In The News

Feedback on New Direction Request for Information (RFI) Released, CMS Innovation Center’s Market-Driven Reforms to Focus on Patient-Centered Care

Today, the Centers for Medicare & Medicaid Services (CMS) announced that it has released the comments submitted by patients, clinicians, innovators, and others in response to the CMS Innovation Center’s New Direction Request for Information (RFI). Last fall, CMS released the RFI to collect ideas on a new direction for the agency’s Innovation Center to promote patient-centered care and test market driven reforms that: empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes. The Innovation Center is a central focus of the Administration’s efforts to accelerate the move from a healthcare system that pays for volume to one that pays for value and encourages provider innovation.

CMS received over 1,000 responses to the RFI from a wide variety of individuals and organizations located across the country, including medical societies and associations, health systems, physician groups, and private businesses. Since the RFI comment period closed last November, CMS has been reviewing the responses, which provided valuable insight on the potential to improve existing models as well as ideas for transformative new models that aim to empower patients with more choices and better health outcomes.

“HHS has made shifting our healthcare system to one that pays for value one of our top four department priorities,” said HHS Secretary Alex Azar. “Using bold, innovative models in Medicare and Medicaid is a key piece of this effort. We value stakeholder input on the new direction for the Innovation Center, and look forward to engaging on especially promising, groundbreaking ideas such as direct provider contracting.”

“We recognize that the best ideas don’t come from Washington, so it’s important that we hear from the front lines of our healthcare system about how we can improve care” said CMS Administrator Seema Verma. “The responses from this RFI will help inform and drive our initiatives to transform the health care delivery system with the goal of improving quality of care while reducing unnecessary cost.”

The responses focused on a number of areas that are critical to enhancing quality of care for beneficiaries and decreasing unnecessary cost, such as increased physician accountability for patient outcomes, improved patient choice and transparency, realigned incentives for the benefit of the patient, and a focus on chronically ill patients. In addition to the themes that emerged around the RFI’s guiding principles and eight model focus areas, the comments received in response to the RFI also reflected broad support for reducing burdensome requirements and unnecessary regulations.

CMS is sharing the feedback received to promote transparency and facilitate further discussion of how to move the Innovation Center in a new direction. The RFI was a critical step in the model design process to ensure public input was available to help shape new models. Over the coming year, CMS will use the feedback as it works to develop new models, focusing on the eight focus areas outlined in the RFI.

Today, CMS is also taking a next step to develop a potential model in the area of direct provider contracting, informed in part by the RFI. A direct provider contract model would allow providers to take further accountability for the cost and quality of a designated population in order to drive better beneficiary outcomes. Such a model would have the potential to enhance the doctor-patient relationship by eliminating administrative burden for clinicians and providing increased flexibility to provide the high-quality care that is most appropriate for their patients, thus improving quality while reducing expenditures.

As part of its process to gain further insight from the public in this area and ask more focused questions, CMS is issuing a follow up RFI. The information being requested is detailed in nature and is intended to provide CMS the data needed to potentially design and release a model in this area. CMS is excited to continue to evaluate the concept of direct provider contracting and is also focusing its attention on other areas guided by input and feedback from the New Direction RFI as well as the public.

The public comments that were received by the CMS Innovation Center in response to the New Direction RFI are available at: https://innovation.cms.gov/initiatives/direction.

The Direct Provider Contracting RFI is available at: https://innovation.cms.gov/initiatives/direct-provider-contracting/

The U.S. Public Health Service Commissioned Corps: Fighting the Opioid Crisis Before and After Hours

Summary: U.S. Surgeon General Jerome M. Adams and Commissioned Corps officers visit the opioids memorial on the Ellipse and discuss how they can fight the opioid crisis.

Officers of the U.S. Public Health Service Commissioned Corps take on many different jobs across the federal government, including foreign deployments that deal with life-threatening conditions. But at the end of the day, many of them continue to serve on their own time. Increasingly, they are finding a role to play in fighting the opioid crisis in the communities where they live.

Cmdr. Leo Angelo Gumapas, an engineer working on water systems, and Lt. Cmdr. John Pesce, managing a portfolio of research grants at NIH related to parasite infection, have been spending their off duty hours educating the public about the dangers of opioids and connecting individuals with resources to help prevent addiction.

Read More

AHRQ’s EvidenceNOW – Advancing Heart Health in Primary Care

[ Full article ]

NQF Leads a National Discussion about Opioid Stewardship

March 29, 2018

Nearly 600 members of the public joined NQF’s National Quality Partners™ (NQP™) Opioid Stewardship Action Team for a March 29 national discussion about how healthcare organizations, clinicians, pharmacists, and patients can support safe and effective pain management strategies, including appropriate prescribing of opioids.

At the heart of the discussion was the recently launched NQP Playbook™: Opioid Stewardship, which offers practical strategies, identifies barriers and solutions, and provides tools and resources for implementing or strengthening existing opioid stewardship programs across the country. Here are some of the discussion highlights:

“We’re quite excited about the NQP Playbook and the applicability to many different organizations at different stages of development in their own work on opioid stewardship,” said Paul Conlon, PharmD, JD, senior vice president, chief quality and patient safety, Trinity Health, and co-chair of the NQP Opioid Stewardship Action Team.

