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Review: Telehealth Shows Mixed Results

A federal review of the use of telehealth services suggests that such services may be appear useful in helping to improve care and reduce costs under certain conditions but are less useful in others.

According to a draft currently under review by the Agency for Health Care Research and Quality,

  • Remote intensive care unit (ICU) consultations likely reduce ICU mortality and ICU length of stay (LOS); specialty telehealth consultations likely reduce the time patients spend in the emergency department; and remote consultations for outpatient care likely improve access and a range of clinical outcomes (moderate strength of evidence in favor of telehealth).
  • Findings with lower confidence are that telehealth consultations may: reduce inpatient LOS and costs; may improve outcomes and reduce costs for emergency care due to fewer transfers; and may reduce outpatient visits and costs due to travel (low strength of evidence in favor of telehealth).

On the other hand,

  • Current evidence reports no difference in overall hospital LOS with remote ICUs, no difference in clinical outcomes with inpatient telehealth specialty consultations, no difference in mortality but also no difference in harms with telestroke consultations; and no difference in satisfaction with outpatient telehealth consultations (low strength of evidence of

CMS Unveils Rural Health Strategy

The Centers for Medicare & Medicaid Services had introduced what it calls its “first rural health strategy.”

According to the agency, the purpose of the strategy is

…to provide a proactive approach on healthcare issues to ensure that the nearly one in five individuals who live in rural America have access to high quality, affordable healthcare.

“For the first time, CMS is organizing and focusing our efforts to apply a rural lens to the vision and work of the agency,” said CMS Administrator Seema Verma. “The Rural Health Strategy supports CMS’ goal of putting patients first. Through its implementation and our continued stakeholder engagement, this strategy will enhance the positive impacts CMS policies have on beneficiaries who live in rural areas.”

CMS explains that its strategy,

…built on input from rural providers and beneficiaries, focuses on five objectives to achieve the agency’s vision for rural health:

  • Apply a rural lens to CMS programs and policies
  • Improve access to care through provider engagement and support
  • Advance telehealth and telemedicine
  • Empower patients in rural communities to make decisions about their healthcare
  • Leverage partnerships to achieve the goals of the CMS Rural Health Strategy

Learn more about CMS’s rural health strategy by visiting …

Short-Term Plans May Short-Change Purchasers

The short-term health insurance plans that the administration proposes making more available to consumers as an alternative to comprehensive health insurance that meets Affordable Care Act coverage requirements may leave consumers with greater out-of-pocket costs and less coverage for some critical services.

According to a Kaiser Family Foundation review of available short-term, limited duration plans in 10 markets across the country, those plans:

  • often do not cover mental health and substance abuse services and outpatient prescription drugs
  • may turn down individuals or charge them higher premiums based on age, gender, or health status, including pre-existing conditions
  • require greater cost-sharing by their purchasers
  • do not cover maternity services at all

Such plans are not required to comply with the Affordable Care Act’s essential health benefits requirement.

For a closer look at short-term health insurance plans, how they operate, and what they do and do not cover, see the report “Understanding Short-Term Limited Duration Health Insurance, which can be found here, on the web site of the Kaiser Family Foundation.…

Eat! You’ll Feel Better

And maybe need to spend less on health care.

That is the lesson learned from a program in Massachusetts that provided home delivery of food to dually eligible Medicare/Medicaid recipients who were struggling with their meals.

In a limited experiment, selected individuals received home delivery of food:  some received general meal deliveries while others received food tailored to their individual medical conditions.  The purpose:  address a major social determinant of health in this difficult-to-serve population.

The result, according to a report published in the journal Health Affairs, was that

Participants in the medically tailored meal program also had fewer inpatient admissions and lower medical spending. Participation in the nontailored food program was not associated with fewer inpatient admissions but was associated with lower medical spending. These findings suggest the potential for meal delivery programs to reduce the use of costly health care and decrease spending for vulnerable patients.

Learn more about the program and its results in the Health Affairs article “Meal Delivery Programs Reduce the Use of Costly Health Care in Dually Eligible Medicare and Medicaid Beneficiaries,” which can be found here.…

Tackling Social Determinants of Health

The growing awareness of the impact of social determinants of health comes at a time when health care providers are assuming unprecedented degrees of risk for the health of their patients, leaving many providers wondering how best to invest resources that will meet both their own needs as well as the needs of their high-cost, high-need patients.

A new document from the Commonwealth Fund, “Investing in social services as a core strategy for healthcare organizations:  Developing the business case,” seeks to serve as a manual for providers seeking to move into this relatively new territory.

The report takes providers through key steps in the process, including establishing a common definition of social service investment; identifying common barriers to social service investments; and building the business case for such investments.  It also addresses six aspects of building that business case:

  • identifying potential social investment options
  • defining success
  • measuring costs
  • determining an investment model
  • developing a return on investment approach
  • sensitivity analysis and investment launch

Finally, it identifies the major social determinants of health providers might seek to address:

  • economic stability
  • neighborhood and physical environment
  • education
  • food
  • community and social context

For a closer look at the considerations that go into the …