Difference between revisions of "What Works?"

Revision as of 15:43, 29 March 2018 (view source) Admin (Talk | contribs) (→‎Health Services - What Works?) ← Older edit		Revision as of 15:58, 29 March 2018 (view source) Admin (Talk | contribs) (→‎Digital Health Technology - What Works?) Newer edit →
Line 323:		Line 323:
	==[[Digital Health Technology]] - ''What Works?''==		==[[Digital Health Technology]] - ''What Works?''==
	===[http://www.patientdeterminants.org/index.php?title=E_Intervention_Health_Services#Convenient_Access Convenient Access] - ''What Works?''===		===[http://www.patientdeterminants.org/index.php?title=E_Intervention_Health_Services#Convenient_Access Convenient Access] - ''What Works?''===
		+	Digital Communications <br>
		+	* [http://www.mercurynews.com/2016/11/28/elders-who-use-tech-tools-feel-less-lonely-more-physically-fit-stanford-study-finds/ Use of computers and cell phones is linked to higher levels of mental and physical well-being among those over age 80 (11/28/16)]
		+	* [http://stateofreform.com/wp-content/uploads/2015/12/AJMC_12_2015_Reed-final.pdf Patients with chronic conditions sent secure e-mail messages to their providers as a first method of contacting the healthcare delivery, nearly one-third of respondents reported that e-mailing their healthcare providers had improved their overall health, and more than 1 in 3 reported that e-mailing their provider decreased their phone calls to their providers or their in-person doctor’s office visits. (12/21/15)]
		+	* [http://www.cityam.stfi.re/230372/digital-health-wearables-and-apps-9-in-10-brazilian-doctors-use-whatsapp-to-talk-to-patients?sf=vkrgwp 9 in 10 Brazilian doctors use WhatsApp to talk to patients (12/7/15)]
		+	* [http://www.beckershospitalreview.com/healthcare-blog/the-doctor-will-email-you-now.html Physicians at Kaiser Permanente received approximately 13 million secure emails from patients in one year. (4/9/14)]
		+	* [http://content.healthaffairs.org/content/32/8/1361.abstract Electronic Communication Improves Access, But Barriers To Its Widespread Adoption Remain (8/13)]
		+
		+	Patient Provided Digital Data
		+	* [http://www.bostonglobe.com/lifestyle/health-wellness/2013/07/28/century-house-call/tdupWvOQI6b3dKdKcEgdGM/story.html Partners HealthCare allows patients to upload information from their medical devices into their electronic records in doctors’ offices. (7/29/13)]
		+
		+	Predictive or Diagnosis Devices <br>
		+	* [http://www.mobihealthnews.com/content/study-finds-wearables-may-help-detect-serious-illness Study finds wearables may help detect serious illness (1/12/17)]
		+	* [http://www.healthcareitnews.com/news/va-study-wearables-ai-shows-promise-heart-failure-patients VA study of heart failure patients demonstrated how AI-based personalized physiology analytics could be applied to wearable biosensor data to predict when a patient might be at risk of hospitalization. (3/12/18)]
		+
		+	Smart Phone and Attachments <br>
		+	Technical Help Desk <br>
		+
		+	Text Messaging <br>
		+	* [http://www.mobihealthnews.com/content/study-texting-improve-medication-adherence-shows-high-engagement Study: Texting to improve medication adherence shows high engagement (5/16/17)]
		+	* [http://www.fiercehealthcare.com/practices/using-patient-engagement-strategies-to-increase-colon-cancer-screenings Ochsner Health System used automated text messages to patients’ cell phones. Patients could touch a link to connect to a live person to schedule appointment or answer questions. 578 patients scheduled colon cancer screenings, pre-cancerous polyps found in an estimated 145 patients (11/15/16)]
		+	* [http://www.denverpost.com/2016/10/13/denver-health-text-messages/ Patients who got texts made it to their appointments 73% of the time, compared to a 66% attendance rate for those who didn’t (10/13/16)]
		+	* [http://archinte.jamanetwork.com/article.aspx?articleid=2495276%20 A text-based smoking cessation intervention improve outcomes among young people. (3/2016)]
		+	* [http://archinte.jamanetwork.com/article.aspx?articleid=2484905 Mobile phone text messaging increases medication adherence rates from 50% to 67.8% (3/2016)]
		+	* [http://www.beckershospitalreview.com/healthcare-information-technology/study-patients-who-receive-texts-from-physicians-more-likely-to-exercise.html Study: Patients who receive texts from physicians more likely to exercise (12/14/15)]
		+	* [http://www.ncbi.nlm.nih.gov/pubmed/?term=Feasibility+of+a+Text+Messaging+Intervention+to+Promote+Self-Management+for+Patients+Prescribed+Oral+Anticancer+Agents. Text Messaging Intervention to Promote Self-Management for Patients Prescribed Oral Anticancer Agents. Patients had high satisfaction with the texts, and adherence and symptoms improved after the intervention. (11/2015)]
		+	* [http://jama.jamanetwork.com/article.aspx?articleid=2442937 Text messaging can help improve patient risk factors in patients with coronary heart disease (9/22/15)]
		+	* [http://talkspace.com/online-therapy/wp-content/uploads/2015/06/Talkspace-Preliminary-Research-Study.pdf 90% of those who received text-based Psychotherapy were doing better on average than those who received no treatment 6/2015)]
	==[[E Intervention Support Services]] - ''What Works?''==		==[[E Intervention Support Services]] - ''What Works?''==

---

Revision as of 15:58, 29 March 2018

Everyday we get a new understanding of which interventions work to impact patient health. With most healthcare research, sites and journals primarily dedicated to which Healthcare Interventions work, this page will now duplicate it. This page will begin to catalog the E Interventions, Patient/Caregiver Interventions and Organization Interventions that work. While these are typically not peer reviewed articles, links are provided for people or organizations interested in further evaluating their efficacy and context to managing health.

Care Management Programs - What Works?

Non-Medical Interventions that can improve a patient's health care outcome, overall health and well-being.

Behavioral Health & Primary Care Integration - What Works?

• Montefiore Health System integrated mental health treatment with primary care and used the Valera Health smartphone app and platform to improve treatment of anxiety and depression. (5/24/17)
• Patients who received integrated primary care and behavioral health treatments had fewer emergency department visits, hospital admissions, ambulatory care sensitive visits and primary care physician encounters. (8/23/16)
• UCLA Health combines primary care with behavioral health to reduce emergency room use by 13% for patients in program. (8/16/16)
• NY health system's collaborative care program helps patients battle depression through screening and outreach (5/25/16)
• It costs Intermountain Health’s SelectHealth insurance subsidiary $22 per member per year to embed mental health workers in primary care clinics and processes, and SelectHealth gets an annual return on investment of $115 per member. (4/12/16)

Chronic Care Management - What Works?

