How States Stop Medicaid Innovation

How States Stop Medicaid Innovation

Large health systems are investing a lot of money to provide more services at home, ranging from post-operative care to the treatment of chronic illnesses.

Monitoring patients’ vital signs at home promises to reduce emergency room visits and better manage costly chronic conditions.

But state Medicaid offices stay an obstacle to scaling up them at the national level.

Medicaid programs in 19 states do not reimburse remote patient monitoring, according to data from the Center for Connected Health Policy. Several states that pay for remote monitoring have strict restrictions on its use.

Medicaid’s skepticism about paying for experiments with no immediate payback could mean missed savings down the road.

Where remote monitoring works:

  • Kaiser Permanente found this 90% of his patients using remote monitoring could get their Gestational diabetes under control within eight weeks.
  • Ochsner Health found that half of patients with high blood pressure have their disease under control when equipped with a blood pressure cuff or glucometer, a mobile health app to log their data, and a care team to keep them on track – 23% better than care usual.
  • The VA reported that patients enrolled in its remote patient monitoring programs saw a 53% decrease in “bed days” and a 33% reduction in hospital admissions.

That didn’t sell state Medicaid offices on the value of trying new things.

Dean Schillinger, a chronic disease management expert at the University of California, San Francisco, recalled a remote monitoring program done in conjunction with a Medicaid health plan.

It improved patients’ quality of life at a reasonable cost, but did not generate immediate savings.

“The health plan did not pursue this project,” he said.

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Today on our Pulse check podcast, Daniel Payne talks to Alice Miranda Ollstein about why the overwhelming majority of rural hospitals are rejecting a plan passed by Congress to stop hospital closings. Plus, Katherine Ellen Foley breaks down the latest Centers for Disease Control and Prevention report on monkeypox.

Text messaging can save lives: Sending automated text messages to patients to check on them after they leave hospital can reduce their chances of readmission or emergency room visit, a new study has found.

The study in Open JAMA Network reports that patients who received text messages from their primary care practice after hospitalization were 41% less likely to return within the next month.

How it works ?

  • Patients found the texts engaging. More than four out of five replied to at least one message.
  • If a patient said something was wrong, another message asked for details. This prompted a follow-up phone call.

Researcher Eric Bressman, a member of the National Clinician Scholars Program at the University of Pennsylvania, said future impulse the texts may have caused patients to alert their physicians earlier to their health concerns.

And by intervening more quickly, doctors could catch problems before they get worse.

What are the barriers to this work in the real world?

Bressman said it comes down to three things:

  1. Patient access to mobile phones and an unlimited messaging plan
  2. Healthcare systems with the ability to create and implement an automated texting program that integrates with their electronic medical records
  3. Health Care Provider Adherence

Finally, Bressman says the way we pay for health care may need to change.

“With all these advances in digital health, digital medicine, virtual care, there’s probably going to be a need to rethink how we encourage these interactions,” he said.

A new infectious disease is spreading in two countries in South America, killing many children and leaving others paralyzed. With very little information, political leaders must decide to close schools and ban travel.

Play the next pandemic: This was the fictional scenario that health officials from the United States, Angola, Germany, India, Liberia, Nigeria, Rwanda, Senegal, and Singapore grappled with. Brussels this week.

Officials found that although they had just come through the Covid-19 pandemic, they still disagreed on what to do, said Tom Inglesby, director of the Johns Hopkins Center for Health Security. at the Bloomberg School of Public Health. future impulse.

Inglesby organized the exercise with the Bill & Melinda Gates Foundation and the World Health Organization.

Lessons learned:

  • Many questions raised about the Covid-19 pandemic, and the response to it, remain unanswered.
  • The next pandemic could be different from Covid, threatening people in different ways and requiring different responses.
  • The public and the media will always question decisions made by officials.

“There is no forgiveness” said Mike Ryan, head of the WHO’s health emergencies programme, to a panel during exercise. “I’ve seen it over and over again: reasonable decisions made on the basis of uncertainty are then thrown back into the wringer six months later and politicians pay the price.”

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