Here are some excerpts from our interview with Lisa Griffin, vice president of front-end operations  Jefferson Health. They have been edited for length and clarity.

We were actually able to pivot very quickly because we had been scheduling telehealth visits. Telehealth has been a part of a patient's choice. So patients had choices of in-person and telehealth our schedulers had the ability to give those patients those choices. Not to the scale that we moved to because of COVID-19, but it has always been a part of our normal scheduling.

We had physicians internally that had already been trained, and they were already seeing patients, but that was happening in another arm of our organization, Jeff Connect, that outside of our employee physicians. So we ended up just flipping that (Jeff Connect) model into the same model that we would use with our physicians. So we scaled that up by asking our retired of providers to begin to come back and work with us. Emeritus, retired physicians that were a part of our organization. We reached out to them and then we scaled up using that other Jeff Connect arm. we just had to really scale that up pretty quickly

We decided early that there were a specific number of patients that had to be seen face to face. And so we had to make sure that those patients felt safe enough to get us and that our operations were safe and that they could come to us. So we spent a great deal of understanding the patient's fears, and things of that nature, and making sure we address them, so we didn't lose those patients.

We had to stop elective surgeries because of requirements. We were forced to do that. So we kept a handle on those patients and actually went through and said, which ones could wait truly wait.

\We kind of went through like a command center and going through these processes with a patient-safety mindset, keeping them safe and not losing them because of the shifts in telehealth and in- person.

So it was pretty intense in the beginning trying to make sure that we kept our pulse on those patients.

We had to come together as executives and say, either we're all in or not. We had to not just look at it from single view of being revenue generating. We knew that the implications were there where we potentially could not get paid. And so we had to make those types of decisions very early to say, you know, we're here for this specific reason, and take care of patients and care for people. And we had to make a decision to say that's our guiding principle, our North Star. So, or we look at the revenue, let's make sure we have that as a North Star. And I think that allowed us to guide how we do business from a humanity perspective versus us not being reimbursed. And of course, we know this is a business. So we did keep our pulse on that, keeping those patient visits within our EMR with an identifier.
But we decided that we had to operate with that North Star mentality of caring for people.

On switching patients to telehealth visits

Systematically we had to change in our EMR, so you have the ability to take a regular appointment as a scheduler (and switch it to a telehealth visit). So you could call us, and say, “Hey, I am going to be 10 minutes late for my in-person visit.” And based on what you're coming for, we could say, “Well, you can be 10 minutes late or would you like to switch to a telehealth visit,” Having the ability to be that nimble to flip that was not easy. We had to go through to change our scheduling, making it where the scheduler could do it. We really pressed the issue of saying this needs to be seamless at the scheduler level — seamless for our patients.

People already have angst. And we would be adding to the angst. So we had to really look at this from a patient-centric viewpoint.

On being called the “seamless access” department

We're called seamless access. And that just means that every connection point for our patients that they want to connect with us, it has to be barrier free. If they're calling to pay a bill, if they want to speak with our customer service and ask questions, if they want directions, if they want to schedule an appointment — all those avenues have to be seamless and barrier free to where the patients can get to us. So that is a premise around something being seamless.

I've been here a little over a year. I ripped off the Band-Aid and changed all of my positions, the task competencies, key measures and weightings, and then put training around those job roles so that we can get the right people that understand the concept of first-call resolution from every patient that calls in, or if they decide to use our chatbot online to get to us or fill out a form on our website. All those channels are employees within seamless access. They are trained on all of those channels, 

Our schedulers are trained on if you're self-pay, and you need additional services, linking you up with a payment plan. If you can't do a payment plan and you need financial assistance, we are a nonprofit hospital, so we have financial assistance programs that allow patients to seek care without the ability to pay. So there are a number of ways that we're addressing when patients may be at that stage where they can't pay but they need the services. So our schedulers are trying to do all of those things I just mentioned, talk to them find out about where they are. We also have social workers that can help a patient get Medicaid coverage or help guide them through that process.

