Sue Ducat
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Camille Ahearn
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Health Affairs’ March Issue: Delivery System Innovation

Bethesda, MD - The March issue of Health Affairs explores various aspects of delivery system innovation as it relates to efficiency, improved quality, better patient engagement, and a more satisfied clinical workforce.

The issue was supported by Blue Shield of California Foundation, The Colorado Health Foundation, Missouri Foundation for Health, and New York State Health Foundation.

YMCA of the USA interventions reduce Medicare spending and utilization.
The YMCA of the USA’s prediabetes intervention program saved Medicare an average of $278 per member per quarter over the first three years. Maria Alva of RTI International and coauthors reviewed claims data to test whether the program—which helps participants lose weight and increase physical activity—would reduce medical spending and utilization in the Medicare population. They found that program participants had lower spending than a comparison group. Total decreases in inpatient admissions and emergency department (ED) visits were also significant, with nine fewer inpatient stays and nine fewer ED visits per 1,000 participants per quarter. Results on spending estimates from the first two years of this evaluation were cited in the Centers for Medicare and Medicaid Services’ policy determination that Diabetes Prevention Program services were eligible for coverage as additional preventive services under Medicare. The authors note that to address the growing incidence of diabetes in the US, large-scale diabetes prevention efforts need to be rigorously assessed.

Also of interest:

Convenient care may make access easier but doesn’t necessarily save money.
As direct-to-consumer telehealth grows, patients have more access to convenient care, in turn paving the way for increased utilization of care—care they might previously have forgone for lack of convenient options. Using three years of claims data, J. Scott Ashwood of the RAND Corporation and coauthors found that nearly 12 percent of telehealth visits for acute respiratory illness represented a substitution (replacing a visit to other providers or the emergency department), while 88 percent represented new utilization. Ultimately, the spending from new utilization outweighed savings from substitution. The authors note that because telehealth care’s convenience is leading to greater use of care and increased spending, new strategies—like increasing patient cost sharing and targeted patient outreach—may make it possible to use this popular service as a way to increase the value of care.

eConsult system can frequently resolve medical issues without a separate specialist visit.
Electronic systems for delivering specialty care remotely, also known as eConsult, could improve access to specialist care for underserved patients. Michael Barnett of the Harvard T. H. Chan School of Public Health and coauthors studied the implementation of an eConsult system in the Los Angeles County Department of Health Services (DHS), which shifted all specialty referrals to an electronic system for initial triage. The system grew rapidly from its start in 2012, with over 12,000 monthly requests by the end of 2015 and over 3,000 primary care physicians using the system (see the exhibit below). The median time to first response to a request was less than twenty-four hours, and 25 percent of requests were resolved without a specialist visit. Median time to appointment also decreased from 2014 to 2015, implying that eConsult decreased the backlog of patients waiting for appointments. The authors conclude that their findings should be encouraging to safety-net health systems interested in using eConsult systems to improve access to specialty care.

Large proportion of high-needs patients gives some practices a leg up.
High-needs patients—those with two or more physical, mental, or behavioral health conditions—have distinct care needs that may be better met in practices serving a higher proportion of these patients. Using data from Blue Cross Blue Shield of Michigan, Dori Cross of the University of Michigan and coauthors found that practices with moderate (2–10 percent of their patient panel) and substantial (more than 10 percent) proportions of high-needs patients performed better on a range of patient outcomes, relative to practices with a minimal proportion (less than 2 percent). For example, health care spending was nearly 12 percent lower in moderate and more than 40 percent lower in substantial practices. Patients in these practices were also less likely to have any ED visits or thirty-day hospital readmissions, commonly used markers of care quality. Based on these results, the authors encourage policy makers to consider experimenting with models that encourage a subset of practices to specialize in complex care to help achieve high-value care for high-needs patients.

Also of interest:

NOTE: Check out Health Affairs’ newest web hub: From Obamacare to Trumpcare. Key health policy questions are explored for the Affordable Care Act (ACA), Medicare, Medicaid, and payment reform.

About Health Affairs

Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print, online, and on mobile and iPad app. Additional and late-breaking content is found at To update your subscription preferences, please visit our Alerts page on the website.