• Chronic care management program at Cincinnati Children's Hospital helped care teams improve pediatric outcomes for certain conditions by up to 20 percent. (2/28/17)
• Preventive Care, Specialists Key To Controlling Kidney Failure Treatment Costs (8/22/16)
• 6 best practices for managing hypertension under population health models (5/27/14)
• Improving Continuity of Care for Elderly Patients with Chronic Diseases Cuts Costs and Complications (3/17/14)
• Medicare Coordinated Care Demonstration reduced hospitalizations by 8–33 percent among enrollees who had a high risk of near-term hospitalization. The six approaches were: telephone calls to patients; meeting with providers; acting as a communications hub for providers; delivering education to patients; providing medication management; and comprehensive transitional care after hospitalizations. (6/2012)

Asthma

• Nemours Children’s Health System pilot program to improve asthma outcomes saw a 60% reduction of asthma-related ER visits, a 44% reduction in asthma-related hospital admissions, and more than a $2,100 reduction in annual medical costs per child after three years. (6/16/17)

Dementia Care

• A memory care clinic for older adults suffering from dementia and depression generates an annual net cost savings of up to $2,856 per patient (4/2014)

Patient Reported Outcomes

• Study of Memorial Sloan Kettering Cancer Center cancer patients demonstrated a Patient Reported Outcome (PRO) group had a better quality of life and lived an average of 5.2 months longer than an randomly assigned usual care group. The PRO group self-report 12 common symptoms at and between visits via a web-based PRO questionnaire platform. (6/4/17)

Suicide Prevention

• Zero Suicide, a model for better identification and treatment of patients at risk for suicide. (6/2016)

Episode Management - What Works?

• Taking a population health approach to prenatal care and high-risk pregnancies can cut costs for payers and improve outcomes, AHIP says. (4/26/17)
• How 10 more hospitals upgraded their total joint replacement programs and saved $300k+ (11/4/16)
• BPCI hospitals drove down Medicare payments for lower extremity joint replacement by $1,166 (9/20/16)
• Baptist Health System generate $6.1 million in savings on joint replacement with a bundled payment program that creates incentives for physicians, hospitals, and post-acute care providers to collaborate to drive down costs and improve quality. (8/3/16)
• Illinois hospitals participating in the Hospital Engagement Network (HEN) from January 2012 through March 2014 prevented 15,887 patient harms, with an associated cost savings of $161.8 million. (10/2014)

Navigators

• CHI St. Vincent's readmission rate fell by 90%, due largely to the heightened scrutiny of individual patients' processes of care and needs such as transportation gaps, lack of social support or financial obstacles. (11/25/15)
• Preliminary UAB study shows dramatic trend of cost savings in lay navigation program for cancer patients. (7/7/15)
• 'Patient navigators' reduced readmissions, overuse of ER in pilot program (1/27/15)

Patient Education about Procedures

• Informed patients have better surgical outcomes. Only 36% of patients met the criteria for an informed patient-centered decision. Informed patients were significantly more likely to report being extremely satisfied with their treatment. (3/23/17)

ER Case Management - What Works?

• Presbyterian Healthcare Services patient navigation program screens all emergency department patients, they transfer non-emergency patients to a more appropriate setting, like an urgent care center or primary care facility. Program helped drop ER overuse, improved patient engagement and decreased in treatment or diagnosis delays. (3/21/17)
• Minnesota system flags patients who visited hospital ERs as much as 150 times in a single year and people who routinely hop from one physician to the next searching for prescription painkillers. By limiting these “high use” patients to a single primary care provider, along with a hospital and one pharmacy, the program is saving taxpayers at least $7 million a year in unnecessary medical costs (12/3/16)
• Patient Navigators in the ER helps reduce returns by 55% among the 254 patients that navigators are managing. Navigators help with non-medical problems sucah as housing, food insecurity and lack of transportation. (6/17/16)
• 'Frequent flyer' ER visits drop with coordinated care (7/11/13)

Exercise & Nutrition - What Works?

• A small diabetes prevention program based out of a YMCA in Indianapolis (3/31/16)
• Organized programs help prevent or delay diabetes (7/13/15)
• Participants in a lifestyle intervention of reduced calorie, low-fat diet of conventional foods and 150 min/wk of physical activity (typically brisk walking), with the goal of losing 7% of initial weight. After an average of 2.8 years, participants in the lifestyle intervention lost 5.6 kg in comparison to 0.1 kg in the placebo group. The risk of the lifestyle group developing type 2 diabetes was reduced by 58% in comparison with placebo group. (3/5/12)

Health Coaching - What Works?

Care Goal Setting and Motivational Interviewing

• Monitoring app, health coaching plus low-carb diet reverses diabetes progression by lowering average HbA1c from 7.6% to 6.3% and weight reduction of 12% (2/8/18)
• Johns Hopkins study: coaching app can increase weight loss, activity in prediabetes patients (3/8/18)
• Mobile Phone-Based Health Coaching Intervention for Weight Loss and Blood Pressure Reduction. Participants lost an average of 3.23% total body weight (TBW) at 4 months of coaching. (6/8/17)
• Wellness coaching has a positive impact on BMI reduction that is both statistically and clinically significant. (1/26/17)
• Health coaching is effective for chronic disease self-management in the primary care safety-net setting. Most clinical outcomes improvements persisted 1 year after the completion of the health coaching intervention. (5/2016)
• Diabetics + patient navigators improved blood glucose control by 32% in Cleveland Clinic pilot (3/18/14)
• Health coaching improves the management of chronic diseases. It is an effective patient education method that can be used to motivate and take advantage of a patient's willingness to change their life style and to support the patient's home-based self-care. (5/15/16)
• Health coaching improves the management of chronic diseases (11/2014)

Diabetes Prevention

• YMCA Of The USA Diabetes Prevention Program saved $278 per member per quarter during the first three years of the intervention period. Nine fewer ED visits per 1,000 participants per quarter. (3/2017)

Virtual Programs

• Digital behavioral health coaching program from Omada Health has been shown to reduce overweight and obese seniors' risk of developing type 2 diabetes and heart disease by helping them lose weight and adopt healthier behaviors. (10/13/16)
• 64% of the 43 overweight or obese adult participants, with a diagnosis of prediabetes, people using health coaching app during 24 week program lost more than 5 percent of their weight, which is comparable to the Centers for Disease Control’s findings from traditional diabetes prevention programs. (9/8/16)
• Digital health diabetes program that help people with diabetes self-manage their health through online workshops, coaching, and medication adherence and emotional support showed improvement across five key indicators – blood sugar levels, medication adherence and exercise all improved, hypoglycemic symptoms decreased in frequency, and depression symptoms improved. (8/31/16)
• Ochsner used connected devices, text messages, health coaching and medication management assistance to bring two-thirds of hypertension patients within range (6/22/16)

High Need High Cost - What Works?

• Initiative to reduce avoidable hospitalizations among nursing facility residents reduced per resident average of $60–$2,248 for all-cause hospitalizations and by $98–$577 for potentially avoidable hospitalizations. (3/2017)
• Houston’s Patient Care Intervention Center program has reduce patient costs in program by 83% and hospital visits by 70%. The program developed by the Camden Coalition led by Dr. Jeffrey Brenner uses social workers who seek out high-need-high-cost patients to address social needs such as securing stable housing. (1/23/17)
• Hennepin Health's outreach efforts helps clients find a job or an apartment — the project has shown it can improve patients’ health while saving money and greatly reducing the number of times they turn up at the ER in crisis. (12/30/16)
• A strategy focused on team-based care and listening to “super-users” helped a Florida health system cut hospitalizations of such patients by a quarter while also driving down uninsured admissions (8/24/16)
• Intensive Outpatient Care Program (IOCP), which embeds care coordinators in medical practices. Care coordinators work with high-needs patients in medical practice where patients, emergency room visits declined 59 percent and admissions declined 29 percent. (8/22/16)
• Complex Care Initiative: Building Capacity to Help “Superutilizers” in Underserved Communities. Number of hospitalizations among participants fell by 27% and emergency department visits dropped by 32%. (8/9/16)
• Study compares the operational approaches of 18 successful complex care management programs in order to offer guidance to providers, payers, and policymakers on best practices for complex care management. (8/7/2014)
• 'Intensive care coordination' saves $14M in superuser costs (6/27/16)
• Intensive Outpatient Care Program (IOCP) in commercial populations show a reduction in costs among the medically complex by up to 20 percent. (2/2/16)
• Programs focus on high-risk patients to reduce spending (9/16/14)
• Six Features Of Medicare Coordinated Care Demonstration Programs That Cut Hospital Admissions Of High-Risk Patients (6/2012)

Home Care - What Works?

