iLoveBenefits: Industry News Blog

Medicaid programs educating beneficiaries

A new AHIP Issue Brief provides background information about the Medicaid program and explains how health plans work with the states to deliver care for Medicaid beneficiaries.

Our issue brief provides an overview of the federal-state Medicaid partnership, who is covered by Medicaid and the benefits they receive, the role of Medicaid health plans, research findings on the value offered by Medicaid health plans, and the key issues health plans face under the Medicaid “mega reg” that CMS is expected to finalize at some point this spring.

The brief also highlights key areas where Medicaid health plans are demonstrating strong leadership:

  • By offering integrated health care delivery systems, Medicaid health plans promote access to coordinated, quality care and prevent overutilization of services that are both unnecessarily costly and potentially harmful for their enrollees, including dual eligibles.
  • By conducting outreach and health education efforts that encourage Medicaid beneficiaries to receive needed preventive care, Medicaid health plans help to reduce unnecessary hospital admissions.

By helping to manage chronic conditions through patient-centric disease management programs, Medicaid health plans are improving health outcomes while also reducing the costs of providing health care to beneficiaries with complex health care needs.

The health care business model is changing

According to a recent report, 18% of physicians have changed their business models to provide certain services. Within that group, those services include the following:

  • Virtual technology: 51%
  • One-stop shopping: 41%
  • Behaviorial health services: 24%
  • Pharmacist services: 19%
  • House calls: 17%
  • Group visits: 9%
  • Other: 11%

Source: “Kaiser Health Tracking Poll: February 2016,” The Henry J. Kaiser Family Foundation, February 25, 2016,

Communication With Health Providers

Among adults who reported having poor communication with their health providers in 2012, Hispanics had the highest percentage (11 percent) followed by blacks (10 percent) and whites (7 percent). (Source: Agency for Healthcare Research and Quality, 2014 National Healthcare Quality and Disparities Report, Chartbook for Hispanic Health Care.)

EHRs: My How Things Have Changed

According to a recent analysis:

  • 74.1% of office-based physicians had a certified electronic health record (EHR) system in 2014, up from 67.5% in 2013.
  • The percentage of physicians who had a certified EHR system ranged from 58.8% in Alaska to 88.6% in Minnesota.
  • 32.5% of office-based physicians with a certified EHR system were electronically sharing patient health information with external providers.
  • Among physicians with a certified EHR system, 14.0% shared patient health information electronically with behavioral health providers, 13.6% with long-term care providers, and 15.2% with home health providers.

Source: “Adoption of Certified Electronic Health Record Systems and Electronic Information Sharing in Physician Offices: United States, 2013 and 2014,” NCHS Data Brief No. 236, Centers for Disease Control and Prevention, January 2016,

Improving Patient Care Through Patient Reported Information

Further research is needed to establish best practices for integrating patient-reported information into practice through innovative health IT, according to AHRQ-funded research. Part of a journal issue that examined clinical decision support and the concept of usability, “Evidence into Action: Improving User Interface to Improve Patient Outcomes,” includes AHRQ-funded studies that highlight lessons learned by developing and testing health IT interfaces, such as websites, apps, and dashboards. The tools examined in this special issue were purposed to improve patient care. Select to access the special issue of eGEMS (Generating Evidence and Methods to Improve Patient Outcomes).


The Use of Telehealth Continues to Grow

According to a recent survey of family physicians, 15% use telehealth in their practices overall; 29% use telehealth in rural practices versus 11% in urban practices. Source: “A First Look at Attitudes Surrounding Telehealth,” The American Academy of Family Physicians (AAFP),ThinkAnthem and the Robert Graham Center; November 13, 2015,

IOM: Improving Diagnosis in Health Care

The 2015 report Improving Diagnosis in Health Care says that patients and their loved ones should be central members of the diagnostic team; they provide vital input that informs diagnosis and decisions about the path of care. Yet for a variety of reasons, patients may not be effectively engaged in the diagnostic process.Visit this page with resources to facilitate communication between patients and clinicians.

Health Care: People are not going to the places closest to their homes

According to a recent analysis of data from the 2009-2010 National Hospital Ambulatory Medical Care Survey:

  • The emergency departments (EDs) that patients visited were located an average of 6.8 miles from the patient’s home, although the nearest ED was an average of 3.9 miles from the home
  • 43.8% of all ED visits occurred at the ED closest to the patient’s home
  • Only 37.2% of ED visits within metropolitan areas took place at the closest ED, compared with 70.1% of visits outside of metropolitan areas
  • In metropolitan areas, the average wait time for being seen (by a physician, physician’s assistant, or nurse practitioner) at the ED closest to a patient’s home was 52.3 minutes, compared withan average wait time of 62.3 minutes for visits to EDs that were farther away

Source: “Emergency Department Visits and Proximity to Patients’ Residences, 2009–2010,” Centers for Disease Control and Prevention, NCHS Data Brief Number 192, March 2015,


AHRQ Report Features Hospitals’ Use of ‘Lean’ Process Redesign

A new AHRQ-funded report shows how hospitals used an organizational redesign approach known as “Lean” to enhance the quality and efficiency of various health care processes. The report, “Improving Care Delivery Through Lean: Implementation Case Studies,” includes six in-depth case studies that explain how Lean principles were applied in 13 distinct implementation projects. The implementation projects included improving patient flow during hospital care, electronic prescribing of medicines, reducing the cost of hip and knee replacement surgery and preventing urinary tract infection. For each case study, researchers assessed how Lean was implemented. They identified success factors and implementation challenges that affected achievement of outcomes, such as improvement in quality, efficiency, costs and employee satisfaction. Among the organizational factors shaping project success and the progress of the overall Lean initiative were executive and project leadership; the organization’s existing improvement structure; information technology support; project planning and scheduling. The practical information from this analysis can help other hospitals and health systems apply Lean principles to their own efforts.

Meaningful Use is Having an Impact on Health Care Practice

According to a recent study at 47 ambulatory practices in an integrated delivery system:

  • 28.4% of physicians, compared to 47.1% of advanced-practice providers and. 42.6% of nursing staff, have strong confidence in their department’s ability to solve Meaningful Use implementation problems
  • 57.9% of physicians, compared to 83.3% of advanced-practice providers and. 82.0% of nursing staff, report strong willingness to change their work practices for Meaningful Use

Source: “Stage 1 of the meaningful use incentive program for electronic health records: a study of readiness for change in ambulatory practice settings in one integrated delivery system,” BMC Medical Informatics & Decision Making, December 14, 2014,

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