There were people that were losing jobs very quickly. Unemployment was held up because of the vast number of claims. Some of them, not because of any fault of their own, now are faced with “I need to be seen” and making a decision if I can I be, based on payment. And so we had to let really impress on our schedulers the need to have different type of conversations today because these patients, some of them have never been in this situation. They're faced with the unknown. They've always worked, they always had insurance, and now they're faced with waiting for unemployment, and no insurance.  We really had to have some sensitivity type of training and reinforce on high alert the need to be able to meet the whole person related to their health care.

I am finished my dissertation around that subject in a healthcare environment, so it is close to my heart to make sure that we're dealing with those things. 

I came here because that conversation is an open conversation. We have a team that's called B.R.A.V.E. [Bold, Relevant, Authentic, Valuable and Educational]. And that B.R.A.V.E. team allows us to have those types of discussions. The one thing I can tell people is be OK with being uncomfortable — with uncomfortable conversations. And sometimes you have to look at it in that perspective and be OK with someone else's viewpoint and being challenged by that viewpoint, because we all have a viewpoint. 

Early on in my life I was told by my own grandmother, you know, people hold the purse, so you do what they say, be silent, don't put a lot of attention on yourself. And so just having been in a work environment that has allowed me to say, “Here's what I think, here's what I'm feeling. Here's why I'm feeling that way,” and having the other person be okay with that, and vice versa. And being able to educate each other. 

I think that is that brave mentality that Jefferson has taken on and that our employees have embraced of talking to one another.

I'll leave you with this thing. My five-year-old granddaughter watched Sesame Street on racism. And she calls me every day she says, “I'm worried about you.” And I said yes. She said, “I looked at that Sesame Street thing on race,” and I said. “Oh, you did. What do you think about that?” And she says, “The adults have the problem. My friend is white.” And I said, “You may have something there.” This is a five-year-old. So I take that every day and I keep it in my mind.”

Articles

Excerpts from our interview of Lisa Griffin, senior vice president of front-end operation, at Jefferson Health,

Excerpts From Our Interview with Lisa Griffin of Jefferson Health

The FDA has approved another biosimilar to Humira (adalimumab) and with that approval,  28 biosimilars all together. But only 17 are on the market and none of the currently aprpoved Humira biosimilars will be available till 2023.

The agency quietly (it didn’t put out a press release) approved Mylan’s Humira biosimilar 

(adalimumab-fkjp) on Monday. Hulio is the sixth biosimilar to Humira that has been approved by the federal agency. The others are Abrilada (adalimumab-afzb), Amjevita (adalimumab-atto), Cyltezo (adalimumab-adbm), Hadlima (adalimumab-bwwd) and Hyrimoz (adalimumab-adaz)

Humira’s manufacturer, AbbVie, has contracted with all six Humira biosimilar developers for  launch dates in 2023, according to our colleagues at the 

. Three other companies with unapproved Humira biosimilars may also be in the mix

By competing on price with expensive biologics, biosimilars are supposed to be a market-oriented way of lowering healthcare costs. But patent and other issues have kept FDA-approved biosimilars off the market, somewhat stunting the market dynamics that proponents were hoping for. That may change in 2023 when Humira, which has been the top selling drug by sales revenue for many years, is expected to face an onslaught of FDA-approved competitors.=

Hulio is the second biosimilar approved by the FDA this summer. The agency approved Nyvepria (pegfilgrastim-apgf), a biosimilar to Neulasta (pegfilgrastim)in June.

Along with the other Humira biosimilars, Hulio will not be on the market till 2023.

FDA Approves Hulio, the Sixth Biosimilar to Humira

Here are some excerpts from our interview with Lisa Griffin, vice president of front-end operations Jefferson Health. They have been edited for length and clarity.

Peter Wehrwein, senior editor at Managed Healthcare 
Executive, spoke with Lisa Griffin, senior vice president of front-end operations at Jefferson Health in Philadelphia, about the pivot to telehealth, "seamless access" and racism.  

Lisa Griffin of Jefferson Health Talks Telehealth, COVID-19 (Pt. 1)

, an innovative health benefits company, recetly introduced the first-of-its-kind zero-deductible, zero-copay health plan. The new plan, called Gravie Comfort, offers 100% coverage on most common healthcare services, including preventive care, primary care, specialist visits, labs and imaging, generic prescriptions, online care, and more – all at a cost comparable to most traditional group health plans. For less frequently used services, such as hospitalization and specialty drugs, Gravie Comfort allows employees to choose a simple out-of-pocket expense limit, according to a release.