• Hospital at Home Model: Bringing hospital-level care to the patient results in lower readmissions, better outcomes and lower costs. 92% of patients offered the service took it. It has high patient satisfaction, as patients remained close to their support networks and had less disruption to their lives. (8/22/16)
• A new study finds that front-loaded home care combined with physician office visits shows promise in reducing HF readmissions. (8/11/16)
• Mt. Sinai Hospital's Mobile Acute Care Team (MACT) program delivers hospital-quality home care for patients who are at high risk for readmission. The pilot program cut costs by nearly 20 percent (6/6/16)

Aging in Place

• Senior Alert program resulting in 30% reduction in falls, decline in pressure ulcers from 14.3% to 9.4%, and a decline in the incidence of weight losses greater than 5 percent of total body weight from 14.3% of patients to 12.5%. (9/15/16)
• Aging in place program asks low-income seniors with disabilities how their lives at home could be better. At the end of the program, 75% of participants were able to perform more daily activities than they could before and symptoms of depression also improved. (9/7/16)
• Telehealth program for seniors leads to better outcomes (86.7% reduction in realized versus expected hospitalization rates) and better engagement (94% of patients interact with the technology and report in their vital signs every day, compared to less than 25% percent in a 2014 national survey of patients in telehealth programs). (8/2/16)
• Home-Based Care Program Reduces Disability And Promotes Aging In Place. 75% of participants improved their performance of activities of daily living (ADLs)after completing the five-month program. (9/2016)
• How coordinated care gives patients the freedom to stay at home (7/27/15)
• The Basque region of Spain saved $55 million and eliminated 55,000 visits with a telemedicine program aimed at the elderly. (11/15/13)

Falls Prevention

• In the three years after The LIFT (Living Independently and Falls-free Together) Wellness Program, that included a comprehensive in-home assessment by a registered nurse, participants had a 33% lower incidence of claims for long-term care services and supports (6/2015)

Home-Based Primary Care

• Medicare’s Independence at Home Demonstration saved $3,070 per beneficiary on average in the first year, primarily by reducing hospital use under this shared-savings program (6/7/17)

Home Visits

• Study finds 5 innovative Home Visit models associated with reductions in costs, hospitalizations, and emergency department use (3/2017)
• Home Visits - Children's Hospital of Philadelphia (CHOP) sends home visitors to high-risk asthma patients in inner-city Philadelphia (7/29/13)
• House Calls: California Program For Homebound Patients Reduces Monthly Spending, Delivers Meaningful Care (1/2016)

Medical House Calls

• Medical House Call Program reduced Medicare spending by 20 percent relative to expected spending for that population ($4,060 vs. $5,076) (7/27/16)
• Doctors’ house calls saving Medicare an average of almost $13,600 for each patient in a pilot project. (5/23/16)
• Doctor Treats Homebound Patients, Often Unseen Even By Neighbors (11/8/15)
• Medicare Home Visit Program Associated With Fewer Hospital And Nursing Home Admissions, Increased Office Visits (12/2015)
• House Calls Keep People Out Of Nursing Homes And Save Money (8/7/14)

Medical Home - What Works?

Ensuring followup on referrals and recommended preventive screening completed based on USPSTF recommendations.

• Medical home model improves care, but not costs among safety-net providers (6/27/17)
• Review of Medical Homes Shows Reduction in Spending for High-Risk Patients, But Design and Implementation Matter (3/28/17)
• Health care 'homes' save Minnesota $1 billion (2/9/16)
• A “medical village” of providers and community-based resources for patients with diabetes, asthma, and congestive heart failure reduced ED visits by 29.7% percent and hospitalizations by 28.5% (11/2014)

Care Gaps

• 3 Healthcare systems explain the technology, process and grit they used to close care gaps needed to improve patient care. (11/3/15)

Care Plan Development

• Moving paradigm from determining “what is the matter?” to discovering “what matters to you?” improves health outcomes (9/2014)

Oncology

• Innovative Oncology Care Models Improve End-Of-Life Quality, Reduce Utilization And Spending (3/2017)

Preventive Care

• Comparing 28 recommended preventive services, HealthPartners researchers found that tobacco counseling and pediatric immunizations outranked the others in cost-effectiveness and the potential to save lives. (1/9/17)

Patient Centered Medical Homes (PCMH)

• PCMH programs cut costs and improve quality. Collaboration is the key to their success (7/11/17)
• A study of 11 PCMH initiatives showed little improvement in costs, utilization, or quality. (3/16/17)
• Blue Cross Blue Shield of Michigan's Patient Centered Medical Home (PCMH) program for primary care practices reduced medical costs by $427 million, in part due to lower healthcare utilization. 2016 data show BCBSM-designated PCMH practices had a 15.2% lower rate of adult emergency department visits and 21.4% lower rate of hospital admissions for certain conditions. (9/13/16)
• Study: Patient-centered medical homes reduce ER visits among chronically ill (9/3/14)
• Patient-centered medical homes (PCMH) can cut more than 20% off the treatment cost for a chronically ill patient (7/24/13)

Primary Care Practices

• Patients with high continuity of care were admitted to the hospital 12.49% fewer times than those with low continuity of care (2/2/17)
• Patients who resided in regions with the most primary care involvement accrued roughly $4,000 less in Medicare spending in their last two years of life, spent nearly 1.4 fewer days in the intensive care unit in their last six months of life and were less likely to be enrolled in hospice. (1/9/17)
• Seniors that consistently see the same physician in an outpatient setting are 20% less likely to go to the emergency department (8/25/16)
• Primary Care Physicians deliver 12% lower healthcare costs, 37% lower hospitalization at one site (5/4/2015)
• Increasing family physician comprehensiveness of care is associated with decreasing Medicare costs and hospitalizations. (5/2015)
• Primary Care Physicians deliver 20% lower overall healthcare costs, increase patient satisfaction (1/15/2015)
• How an ACO led by doctors helped cut the cost of care in Texas town (9/24/14)
• Evidence shows that primary care helps prevent illness and death (2005).

Virtual Primary Care

• When Banner Health launched its iCare telemedicine program, patients didn't use it because it required them to replace their primary care physician. Once they changed that rule, very few patients have left the program voluntarily, and Banner Health saw costs per beneficiary drop by 27% while hospitalizations were reduced by 45%. (12/5/16)

Medication Management - What Works?

