Stephen Dahmer

California’s Whole Person Care Pilot program (#WPC) was a #Medicaid Section 1115 waiver demonstration program focused on the provision of #carecoordination and other services to address eligible beneficiaries’ health-related social needs (HRSN). #managedcareplans Systems for Action researchers Emmeline Chuang, Nadereh Pourat and team recognized evidence of the implementation and impact of #HRSN interventions is limited. Their mixed-methods S4A study examines pilot-level variation in impact on acute care utilization and identifies program implementation strategies. #EDvisits #hospitalizations #systemsalignment Read their findings in 𝘔𝘦𝘥𝘪𝘤𝘢𝘭 𝘊𝘢𝘳𝘦 𝘙𝘦𝘴𝘦𝘢𝘳𝘤𝘩 𝘢𝘯𝘥 𝘙𝘦𝘷𝘪𝘦𝘸: https://lnkd.in/gdDB5_8B

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#actcenterorg's "Rapid Evidence Scan" on Pain Management Models, answering the questions: (1) What are evidence-based models for primary care-based pain management? (2) What are key elements of these models? What is the role of telehealth in these models? ACT Center scientists conduct Rapid Evidence Scans at the request of Kaiser Permanente Washington Care Delivery leaders to help inform important and strategic decisions. READ MORE here: https://lnkd.in/dcZaP8Qb | #evidencebase #evidencescan #learninghealthsystem #healthcare #painmanagement #pain #opioids #opioidusedisorder #telehealth #interventions #researchtoaction #caretransformation

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In a new peer-reviewed study just published in Health Affairs, Waymark co-founder and Head of Clinical Sanjay Basu and co-authors at the University of Pennsylvania and University of California, San Francisco explore how cost-effective analyses—one of the most commonly used tools to evaluate health interventions—may risk perpetuating health disparities. The study finds that standard approaches to cost-effective analyses tend to undervalue interventions that would primarily benefit disadvantaged groups due to: ⚫ Marginalized groups facing a higher risk of dying from multiple potential causes that diminish the benefits of treating diseases (known as “competing risks”)  ⚫ Underinsurance or lack of insurance that result in lower baseline healthcare costs  ⚫ Pre-existing wage disparities that may appear to show lower lost work productivity compared to more privileged groups The authors outline several approaches to ensure our analytical methods serve all members of society, especially the chronically underserved. This is critical work that deserves the attention of not just academics and researchers, but also policymakers, payers, and providers who care about improving health equity. Read the full study here: https://lnkd.in/eA9zfGge

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Quick summary of the latest CDC updates to its opioid prescribing guidelines, including 12 key recommendations and 5 guiding principles to aid in implementation https://lnkd.in/eXMdQTHt #opioids #medication #painmanagement #primarycare

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Scripps Health’s potential departure from Anthem Blue Cross’s network, affecting over 125,000 Southern Californians, raises serious concerns about healthcare accessibility for patients in the region. Scripps argues that financial pressures are driving this decision, but a closer look reveals that their revenue has nearly doubled since 2011. This growth suggests that Scripps has the financial resources to support both their mission and their community’s healthcare needs, not to mention salary packages of more than $1 million each for eleven executives. Instead of negotiating in ways that could destabilize access to care, Scripps should prioritize a sustainable partnership that safeguards patients’ access to affordable, high-quality healthcare. Healthcare reimbursement can be complex, but it’s crucial that healthcare institutions keep people—not just profit margins—at the core of their decisions. We hope Scripps will reassess its approach and find a solution that ensures continuous care for all Southern Californians, without placing patients’ health at risk. https://lnkd.in/ePfCJaCf