Gravie Comfort represents a new model for employer-sponsored health plans, offering full coverage for most services on day one of the plan. Through this plan, employees have health beneﬁts they can actually use and get care when they need it without worrying about the out-of-pocket expenses associated with copays and deductibles. Gravie Comfort provides access to a broad, national network and is available for the upcoming 2021 plan year.

“The majority of individuals who get their health insurance through their employer are frustrated by the continuing reduction in the level of coverage that their health benefits offer,” says Marek Ciolko, CEO of Gravie. “With ever-increasing out-of-pocket costs, narrowing choice of providers, and the administrative obstacles they have to navigate, traditional health plans often make it difficult for employees to get care when they need it. With employee healthcare often representing employers’ second highest expense category, the investment they make should pay off in health benefits that employees can actually use. Gravie Comfort eliminates unnecessary costs and other hoops individuals have to jump through, and incentivizes them to get care, without fear of surprise bills or hidden costs.”

Since 2013, Gravie has been designing disruptive benefits solutions that put employers’ and employees’ needs at the center of the healthcare ecosystem. Gravie’s solution allow employers to control costs without compromising value. With Gravie’s defined contribution approach, employers are able to set and stick to a benefits budget that works for their business, and employees are free to choose the out-of-pocket maximum that works for them.

With traditional health benefits, high deductibles, copays, and other out-of-pocket costs leave many employees feeling like their health benefits are not worth the expense, and often end up discouraging them from accessing care when they need it. Gravie Comfort is a benefit employers can offer to remove uncertainty around what is covered and lower employees’ overall healthcare expenses, promoting health and happiness within the workplace.

In addition, Gravie eliminates the challenge historically faced by employers and employees as they’re forced to navigate the complexities of the health benefits industry on their own. For employers, Gravie assumes much of the administrative burden that comes with managing employee health benefit programs, from helping employees choose and manage their health benefits, to staying compliant with rules and regulations. 

Through regular check-ins with their Gravie account manager, and access to an intuitive online portal where they can view and make changes to their benefit program in real-time, employers can remain in control of their benefit programs with Gravie doing most of the heavy lifting.

The company's comprehensive support services also extend to employees, from helping them choose the best benefits for themselves and their families to offering year-round guidance to get the most out of their benefits. And most importantly, with Gravie Comfort, the coverage is simple and easy to understand, taking away the confusion and uncertainty often associated with other health plans.

The new plan, called Gravie Comfort, offers 100% coverage on most common healthcare services, including preventive care, primary care, specialist visits, labs and imaging, generic prescriptions, online care, and more – all at a cost comparable to most traditional group health plans.

Gravie Introduces First-Of-Its-Kind Zero-Copay,-Deductible Employer-Sponsored Health Plan

The United States Preventive Services Task Force (USPSTF) announced proposed changes to its 

 today that the task forces estimates would more than double the number of Black Americans eligible for screening and also increase the eligibility of women.

USPSTF is proposing to recommend annual screening for adults, ages 50 to 80, who have a 20 pack-year smoking history and either currently smoke or quit smoking within the past 15 years.

The current recommendation, which dates from 2014, is for annual screening to start five years later, at age 55, and for a history of heavier smoking — 30 pack-years instead of 20. 

A pack-year is a common way of measuring a person's exposure to cigarettes and  is calculated by counting the number of years that a person has smoked, on average, 20 (the number of cigarettes in a pack) cigarettes a day.  

Starting screening at age 50 and including people with lighter smoking histories would increase the number of Americans eligible for lung cancer screening by 86% overall, the task force says in the discussion section of its guidelines. 

Among non-Hispanic Blacks, the relative increase would be 105% compared with 77% among non-Hispanic whites, the task force says. There would also a gender difference with the wider eligibility: an 81% relative increase among men compared with a 96% increase among women. 

The task force mentions that African American have a higher risk of lung cancer than whites and that the difference in risk is more apparent at lower levels of smoking. It also cites a study that found that 17% of African American smokers were eligible for screening using the 2014 USPSTF recommendations compared with 31% of white smokers. 