• Children's Health uses ingestible sensor to improve adherence in adolescent transplant patients (2/22/17)
• Pharmacogenetic testing of polypharmacy home health patients aged 50 and older considerably reduced re-hospitalizations and ED visits at 60 days following enrollment resulting in potential health resource utilization savings and improved healthcare. (2/2/17)
• Walgreens pill reminder, activity tracking both improved medication adherence in study (9/12/16)
• Patients with multiple medical conditions who adhered to their prescription schedules who had diabetes saved $5,341 annually in medical costs; those who had hypertension saved $4,423, while those who had high cholesterol saved $2,081 (8/27/16)
• Interventions to keep chronic illness patients on their meds could save billions (8/23/16)
• The study of 35 patients aged 12-20 with a baseline medication adherence of 42-43%. After 6 months, those with mobile app only increased to 60% and those with the app and reminder calls 85.4% (8/22/16)
• Syncing Up Drug Refills: A Way To Get Patients To Take Their Medicine (8/8/16)

• Study shows that the use of a high-touch pharmacy patient engagement system made patients 2.57 times more likely to stay adherent to their medications. (10/27/15)
• Pennsylvania Pharmacist Project significantly improved adherence for all medication classes, from 4.8% for oral diabetes medications to 3.1% for beta-blockers. It also helped reduce per patient annual health care spending for patients taking statins ($241) and oral diabetes medications ($341). (8/2014)

During Care Transitions

• Hospital readmission decreased 50 percent when pharmacists reviewed patients' medication regimens and provided counseling during transitions from hospital to home (7/15/16)
• Care Transition Program Emphasizes Medication Reconciliation, Reduces Readmissions And Costs. The program saved $2 for every $1 spent. (7/2016)
• Prescription assistance programs lead to drop in ER visits (4/7/16)

Palliative Care - What Works?

• ‘Pre-Hospice’ Saves Money By Keeping People At Home Near The End Of Life (3/27/17)
• Dying patients who received community-based palliative care visited the emergency department half as much in their last year of life, according to a study. (2/22/17)
• Aetna’s Compassionate Care Program resulted in improved member satisfaction, an 81% decrease in inpatient days, and net savings of $12,000 per participating member (7/2016)
• Early palliative care can save money, reduce patient stay in hospital (7/1/15)
• University of Rochester Medical Centers in 2007 found the palliative care intervention saved about 1,400 ICU patient days, at an average of about $450 a day. (8/6/12)

Transitional Care Management - What Works?

• Christiana uses its CareLink CareNow infrastructure to help coordinating care for close to 75,000 Medicare beneficiaries beyond discharge. The system has seen a 30% reduction in 90-day readmission rates. (6/19/17)
• Involving patient's family in discharge process linked to 25% reduction in hospital readmissions (4/4/17)
• Patients who had one or more primary care visits within seven days of being discharged home were 12% to 24% less likely to be readmitted to the hospital than those who did not have an outpatient visit from a clinician. (11/22/16)
• San Diego County program saved Medicare an estimated $13.8 million (reduced hospital readmissions) over a two-year period with a care transition program that sends nurses and social workers into homes to ensure transitions go smoothly, checking medications one by one, making sure they know how to take them, walking through the house looking things that could cause a fall, asking about caregivers to help with bathing and dressing. (9/6/16)
• Hospitals with the lowest readmission rates. Roper St. Francis Healthcare's Care Transitions Program helps elderly patients recognize symptoms of health decline and assists them in managing their medications. University of Colorado Health's Memorial Hospital assigns a case manager to follow up with patients at risk of heart failure, stroke, pneumonia or heart attack. Hospital for Special Surgery in New York City is developing a mobile application that will allow staff to interact with patients remotely post-discharge. (12/5/15)
• Hospital intervention cuts readmissions for patients at risk for delirium, suicide (7/1/15)
• Transitional Care Interventions Prevent Hospital Readmissions For Adults With Chronic Illnesses (9/2014)
• 10 stories, studies on reducing readmissions (8/18/14)
• How Ritz-Carlton helped one hospital reduce readmissions to .74 percent for knee and hip replacements (7/15/14)
• JAMA Studies 18 Activities That Are Preventing 30-Day Hospital Readmissions (7/2014)
• Beth Israel Deaconess lowers readmissions with post-discharge program (4/4/14)
• A study demonstrated high risk patients being discharged from the hospital that receive social work interventions reduce readmission rates to 7% as compared to the 15 percent readmission rate for the control group--patients discharged (7/5/13)
• Three nonprofit hospitals in the Bronx, N.Y. significantly dropped readmission rates thanks to personal contact with patients before and after discharge (6/28/13)
• A collaborative initiative involving 83 hospitals and 93 community partners in Minnesota saw 4,570 fewer avoidable hospital readmissions over 24 months, saving more than $40 million by using comprehensive discharge planning, medication management, patient engagement, transition care support, and transition communications. (5/30/13)
• Hospital Strategies Associated With 30-Day Readmission Rates for Patients With Heart Failure (5/15/13)

Post Surgical Follow-up

• App-based visits seem viable for post-surgical follow-ups (3/23/17)

Health Services - What Works?

Convenient Access - What Works?

24x7 Managing Health Services
Hot Spotters

• Dr. Jeffrey Brenner analyzed data on the locations where ambulances picked up patients with fall injuries, and discovered that a single building in central Camden sent more people to the hospital with serious falls—fifty-seven elderly in two years. One patient had three hundred and twenty-four admissions in five years. The most expensive patient cost insurers $3.5 million. Dr. Brenner secured funding and approvals to begin a Wellness Program at Northgate II tower that housed the high cost high need patients. (1/24/11)

Mental Health Centers

• San Antonio built a crisis center for psychiatric and substance abuse emergencies and a 22-acre campus for the homeless that resembles a community college. To date, more than 100,000 people have been diverted from jail and emergency rooms to treatment, local officials say, resulting in a savings of nearly $100 million over an eight-year period. (12/11/16)
• Mental health crisis center saved $6 million last year by stabilizing people in crisis who otherwise would have ended up in state hospitals, local emergency rooms or jails and prisons. (11/15/16)

Same Day Appointments

• In 2016, Cleveland Clinic had 1.3 million same-day appointments. CEO Toby Cosgrove stated that every patient who calls the Clinic is asked whether he or she would like to see a doctor that same day. 98% of the people who asked to be seen the same day was successful in doing so. (1/10/17)

Digital Health Applications - What Works?

• Multi-component interventions appear to be more effective than stand-alone app interventions to improve diet, physical activity and sedentary behaviours can be effective. (12/7/16)
• Three-minute surveys on mobile device by frontline personnel helped detect clinically relevant alerts for intervention. Medicare beneficiaries with 3 or more admissions in the prior year had 29.2% decrease in inpatient admissions and $28,656 reduction in Medicare A inpatient expenditures per beneficiary per year. (11/18/15)
• Mobile health company offers way to improve interactions with Medicaid patients, care managers by demonstrating a 12% increase in prescription refills, a 40% increase in attending health appointments and a 22% increase in their knowledge of the recommended lifestyle changes for their care plan. (12/5/14)

Activity Trackers

• Activity platform with adaptable, tailored reminders and activity trackers increased employee activity by an average of 970 steps per day compared to control group with just the trackers. (2/9/16)

Cardiac Rehab

• Veterans respond well to home-based cardiac rehab app, VA study shows. 80% retention rate 90 days later. 20% improvement in functional capacity and a reduced systolic blood pressure of 10 mmHg from baseline. Considering low turnout for other cardiac rehab programs, the investigators were impressed with the apps response. (4/6/17)
• Digital health tool helps cardiac rehab patients shed more pounds (3/23/16)
• Mayo Research Shows Cardiac Rehab Patients Who Use Smartphone App Recover Better (3/29/14)

Depression

• To Treat Depression, Try a Digital Therapist. Studies suggest online tools do just as well—if not better—than traditional therapy for some patients (6/23/17)

