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Finding New Vistas in Health Care

waterfall

A couple of weeks ago, I was talking with a neighbor who had just completed a 100-mile race across the Bonneville Salt Flats in Utah. He is an adventurer who loves river running, skiing and most any outdoor activity. I enjoy hiking, so we often talk about different trails in Utah. I've lived in Salt Lake City most of my life and feel I'm pretty knowledgeable about local treks, until he told me about the Heughs Canyon waterfall. I had never heard of this waterfall and was intrigued since the trailhead was less than 10 minutes away from my neighborhood.

My wife and I hiked to this beautiful waterfall last weekend and were surprised to find a cave, lean-to and fun bridges on the trail. As I was returning from the hike, I was reminded of the knowledge (and adventures) right under our noses that we often overlook because we don't know where to find them. I was grateful for a friend who pushes beyond the status quo and finds new adventures in the outdoors.

In health care, we are constantly pushing beyond the limits and looking for transformation and innovation to propel our health care system to heights never seen before. Currently, payment reform is big focus. Medicare is taking a leading role with bipartisan support behind the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation and is beginning to roll out the Quality Payment Program (QPP). There is a lot of information and resources about payment reform and QPP that clinicians may not know are available.

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Inspiring Leaders in an Environment of Change

Young Adults

Rapid organizational change can be both exciting and unsettling at the same time. HealthInsight has experienced its share of this kind of rapid change in the past few years—so much so that exciting and unsettling seems to describe just about every day around here. We've seen:

  • Significant corporate growth, most recently by expanding our programs into Oregon and into End-Stage Renal Disease work.
  • Challenging new initiatives on top of our already large portfolio of work for the Medicare program—including but not limited to helping improve the quality of care in Indian Health Service hospitals across the nation, integrating behavioral health screening into primary care and preparing Medicare providers for value-based payment.
  • Regionalization of several of our programs, requiring new ways of engaging stakeholders and coordinating regional activities while maintaining essential local focus.
  • Persistent and pervasive uncertainty and change in the health care environment we seek to influence.

This rapid change in our organization and in the world is very likely to continue into the future as well. But the pace and intensity of efforts to keep up and reinvent our organization has led at times to "change fatigue," similar to the burnout that many of our stakeholders have reported experiencing as they implement multiple, simultaneous and sometime overlapping quality improvement activities.

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United to Save Lives

Man and woman looking at meds

A few weeks ago, I was privileged to join 2,250 other attendees at the 2017 National Rx Drug Abuse & Heroin Summit in Atlanta, put on by Operation UNITE. Billed as "the largest annual conference addressing the opioid crisis," this event brings together professionals from across the nation to discuss how to respond to the epidemic of opioid abuse, misuse and overdose.

Attendees of this summit are acutely aware of the grim statistics. The Centers for Disease Control and Prevention reported more than 33,000 deaths in 2015 from prescription opioids and heroin. That's an average of more than 90 deaths a day of Americans from all parts of the country, all walks of life and all age groups.

As a non-health care professional, I listened for three days as advocates, researchers, providers, clinicians, law enforcement and government officials—including my HealthInsight Oregon colleagues—described efforts to reverse the current trends and save lives. I heard about many initiatives, ranging from prevention of opioid abuse and misuse to addiction services and diversion tools. Several focus areas emerged for me.

  • Reduce unneeded opioid prescribing. Prescription Drug Monitoring Programs are electronic databases that provide a complete history of controlled prescription medications given to a patient. Almost all states have implemented these programs to help physicians and pharmacists detect worrisome prescribing patterns and reduce harmful drug interactions and overprescribing.
  • Consider alternative methods to treat and manage pain. Non-pharmaceutical treatments and non-opioid medications are preferred over opioids for most painful conditions. There is good evidence that non-pharmaceutical treatments are beneficial, with low cost and minimal side effects. These treatments include physical and occupational therapy, acupuncture, chiropractic and massage therapy as well as cognitive behavioral therapy and guided meditation to redirect painful symptoms. Physicians are seeing the value of these kinds of treatments and insurers have begun paying for them. When opioids are needed to treat serious painful conditions, providers and pharmacists play an essential role in educating patients and their families about the risk of opioids and how to safely use, store and dispose of them.
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New ATOP Director Talks Project Progress and Perspective

Nurses

I fully embraced the opportunity to join HealthInsight Nevada as the director of the Admissions and Transitions Optimization Program (ATOP) in October 2016 and take the reins of the Phase 2 project. It has been an extraordinary six months of learning and leading for me with invaluable professional and personal growth. ATOP began in 2012 with Phase 1 targeting 24 nursing facilities in Nevada to receive supplemental clinical resources by making RNs and APRNs available to improve the health care outcomes of long-term residents and reduce health care costs without restricting access to care or choice of provider. ATOP nurses focused on the training and education of facility staff (CNAs, LPNs, RNs) as well as providing direct care (in a teaching manner) to facility residents. This project was driven by a Centers for Medicare & Medicaid Services (CMS) measurement showing that a staggering 45 percent of hospital transfers for this population are deemed potentially avoidable.

Phase 1 concluded in September 2016 with impressive results. The ATOP project in Nevada reported that total spending dropped 21.7 percent per resident on average and potentially avoidable hospitalization occurrences declined by 25.5 percent.

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Medication Management: No Simple Task

Closeup pills

$320 billion – this is how much money was spent in 2015 on prescription medications, according to the Centers for Medicare & Medicaid Services' Office of the Actuary National Health Statistics.

10 percent – this is the percentage of people who are taking at least five medications a month, according to the Centers for Disease Control and Prevention's National Center for Health Statistics.

We know that older adults are likely to be on more medications to manage their chronic conditions, and we also know that four out of every 1,000 patients visit the emergency room for adverse events related to their medications. Patients see many different providers. New drugs are coming into the market that may interact with others. Transport to the pharmacy may be an issue. Older patients may not be able to hear the prompts to refill a prescription. And, of course, costs continue to rise. How do patients and their care givers keep on top of all of this?

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