plan that reflects the priorities and preferences of patients and their families, and takes into account things like behavioral health, social service needs, and barriers to care is also critical. Programs should also focus on ensuring safe care transitions with medication reconciliation and developing action plans when certain trigger events occur.
