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September 2017

RAND Health Advisory Services

Dear RHAS Community,

We hope that you are enjoying the start of a beautiful autumn. We are launching several new projects and preparing presentations for domestic and international conferences. As always, we welcome your feedback and also encourage you to visit our website to access full reports and white papers.

Soeren Mattke

Managing Director, RAND Health Advisory Services

Soeren_Mattke@rand.org

Recent Publications

Pharma, Biotech, and Medical Devices

Economic Value of Advanced Transfemoral Prosthetics

Group of people with prosthetics

In this report, Soeren Mattke, Hangsheng Liu, and co-authors simulated the differential clinical outcomes and costs of microprocessor-controlled knees (MPKs) compared with non-MPKs (NMPKs). The economic benefits of MPKs align with commonly accepted criteria for good value for money and are comparable to those of total knee replacement.

Read more »

Impact of State Reporting Laws on Central Line-Associated Bloodstream Infection Rates in U.S. Adult Intensive Care Units

Doctor inserting a catheter

Hangsheng Liu and co-authors examined the effect of mandated state health care-associated infection (HAI) reporting laws on central line-associated bloodstream infection (CLABSI) rates in adult intensive care units. These requirements improved care, but more research is needed to determine why and how these laws decrease CLASBI rates.

Read more »

Health IT & Other Services

Accelerating Innovation in Health IT

Doctor showing a health app on a smartphone to an older patient

In The New England Journal of Medicine, Robert Rudin and co-authors argue that accelerating the innovation of health information technology (IT) products needs long-term collaboration between developers and users, the transformation of care processes in tandem with IT tools, and development of new funding models.

Read more »

Leveraging Telehealth to Bring Volunteer Physicians Into Underserved Communities

A doctor and patient during a telehealth session

Writing in Telemedecine and e-Health, Robert Rudin and co-authors comment on the available workforce of retired and semi-retired physicians interested in volunteering. Learning to integrate volunteer physicians into telehealth programs may allow them to improve care in underserved communities and provide a fulfilling and exciting opportunity for this untapped workforce.

Read more »

Identifying and Coordinating Care for Complex Patients

Medical team

In a literature review, Robert Rudin and co-authors learned that analytics and HIT are being used in innovative ways to coordinate care for complex patients but that the capabilities are limited, evidence of their effectiveness is lacking, challenges are substantial, and important foundational work is still needed.

Read more »

Lessons Learned from the MAVEN Project Pilot: Using physician Volunteers to Increase Access to Care via Telehealth

Man talking with a doctor on a laptop

In a recent RAND report, Robert Rudin conducted a qualitative evaluation of the Medical Alumni Volunteer Expert Network (MAVEN) Project. Rudin and Lori Uscher-Pines found that while on-site clinicians praised physician volunteers, workflow and communication issues were common.

Read more »

Providers

The Impact of Using Mid-Level Providers in Face-to-Face Primary Care on Health Care Utilization

Male doctor talking to his patient

Writing in Medical Care, Hangsheng Liu shared the results of a natural experiment that found the greater use of nurse practitioners and physician assistants in primary care did not increase utilization or spending.

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Behavioral Interventions to Reduce Inappropriate Antibiotic Prescribing: A Randomized Pilot Trial

Doctor filling out a prescription

Mark Friedberg and co-authors wrote about a randomized trial of clinically appropriate antibiotic prescribing for acute respiratory infections. They did not find any significant relationships between any interventions—accountable justifications, suggested alternatives, or peer comparison—and antibiotic prescribing for non-antibiotic-appropriate ARI diagnoses.

Read more »

The Clinical Pharmacy Specialist: Part of the Solution

Clinical pharmacist

In the Journal of General Internal Medicine, Robert Rudin and co-authors commented on the role of clinical pharmacists in team-based care. The authors argue that clinical pharmacists have been excluded from previous solutions on improving the quality, accessibility, and sustainability of primary care.

Read more »

Evaluation of the ProPublica Surgeon Scorecard "Adjusted Complication Rate" Measure Specifications

A surgical team in an operating room

In the Annals of Surgery, Mark Friedberg and co-authors called into question the validity of ProPublica's Surgeon Scorecard, used to report on individual surgeon outcomes, based on an assessment of its outcome measure with ACS-NSQIP data.

Read more »

Measuring Workplace Climate in Community Clinics and Health Centers

Doctor explains treatment to a patient

Writing in Medical Care, Mark Friedberg and co-authors assessed the psychometric properties of a survey instrument fielded in 30 California community clinics and health centers. After reviewing existing measures and instruments, authors argue that a single, shorter survey can be used in the future.

Read more »

Federally Qualified Health Center Clinicians and Staff Increasingly Dissatisfied with Workplace Conditions

Male doctor at his desk looking unhappy

In a recent issue of Health Affairs, Mark Friedberg and co-authors argue that better working conditions for clinicians and staff could help primary care practices implement delivery system innovations and help sustain the U.S. primary care workforce.

