Value-based focused global population health management.

In 2018, approximately 18 million people worldwide were diagnosed with cancer and are predicted to double by 2040. The global quality chasm in improving health care worldwide requires "systems thinking" as the key to success. Aligning the goal around person-centered care captures the total needs of care of a population and not just disease categories. The integration of the Institute of Medicine's (IOM) six aims of quality termed "value-based focused" and population health management (PHM) provides all health care leaders grappling with improving the health care of the populations a framework for the communities they serve. In this context, the question becomes finding solutions to providing high quality, compassionate and patient-centered health care delivery. Over the last two decades, three paradigms have emerged; the six aims of quality, outcome-focused population health, and the "Quadruple Aim". We have termed the intersection of these concepts as Value-based focused Population Health Management (VBPHM). This review applies VBPHM across the geographic county and community levels in the United States. Specifically, we examine VBPHM at the county or county-equivalents and community levels within the United States. Lastly, the potential role of Community-based Participatory Research and it is applicability to our framework is discussed. VBPHM can comparably be applied globally to improve population health, especially in preventing and treating cancer better.

The conceptual relevance of assessment measures in patients with mild/mild-moderate Alzheimer's disease.

INTRODUCTION: This study aims to evaluate the conceptual relevance of four measures of disease activity in patients with mild/mild-moderate Alzheimer's disease (AD): (1) the Alzheimer's Disease Assessment Scale-Cognitive Subscale; (2) the Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory; (3) the Neuropsychiatry Inventory; and (4) the Dependence Scale. METHODS: A conceptual model depicting patient experience of mild AD was developed via literature review; concepts were compared with the items of the four measures. Relevance of the concepts included in the four measures was evaluated by patients with mild AD in a survey and follow-up interviews. RESULTS: The four measures assessed few of the symptoms/impacts of mild AD identified within the literature. Measured items addressing emotional impacts were deemed most relevant by participants but were included in the measures only superficially. DISCUSSION: The four assessment measures do not appear to capture the concepts most relevant to/important to patients with mild/mild-moderate AD.

Population Health Service Organizations: Managed Care Gets a New 4-Wheel Drive Vehicle To Navigate the Value-based Terrain.

Population health service organizations (PHSOs) are supplanting management service organizations that gained popularity in the '90s. PHSOs are emerging as the organizations within health systems that can improve the clinical and financial outcomes of the populations the health systems serve.

Telemedicine Seems To Work But Payment Creates a Disconnect.

The cost savings go to payers, but providers often wind up footing the bill. Value-based care could solve the problem.

Can Managed Care Manage Polypharmacy?

Polypharmacy has come to mean the inappropriate use of multiple medications. Polypharmacy can occur as a result of a range of situations, including the excessive application of clinical guidelines, lack of coordination among multiple prescribers, treating adverse drug events, misaligned medications across transitions of care, patient self-treatment, and inappropriate overtreatment. Polypharmacy is a problem because the benefits of a specific medication at the dose and frequency that an individual patient is taking are often outweighed by the costs. These costs can be financial; however, they may place a greater burden when they lead to unrealized benefits or adverse clinical effects.

Prevalence and Description of Palliative Care in US Nursing Homes: A Descriptive Study.

OBJECTIVE: To describe rates and policies in U.S. Nursing Homes (NH) related to palliative care, comfort care, and hospice care based on a nationwide survey of directors of nursing. MEASUREMENTS: A national survey was distributed online and was completed by 316 directors of nursing of NHs (11% response rate). The directors of nursing were asked about availability and policies in their facilities. Specifically, questions were related to policies, referral patterns, discussion about such care, and types of medical conditions qualifying for such services. RESULTS: Hospice is significantly more available than palliative or comfort care programs; also, for-profit facilities, compared to non-profits, are significantly more likely to have palliative care programs and medical directors for palliative care. Social workers and nurses were most likely to suggest palliative type programs. Only 42% of facilities with palliative program provide consultation by a palliative certified physician. Residents with non-healing pressure ulcers, frequent hospitalizations, or severe/uncontrolled pain or non-pain symptoms were less likely to be referred. CONCLUSIONS: There is limited availability of palliative type programs in NH facilities and underutilization in those NH with programs.

Why Different Health Systems Treat The Same Kind of Patient Differently.

ACOs may be the answer to striking the right balance between utilization and clinical outcomes, but separate Part D coverage throws a wrench into the works.