WEDNESDAY, AUGUST 20, 2014
Daily Health Policy Report
Check back on Kaiser Health News for the latest headlines
KHN ORIGINAL REPORTING & GUEST OPINION
SUMMARIES OF NEWS COVERAGE
KHN ORIGINAL REPORTING & GUEST OPINION
NEW FROM KHN
1. San Antonio Police Have Radical Approach To Mental Illness: Treat It
Kaiser Health News staff writer Jenny Gold reports: “To deal with the problem, San Antonio and Bexar County have completely overhauled their mental health system into a program considered a model for the rest of the nation. Today, the jails are under capacity, and the city has saved $50 million over the past five years. The effort has focused on an idea called 'smart justice' – basically, diverting people with serious mental illness out of jail and into treatment instead. It is possible because all the players in the system that deal with mental illness -- the police, the county jail, mental health department, criminal courts, hospitals and homeless programs – pooled their resources to take better care of people with mental illness” (Gold, 8/19). Read the story, which also ran on NPR.
2. Insuring Your Health: HMO, PPO, EPO: How's A Consumer To Know What Health Plan Is Best?
Kaiser Health News consumer columnist Michelle Andrews writes: “What’s in a name? When it comes to health plans sold on the individual market, these days it’s often less than people think. The lines that distinguish HMOs, PPOs, EPOs and POS plans from one another have blurred, making it hard to know what you’re buying by name alone--assuming you're one of the few people who know what an EPO is in the first place” (Andrews, 8/19). Read the column.
3. Missouri Lags Behind In Insurance Pricing Transparency
The St. Louis Post-Dispatch's Samantha Liss, working in partnership with Kaiser Health News, reports: "Connecticut, Kansas and Illinois are among a long list of states and the District of Columbia that have some sort of authority to review insurance rates, meaning pricing, before plans are sold. But that type of authority does not exist in Missouri. The Show-Me State is one of the only states that does not have the ability to review health insurance rates. Wyoming is close behind; it has only the ability to review rates for health maintenance organizations, or HMOs" (Liss, 8/18). Read the story.
4. Political Cartoon: 'Sampling Error?'
Kaiser Health News provides a fresh take on health policy developments with "Sampling Error?" by Marty Bucella.
Meanwhile, here's today's haiku:
LOOKING BEYOND THE SYSTEM
Veterans' health care
A new meaning for "private"
Could be expensive!
If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.
SUMMARIES OF NEWS COVERAGE
HEALTH INFORMATION TECHNOLOGY
5. Chinese Cyberattack Steals 4.5 Million Patients' Data From Hospital Records
Tennessee-based Community Health Systems, which runs 206 hospitals in 29 states, says no medical information was exposed, however.
The New York Times: Hack Of Community Health Systems Affects 4.5 Million Patients
Community Health Systems, a publicly traded hospital operator based in Franklin, Tenn., said that personal data, including names, Social Security numbers and addresses, for 4.5 million patients had been compromised in a Chinese cyberattack on its systems from April to June (Perlroth, 8/18).
Los Angeles Times: Hackers Stole 4.5 Million Patients' Data In Hospital Breach
A cyberattack suspected to have originated in China stole Social Security numbers and other personal data for 4.5 million patients whose records were in Community Health Services Inc.'s system, the company said Monday. The data breach included the names, addresses, birth dates, telephone numbers and Social Security numbers of patients who were referred for or received services from doctors affiliated with the hospital group in the last five years. It did not include patient credit card, medical or clinical information, the company said in regulatory filings (Garland, 8/18).
The Wall Street Journal: Community Health Systems Says It Suffered Criminal Cyberattack
The rural hospital operator and cybersecurity firm Mandiant believe the attacker was an "Advanced Persistent Threat" group originating from China, it said. The attacker, which used highly sophisticated malware and technology to attack the company's systems, was able to bypass Community Health Systems' security measures and to successfully copy and transfer certain data outside the company, it said (McCarthy, 8/18).
The Wall Street Journal: Investigators: We Don’t Know Why China Hacked Hospitals
Community Health Systems Inc. made headlines Monday when it announced Chinese hackers took records on 4.5 million patient records, according to a securities filing. But it remains unclear why the hacker group, which normally targets trade secrets like plane blueprints and health device designs, wanted personal data (Yadron, 8/18).
