The answer to America’s health care cost problem might be in Maryland

Maryland is the site of two big experiments in containing health care costs. The first: Since the 1970s, the state has set the prices hospitals can charge for medical care, known as all-payer rate setting.

The second experiment: Since 2014, it’s also capped how much health spending can grow overall, including how much revenue each hospital can take in.

The full Vox article can be viewed at this link.  

Translational research: turning research into advocacy

The social determinants of health are increasingly being recognized within the trauma community. These determinants are major drivers of health and have a huge impact on access to surgery and surgical disparities. As trauma surgeons, we continue to struggle with optimizing care for our patients with many social needs and struggle with trauma as a chronic disease. As we are now using public health approaches to combat complex issues such as gun violence, it is ideal to view our work in a wider context which includes addressing the root causes of trauma and advocating for our patients and our communities. In addition, we need to teach and mentor this broader approach for our students and residents.

The full opinion article can be downloaded below.  

LiveWell RERC State of the Science Conference Report on ICT Access to Support Community Living, Health and Function for People with Disabilities

This article summarizes the proceedings of the three session State of the Science (SOS) Conference that was conducted by the Rehabilitation Engineering Research Center for Community Living, Health and Function (LiveWell RERC) in June 2019 in Toronto, Canada. RERCs customarily convene an SOS conference toward the end of their five-year funding cycle in order to assess the current state and identify potential future research, development, and knowledge translation efforts needed to advance their field. The first two sessions focused on the current and future state of information and communication technology (ICT) for mobile health (mHealth) and mobile rehabilitation (mRehab). The third session was a wide-ranging discussion of pressing needs for future research and development in the field. Several “big ideas” resulted from the discussion among participants in the SOS Conference that should inform the structure and operation of future efforts, including: (1) identifying active ingredients of interventions, (2) incorporating effective behavior-change techniques into all interventions, (3) including measures of social determinants of health in evaluation studies, (4) incorporating user-customizable features into technology solutions, and (5) ensuring “discoverability” of research and development outputs by stakeholders via structured and continuous outreach, education and training. Substantive areas of work include gaming and esports, the gamification of interventions for health and fitness, the cultivation of community supports, and continuous outreach and education wherever a person with a disability may live.

The full article can be viewed at this link.  

Nine Experts On The Trends That Changed Healthtech In The Last Decade, And The Innovations To Expect By 2030

As we enter 2020, it seems like a good moment to reflect on how technology has reshaped the way we think about, and deliver, healthcare in the last 10 years, and to look forward to the innovations that might transform our sector in the decade ahead. 

I asked some of my peers to share their views on the biggest developments in digital health during the 2010s, and their predictions for what the 2020s will bring.

The full Forbes article can be viewed at this link.  

Toward a Person-Centred Learning Health System: Understanding Value from the Perspectives of Patients and Caregivers

What matters most to people who use healthcare?  What matters to their caregivers?  How do we use this information to support ongoing quality improvement in the healthcare system?  In this paper, we explore three concepts from the current healthcare discourse, intended to drive health system improvements: person-centred care, value-based healthcare and learning health systems.  We propose that key tenets from each of these concepts should be combined to create a person-centred learning health system (PC-LHS).  We highlight two key points: First, in achieving a PC-LHS, the experiences, priorities and values of patients and their caregivers should be continually collected and fed into data systems to monitor ongoing quality improvement and performance benchmarking.  Second, the information collected in determining value must include important contextual factors-- including the social determinants of health-- as patient health and well-being outcomes will ultimately be shaped by these factors, in addition to health system and disease factors.  In summary, improving value for patients and caregivers, by capturing the things that matter most to them, within their life contexts, needs to be part of the continuous quality improvement cycle that lies at the heart of a learning health system.  

The full article can be downloaded below.  

From Policy Statement to Practice: Integrating Social Needs Screening and Referral Assistance With Community Health Workers in an Urban Academic Health Center

Social and economic factors have been shown to affect health outcomes. In particular, social determinants of health (SDH) are linked to poor health outcomes in children. Research and some professional academies support routine social needs screening during primary care visits. Translating this recommendation into practice remains challenging due to the resources required and dearth of evidence-based research to guide health center level implementation. We describe our experience implementing a novel social needs screening program at an academic pediatric clinic.

The Community Linkage to Care (CLC) pilot program integrates social needs screening and referral support using community health workers (CHWs) as part of routine primary care visits. Our multidisciplinary team performed process mapping, developed workflows, and led ongoing performance improvement activities. We established key elements of the CLC program through an iterative process We conducted social needs screens at 65% of eligible well-child visits from May 2017 to April 2018; 19.7% of screens had one or more positive responses. Childcare (48.8%), housing quality and/or availability (39.9%), and food insecurity (22.8%) were the most frequently reported needs. On average, 76% of providers had their patients screened on more than half of eligible well-child visits.

Our experience suggests that screening for social needs at well-child visits is feasible as part of routine primary care. We attribute progress to leveraging resources, obtaining provider buy-in, and defining program components to sustain activities.

The full article can be downloaded below.  

Social Determinants of Health Among Adults with Diagnosed HIV Infection, 2017

HIV continues to disproportionately affect various populations in the United States. According to the 2017 HIV Surveillance Report, numbers and rates of annual diagnoses of HIV infection decreased from 2012 through 2016 in the United States [1]; however, numbers and rates increased in some populations and remained stable in others. Differences in HIV burden, by sex and race/ethnicity (i.e., blacks/African Americans, Hispanics/Latinos, and whites), have long been highlighted through HIV surveillance data in the United States. Factors other than individual attributes related to sex, race/ethnicity, or behavioral risk factors are likely contributing to the rate disparity, and may be partly explained through a better understanding of the social determinants that affect the health of populations.

The term social determinants of health (SDH) refers to the overlapping social structures and economic systems (e.g., social environment, physical environment, health services, and structural and societal factors) that are responsible for most health inequities [2]. Stratifying public health data by key SDH is useful in monitoring health inequities. Addressing the SDH that adversely affect health outcomes may advance efforts in reducing disparities in HIV diagnosis rates between populations. Addressing SDH also helps to quantify health differences between populations or geographic areas and can provide insight for identifying populations or areas that may benefit from HIV testing, prevention, and treatment initiatives.

The full CDC HIV Surveillance Supplemental Report can be viewed at this link.  

How AI Is Revolutionizing Health Care

The market value of AI in the health care industry is predicted to reach $6.6 billion by 2021. Artificial intelligence is increasingly growing in popularity throughout various industries. Most of us associate AI with things like robots, Alexa and self-driving cars.

But AI is a lot more than that. AI experts see it as a revolutionary technology that could benefit many industries.

The full Forbes article can be viewed at this link.  

Access And Actionability Are Key For Genetic Testing And Precision Medicine

Over the past two decades, the field of medical genomics underwent nothing less than a revolution in terms of both technological advancement and accumulated knowledge. This revolution holds the promise of changing the entire medical practice, and while the industry continues to improve genome sequencing technologies and decrease the price of sequencing a genome, other challenges are lurking that hinder the prospects of this revolution and undermine the efforts of wide-scale integration of genomics into mainstream medicine.

The full Forbes article can be viewed at this link.  

Fewer in U.S. Continue to See Vaccines as Important

Widespread public support for childhood vaccines creates a wall preventing contagious diseases like measles and polio from spreading in the U.S., but a breach in that wall appeared in 2015 and it has not been repaired. A recent Gallup survey finds 84% of Americans saying it is extremely or very important that parents vaccinate their children. That matches Gallup's prior reading in 2015 but is down from 94% in 2001.

The full Gallup article can be viewed at this link.