Diabetes

• Virta Health program to prevent, control or reverse diabetes uses video chat with remote Virta physician who consults with primary care physician, reviews blood tests and medical history and makes diet and drug recommendations. Study of 241 Type 2 diabetics found that 56% lowered their blood sugar to non-diabetic levels in 10 weeks. (4/11/17)
• One Drop Mobile analyzed at least two A1C values in their patient app between two and twelve months apart. The average starting A1C was 8.2 percent, while the average second A1C was 7.2 percent, which represents a one percent reduction. (4/3/17)
• Study of 501 patients had high participation (92%) and high engagement, with patients using app frequently as 19 times per week. Participants lost 7.5% of body weight, improved A1c by 0.14%, and reduced total cholesterol by 7 mg/dL. (4/3/17)
• Online intervention for type II diabetes helped reduce hemoglobin A1c and weight for a small study group (3/15/17)
• Monitoring diabetes is hard, but mobile apps make the process easier (11/22/16)
• Mobile diabetes intervention reduced HbA1c 2 percentage points more than standard of care (1/26/16)

Medication Adherence

• Smart inhaler boosts medication adherence 144 percent in small study (9/30/15)

Parkinson

• NHS study finds mobile app improves management, quality of doctor visits for people with Parkinson's Disease (1/19/17)

Symptom Monitoring

• Study: Real-time electronic symptom reporting helps cancer patients live longer (6/5/17)

Weight Loss

• App-enabled weight loss pilot helped 800 Verizon employees lose weight (3/23/16)
• A study by Omada Health and Humana to evaluate the effectiveness of digital health tools to achieve weight loss among Medicare Advantage members showed an average 8.7 percent reduction in body weight for the 491 participants over a six month period. (11/13/15)

Education - What Works?

• Charleston Area Medical Center was able to reduce readmission rates for Congestive Heart Failure by over 22% and COPD by almost 30% with educational videos to help patients self-manage their health. (2/9/17)
• Choosing Wisely provides decision making education for physicians and patients on over 135 tests and treatments that they say are overused or inappropriate.
• Holistic education led to dramatic improvements for diabetes patients (8/11/14)
• South Carolina initiative cuts readmissions through cooperation, education (7/8/15)

Behavioral

• More than 80 percent of the randomized clinical trials that included a behavioral intervention reported a significant improvement for the targeted behavior and a significant physiological impact such a reduction in weight or blood pressure. (11/10/15)

Self-Administer

• Parkland Health & Hospital System trained over 1,000 patients to self-administer IV antibiotics in their homes. In the first four years of this effort, these patients experienced a 47% lower 30-day hospital-readmission rate than those receiving treatments in an outpatient facility while the mortality rates of both groups were similar. (6/2/17)

Home - What Works?

Home Visits
Housing and Healthcare Integration

• Clinical outcomes of an integrated model of care for frail seniors that bridges housing and healthcare. 50% lower inpatient hospitalization rates, 80% lower readmission rates, 15% lower rate of emergency department use (3/23/17)

Medication Reconciliation
Paramedic Visits

• Only 22% of Paramedic responses required transport; 78% were evaluated and treated in the home. Paramedics were trained to evaluate and, with telemedicine-enhanced physician guidance, treat acute illnesses in individuals’ homes. (8-30-16)

Passive Data Analysis
Passive Data Monitoring

• Sensors let Alzheimer's patients stay at home, safely (10/12/14)

Price Transparency - What Works?

Shared Decision Making - What Works?

• Study: Shared decision-making boosts patient outcomes, leads to higher satisfaction rates (3/15/17)

Special Need Patients - What Works?

• People returning to communities from prison that were referred by correctional partners to an enhanced primary care Transitions Clinic Network (TCN) had fewer acute care visits than people referred later. (6/2017)

Technology - What Works?

Digital Communications

• Use of computers and cell phones is linked to higher levels of mental and physical well-being among those over age 80 (11/28/16)
• Patients with chronic conditions sent secure e-mail messages to their providers as a first method of contacting the healthcare delivery, nearly one-third of respondents reported that e-mailing their healthcare providers had improved their overall health, and more than 1 in 3 reported that e-mailing their provider decreased their phone calls to their providers or their in-person doctor’s office visits. (12/21/15)
• 9 in 10 Brazilian doctors use WhatsApp to talk to patients (12/7/15)
• Physicians at Kaiser Permanente received approximately 13 million secure emails from patients in one year. (4/9/14)
• Electronic Communication Improves Access, But Barriers To Its Widespread Adoption Remain (8/13)

Patient Provided Digital Data

• Partners HealthCare allows patients to upload information from their medical devices into their electronic records in doctors’ offices. (7/29/13)

Predictive or Diagnosis Devices

• Study finds wearables may help detect serious illness (1/12/17)
• VA study of heart failure patients demonstrated how AI-based personalized physiology analytics could be applied to wearable biosensor data to predict when a patient might be at risk of hospitalization. (3/12/18)

Smart Phone and Attachments
Technical Help Desk

Text Messaging

• Study: Texting to improve medication adherence shows high engagement (5/16/17)
• Ochsner Health System used automated text messages to patients’ cell phones. Patients could touch a link to connect to a live person to schedule appointment or answer questions. 578 patients scheduled colon cancer screenings, pre-cancerous polyps found in an estimated 145 patients (11/15/16)
• Patients who got texts made it to their appointments 73% of the time, compared to a 66% attendance rate for those who didn’t (10/13/16)
• A text-based smoking cessation intervention improve outcomes among young people. (3/2016)
• Mobile phone text messaging increases medication adherence rates from 50% to 67.8% (3/2016)
• Study: Patients who receive texts from physicians more likely to exercise (12/14/15)
• Text Messaging Intervention to Promote Self-Management for Patients Prescribed Oral Anticancer Agents. Patients had high satisfaction with the texts, and adherence and symptoms improved after the intervention. (11/2015)
• Text messaging can help improve patient risk factors in patients with coronary heart disease (9/22/15)
• 90% of those who received text-based Psychotherapy were doing better on average than those who received no treatment 6/2015)

Virtual Services - What Works?

Behavioral Health

• Study using Valera Health app shows boost in engagement from patients with depression, anxiety (5/25/17)
• 8-week behavioral health intervention delivered by a licensed clinical social worker and a behavioral coach via phone or secure video helped reduce all-cause hospital admissions in 6 months (2/27/15)
• In rural SC, telepsychiatry cuts wait times for mental health exams from 4 days to 10 hours (6/27/14)
• Telephone Therapy Helps Older People In Underserved Rural Areas, Study Finds (8/5/15)

Disease Management

• Mississippi Diabetes Telehealth Network program trial for 100 diabetic patients resulted in 96% medication compliance, hemoglobin A1c levels decreasing by 1.7% and compliance with scheduled health sessions reaching 83%. Not a single program participant was hospitalized or visited an emergency room due to complications of their diabetes, saving payers $339,184. (9/13/16)
• Virtual care reduces diabetes costs by 9% (6/26/15)

Tele-Health Visits

• INTEGRIS reduced cost of treating low acuity, non-emergent medical conditions such as upper respiratory infections (URI). In 2016, the cost for onsite visits to treat URIs was $383,702. During the first three months of 2017, costs to treat URI patients virtually was only $9,744. It is expected to save hundreds of thousands of dollars annually (4/20/17)
• JAMA study shows telemedicine can improve screening access, efficiency for diabetes-caused blindness in LA County safety net populations (4/11/17)
• Telehealth Doctor Visits May Be Handy, But Aren't Cheaper Overall (3/26/17)
• Virtual Care Center has led to a more than 33 percent decrease in Mercy's emergency room visits and hospitalizations. (9/15/16)

Virtual Second Opinions

• 20 oral pathologists gathered virtually using the WhatsApp Broadcast functionality to get a second opinions. The accuracy of the 4,940 second opinion diagnoses (SOD) was 98% correctly diagnosed. (11/22/16)

Digital Health Technology - What Works?

