Partnering Urban Academic Medical Centers And Rural Primary Care Clinicians To Provide Complex Chronic Disease Care

Arora, Sanjeev; Kalishman, Summers; Dion, Denise; Som, Dara; Thornton, Karla; Bankhurst, Arthur D.; Boyle, Jeanne; Harkins, Michelle; Moseley, Kathleen; Murata, Glen H.; Komaramy, Miriam; Katzman, Joanna G.; Colleran, Kathleen; Deming, Paulina; Yutzy, Sean H.

doi:10.1377/hlthaff.2011.0278

Cited by 244 publications

(196 citation statements)

References 8 publications

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“…Some practices have implemented additional, practical policies, such as having a single prescriber, and no prescribing for COAT patients at night or on weekends. Risk/benefit of opioids for chronic noncancer pain Integration of guidelines into electronic health records, use of pharmacist comanagement, 35 regular use of state prescription drug monitoring programs, and more widespread use of specialty consultation via video linkage to academic medical centers 36 are currently expanding areas of innovation. In addition, payers need to offer adequate payment incentives for treatment alternatives to the opioid prescription for acute, subacute, and chronic pain.…”

Section: When and How Should Prescribers Usementioning

confidence: 99%

Opioids for chronic noncancer pain

2014

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The Patient Safety Subcommittee requested a review of the science and policy issues regarding the rapidly emerging public health epidemic of prescription opioid-related morbidity and mortality in the United States. Over 100,000 persons have died, directly or indirectly, from prescribed opioids in the United States since policies changed in the late 1990s. In the highest-risk group (age 35-54 years), these deaths have exceeded mortality from both firearms and motor vehicle accidents. Whereas there is evidence for significant short-term pain relief, there is no substantial evidence for maintenance of pain relief or improved function over long periods of time without incurring serious risk of overdose, dependence, or addiction. The objectives of the article are to review the following: (1) the key initiating causes of the epidemic; (2) the evidence for safety and effectiveness of opioids for chronic pain; (3) federal and state policy responses; and (4) recommendations for neurologists in practice to increase use of best practices/universal precautions most likely to improve effective and safe use of opioids and to reduce the likelihood of severe adverse and overdose events.

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Section: When and How Should Prescribers Usementioning

confidence: 99%

Opioids for chronic noncancer pain

2014

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“…Project ECHO, based at the University of New Mexico, has used teleconferencing to successfully manage hepatitis and other complex chronic conditions within IHS facilities. 41 Brigham and Women's Hospital, in Boston, Massachusetts, has established a partnership with the IHS to deliver specialty care. This delivery model helps create a foundational relationship between the academic specialists and IHS clinicians.…”

Section: Innovation Within the Indian Health Servicementioning

confidence: 99%

Indian Health Service Innovations Have Helped Reduce Health Disparities Affecting American Indian And Alaska Native People

Sequist

Cullen²,

Acton³

2011

Health Affairs

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The Indian Health Service (IHS), a federal health system, cares for 2 million of the country's 5.2 million American Indian and Alaska Native people. This system has increasingly focused on innovative uses of health information technology and telemedicine, as well as comprehensive, locally tailored prevention and disease management programs, to promote health equity in a population facing multiple health disparities. Important recent achievements include a reduction in the life-expectancy gap between American Indian and Alaska Native people and whites (from eight years to five years) and improved measures of diabetes control (including 20 percent and 10 percent reductions in the levels of low-density lipoprotein cholesterol and hemoglobin A1c, respectively). However, disparities persist between American Indian and Alaska Native people and the overall US population. Continued innovation and increased funding are required to further improve health and achieve equity.

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“…[39][40][41] Few new payment mechanisms provide incentives for more efficient use of evaluation and management services delivered by primary care physicians and specialists. Several initiatives support primary care physicians for non-reimbursable services, including patientcentered medical home initiatives and the recently implemented chronic care management fees, but they offer little incentive for reducing unnecessary primary care visits and offer no incentive for specialists to reduce visits or provide nonreimbursable care.…”

Section: Discussionmentioning

confidence: 99%

Variation in Specialty Outpatient Care Patterns in the Medicare Population

2016

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BACKGROUND: Multiple payment reform efforts are under way to improve the value of care delivered to Medicare beneficiaries, yet few directly address the interface between primary and specialty care. OBJECTIVE: To describe regional variation in outpatient visits for individual specialties and the association between specialty physician-specific payments and patient-reported satisfaction with care and health status. DESIGN: Retrospective cross-sectional study. PATIENTS: A 20 % random sample of Medicare fee-forservice beneficiaries in 2012. MAIN MEASURES: Regions were grouped into quartiles of specialist index, defined as the observed/expected regional likelihood of having an outpatient visit to a specialist, for ten common specialties, adjusting for age, sex, and race. Outcomes were per capita specialty-specific physician payments and Medicare Current Beneficiary Survey responses. KEY RESULTS: The proportion of beneficiaries seeing a specialist varied the most for endocrinology and gastroenterology (3.7-and 3.9-fold difference between the highest and lowest quartiles, respectively) and least for orthopedics and urology (1.5-and 1.7-fold difference, respectively). Multiple analyses suggested that this variation was not explained by prevalence of disease. Average specialty-specific payments were strongly associated with the likelihood of visiting a specialist. Differences in per capita payments from lowest (Q1) to highest quartiles (Q4) were greatest for cardiology ($89, $135, $172, $251) and dermatology ($46, $64, $82, $124 Q4, 94.5 % [94.4-94.8 %]). CONCLUSIONS: Substantial regional variability in outpatient specialist visits is associated with greater payments with limited benefits in terms of patient-reported satisfaction with care or reported health status. Reducing outpatient physician visits may represent an important opportunity to improve the efficiency of care.

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Partnering Urban Academic Medical Centers And Rural Primary Care Clinicians To Provide Complex Chronic Disease Care

Cited by 244 publications

References 8 publications

Opioids for chronic noncancer pain

Opioids for chronic noncancer pain

Indian Health Service Innovations Have Helped Reduce Health Disparities Affecting American Indian And Alaska Native People

Variation in Specialty Outpatient Care Patterns in the Medicare Population

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