Bloomberg: Why Would Chinese Hackers Steal Millions Of Medical Records
Security experts say it's unusual for accomplished thieves of corporate secrets to suddenly turn to stealing personal data on individuals, which is what you'd expect from Eastern European hacking gangs and cyber-crime rings. It's possible that the hackers were scraping all the data they could from Community Health's systems and wound up with personal data, without any intentions of selling or using it. The hackers could also have stolen the information for the purposes of locating new targets or adding private data to the profiles of existing targets. Perhaps the most likely theory is that rogue members, tempted by the money they could make, stole the data to sell it on the black market in actions not sanctioned by their superiors, according to a person familiar with the investigation, who spoke on condition of anonymity (Riley and Robertson, 8/18).
USA Today: Health Network Reports 4.5 Million Patients Had Information Hacked
Too few health care companies invest in computer security, said Philip Lieberman, president of Lieberman Software in Los Angeles. He noted the FBI had warned health care companies in April that the sector's cybersecurity was lax. HIPAA does little to protect patients and offers companies little incentive to invest in computer security — and too many haven't done so, he said. Still, says Trey Ford, a security strategist at Rapid7, a security analysis firm in Boston, "hospitals are arguably one of the hardest network environments to secure; their primary focus is on protecting and improving human life, and this often eclipses all other priorities," he said (Weise, 8/18).
6. White House Won't Turn Over Security Info For Healthcare.gov
The Obama administration rejects a request from The Associated Press, saying the information could be used by hackers to break into people's accounts.
The Associated Press: U.S. Won’t Reveal Records On Health Website Security
After promising not to withhold government information over "speculative or abstract fears," the Obama administration has concluded it will not publicly disclose federal records that could shed light on the security of the government's health care website because doing so could "potentially" allow hackers to break in. The Centers for Medicare and Medicaid Services denied a request by The Associated Press under the Freedom of Information Act for documents about the kinds of security software and computer systems behind the federally funded HealthCare.gov. The AP requested the records late last year amid concerns that Republicans raised about the security of the website, which had technical glitches that prevented millions of people from signing up for insurance under President Barack Obama's health care law (Gillum, 8/19).
Fox News: White House Won’t Reveal Documents Related To Obamacare Website Scrutiny
The White House has rejected a request to publicly disclose documents relating to the kinds of security software and computer systems behind the federal health care exchange website on the grounds that the information could "potentially" be used by hackers. The Centers for Medicare and Medicaid Services denied a Freedom of Information Act request made late last year by the Associated Press amid concerns that Republicans raised about the security of the website, which had technical glitches that prevented millions of people from signing up for insurance under ObamaCare. In denying access to the documents, including what's known as a site security plan, Medicare told the AP that disclosing them could violate health-privacy laws because it might give hackers enough information to break into the service (8/19).
7. Alaska Challenge: Signing Up Those Entitled To Free Care
The Washington Post explores the difficulties of enrolling Native Americans in coverage when they are exempt from the health law's mandate and get free care. Other stories look at the still scanty evidence that medical homes are more efficient, and how thousands of consumers eligible to sign up for coverage before the next enrollment period because they changed jobs, gave birth, gained citizenship or got married.
The Washington Post: The Trouble With Trying To Sign People Up For Health Insurance When Care Is Already Free
It’s hard work trying to get people to sign up for health insurance when their care is mostly free to them. Andrea Thomas is working to get Alaska Natives in Sitka, Alaska, to do just that. She’s the outreach and enrollment manager at SouthEast Alaska Regional Health Consortium (SEARHC), and it’s her job to sign people up for health insurance coverage through exchanges created as a result of the Affordable Care Act. To get a sense of just how uphill Thomas’s battle is, consider this: Of the more than 100,000 people who live in Alaska and self-identify as Alaska Native or American Indian, only 115 had signed up for health insurance through an Affordable Care Act exchange as of March 31. Alaska Natives and American Indians are exempt from tax penalties for not signing up for health insurance (Sheftie, 8/18).
The Associated Press: Who’s Eligible To Get Health Insurance Before Nov?
More than 200,000 Floridians may be eligible to sign up for health insurance under President Obama's Affordable Care Act soon even though enrollment doesn't officially start until November. Consumers that get married, move, give birth or gain citizenship may qualify for a special enrollment period. They may also qualify if they became unemployed or got a divorce. Enroll America released a report Tuesday showing 222,700 Floridians may be eligible to for special enrollment. Enroll America used Census data to estimate the number of consumers who may qualify for special enrollment (8/19).