The proposed updated recommendation and the 2014 recommendation both set 80 as the the upper-age limit for screening. They update also doesn't differ from the 2014 recommendations in saying that lung cancer screening should stop once someone hasn't smoked for 15 years or develops a heart problem that substantially shortens their life expectancy. 

Possible harms from lung cancer screening include false positives and related workups, and radiation exposure from the the low-dose CT scans used in screening, according to the task force. Lung cancer screening also results in incidental findings that may lead to more imaging and tests —  imaging and tests that may, depending on the finding, be unnecessary and possibly cause harm. 

The USPSTF gave its lung cancer screening recommendation a "B" grade, which means it sees a moderate net benefit as being highly certain or has moderate certainty of a moderate-to-substantial benefit.

The task force is accepting public comments on its proposed recommendation till August 3.

Lowering the age and smoking history standards would result in substantially more Blacks and women being eligible for screening.

New USPSTF Lung Cancer Screening Recommendations Would Double Scans Among Blacks, Women

The maternal mortality rate in the U.S. has experienced a consistent and alarming increase in recent decades, driven in part by an increase in expecting mothers’ comorbidities such as obesity, hypertension, diabetes and cardiac disease.

In fact, the nation’s maternal mortality rate has more than doubled since 1987, up to 17.3 deaths per 100,000 live births, according to the U.S. Centers for Disease Control and Prevention (CDC). That number far exceeds the 

There is certainly opportunity for improvement, however. In a recent study, the CDC estimated that 

 were preventable. The nation would comfortably meet the Healthy People 2020 goal if we could prevent those deaths.

In addition to the rise in mothers’ comorbid conditions, another significant factor has contributed to the steady increase in maternal mortality: General disagreement on best approaches for managing maternal patients, from creating a single oxytocin checklist to detailing more complex processes for managing preeclampsia.

Part of the problem is that there is debate among clinical experts regarding the physiological parameter thresholds for various conditions, which has led to a situation in which treatment protocols across the country differ. Adding to the challenge, research has lagged on maternal early warning systems that could help clinicians recognize and respond to warning signs before a mother’s condition deteriorates.

Nonetheless, the outlook for decreasing the maternal mortality rate in the country has recently improved as a result of a recent initiative by the Joint Commission, which has developed 

 (EOPs) to help evaluate hospitals. Potentially beginning as soon as this month, all accredited hospitals that provide obstetric services must demonstrate compliance with these standards, which address two of the nation’s most frequent causes of maternal morbidity and mortality.

Although regular on-site surveys have recently been 

 by the Joint Commission due to the COVID-19 pandemic, hospital and health system leaders should begin reviewing the EOPs to ascertain where they stand today. Pandemic or no pandemic, adhering to evidence-based guidelines benefits both patients and providers in the form of better clinical outcomes.

Following is a brief review of the Joint Commission’s new EOPs that are designed to enhance safety for mothers and new-born babies.


Maternal hemorrhage is the focus of the first set of EOPs, and for good reason. Maternal hemorrhage is the 

leading cause of maternal deaths worldwide

 in the U.S. Data from the CDC also shows black women are two to three times more likely to experience issues with hemorrhaging than white women despite not being considered at higher risk for blood loss during delivery. 

Common reasons for deaths by maternal hemorrhage clinicians missing or miscommunicating signs of active blood loss, underestimating the extent of blood loss, and a lack of standardized safety responses.

The Joint Commission has issued the following seven EOPs covering maternal hemorrhage:

Use an evidence-based tool to determine maternal hemorrhage risk on admission to labor and delivery and postpartum

: Assessing and discussing hemorrhage risk helps clinical teams identify higher-risk patients and be prepared.

Create written evidence-based procedures for stage-based management of patients who experience maternal hemorrhage

: These written procedures cover a variety of scenarios and should be developed by a multidisciplinary team that includes representation from obstetrics, anesthesiology, nursing, laboratory, and blood bank.

Stock each obstetric unit with a standardized, secured, dedicated hemorrhage supply kit

: Each kit must contain emergency hemorrhage supplies as determined by the organization, as well as the organization’s approved procedures for severe hemorrhage response.