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In the #340B Spin Room Predictably, covered entities and their advocates are in full spin mode following the Health Resources and Services Administration (HRSAgov), HHS, announcement that the program expanded by an astonishing 24% last year. The spin room’s spin doesn’t seem particularly convincing to me, but, more to the point, it ignores the patient. Here’s the spin as catalogued in a (very interesting) article by William Newton at the 340B Report, citing an impressive array of covered entity #advocates: 1) “The growth in total 340B purchases last year was largely a result of drugmaker #price increases….”; “Exploding drug price increases” are the primary reason for the program growth. I think not. As IQVIA has reported, “[o]verall spending growth in the U.S. market for #medicines slowed to 2.5% in 2023”. The 24% increase in 340B is almost 10x that rate of growth. Indeed, the article concedes a fundamental point that should have DECREASED 340B sales, measured, as HRSA did, based on dollars. As the article notes, quoting an advocate, “a new provision of the #InflationReductionAct“, which was implemented in 2023, “began penalizing #drugmakers for raising prices faster than #inflation, leading manufacturers to SLOW the rate of price increases….”. 2) The #HRSA report, another advocate says, “did not offer a side-by-side comparison to the non-340B prescription drug market”. Sorry. Nope. See above. The increase in the total market, inclusive of both non-340B and 340B, was 2.5%, while 340B increased 24%. 3) “Broader #healthcare trends” are “increasingly shift[ing]” care “from inpatient to outpatient settings”, and 340B is an outpatient only program. Well, sorry, that doesn’t really explain last year. Though it’s certainly true that, over the last 20 years, #inpatient services have declined and outpatient services have increased, #outpatient visits per 1000 people increased ONLY 0.3% from 2022 to 2023. But, for me, all of the sturm und drang over expansion isn’t even the be all and the end all of the debate; the patient is. And that’s where the spin really falls short. There’s no assertion in the spin room that assistance to patients at the #pharmacy counter has increased by 24%—or anything approaching that. Indeed, when IQVIA looked in 2022 at #patient assistance at contract #pharmacies, it found that a meager 1.4% of those patients received #assistance. Nor is there any suggestion in the spin room that charity care increased 24%. In fact, charity care percentages are moving COUNTER to 340B expansion. According to the Pioneer Institute, 340B hospital charity care ratios FELL by 46% from 2013 to 2022, with just 2.28% of operating expenses devoted to charity care in 2022. The spin just isn’t convincing. #lifesciences #drugpricing #patientsfirst #medicaldebt #affordability #Medicare #Medicaid #copays #coinsurance #costsharing #insurance

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Wound care folks, I highly recommend reading CMS’ National Coverage Analysis Review (NCAR) document (8/7/2024): https://lnkd.in/ehUWRJfa . The “Methodological Principles” section offers valuable insights into evidence synthesis for coverage decisions. That said, I must take exception to the “Precision of Estimates” section, which states: “Precision is typically judged based on the width of the confidence interval and, more importantly, whether that interval encompasses values that suggest no meaningful effect and values that indicate a meaningful effect.” This is problematic for two reasons: 1️⃣ Confidence Intervals don’t provide probabilistic statements about the true parameter. Instead, they reflect long-run properties of repeated sampling. This is a statement about the data, not the parameter (or population treatment effect). This is a subtle but very important distinction. 2️⃣ Credible intervals (Bayesian) directly quantify the probability of a parameter (or population treatment effect) lying within a range, while Confidence Intervals (frequentist) do not. It’s fascinating—and concerning—that the National Coverage Review relies on Bayesian ideas while using frequentist terminology. This implicit and incompatible blending of frameworks can cause confusion and lead to inappropriate conclusions in wound care, especially with coverage implications like the CAMPS/Skin Sub LCD’s. Open Wound Research

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The newly updated Parent and Caregiver Handbook for Sickle Cell is a comprehensive 160-page guide that was refined based on feedback from community organizations through focus groups conducted across various states. This resource is the product of collaboration between UCSF Benioff Children's Hospital Oakland Sickle Cell Center, the California Department of Health's Genetic Disease Screening Program and the Sickle Cell Disease Foundation. Learn more: https://buff.ly/3ZZNbtN

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Washington State Authority Health Care Authority Publishes Draft Findings Providing Coverage for Spinal Cord Stimulation As some of you may know, Washington State Authority Health Care Authority has been considering coverage for spinal cord stimulation. Other states will be doing the same. ASIPP has been working on this for quite some time, along with multiple other organizations. Dr. Amol Soin and Dr. Chris Gharibo were intimately involved. Dr. Gharibo testified on our behalf in front of the Commission. Dr. Soin wrote the public comments. Overall, Washington State Authority Health Care Authority changed its policy, and the draft policy shows they are going to cover spinal cord stimulation for post lumbar laminectomy syndrome, non-surgical low back pain, and painful diabetic peripheral neuropathy, but not for complex regional pain syndrome. Overall, this is very good, but we will have to overcome multiple limitations included in this, such as each patient undergoing the completion of a comprehensive cognitive behavioral therapy, chiropractic, or acupuncture, which seems to be impractical or extremely difficult to achieve. We are working on these issues, as well as with other organizations. ASIPP congratulates all those involved in this great cause, which is largely moving in a positive manner. This is a big step forward considering that it was not covered at all. Please find the Spinal Cord Stimulation DRAFT findings and decision: https://lnkd.in/eCRR-bm8