The Hill: HHS Pressed On Insurance Discrimination Claims
Patient advocacy groups say health insurers are violating ObamaCare by discriminating against those with chronic diseases, and the groups are forcing the administration to respond. A Health and Human Services spokesperson cited by The Associated Press says a response is nearly prepped for advocacy organizations fighting AIDS, leukemia, epilepsy and other diseases. Groups such as the National Health Law Program and the AIDS Institute have filed complaints with the administration claiming insurers are in violation of the Affordable Care Act’s provisions that prevent them from discriminating against people with pre-existing conditions and chronic diseases (Al-Faruque, 8/18).
The Hill: Lawyers Argue O-Care Case Should Go Straight To Supreme Court
Lawyers arguing ObamaCare subsidies should only be granted to states that have created their own health exchanges say they should be allowed to appeal their case directly to the Supreme Court. Plaintiffs in the Halbig v. Burwell case are suing the federal government over an IRS rule that allows the federal government to give subsidies to all health exchanges under the Affordable Care Act (ACA). While they recently won the case in the D.C. Circuit Court, the government has asked for a rehearing before it can be appealed at the Supreme Court. In a submission filed Monday to the D.C. Circuit Court of Appeals, the business groups, individuals and states backing the case said continued “uncertainty” about the rule was “simply not tenable” (Al-Faruque, 8/18).
Modern Healthcare: Medical-Home Adoption Growing; Evidence Of Effectiveness Still Elusive
Primary care is a foundation of healthcare reform efforts, and patient-centered medical homes are one of the delivery system innovations encouraged by the Patient Protection and Affordable Care Act. But recent studies present a mixed picture of the effectiveness of medical homes in improving quality and reducing costs (Robeznieks, 8/18).
8. Poll Shows California Voters' Health Law Support Improving
News outlets in California, Connecticut and Oregon examine issues related to the health law and how voters are viewing it -- including how the overhaul has impacted the cost of coverage as well as uninsured and poverty rates.
The Sacramento Bee: California Voters’ Support For Health Care Law Inches Up
The federal health care overhaul is garnering more support from California voters than at any time since its passage in 2010, but they believe the state could still do more to limit the amount insurance companies can charge customers for coverage, according to a new Field Poll. Some 56 percent of registered voters support the law and 35 percent are opposed, contrasting sharply with the national average showing 54 percent oppose and 41 percent approve. Growing approval for the law in California could undercut what many considered a potent issue for Republicans heading into the Nov. 4 election (Cadelago, 8/19).
The CT Mirror: Fact Check: What Impact Did Obamacare Have On CT’s Uninsured Rate?
State officials declared this month that the number of Connecticut residents without health insurance had been cut nearly in half -- from almost 8 percent of the population to 4 percent -- following the implementation of Obamacare. That 4 percent figure is almost certain to be a talking point in the coming months as Gov. Dannel P. Malloy, one of the officials touting the drop, campaigns for re-election. But unlike the data officials usually rely on to evaluate the uninsured rate, this figure was based on some unorthodox methods (Becker, 8/19).
The Oregonian: Poverty in Oregon: Interactive Maps Show Rising Medicaid Rates From Affordable Care Act
The implementation of the Affordable Care Act led to increased enrollment in Medicaid across all Oregon counties, state data show. At the same time, reliance on food stamps and welfare fell slightly as Oregonians continue their slow and steady climb out of the Great Recession. But the state isn't in the clear yet: More than one in five Oregonians continue to rely on food stamps, a stubbornly high rate that has remained about the same for years (Zheng, 8/18).
9. GOP Ad Strategy On Health Law Shifts In Senate Races
Some Republican strategists say the health overhaul is losing its punch, Bloomberg reports. In other political news, the American Hospital Association reports that it gave $3.3 million to state affiliates to lobby local officials on Medicaid expansion.
Bloomberg: Obamacare Losing Punch As Campaign Weapon In Ad Battles
Republicans seeking to unseat the U.S. Senate incumbent in North Carolina have cut in half the portion of their top issue ads citing Obamacare, a sign that the party's favorite attack against Democrats is losing its punch. The shift -- also taking place in competitive states such as Arkansas and Louisiana -- shows Republicans are easing off their strategy of criticizing Democrats over the Affordable Care Act now that many Americans are benefiting from the law and the measure is unlikely to be repealed. "The Republican Party is realizing you can't really hang your hat on it," said Andrew Taylor, a political science professor at North Carolina State University. "It just isn’t the kind of issue it was" (Przbyla, 8/19).