Convenient Access - What Works?

Digital Communications

• Use of computers and cell phones is linked to higher levels of mental and physical well-being among those over age 80 (11/28/16)
• Patients with chronic conditions sent secure e-mail messages to their providers as a first method of contacting the healthcare delivery, nearly one-third of respondents reported that e-mailing their healthcare providers had improved their overall health, and more than 1 in 3 reported that e-mailing their provider decreased their phone calls to their providers or their in-person doctor’s office visits. (12/21/15)
• 9 in 10 Brazilian doctors use WhatsApp to talk to patients (12/7/15)
• Physicians at Kaiser Permanente received approximately 13 million secure emails from patients in one year. (4/9/14)
• Electronic Communication Improves Access, But Barriers To Its Widespread Adoption Remain (8/13)

Patient Provided Digital Data

• Partners HealthCare allows patients to upload information from their medical devices into their electronic records in doctors’ offices. (7/29/13)

Predictive or Diagnosis Devices

• Study finds wearables may help detect serious illness (1/12/17)
• VA study of heart failure patients demonstrated how AI-based personalized physiology analytics could be applied to wearable biosensor data to predict when a patient might be at risk of hospitalization. (3/12/18)

Smart Phone and Attachments
Technical Help Desk

Text Messaging

• Study: Texting to improve medication adherence shows high engagement (5/16/17)
• Ochsner Health System used automated text messages to patients’ cell phones. Patients could touch a link to connect to a live person to schedule appointment or answer questions. 578 patients scheduled colon cancer screenings, pre-cancerous polyps found in an estimated 145 patients (11/15/16)
• Patients who got texts made it to their appointments 73% of the time, compared to a 66% attendance rate for those who didn’t (10/13/16)
• A text-based smoking cessation intervention improve outcomes among young people. (3/2016)
• Mobile phone text messaging increases medication adherence rates from 50% to 67.8% (3/2016)
• Study: Patients who receive texts from physicians more likely to exercise (12/14/15)
• Text Messaging Intervention to Promote Self-Management for Patients Prescribed Oral Anticancer Agents. Patients had high satisfaction with the texts, and adherence and symptoms improved after the intervention. (11/2015)
• Text messaging can help improve patient risk factors in patients with coronary heart disease (9/22/15)
• 90% of those who received text-based Psychotherapy were doing better on average than those who received no treatment 6/2015)

E Intervention Support Services - What Works?

Behavioral Health - What Works?

• Care Oregon has a Health Resilience Specialist program that increased behavioral health visits by 16 percent, while E.D. visits and hospitalizations dropped by roughly 20 percent. (6/29/16)

Caregiver Support - What Works?

• ‘Boot Camp’ Helps Alzheimer’s, Dementia Caregivers Take Care Of Themselves, Too (5/9/17)
• Teaching In-Home Caregivers results in emergency room visits declining by 24% in the first year after caregivers were trained and 41% in the second year (8/11/16)
• More evidence adult daycare eases stress on dementia caregivers (8/20/14)
• North Dakota Assistance Program For Dementia Caregivers Lowered Utilization, Produced Savings, And Increased Empowerment (4/2014)
• Enhanced support services for caregivers of people with dementia have been shown to improve caregivers’ capabilities and well-being and delay patients’ institutionalization (4/2014)

Community Health Workers - What Works?

• Penn's Innovative Community Health Worker Model Improves Outcomes for High-Risk Patients (2/10/14)
• A not-for-profit trains grandparents to work as grand-aides, helps reduce readmissions by over 50% and get medication adherence of 91%. (4/8/14)
• Northern Maine - coordination among businesses and health workers helped to improve health outcomes. (3/19/14)
• Note Takers Help The Elderly At The Doctor (2/28/14)

Community & Social Services - What Works?

• Medicaid insurer provides ‘life services’ to connect clients with education, jobs (8/7/16)
• Faith Health program has helped to reduce readmissions through a volunteer initiative aimed at helping patients get the emotional support they need after discharge. (6/27/16)
• States with a higher ratio of social to health spending (social spending divided by Medicare and Medicaid spending) had better subsequent health outcome, including for: adult obesity, asthma, mentally unhealthy days, days with activity limitation, mortality rates for lung cancer, acute myocardial infarction and type 2 diabetes. (5/2016)
• Health system addressed 2,000 patients' social needs in 2 years. Undergraduate students from local universities, called advocates, connect patients with resources for food stamps, subsidized child care or housing or payment plans and discounts for their electricity bills. (6/2/16)
• Strong Social Support Services, Such As Transportation And Help For Caregivers, Can Lead To Lower Health Care Use And Costs (3/2013)
• Providence turns to online interpreters to improve health outcomes (5/19/14)
• Positively Impacting Social Determinants of Health - How Safety Net Health Plans Lead the Way (6/2014)
• Oregon is showing success in integrating of health care with social services and public health (2/12/15)
• 79 evidence-based disease and injury prevention programs that have saved lives and improved health. (11/2013)
• What Works? Strategies to Improve Rural Health (7/2015)
• Lessons Learned: Leaders Successfully Stepping Out to Transform Health and Health Care (4/2015
• Research provide evidence that addressing social determinants of health can improve health and reduce health care costs. Study describes effective interventions 7 Housing examples, 5 Nutrition Assistance examples, 2 Income Support examples, public safety and education examples. (6/2015)

Employment - What Works?

• Individual placement and support services, an evidence-based supported employment intervention, enables about 60 percent of people with serious mental illnesses who receive the services to gain competitive employment and improve their lives. Yet funding is lacking. (6/2016)

Financial Counseling - What Works?

• How Patients Can Receive Financial Assistance For Medication (1/1/14)
• Insured patients can save money by pretending to be uninsured (1/3/14)

Home Support - What Works?

Housing Support - What Works?

• Hospital provides free housing to frequent ER patients. $3,000 per day to care for patients who frequently visit the emergency room or approximately $33 per day for an apartment. (6/30/16)
• Motels Get New Life Helping Homeless Heal (6/29/16)
• Utah Reduced Chronic Homelessness By 91 Percent; HUD estimates that annual cost of homelessness is between $30,000 and $50,000 per person because of services like emergency room visits and jail time. (12/10/15)
• Affordable Senior Housing Plus Services Program Slows Growth in Medicare Costs (12/15/14)
• 'Homeless navigators' help reduce ER use, readmissions (10/25/13)
• Formerly Homeless People Had Lower Overall Health Care Expenditures After Moving Into Supportive Housing (1/2016)
• Housing First program for people experiencing chronic homelessness in Seattle and Boston results in $29,388 per person per year in net savings, and $8,949 per person per year in net savings, respectively (6/2015)
• Special Homeless Initiative (HI) Adults with serious mental illness in Boston results in 93% reduction in hospital costs, $18 million reduction in health care costs annually (6/2015)
• 10th Decile Project for high-need homeless in Los Angeles 72% reduction in total health care costs; positive rate of return as every $1 invested in housing and support was estimated to reduce public and hospital costs by $2 the following year and $6 in subsequent years (6/2015)
• UPMC developed a “shelter plus care” program through a multi-party partnership including primary care practice, local government and community services. A 23% reduction in overall per-member-per-month (PMPM) claims costs. Roughly $4,100 before program to roughly $3,200 while in program (6/2014)

Legal Support - What Works?