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What’s new from Comagine Health? Comagine Health Clinical Director Evan Saulino was part of an Oregon Health Forum panel on challenges to primary care in August. Dr. Saulino spoke about some of the issues contributing to an insufficient primary care workforce pipeline — burnout, the burden of administrative tasks and lower reimbursement rates compared to other specialties. Read more at https://lnkd.in/es9kudR8. ***** Congratulations to Cindi McElhaney, manager of analytics measurement and reporting at Comagine Health, who has been appointed to a three-year position on the Partnership for Quality Measurement (PQM)’s Endorsement and Maintenance Committee. The Endorsement and Maintenance Committee ensures measures submitted for endorsement are evidence-based, scientifically sound, safe and effective. As a committee member, Cindi will review clinical quality and cost/resource use measures and provide feedback on measures under review. To learn more about the committee, visit https://p4qm.org/EM. ***** For long-term and post-acute care centers, emergency preparedness is critical to ensuring resident safety. Comagine Health’s series on emergency preparedness plans is here to help your facility tackle key issues. o  Seven Broad Topic Areas to Review: https://lnkd.in/gsNGap3V o  Navigating the Critical Role of Staffing: https://lnkd.in/gmkXJGiG o  Ensuring Safe Passage for Residents: https://lnkd.in/gVwE9vx7 o  Safeguarding Health: The Imperative of Infection Control in Emergency Preparedness: https://lnkd.in/gEXBr2fj

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Dr. Jeff Patton, MD and Dr. Debra Patt, MD PhD MBA recently sat down with OncLive to discuss some of the lesser known elements of the Inflation Reduction Act's second cycle of Medicare Drug Pricing Negotiations. The Community Oncology Alliance has recently raised these issues to Centers for Medicare & Medicaid Services' draft guidance. Dr. Patton: “Like most government programs, it’s complicated, way too complicated. Anything that’s complicated creates a burden on clinics to implement, so there’s going to be an execution burden on practices." "Implementing the policy and tracking whether the community clinic has received the MFP-based reimbursement now will be necessary with the prospective model," Dr. Patton noted. “The IRA implementation policies are complicated, burdensome, and financially unattractive for community practices." Click below to read the entire story. https://lnkd.in/eBddAF7a

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States now have opportunities to improve Medicaid coverage for incarcerated individuals, offering pre-release services & expanding eligibility. This article dissects CMS recommendations, proposing strategies for improved community connection & health care. https://ja.ma/45s4A0x

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During the most recent American Society For Metabolic And Bariatric Surgery (ASMBS) in San Diego, we learned that recurring issues reported in surgical practices were diet and vitamin nonadherence, increased depression and suicidality, increased alcohol use, return of old eating behaviors and lack of support. This symptomatology is particularly prevalent in patients more than 1 year postop and closer to 2 years. The consistent message from surgeons and bariatric coordinators was frustration and lack of resources to refer patients to "get back on track" and maintain motivation to sustain a healthier lifestyle required for long-term success with metabolic & bariatric surgery. In response to this need, PsyMed Health is offering POWER, a Post-Operative Wellness Evaluation & Resources. This post-op assessment evaluates each patient's behavioral and nutritional habits, coping styles and maladaptive behaviors contributing to weight regain and plateaus (emotionally and weight/ food related). Additionally, we will assess each patient's communication style and self-image to better equip them with appropriate tools and understanding their approach to behavior change. Once assessed, patients are presented with comprehensive supportive and corrective options. We look forward to giving the patients their POWER back to living a long, healthy life after bariatric surgery.  💪 #bariatricsurgery #obesity #medicalweightloss #metabolicsurgery

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Are you interested in learning how to use current and best evidence to guide healthcare decisions at your organization? The Evidence-based Practice (EBP) Consulting team at Memorial Sloan Kettering Cancer Center (MSK) provides guidance to organizations around improving patient outcomes and aligning clinical decision-making with institutional values. Learn how to get involved:: https://bit.ly/40oqvV7

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