Modern Healthcare: AHA Doled Out $3.3 Million In 2013 To Advocate Medicaid Expansion
The American Hospital Association's expenditures increased by 7% in 2013, to $117 million, spurred in part by efforts to convince states to expand Medicaid, according to the organization's most recent tax return. The group spent $3.3 million on grants to state hospital associations last year to assist with efforts to convince states that they should expand Medicaid to households with incomes up to 138% of the federal poverty level. Under the Patient Protection and Affordable Care Act, the federal government will pick up 100% of the tab for the first three years of Medicaid expansion and 90% of the cost thereafter (Demko, 8/18).
Meanwhile, from the White House -
The New York Times: Behind Closed Doors, Obama Crafts Executive Actions
When President Obama announced in June that he planned to bypass congressional gridlock and overhaul the nation’s immigration system on his own, he did so in a most public way: a speech in the White House Rose Garden. As recommendations pour in, the most frequent question Mr. Obama’s aides are asking, the people involved said, is whether the moves could withstand a legal challenge, which comes as House Republicans voted to sue Mr. Obama for unilateral action in changing elements of his signature health care law (Hirschfeld Davis, 8/18).
And in news from Capitol Hill, the passing of a former senator --
The Washington Post: James M. Jeffords, Vermont Republican Who Became Independent, Dies At 80
A former Vermont state senator and attorney general, Mr. Jeffords served seven terms in the U.S. House of Representatives before winning election to the Senate in 1988. He established himself as a moderate-to-liberal Republican, a reflection of his state’s political tendencies, and frequently voted with Democrats on matters such as health care, taxes, abortion, gay rights, gun control and the environment. ... On May 24, 2001, Mr. Jeffords announced that he would become an independent and caucus with Democrats (Langer, 8/18).
HEALTH CARE MARKETPLACE
10. Amid Tumult And Turmoil, Health Care Sector Expected To Show Revenue Growth
The Wall Street Journal: Risks Create Tumult for Tech, Health-Care Firms
Seismic shifts in the technology and health-care sectors highlight why executives are divided or undecided about taking financial and strategic risks. … At the opposite end of the spectrum is the health-care industry. The still-evolving Affordable Care Act, has made many companies hire thousands and plow millions into their businesses. The health-care sector is expected to post revenue growth of 12.2%, the highest of any sector, and earnings growth of 15.9%, second only to the telecommunications industry. Health-care companies increased spending on buildings and equipment by 15%, the greatest surge of any sector and compared with a 24% decline in the second quarter last year, according to FactSet (Knox and Murphy, 8/18).
11. Illinois Took Federal Medicaid Money It Couldn't Repay, Audit Says
Elsewhere, an auditor in Louisiana questions data the governor's office has provided on the outlook of the state's Medicaid privatization efforts, and Florida pediatricians could soon see higher Medicaid payments.
Chicago Tribune: Illinois Took Too Much Money From Federal Medicaid Account, Audit Says
Illinois overdrew money from a federal Medicaid account by an average of $60 million per quarter over a three-year period because of “faulty” and “imprecise” practices, according to a federal audit released Monday. The U.S. Department of Health and Human Services' Office of Inspector General said that the state’s improper accounting in fiscal years 2010 through 2012 left it unable to repay the federal government the difference until two to six months later. As a result, the federal government may have lost as much as $792,000 in interest during that period (Frost, 8/18).
The Associated Press: Audit: Illinois Overdrew Federal Medicaid Dollars
Illinois used faulty methods for withdrawing federal Medicaid money, resulting in "a perpetual 'treadmill effect'" of regular overdraws of dollars that the state later had trouble repaying, federal auditors said in a report released Monday. The state's withdrawals exceeded its actual Medicaid spending by an average of $60 million per quarter during the three years reviewed, according to the report from the U.S. Department of Health and Human Services' Office of Inspector General (Johnson, 8/18).