Deliver role-specific education about the organization’s hemorrhage procedure to all staff and providers who treat pregnant and postpartum patients

: This education and training should be conducted at orientation, whenever changes to the processes or procedures occur, or every two years.

Perform annual drills to determine system issues as part of on-going quality improvement efforts

: Drills should include representation from each team identified in the organization’s hemorrhage response procedure and include a debriefing session after the drill is completed.

: These reviews should evaluate the effectiveness of care, treatment, and services provided by the hemorrhage response team.

At a minimum, hospitals should deliver education that helps patients recognize the signs and symptoms of postpartum hemorrhage that should prompt them to seek immediate care.

Severe hypertension/preeclampsia requirements


The second set of EOPs pertains to hypertensive crisis/preeclampsia, which is responsible for 6.8% of pregnancy-related deaths in the U.S., according to the CDC. Worldwide, preeclampsia is estimated to occur in 

While common symptoms of hypertension and preeclampsia include sudden edema, weight gain, headaches and visual disturbances, in many cases patients experiencing these conditions do not present with these symptoms. To help hospitals improve patient assessment of these conditions, the Joint Commission issued the following six EOPs:

Develop written evidence-based procedures for measuring blood pressure

: At a high level, these procedures should cover standard blood pressure measurement best practices, including cuff size, proper patient positioning, and frequency of measurement.

Develop evidence-based procedures for managing patients with severe hypertension/preeclampsia: 

These procedures should include guidance on when to use continuous fetal monitoring, when to consider emergent delivery and when to consult additional experts and consider transfer to a higher level of care.

Provide role-specific education about the hospital’s evidence-based severe hypertension/preeclampsia procedure

: Because the emergency department (ED) is often where post-partum patients with signs of severe hypertension present for care, hospitals should provide education to ED staff and providers.

Conduct annual severe hypertension/preeclampsia drills

: These drills create an opportunity for organizations to practice skills and identify system issues in a controlled environment, with an eye toward process improvement in the future.

Review severe hypertension/preeclampsia cases

: These reviews help organizations find errors and improve skills to ensure that patients are receiving the highest level of care.

: Educational materials should include information on signs of severe hypertension/preeclampsia that alert patients to seek immediate care, as well as when to schedule a post-discharge follow-up appointment.


Maternal hemorrhage and severe hypertension/preeclampsia have been responsible for too many deaths across the nation, but renewed focus on the problems could help us reverse the trend. Adherence to the Joint Commission’s new EOPs is likely to result in enhanced maternal and fetal safety and bring the U.S. closer to achieving the Healthy People 2020 goal of lower maternal mortality.

Alana McGolrick, DNP, RNC-OB, C-EFM, is Chief Nursing Officer of 

, a company delivering innovative perinatal software solutions.

The outlook for decreasing the maternal mortality rate in the country has recently improved as a result of a recent initiative by the Joint Commission, which has developed 13 new elements of performance (EOPs) to help evaluate hospitals.

New Joint Commission Requirements Likely to Boost Maternal Patient Safety

Dr. Leslie Solomon is director of healthcare at

 in San Diego.She has more than 25 years of experience in healthcare leadership development, talent management, quality process improvement, change and transformation.

As hospitals and health services providers grapple with the financial fallout of COVID-19, many newly attuned to their organizations’ vulnerabilities are reimagining their business and reimbursement models.

Disruption from the pandemic offers a window of opportunity for healthcare organizations to also recreate their cultures, building intentional, strong work environments. Creating a strong culture is a business imperative that industry has ignored too long.

While research has consistently shown organizations with strong cultures aligned to their strategic goals are far more likely to meet and exceed big-picture objectives, most hospitals have never prioritized culture-building. Instead, they’ve allowed dysfunction to permeate and reveal itself in myriad ways. These include workforces increasingly defined by anxiety, fear and mistrust of leadership; physician practices and leadership misaligned with enterprise strategy or optimal care delivery; and a lack of connection to purpose, mission and values.

When COVID-19 began to send waves of patients seeking emergency care, many organizations that had long ignored culture began to grapple with troubling and distracting issues. News outlets reported that front-line hospital workers faced disciplinary action for speaking with the media about employee safety. In addition, shortages of PPE revealed nation-wide supply chain challenges that impacted some hospitals more than others.

