Today! 12-1 pm PT! @UCSF_IHPS faculty presenting at the PHDI seminar: Make CMS Medicare Data Work for You! Julia Adler-Milstein (@j_r_a_m ) Taressa Fraze (@frazetk) Ulrike Muench (@ullimuench) Elan Guterman & Lauren Hunt (@laurenhuntRN ) https://t.co/VUMfOgWpLJ
Excited to see our paper in @AnnFamMed! We interviewed health care orgs to explore their use of case management to improve patients’ social needs. Some key findings… (1/6) @LBBeidler @CarolineFichte1 @SIREN_UCSF@UCSF_IHPS
Healthcare orgs interviewed in new pub by @frazetk, et al describe four main challenges to address patient social needs:
➡️ Effective community outreach
➡️ Clinical staff buy-in
➡️ Incorporating patient perspectives
➡️ Program sustainability
https://t.co/IjCO6GaO4O
Who is in the driver’s seat?
By not using patients as experts, health care organizations may miss out on useful and impactful knowledge that could make efforts more effective. (5/6)
Care managers developed and maintained care plans. Clinicians were less involved. At some ACOs, clinicians didn't have access to care plans. What should be the role of clinicians in defining patient care plans and goals?? Good question... (5/5)
Excited to see our latest paper out in JGIM on how ACOs implement care plans for patients with complex health needs. Care plans are an evidence-based tool that can improve outcomes while engaging patients. Main findings... @LBBeidler@ADMBriggs@CHColla (1/5)
ACO use of care plans for patients with complex health needs does not align with prescribed best practices: ACOs adapt use of care plans to better fit the needs of patients and providers. @frazetk https://t.co/tkyBabNWdE
Care plans: A tool for who...? Some ACOs used care plans as a collaborative tool to help patients take ownership of their health goals. Others used care plans to organize information about the patient for providers, which may fail to prioritize goals important to patients. (4/5)
New research shows incentives in today’s value-based payment models do not appear sufficient to encourage primary care practices to initiate screening for health-related social needs https://t.co/kWpR4HMnBr CC @CPR4healthcare@HealthPolicyHub@frazetk@lauragotmd@valeriealewis
@MonicaOReillyJ1@JoanneSpetz@UCSF_IHPS Visit patterns were similar whether a beneficiary was cared for by an NP who was in a primary care or a specialty practice (6 visits vs. 6.5 visits)
Hospital utilization (adjusted for patient characteristics) was similar according to specialty or PCP setting.
@MonicaOReillyJ1@JoanneSpetz@UCSF_IHPS We found that after reassigning NPs to a specialty practice or a PC practice, we observed similar patterns regardless of the setting (NPs see complex patients as much as their physician counterparts).
@MonicaOReillyJ1@JoanneSpetz@UCSF_IHPS For example, in specialty practices, 6.5% of beneficiaries cared for by nurse practitioners had 6+ HCCs compared with 4.95% for physicians (5.42% versus 4.21% in primary care practices).