The Associated Press: Louisiana Auditor Questions Data In Medicaid Program Review
An annual report evaluating Gov. Bobby Jindal's privatization of Medicaid lacked important financial information and presented rosy performance reviews not corroborated by data, according to a review released Monday. Legislative Auditor Daryl Purpera's office raised questions about the report that Jindal's Department of Health and Hospitals submitted to lawmakers in January. It analyzed the performance of the private managed-care networks handling Medicaid services. Under a state law enacted in 2013, the department is required to submit a yearly report about the performance of the Bayou Health program, an insurance-based model that covers 900,000 of Louisiana's 1.4 million Medicaid recipients, mostly pregnant women and children (DeSlate, 8/18).
Miami Herald: Pediatricians In Florida Could See Relief From Low Medicaid Payments
After years of hearings and delays, the possible resolution this fall of a class-action lawsuit against Florida health and child-welfare officials could mean that physicans will at last receive what they consider to be adequate compensation for treating children of the poor. The lawsuit, filed in 2005 by pediatricians, dentists and nine children against the Agency for Health Care Administration, the Department of Children and Families and the Department of Health, claimed that Florida violated federal law by providing inadequate Medicaid services to children, and that their care had been hampered by low Medicaid payments to doctors. A federal judge is expected to rule on the case in October (Madigan, 8/18).
12. State Highlights: Messy Health Care Divorce In Pittsburgh
A selection of health policy stories from Pennsylvania, Kansas, Massachusetts, Texas, Georgia and California.
NPR: Pittsburgh Health Care Giants Take Fight To Each Other's Turf
Pittsburgh's dominant health insurance company and its largest health care provider are, essentially, getting a divorce. For decades, Highmark Blue Cross/Blue Shield and University of Pittsburgh Medical Center worked together. But as the line between insurance companies and health care providers across the country blurs, these longtime allies are venturing into each other's business and becoming competitors (Brady, 8/19).
Kansas Health Institute News Service: Kansas Mental Health System Under Increasing Stress
One day last month, Osawatomie State Hospital had 254 patients in its care -- almost 50 more than its optimal capacity. The overcrowded conditions forced a few dozen patients, all of them coping with a serious mental illness and likely a danger to themselves or others, to be triple-bunked in rooms meant for two. “It got really crowded there,” said Mark Hornsby, a 56-year-old Topeka man who was an Osawatomie patient earlier this summer. “In the lunch room, you were like elbow-to-elbow. And it got really loud there. It got to a point where I just wanted to stay in my room and not get in trouble.” With the patient count so high, many of the hospital’s direct-care staff were pressed into working one, two and sometimes three overtime shifts a week (Ranney, 8/18).
The Boston Globe: Insurance Rates Will Increase For Small Businesses
Health insurance rates will rise at a faster clip over the next several months as insurers spend more to implement the federal health care law and patients increase the use of high-cost drugs and medical services, insurers and regulators said Monday. The state Division of Insurance has approved rates that allow small-business health premiums to rise, on average, 3.5 percent in the fourth quarter of this year, compared to the same three-month period in 2013. Last year, the increase was 2.1 percent (McCluskey, 8/19).
Kaiser Health News: San Antonio Police Have Radical Approach To Mental Illness: Treat It
To deal with the problem, San Antonio and Bexar County have completely overhauled their mental health system into a program considered a model for the rest of the nation. Today, the jails are under capacity, and the city has saved $50 million over the past five years. The effort has focused on an idea called “smart justice” -- basically, diverting people with serious mental illness out of jail and into treatment instead. It is possible because all the players in the system that deal with mental illness -- the police, the county jail, mental health department, criminal courts, hospitals and homeless programs – pooled their resources to take better care of people with mental illness (Gold, 8/19).
Georgia Health News: Key Activist Group Sees Flaws In State Health Plan
Last week, when upcoming changes in the state employee and teacher health plan were announced, they drew a generally positive response. Members learned that the 2015 plan would include an increased choice of insurers, which was welcome, and officials presented information showing that many members would see no premium increase. But after studying the proposed rates in greater detail, a group representing teachers, employees and retirees is voicing concern. It says many of the new options will be unaffordable for members looking to switch from their current plans (Miller, 8/18).
The California Health Report: Santa Barbara Joins Forces To Train Dementia Caregivers
Call it “disaster planning.” With rates of dementia expected to reach epidemic proportions as an aging American populous lives longer, a Southern California city has formed an impressive coalition of business leaders, educators, foundations and long-term care settings to help train the next generation of caregivers. Santa Barbara City College is launching two dementia training classes next year with a unique twist: class lectures will be followed immediately -- in some cases the next day -- with practical application at three local residential care facilities (Perry, 8/18).