Read more »

Social Networks in Health Care Teams: Evidence from the United States

Doctor enjoying a conversation with colleagues

In the Journal of Health Organization and Management, Mark Friedberg and co-authors argued that managers should consider factors such as team member proximity, the location of central team members, and linkages between team members when trying to design effective team structure.

Read more »

Patient Perceptions of Integrated Care and Their Relationship to Utilization of Emergency, Inpatient and Outpatient Services

Medical team holding puzzle pieces

Writing in Healthcare, Mark Friedberg and co-authors found that patients who perceive their care to be integrated utilize fewer services in both the emergency department and outpatient setting.

Read more »

Anesthesia Service Use During Outpatient Gastroenterology Procedures Continued to Increase from 2010 to 2013 and Potentially Discretionary Spending Remained High

Anesthesiologist checking monitors while sedating patient

Soeren Mattke, Hangsheng Liu, and co-authors updated recent data on trends for anesthesia service use for outpatient GI procedures. They found that the proportion of patients receiving anesthesia continue to rise, and may increase due to a new CMS rule which waives cost sharing for anesthesia use during screening colonoscopies.

Read more »

Payers

Improving MACRA's Chances of Success

Hospital staff discussing a patient's chart, photo by SelectStock/Getty Images

Mark Friedberg and RAND colleagues argue that ensuring payment mechanisms have a clear clinical rationale, anticipating operational errors, finding a "third way for risk adjustment," and reducing the burden of performance measures may improve outcomes and control costs.

Read more »

Evaluating the Impact of Policies to Regulate Involuntary Out-of-Network Charges on New Jersey Hospitals

Ambulance at a hospital emergency room entrance

Soeren Mattke and colleagues studied the impact on different payers of an all-payer blended rate in New Jersey, similar to the one implemented in Maryland. The authors estimated that a one percent reduction of out-of-network rates would reduce negotiated in-network rates by half a percent and weaken hospitals' bargaining position.

Read more »

Evaluation of the CMS's Federally Qualified Health Center (FQHC) Advanced Primary Care Practice (APCP) Demonstration: Final Report

Medical staff in a busy lobby

Mark Friedberg and colleagues presented the final results of their mixed-methods analysis.

Read more »

Tweets & Reads

Follow Us on Twitter

Mark W. Friedberg

Mark Friedberg @MWFriedberg

These are actual prices paid by commercial plans, not chargemaster. A significant advance. Full report here: rand.org/pubs/research_... Sep 8

Follow Mark »

Robert S. Rudin

Robert S. Rudin @rsrudin

Can volunteer physicians help increase #HealthCare access? Potentially. Check out our new @RANDCorporation study: https://t.co/Y9I93ukeQ9 Dec 16

Follow Robert »

RAND Health

RAND Health @RANDHealth

What defines a "high-performing" health system? There's no consensus, making performance measurement challenging. Aug 16

Follow RAND Health »

Articles We're Reading

Wanted: Talented, Energetic, Creative People to Work on Difficult, Boring Problems. No Perks

NEJM Catalyst, April 2017

Pagel, Christina and Dorien Zwart

Challenges in International Comparison of Health Care Systems

JAMA, July 2017

Papanicolas, Irene and Ashish Jha

Many Mobile Health Apps Target High-Need, High-Cost Populations, But Gaps Remain

Health Affairs, December 2016

Singh, Karandeep et al.

Hospital Prices in Indiana: Findings from an Employer Led Transparency Initiative

RAND Report, September 2017

White, Chapin

Upcoming Conferences and Presentations

Come say hello to a member of our team!

American Board of Medical Specialties Annual Meeting

Presenter: Mark Friedberg

September 25 - 27
Chicago, IL

Employer Healthcare and Benefit Congress

Presenter: Soeren Mattke, "The Impact of Chronic Disease on Workplace Productivity and Absenteeism: Effective Management for Improved Performance"

October 2 - 4
Los Angeles, CA

4th Annual Rare Disease Market Access and Commercialization Summit

Presenter: Soeren Mattke, "Borrowing for the Cure: Payment Model Innovation for Rare Disease Drugs"

October 23 - 24
Boston, MA

American Journal of Managed Care and the ACO Coalition Fall Meeting

Presenter: Mark Friedberg, "Clinician Burnout: Identifying Causes and Addressing Issues"

October 26-27
Nashville, TN

JADPRO Live

Presenter: Soeren Mattke

November 2-5
Houston, TX

MEDTECH Commercial Leaders Forum

Presenter: Soeren Mattke and Hangsheng Liu

November 6-7
Princeton, NJ

SoCalBio Digital Health Summit

Presenter: Soeren Mattke, "Why Healthcare is Ripe for Digital Disruption"
Keynote Presentation

November 7
Los Angeles, CA

American Heart Association Scientific Sessions

Presenter: Soeren Mattke

November 11-15
Anaheim, CA

MEDTECH ACCESS Leaders Forum

Presenter: Soeren Mattke

December 6-8
Berlin, Germany

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