“Nine surgeries, nine times I was prescribed opioids for pain medicine, and nine times I wasn’t really given an option of other pain management suggestions,” said Joan Maxwell, patient partner and NQP Opioid Stewardship Action Team member representing Patient and Family Centered Care Partners, Inc.

“We got here as a nation in an attempt to solve a problem, which was our failure…to effectively manage pain,” said Alice Bell, PT, DPT, senior payment specialist, American Physical Therapy Association and NQP Opioid Stewardship Action Team member. She later added, “There is a role for opioids in pain management. This is not an all-or-nothing phenomenon.”

Join NQF’s national discussion to improve pain management for patients! Download your copy of the NQP Playbook from the NQF Store. Register today for NQF’s May 1 fully-accredited workshop, "Driving Patient Safety and Quality through Opioid Stewardship" to gain the frontline resources and strategies you need to improve opioid stewardship, pain management practices, and patient outcomes at your organization.

Secretary Azar Announces Appointments to Advance Department Priorities

On Thursday, HHS Secretary Alex Azar announced the appointment of two individuals to lead initiatives in areas he has identified as priorities for the Department. Secretary Azar has previously identified four initiatives for his transformation agenda: combating the opioid crisis; bringing down the high cost of prescription drugs; addressing the cost and availability of health insurance; and transforming our healthcare system to a value-based system. The individuals who will be taking key roles on opioids and prescription drug pricing are:

  • Daniel M. Best will be Senior Advisor to the Secretary for Drug Pricing Reform. Mr. Best will lead the initiative to lower the high price of prescription drugs.
  • Brett Giroir, M.D., will, in addition to his duties as Assistant Secretary for Health, serve as Senior Advisor to the Secretary for Mental Health and Opioid Policy. Dr. Giroir will be responsible for coordinating HHS’s efforts across the Administration to fight America’s opioid crisis.

“Under President Trump, HHS has an historic opportunity to confront a number of America’s pressing health challenges, including the high price of prescription drugs and our country’s opioid crisis,” said Secretary Azar. “These leaders will play a unique role at HHS in driving coordination and results on these vital issues.”

“Daniel Best recognizes what President Trump and I, and every American know: prescription drug prices are too high. He has the deep experience necessary to design and enact reforms to lower the price of medicines that help Americans live healthier and longer lives.

“Brett Giroir, our Assistant Secretary for Health, will use his exceptional talents to tackle our country’s crisis of opioid addiction and overdose. His experience coordinating major projects within the federal government will bring new focus to our efforts on this issue.

“These two leaders will be invaluable to HHS and will advance the good work already being done at the Department serve the American people.”

Leaders for healthcare payment reform and value-based transformation of the healthcare system, will be announced in the coming weeks.

Biographical Background

Daniel M. Best, Senior Advisor to the Secretary for Drug Pricing Reform

A highly accomplished, top-performing healthcare industry executive, Daniel Best is an expert on both the pharmaceutical landscape and the largest single payer for prescription drugs, the Medicare Part D program. Best recently served as the Corporate Vice President of Industry Relations for CVSHealth’s Medicare Part D business. This included the company’s prescription drug plans, Medicare Part D plans, and other clients, which together provide prescription drug coverage for millions of Americans. Prior to working at CVS, Best spent 12 years at Pfizer Pharmaceuticals.

Assistant Secretary for Health Brett Giroir, M.D., Senior Advisor to the Secretary for Mental Health and Opioid Policy

Dr. Brett Giroir is HHS’s Assistant Secretary for Health, a role he will continue. He is a four-star admiral in the U.S. Public Health Service Commissioned Corps. Dr. Giroir is the former Director of the Defense Science Office at the Defense Advanced Research Projects Agency (DARPA), and has spent his career leading major projects for academic institutions and the U.S. Departments of Defense, Health and Human Services, and Veterans Affairs. He has been recognized for his novel approach to using biomedical advancements that have accelerated the development and manufacturing of vaccines and other treatments for pandemic influenza and emerging infectious diseases.

Geographic Variations in Arthritis Prevalence, Health-Related Characteristics, and Management — United States, 2015

Kamil E. Barbour, PhD1; Susan Moss, MS2; Janet B. Croft, PhD1; Charles G. Helmick, MD1; Kristina A. Theis, PhD1; Teresa J. Brady, PhD1; Louise B. Murphy, PhD1; Jennifer M. Hootman, PhD1; Kurt J. Greenlund, PhD1; Hua Lu, MS1; Yan Wang, PhD1

Abstract

Problem/Condition: Doctor-diagnosed arthritis is a common chronic condition affecting an estimated 23% (54 million) of adults in the United States, greatly influencing quality of life and costing approximately $300 billion annually. The geographic variations in arthritis prevalence, health-related characteristics, and management among states and territories are unknown. Therefore, public health professionals need to understand arthritis in their areas to target dissemination of evidence-based interventions that reduce arthritis morbidity.