Medication Support - What Works?

• MedStar and CVS Health may have found a simple solution. The pharmacy pre-packages and labels patients' medications in multi-dose pouches. A group of 10 primary care offices recently improved medication compliance among patients taking six or more drugs a day from 60% to more than 90%. (5/8/17)

Nutrition Support - What Works?

• How Community Partnerships Can Help End Food Insecurity - Part 1 (9/20/16) Part 2 (9/21/16)
• Healthy foods delivered to 5% of the patients spending 50% of money can save money (6/22/2015)
• Study found that if every state were to provide home-delivered meals to an additional 1 percent of its population of adults ages sixty-five and older, would save state Medicaid programs over $109 million for the country. (10/2013)
• Steward Health Care delivers three low-sodium meals and two snacks to selected heart failure patient's home each day hoping healthy food will reduce trips to the hospital. (6/10/13)]

Social Workers - What Works?

• Social-work conducted transitional care reduced all cause readmissions among all home-going Medicare FFS beneficiaries by 20%. (5/2016)
• Hospital-based clinic used social workers to reduce ED super-users risk of ED use by 22% and hospitalizations by 30% (5/9/14)
• Social workers are the new frontline of the accountable-care model (9/26/13)
• Hospital Reduces Repeat ER Visits By Providing Social Workers. In four months, visits by 39 people to the ER fell by 68 percent, cost fell from $1.5 million to $440,000. (10/23/15).

Support Communities - What Works?

• Online-video support group could aid in the care of patients with traumatic brain injuries (TBI). (8/5/16)
• Mobile Health Comes to Patient Support Groups (6/3/14)
• One-on-One Cancer Support Empowers Patients (3/10/14)
• 5 advantages of online patient communities (8/2/13)
• Online Patient Communities can provide many potential benefits, such as improving coping skills, reducing anxiety, depression, isolation, ignorance about the condition and finding others that are experience common conditions. (7/11/13)

Transportation - What Works?

• CareMore, Lyft collaboration reduces medical transportation waits by 30% (9/6/16)
• Hospitals Are Partnering With Uber to Get Patients to Checkups (8/15/16)

Patient/Caregiver Interventions - What Works?

Patient/Caregiver Interventions that can improve a patient's health care outcome, overall health and well-being.

Caregiver Activity - What Works?

• Caregivers - States are focusing on activating them (6/22/2015)

Patient Activation - What Works?

• There is promising evidence that cognitive training, managing your blood pressure if you have hypertension and increasing your physical activity may help prevent age-related cognitive decline and dementia. (6/22/17)
• A study of people with low to moderate lower back pain found they could use yoga to reduce back pain and functional limitations (6/22/17)
• DIY Medicine Helps Improve Outcomes, Reduce Cost. Patients avoid long inpatient stays by learning to self-administer care for chronic conditions (5/16/17)
• What patients with chronic illnesses do outside the doctor’s office affect their health conditions (exercise, diet, taking their medication). Diabetic patients who participated in a online self-management program had lower blood sugar levels and took their medication more regularly (9/7/16)
• Patient activation influences readmission rates (10/11/13)

Patient Activity - What Works?

• Specialized brain training can help prevent Alzheimer’s Disease and other afflictions, including normal aging, that sap memory and reduce function. (7/24/16)
• Simple activities, such as playing games, making crafts, socializing and reading books held off mental decline in older adults, according to a Mayo Clinic study (1/31/17)

Gamification

• Heart study says Pokémon Go makes you twice as likely to walk 10,000 daily steps (3/8/17)

Nutrition

• Improving Your Diet Just a Little Bit Can Help You Live Longer, Says Study (7/13/17)
• Study suggests a Mediterranean diet could prevent over 19,000 deaths a year in the UK. (9/29/16)

Physical Activity

• In children, exercise may help to improve cognition and improve waistlines. (6/16/17)
• A 1 hour walk 3 times a week has benefits for dementia (5/24/17)
• An hour of running may add up to seven hours on your life (4/12/17)
• Patients can save $2,500 on medical costs annually just by walking (9/8/16)
• Increased physical activity associated with lower risk of 13 types of cancer (6/16/16)
• When muscles work, they release a protein that appears to generate new cells and connections in a part of the brain that is critical to memory (6/23/16)
• After hip fracture, exercise at home boosts day-to-day function (2/19/14)
• New research: Breaking up your sedentary day with some light activity can prolong your life. (5/1/15)
• Replace sitting with walking – it’s key to decreasing early death rate. (10/27/15)

Patient Lifestyle - What Works?

• Most people retire around age 65. But when people retire at age 66 instead, their mortality rates drop by 11 percent. (9/13/16)

Healthy Lifestyle

• What's Good For The Heart Is Good For The Brain. 7 factors known to benefit the heart and blood vessels: maintaining a normal body weight, good nutrition, not smoking, getting exercise regularly and keeping blood pressure, cholesterol and blood sugar levels under control. (5/2/16)
• A healthy lifestyle could prevent half of all deaths attributed to cancer. 41% of cancer cases and 59% of cancer deaths were potentially preventable in women. 63% of cancer cases and 67% of cancer deaths were preventable, among men. (5/20/16)

Personal Achievement - What Works?

Smoking

• To Quit Smoking, It's Best To Go Cold Turkey (3/15/16)

Health Insurance Payment Models - What Works?

Accountable Care Organizations - What Works?

• Study found an association between participation in an accountable care organization (ACO) and reduced rates of hospitalizations, as well as Medicare spending. (5/9/17)
• Medicare Shared Savings Program was associated with a 9% differential reduction in postacute spending by 2014, driven by reductions in discharges to facilities, length of facility stays, and acute inpatient care. (2/15/17)
• Two-sided financial risk model that encourages population health management significantly narrowed the care disparity gaps between different socioeconomic groups, according to a study from Harvard Medical School. (1/2017)
• Anthem Blue Cross through its 17 ACO partners accrued savings of $70.4 million over a 12-month period. (11/1/16)
• ACO-Affiliated Hospitals Reduced Rehospitalizations from Skilled Nursing Facilities Faster Than Other Hospitals (1/10/17)
• Medicare ACO hospitals faster at reducing readmissions, study finds. (1/9/17)
• ACOs saved Medicare $466M in 2015. (8/26/16)

Episode-Based Payments - What Works?

Commercial Health Plans

• UnitedHealthcare’s bundled payment model for hip, knee and back surgery pilot program has shown an average savings of $10,000 or more among employers for each episode of care when compared against overall median costs for the same procedures in the same region. (1/19/17)

Medicare

• Study of 3942 patients who received joint replacement surgery, there was a decrease of $5577 (20.8%) in total spending per episode. Most of the hospital savings came from implants and supplies and most of the postacute care savings came from decreased use of institutional care. (1/3/17)

Care Services - What Works?

Patient-Centered Medical Homes - What Works?

• CareFirst Patient-Centered Medical Home Program lowered annual adjusted total claims payments by $109 per participating member (95 % CI: −$192, −$27), or 2.8 % lower than before the program and compared to those who did not participate. 42% of the overall decline in spending was explained by lower inpatient care, emergency care, and prescription drug spending. (7/29/16)
• Patient-centered medical homes lower costs, reduce healthcare overuse (1/30/15)

Patient Incentives - What works?