In comparison, organizations with cultures that value trust and engagement have been able to rise to the challenges presented by the pandemic, tapping into communication, innovation, leadership and response strategies to adapt and “leapfrog” into new ways of thinking and operating. They remain best positioned to survive and thrive in spite of the disruption and distress.

Fortunately, healthcare organizations face few barriers to investing in transforming their cultures; in fact, today’s crisis presents an opportunity to engage in this important work. Leaders can use the current disruption to find and fix the fractures in their systems while identifying new breakthroughs in thinking and action that will significantly position their organizations for success now and in the future.

Healthcare leaders looking to engage in culture-building amidst COVID-19 can begin by focusing on four specific imperatives:

the ability of teams to “check as they go,” allowing them to move quickly and responsively. Building this into an organization’s culture can ensure it can best accomplish such goals as pilot testing telehealth models, moving quickly to provide reimbursement, and loosening restrictions on building licenses to allow for more effective crisis management and more flexible care delivery.

the recognition that success requires winning the hearts and minds of one’s people daily. Cultures that truly welcome and support the wholeness of their people – allowing room for individual differences while aligning on purpose – are most able to inspire trust and even love, an imperative for an industry that requires its people to risk their lives on the job.

, an emphasis on action-learning and feedback over command and control. Organizations that make this central to their cultures — part of daily huddles and/or regular department meetings — are better able to shift roles, communications and oversight to meet the evolving demands of an outbreak.

the ability to shift from siloed views of the balance sheet to an Enterprise view of financial success. This can be applied to such matters as budget exercises that have too long revealed themselves as turf battles.

Some championing culture-building might come across resistance among stalwarts of traditional paradigms, especially those who subscribe to the belief of heroic leadership, the perception that problems are solved by extraordinary individuals rather than cultures and systems that have been designed in specific, intentional ways.

While it is true that extraordinary, heroic leaders can certainly devise solutions to thorny problems, too often these fixes yield only immediate relief and leave deeper fractures unresolved. What’s more, some problems, such as COVID-19, are so enormous that they require nothing less than the full support and participation of an organization’s people working together in lockstep. Of course, the bedrock of such collective efforts is an organization’s culture.

Leslie Solomon, Ph.D., is director of healthcare at

She has more than 25 years of experience in healthcare leadership development, talent management, quality process improvement, change and transformation.

Crisis tests a business's culture. It also is a good time to create or strengthen a culture.

Culture-building is a Business Imperative Amid COVID-19

oral corticosteroids such as prednisone and dexamethasone increase the risk gastrointestinal bleeding, sepsis, and heart failure, according to results reported in this week's 

The adverse effects of long-term use of corticosteroids are well characterized and common knowledge among physicians, nurses, and many other healthcare professionals. But short "corticosteroid bursts" of one to two weeks have been seen as being relatively safe and an effective way to quell inflammation, particularly for people experiencing a flare-up of a  chronic inflammatory conditions. And dexamethasone has been in the news lately because researchers have reported that it substantially cuts the mortality risk of people who are seriously ill from COVID-19.

puts corticosteroid bursts in a different light, one in which the benefits are attended by some risk of adverse events, and with the recognition of the drawback the suggestion that they be prescribed only when necessary. 

, M.D.,Ph.D., and his colleagues used data from Taiwan's National Health Insurance Research Database to conduct their study. Of the roughly 15.8 million people in the database, about 4 million had received a prescription for at least one corticosteroid burst. For most of their analysis, Yao and his colleagues winnowed that 4 million down to 2.6 million because of various exclusion criteria designed to make the results more reliable,

When Yao et al. compared the people who were prescribed a corticosteroid burst to those who weren't, they found a large difference in GI bleeds (27.1 cases per 1,000 person-years vs. 16.8) and smaller but real differences in sepsis (1.5 cases per 1,000 person-years vs. 1.4) and heart failure (1.3 cases per 1,000 person-years vs. 0.4). 

, M.D., M. Sc., of the University of Michigan's Institute for Healthcare Policy and Innovation said the findings mean that for a population of 4 million people exposed to corticosteroid bursts, the short-course of the anti-inflammatory corticosteroids would be associated with 41,200 GI bleeding events, 400 cases of sepsis, and 4,000 new cases of heart failure.