EDITORIALS AND OPINIONS
13. Viewpoints: New Debate On Shrinkage In Health Enrollments; 'Mad Medicine' On Generics
Bloomberg: More Bad News For Obamacare
Last Monday, Jed Graham of Investor's Business Daily reported that insurers say Affordable Care Act enrollment is shrinking, and it is expected to shrink further. Some of those who signed up for insurance on the exchanges never paid; others paid, then stopped paying. Insurers are undoubtedly picking up some new customers who lost jobs or had another "qualifying life event" since open enrollment closed. But on net, they expect enrollment to shrink from their March numbers by a substantial amount -- as much as 30 percent at Aetna Inc., for example (Megan McArdle, 8/18).
The Washington Post: The Volokh Conspiracy: Law By Other Means -- A Response To Rob Weiner On Halbig
Rob Weiner is at it again over at Balkinization. This time alleging he's found some smoking gun to prove that the Halbig litigation is "anti-democratic" and rests on a flawed legal theory. As with his posts on the D.C. Circuit's en banc procedures, Weiner's diatribe is long on bluster, but short on meaningful claims. And, as before, he says some things that are false, irrelevant, or both (Jonathan H. Adler, 8/18).
Balkinization: Politics By Other Means
[Opponents of the federal health law subsidies] claimed, in order to coerce states to establish insurance Exchanges, Congress had intended all along to deny insurance subsidies to low income families in states that did not cooperate. The language buried in the formula for calculating subsidies, they asserted, implemented this intent. The argument brings to mind the scene in the classic Woody Allen movie, Take the Money and Run, where a would-be bank robber ends up arguing with the teller as to whether his note says he has a "gun" or a "gub." The ACA opponents argue, in effect, not only that the note said "gub," but that it did so by design. This position is an after-the-fact rationalization (and not a very good one, at that). At the time the statute was enacted, no one – not legislators, not the press, not academics, and not even plaintiffs themselves – suggested that this provision implemented any such design (Rob Weiner, 8/16).
Tampa Bay Times: Medicaid Expansion Creates Jobs, Saves Money, But Florida Still Doesn't Care
For a state that boasts about giving tax breaks (i.e. corporate welfare) to businesses on the vague promise of job creation, it is almost inconceivable to think we wouldn't invest in proven job creation through health coverage. And yet Florida lawmakers have not only rebuffed Medicaid expansion, they don't even talk about it any longer. Ignoring fact-based studies is not simply partisan politics. When the stakes are this high, it is deplorable politics (John Romano, 8/18).
Bloomberg: The FDA's Mad Medicine
[G]eneric manufacturers are not allowed to put warning labels on drugs unless those warnings are also in the warning label for the original brand-name drug. That's when I realized that this was a classic case of outrageous regulatory incompetence. Oblivious bureaucrats at the Food and Drug Administration created a ridiculous situation in which Pfizer can be sued for a product it didn’t make. Then I read further. And it turns out that the FDA has proposed a new rule that would allow generic-drug manufacturers to add labeling to their products independently. And guess who’s blocking it? The generic drug manufacturers, of course (Megan McArdle, 8/18).
The New York Times: Is Gov. Rick Perry's Bad Judgment Really A Crime?
Gov. Rick Perry of Texas is one of the least thoughtful and most damaging state leaders in America, having done great harm to immigrants, abortion clinics and people without health insurance during his 14 years in office. But bad political judgment is not necessarily a felony, and the indictment handed up against him on Friday -- given the facts so far -- appears to be the product of an overzealous prosecution (8/18).
Journal of the American Medical Association: Optimizing Health for Persons With Multiple Chronic Conditions
Although HHS and its partners have made incremental progress in addressing chronic conditions through use of a multiple chronic conditions lens, there is an imperative to accelerate efforts across all of the goals. First, more delivery and payment models will need to focus specifically on subsets of the multiple chronic conditions population that are at highest risk for poor outcomes and high costs. ... Second, evidence-based community prevention and wellness programs currently reaching hundreds of thousands of individuals should be expanded further through partnerships with health care entities to reach tens of millions of individuals with multiple chronic conditions. Third, the multiple chronic conditions population needs to be an area of focus for research on patient-centered outcomes to inform the development of future clinical practice guidelines, best practices, and quality measures (Anand K. Parekh, Richard Kronick and Marilyn Tavenner, 8/18).
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