• Patient Incentives from Payers Encourage Preventive Care Visits. MinuteMember Wellness Rewards program offer $50 incentive for members to visit their In-Plan PCP during the calendar year. “In its first year, approximately 9300 members (or 40 percent) received an incentive check. (5/10/17)
• Financial incentives may be effective for smoking cessation, study finds. After six months, 36% of participants who received cash and about 6% of the control group had quit smoking. (9/9/16)
• Aetna pays employees up to $500 per year for sleeping. Wellness and wellness program responsible for 69 minutes more a month of worker productivity. (4/7/16)
• Small study shows risk of losing reward works better for reaching activity tracking goals (2/16/16)
• Financial incentives were proven effective in smoking cessation (5/28/15)

Performance-Based Pricing - What works?

Provider-Based Health Plans - What works?

Value-Based Care Programs - What Works?

• Study finds participation in voluntary federal programs that push for quality improvements has a greater impact on reducing readmissions than financial penalties levied against hospitals for high rates alone (4/11/17)
• Blue Cross Blue Shield of Michigan members with two or more chronic diseases, including mental health problems, assigned to PCP's participating in the pay-for-performance program for at least four years to outcomes for members assigned to PCPs had almost 20% fewer 30-day hospital readmissions and 27.5% fewer 90-day readmissions. However, total spending did not decline. (3/15/17)
• Anthem Cut ER Costs by 3% with Value-Based Care Reimbursement (2/1/17)
• UnitedHealthcare expanded value-based care programs such as accountable care organizations, which led to 16.8% fewer acute inpatient admissions among mature Medicaid ACOs in Tennessee, 12.2% fewer ER visits among the longest-running Medicare ACOs and 10% fewer hospital admissions and ER visits among top performing commercial ACOs (11/2016)
• 4 strategies BCBS used to save $1B through patient-centered programs. These programs include BCBS' accountable care organizations, patient-centered medical homes, pay-for-performance programs and episode-based payment programs — emphasize prevention, wellness and coordinated care, in conjunction with reducing waste in the healthcare delivery system. (6/2/15)

Hospital-Acquired Condition Reduction Program

• HHS report shows hospitals are paying off, preventing 3.1 million harmful hospital-acquired conditions and the deaths of some 125,000 people. Those improvements saved close to $28 billion in healthcare costs from 2010 through 2015. (12/12/16)

Readmission Penalties

• Fiscal penalties for low-performing hospitals linked to improved readmission rates for heart failure, pneumonia and acute myocardial infarction (heart attack). For every 10,000 patients discharged annually, the lowest performing hospitals avoided 95 readmissions they would have seen before readmissions were penalized under the ACA. (12/27/16)
• Every state but 1 lowered hospital readmissions since 2010, CMS data shows (9/13/16)
• Declining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time. Attributed to Medicare's penalties for re-admissions. (7/2016)

Value-Based Insurance Design - What Works?

Health plan benefit design to increase health care quality and decrease costs by using financial incentives to promote cost efficient health care services and consumer choices

• Enhanced insurance benefit that pays for all patients Type 1 diabetes maintenance is paying off. The state has saved about $1 million on medical services since its inception almost 10 years ago. (7/17/17)
• Value-Based Insurance Design Benefit Offsets Reductions In Medication Adherence Associated With Switch To Deductible Plan (3/2017)
• Horizon Blue Cross Blue Shield of New Jersey declared its Omnia health plans, which uses Tier 1 — or preferred — hospitals and providers for services, have some of the lowest premium rate increases nationally next year. (10/26/16)
• Study finds eliminating drug co-payments leads to cost savings among chronically ill (2/17/16)
• Connecticut’s Value-Based Insurance Plan Increased The Use Of Targeted Services And Medication Adherence (4/2016)

Tiered Provider Network

• Enrollment In A Health Plan With A Tiered Provider Network Decreased Medical Spending By 5% (5/2017)

Wellness Payment Models - What Works?

• Wellness Screenings - Medicare Payment Changes Lead More Men To Get Screening Colonoscopies (12/24/15)

Organization Interventions - What Works?

Communities - What Works?

• Decisive action by communities can reduce health disparities and improve lives (2/28/17)
• San Antonio has built a crisis center for psychiatric and substance abuse emergencies and a 22-acre campus for the homeless. To date, more than 100,000 people have been diverted from jail and emergency rooms to treatment, local officials say, resulting in a savings of nearly $100 million over an eight-year period. (12/10/16)
• West Oakland, one of the city’s poorest areas, improved healthy food access and economic opportunity. 640,000 lbs of produced distributed in food insecure area, 55% sourced locally and 76% of shoppers increased consumption of fruits and vegetables (11/28/16)

Employers - What Works?

Employee Wellness Programs

• Nearly 60% of employees say wellness programs have improved their health, survey shows (6/1/17)
• Study of Workplace Wellness Programs found that medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent (2/21/17)
• Comprehensiveness of workplace cardiovascular health initiatives is related to measures of employees’ health risks, disease prevalence, and medical expenditures. (2/2017)
• Disease management drives return on investment from workplace wellness programs. Two component programs reduced employer’s average health care costs by about $30 per member per month(PMPM). Disease management was responsible for 87% of those savings. Employees participating in the disease management program generated savings of $136 PMPM, with a nearly 30% reduction in hospital admissions. Only 13% of employees participated in the disease management component, compared with 87% for the lifestyle management component. (1/1/14)

On-Site Health Centers

• Coushatta Casino Resort partnered with Premise in 2011 to manage its onsite health center and improve the overall health status of Coushatta's employees and their families. The resort has seen better outcomes and has saved nearly $4 million in healthcare costs. (6/8/17)

Governments - What Works?

• HUD Housing Assistance Associated With Lower Uninsurance Rates And Unmet Medical Need (6/2017)
• Study using data from the New York State Department of Public Health (2002-2013) found 6.2% decline in hospital admissions for myocardial infarction and stroke among populations living in counties with vs without trans-fatty acid restrictions. (4/12/17)
• A Maryland County Cut Soda Sales Without A Soda Tax. The Unsweetened campaign led to a 20% decrease in sales of soda and a 15% decline in fruit drink sales between January 2013 and December 2015. (3/13/17)
• Mexico implemented a 1 peso per liter excise tax on sugar-sweetened beverages. Purchases of taxed beverages decreased 5.5 percent in 2014 and 9.7 percent in 2015, yielding an average reduction of 7.6 percent over the study period. (2/2017)
• The state of Maryland launched a bold approach to improve care with an All-Payer Model to slow the growth of healthcare costs. Maryland has achieved an estimated $429 million in total Medicare hospital savings to date, exceeding the model’s five-year hospital savings requirement of $330 million (1/31/17)
• Some cities, counties, and states have started to see their childhood obesity rates go down by taking a comprehensive approach. (10/2016)
• A food benefit program that pairs incentives for purchasing more fruits and vegetables with restrictions on the purchase of less nutritious foods may reduce energy intake and improve the nutritional quality of the diet of participants (9/19/16)
• Soda Tax Appears To Cut Consumption Of Sugary Drinks (8/23/16)
• State prescription drug monitoring programs are sssociated with 30% reductions in opioid prescribing by physicians (6/2016)
• Introduction of a National Minimum Wage Reduced Depressive Symptoms in Low-Wage Workers (4/4/16)
• Three Interventions That Reduce Childhood Obesity Are Projected To Save More Than They Cost To Implement - (1) sugar-sweetened beverage excise tax, (2) elimination of tax subsidy for advertising unhealthy food to children, (3) nutritional standards for food and beverages in schools outside of meals (11/2015)

Non-Profits - What Works?