Reporting Period: 2015.

Description of System: The Behavioral Risk Factor Surveillance System is an annual, random-digit–dialed landline and cellular telephone survey of noninstitutionalized adults aged ?18 years residing in the United States. Self-reported data are collected from the 50 states, the District of Columbia, Guam, and Puerto Rico. Unadjusted and age-standardized prevalences of arthritis, arthritis health-related characteristics, and arthritis management were calculated. County-level estimates were calculated using a validated statistical modeling method.

Results: In 2015, in the 50 states and the District of Columbia, median age-standardized prevalence of arthritis was 23.0% (range: 17.2%–33.6%). Modeled prevalence of arthritis varied considerably by county (range: 11.2%–42.7%). In 13 states that administered the arthritis management module, among adults with arthritis, the age-standardized median percentage of participation in a self-management education course was 14.5% (range: 9.1%–19.0%), being told by a health care provider to engage in physical activity or exercise was 58.5% (range: 52.3%–61.9%), and being told to lose weight to manage arthritis symptoms (if overweight or obese) was 44.5% (range: 35.1%–53.2%). Respondents with arthritis who lived in the quartile of states with the highest prevalences of arthritis had the highest percentages of negative health-related characteristics (i.e., arthritis-attributable activity limitations, arthritis-attributable severe joint pain, and arthritis-attributable social participation restriction; ?14 physically unhealthy days during the past 30 days; ?14 mentally unhealthy days during the past 30 days; obesity; and leisure-time physical inactivity) and the lowest percentage of leisure-time walking.

Interpretation: The prevalence, health-related characteristics, and management of arthritis varied substantially across states. The modeled prevalence of arthritis varied considerably by county.

Public Health Action: The findings highlight notable geographic variability in prevalence, health-related characteristics, and management of arthritis. Targeted use of evidence-based interventions that focus on physical activity and self-management education can reduce pain and improve function and quality of life for adults with arthritis and thus might reduce these geographic disparities.

[ Full article ]

Exploring individual biological, environmental, and behavioral factors that affect health and disease

Dear Presley Pride,
You recently read about the All of Us Research Program, an ambitious initiative by the National Institutes of Health (NIH) that is exploring individual biological, environmental, and behavioral factors affecting health and disease. This email highlights why it is important for you and your practice to be a part of this historic research program.

Contributing to individualized disease prevention, treatment, and care

The All of Us Research Program, a key component of the federal government's Precision Medicine Initiative, has begun enrolling a diverse population of participants and is rapidly building a large network of partner organizations.

Precision medicine gives clinicians tools to better understand the complex mechanisms underlying a person's health, disease, or condition, and to better predict which treatments and prevention strategies will be most effective. Data and information from participants in All of Us are expected to help accelerate health research and medical breakthroughs, and thus facilitate individualized disease prevention, treatment, and care for everyone.

Find out how you can become a part of the All of Us Research Program »

Advancing health care in a variety of ways

The All of Us Research Program is expected to contribute to advances in health care in a variety of ways, such as identification of the causes of individual variation in response to commonly used therapeutics, and discovery of biological markers that signal increased or decreased risk of developing common diseases.

The program is currently collecting a limited set of standardized patient data from different sources. However, the types of data collected by All of Us will grow and evolve over time.

Sources of data currently being collected by All of Us

  • Participant questionnaires
  • Electronic health records
  • Physical measurements
  • Biosamples (blood and urine samples)
  • Mobile/wearable technologies
  • Geospatial/environmental data

'Arming' patients with wearable devices

One particularly exciting aspect of All of Us is the generation of data from wearable devices that will make it possible to explore the relationship between everyday activities and health outcomes.

Scripps Translational Science Institute (STSI), a part of the Scripps Research Institute in San Diego, is responsible for designing and implementing strategies to keep diverse populations of participants engaged over the long term. Commenting on the importance of gathering individual data from wearable devices, Steven Steinhubl, MD, Director of Digital Medicine at STSI, said that the program will provide "access to comprehensive activity, heart rate, and sleep data that may help us better understand the relationship between lifestyle behaviors and health outcomes and what that means for patients on an individualized basis."

Learn more about how data from patients' wearable devices can
play an important role in advancing health care »

AHRQ Portal Combines Opioid Prevention, Training and Treatment Resources

AHRQ’s Academy for Integrating Behavioral Health and Primary Care now offers an updated online list of resources and tools to promote integrating behavioral health with primary care. Medication-assisted treatment (MAT) for opioid use disorder (OUD) tools and resources are available to help patients, providers and community organizations battle the opioid epidemic. The Opioid & Substance Use Resources page includes information and tools from Federal sources, health professional societies, academic institutions and researchers. Another feature, the Literature Collection, provides access to the growing inventory evidence on the integration of behavioral health and primary care. The online Academy Community allows individuals and practices working to implement MAT to collaborate and share insights with peers.

NIH program to accelerate therapies for arthritis, lupus releases first datasets

Collaborative effort provides important clues about potential research targets.

[ Full article ]