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.

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.)

Lean Six Sigma is a key enabler for hospital value improvement

Study Examines Five Hospital Systems’ Implementation of Lean

Organizational contexts have a profound effect on the successful implementation of Lean strategies and tools and may affect other types of process redesign and quality improvement, according to an AHRQ-funded study. Adopted from Toyota Production Systems, Lean is a continuous quality improvement strategy for standardizing and streamlining work flow. “Effects of Organizational Context on Lean Implementation in Five Hospital Systems” appeared online December 23 in the journal Health Care Management Review. Researchers, including AHRQ’s Michael I. Harrison, Ph.D., identified several ways intra-organizational context shapes Lean implementation and outcomes. These include CEO commitment and support, prior organizational capacity for performance improvement, alignment of the Lean initiative with the organizational mission, dedication of resources and experts, training, appropriate project management and effective communication within and across teams. The findings underscore the importance of ensuring that the management system, information technology and other organizational conditions can support an improvement initiative.

More students enroll in medical school that ever before

The Association of American Medical Colleges released new data that find more students are enrolled in medical school than ever before.  “The number of students who enrolled in the nation’s medical schools for the first time in 2014 has reached a new high, totaling 20,343, according to data released today by the AAMC (Association of American Medical Colleges).  The total number of applicants to medical school also rose by 3.1 percent, to a record 49,480.  First-time applicants—an important indicator of interest in medicine—increased by 2.7 percent to 36,697.”

Why can any physician opt out of maintenance of certification requirements

ABIM weighs issues with MOC grandfatheringThe American Board of Internal Medicine says it is looking at problems with its Maintenance of Certification language and reporting with respect to grandfathered physicians who can opt out of MOC requirements. The American Board of Medical Specialties website does not list grandfathered doctors as meeting MOC requirements, something Dr. Mack Harrell, president of the American Association of Clinical Endocrinologists, calls “a scarlet letter.” Clinical Endocrinology News (8/22)

There is a lack of transparency in Graduate Medical Education (GME) funding

IOM says changes are needed in financing of graduate medical educationDespite increasing public investment in graduate medical education, the system of funding the program still lacks transparency and accountability, according to an Institute of Medicine report released Tuesday. The panel recommended the creation of a Graduate Medical Education Policy Council within HHS and a GME Center within the CMS to handle the distribution of funds. (7/29), The Oncology Report (7/29)

Caution should be used when using Wikipedia to answer questions regarding patient care

Wikipedia vs Peer-Reviewed Medical Literature for Information About the 10 Most Costly Medical Conditions doi: 10.7556/jaoa.2014.035 J Am Osteopath Assoc May 1, 2014 vol. 114 no. 5 368-373 Robert T. Hasty, DO, et. al.

Abstract Context: Since its launch in 2001, Wikipedia has become the most popular general reference site on the Internet and a popular source of health care information. To evaluate the accuracy of this resource, the authors compared Wikipedia articles on the most costly medical conditions with standard, evidence-based, peer-reviewed sources.

Methods: The top 10 most costly conditions in terms of public and private expenditure in the United States were identified, and a Wikipedia article corresponding to each topic was chosen. In a blinded process, 2 randomly assigned investigators independently reviewed each article and identified all assertions (ie, implication or statement of fact) made in it. The reviewer then conducted a literature search to determine whether each assertion was supported by evidence. The assertions found by each reviewer were compared and analyzed to determine whether assertions made by Wikipedia for these conditions were supported by peer-reviewed sources.

Results: For commonly identified assertions, there was statistically significant discordance between 9 of the 10 selected Wikipedia articles (coronary artery disease, lung cancer, major depressive disorder, osteoarthritis, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, back pain, and hyperlipidemia) and their corresponding peer-reviewed sources (P<.05) and for all assertions made by Wikipedia for these medical conditions

Conclusion: Most Wikipedia articles representing the 10 most costly medical conditions in the United States contain many errors when checked against standard peer-reviewed sources. Caution should be used when using Wikipedia to answer questions regarding patient care.


Then there is this

According to a recent survey of U.S. physicians:

  • 78% of doctors use search engines to support medical decision-making
  • 58% say they read case studies on the Web
  • 49% say they read research reports on the Web
  • 10% say they don’t use Web-based resources at all
  • 58% say the top challenge to the trend toward using Web tools and resources for healthcare is that patients often misinterpret what they read online
  • 51% say the top issue is that user-generated content can contain inaccuracies

Source: “Doctors Use the Web at Work, But Wary of What Patients Read Online,” MedData Group Press Release, May 5, 2014,

Experts call for medical education to promote patient-centered care

Changes in medical education and training are needed to promote patient-centered care, experts wrote in the Annals of Internal Medicine. According to the authors, programs should develop and implement a clear and concrete action plan incorporating such steps as including the patient’s perspective in clinical discussions and documentation; including the family and patient viewpoint in teaching rounds, ward rounds and conferences; and seeking real-time feedback from patients. News (4/24)

Improving physician people skills leads to better outcomes

Study links physician people-skills training to better outcomes
Data from 13 clinical trials linked physicians who get training to improve their people skills to better outcomes for patients trying to reduce their blood pressure, lose weight or manage pain, according to a report in PLOS One. Researchers from Massachusetts General Hospital called the effects “modest” but said the results were comparable to those from studies that tested low-dose aspirin or statin medications for heart-attack prevention. HealthDay News (4/10)

Health care: Maybe we don’t know what we think we know


Here is an excerpt from the story:

“If the past is a guide, many currently accepted medical practices will ultimately be overturned. The Mayo Clinic’s academic journal, Proceedings, recently examined articles in the New England Journal of Medicine between 2001 and 2010 on the effectiveness of a medical practice. Articles examining current practices were just as likely to recommend reversal of practices as they were to reaffirm the way things were done. In an accompanying editorial, John Ioannidis, a professor of health research and policy at Stanford University, concludes that “at a minimum, [these results pose] major questions about the validity and clinical utility of a sizable portion of everyday medical care.”

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