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What We’re Reading | Week of 6.5.2017

Healthcare is a rapidly evolving industry – it’s difficult to read up on everything that matters to you. But the success of your practice can depend on how knowledgeable you are about changes in the healthcare landscape. Privia has compiled a weekly list of important articles we are reading on healthcare industry trends, clinical best practices and legislative updates for your convenience. Here are some of the important articles and blogs on healthcare that stood out this week:

>> “Last week’s settlement of a False Claims Act lawsuit against eClinicalWorks makes it easier for providers to make the switch to the electronic health records system of other vendors. The electronic health records system vendor was hit with a fine of $155 million to settle a False Claims Act lawsuit that alleged that eClinicalWorks falsely certified that the EHR met all government criteria; that the vendor failed to adequately test software before release; failed to correct critical and urgent problems and bugs for an extended period of time; failed to ensure data portability and audit log requirements; and failed to reliably record lab and diagnostic imaging orders.

>>The next generation of bundled payments should focus on population health management, researchers recently argued in a Journal of the American Medical Association report. Bundled payment models can align with population health management by extending the care episode duration, making providers outside of the hospital accountable, and integrating with global budget models within accountable care organizations (ACOs), the four authors stated.”

>>What’s more, the shift away from fee-for-service medicine to value-based care and population health incorporates more nurse practitioners and physician assistants to work with doctors in a team-based approach. Insurers are rewarding medical care providers for getting healthcare done right the first time rather than basing pay on volume of care delivered.”

>> In the JAMA paper, Dusetzina cites the EpiPen as one example. Last year, executives at Mylan, the maker of the EpiPen, said the list price of the drug for life-threatening allergic reactions was $600, but the company earned $274 after rebates and other fees. That savings, though, isn’t necessarily passed on to patients in Medicare’s system. Instead, the money tends to be swallowed up by health insurers and middlemen like pharmacy benefit managers.And, even though patients don’t pay list prices for their drugs, those high prices (like $600 for the EpiPen) are used to calculate how much Medicare covers for any individual patient — and sometimes what patients pay out-of-pocket, Dusetzina said.”

>> “Engineers at Boston University are working with local hospitals like Brigham and Women’s Hospital and Boston Medical Center to manage heart disease and diabetes using algorithms that have the ability to predict hospitalizations up to a year in advance with 82% accuracy, Yannis Paschalidis, the director of the Center for Information Systems Engineering at Boston University, wrote in Harvard Business Review. Comparatively, guidelines used by cardiologists to predict a patient’s risk of cardiovascular disease is about 56% accurate.”

>> IBM and Novartis are teaming up on a cognitive solution aimed at improving care and outcomes for breast cancer patients. Novartis will bring its breast cancer expertise, while IBM will contribute its data analytics and machine learning chops, the Swiss pharma said in a statement. The collaboration seeks to use real-world data to better understand the expected outcomes of various breast cancer treatments. IBM markets Watson tools that help oncologists make treatment decisions for cancer patients and facilitate the matching of patients to clinical trials. Meanwhile, Novartis markets four breast cancer drugs, including the newly FDA-approved Kisqali, and has a number of candidates in its pipeline.”

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