Yao and his colleagues noted how common prescriptions for corticosteroid bursts are in Taiwan (a quarter of the people in the database had received a prescription) and that they are prescribed most often for common skin disorders, such as  contact dermatitis and eczema, and upper respiratory tract infections. Short-term use of corticosteroids is not confined to Taiwan problem; the researchers referenced a U.S. study that showed 7% of patients were prescribed short-term courses (less than 30 days) of corticosteroids, most often for upper respiratory tract infections.

As Wallace and Waljee point out, the chance of an adverse event can be outweighed by a medication's benefit. It's a trade-off we are willing to make if the benefit is large enough and occurs often enough. Wallace and Waljee note that corticosteroids prescribed for acute flares of a chronic inflammatory conditions may fend off disability and maintain people's quality of life. 

"In contrast," write Wallace and Waljee, "bursts prescribed for self-limited conditions confer no long-term benefit and may not even reduce symptom duration or severity." 

Yao and his co-authors make similar points and call for prospective studies or clinical trials to    determine the optimal use of corticosteroids by monitoring adverse events.   

The risk of long-term use of oral corticosteroids are well known. This research shows that short "bursts" of one to two weeks also carry some risk of adverse events.

Short 'Bursts' of Oral Corticosteroids Are Associated With GI Bleeds, Other Adverse Events

An analysis of COVID-19 treatment and prevention trials found that many of the 1,200 studies underway won't produce clear results because they are too small or flawed in other ways. 

"It's a huge amount of wasted effort and wasted energy when actually a bit of coordination and collaboration could go a long way and answer a few questions," 

, a professor of medicine at Oxford University was quoted as saying in a 

, the Boston-based biotech news website, and 

, a computational journalism start-up,  joined forces to conduct the analysis, which sifted through data extracted from clinicaltrials.gov, the federal government's comprehensive database of clinical trials. 

-Applied XL project found that 39% of the studies are designed to enroll fewer than 100 patients. Statistically siginficant results in studies that size can be difficult to achieve. The analysis also found that a sixth of the trials are of the malaria drugs, hydroxychloroquine and chloroquine. So far, neither have been shown to be effective as COVID-19 treatments. The

story notes that 237,000 of the 685,000 of the patient volunteers were to be enrolled in trials of hydroxychloroquine and chloroquine. 

"Since patients willing to enter studies are one of the scarcest resources in medicine, this means that other potential treatments, such as ivermectin and favipavir, were not studied," says 

The story points out, though, that researchers have had some success in sorting out which COVID-19 interventions work and which do not. The prime example is the RECOVERY trial, of which Landray is one of the chief investigators. Results from RECOVERY identified dexamethasone, an inexpensive corticosteroid, as effective in reducing mortality among COVID-19 patients put on ventilators.

Almost 40% of trials are designed to have fewer than 100 patients. 

Stat, Applied XL: COVID-19 Trials Too Small to Give Clear Answers

An increase in molecular testing of patients with gastrointestinal stromal tumors (GIST) would allow physicians to make better therapeutic decisions without a significant uptick in the cost of care, according to a new analysis.

The research found that increasing molecular testing rates to 100% among patients with 2 mutation types would result in an overall cost increase of just $15,213 per million members of a managed care plan per year. That breaks down to just 1.5 cents per member, per year, wrote corresponding author 

, M.P.H., of the Analysis Group economic consulting firm.

The research was set to be unveiled at the 

Academy of Managed Care Pharmacy’s 2020 annual meeting

. The in-person event was canceled because of COVID-19, but the research was posted online instead.

Over the past two decades, investigators have learned how to fine-tune therapy for patients with GIST by matching them with therapeutic strategies tied specifically to the mutations behind their cancers. Yet such “precision medicine” is far from universal. “The use of molecular diagnostics to classify GIST has been shown to be successful in optimizing patient treatment, but these methods remain under-utilized,” wrote 

, M.D., of the Oregon Health and Science University and his co-authors in a 

Proudman and colleagues decided one way to encourage more physicians to follow molecular testing guidelines would be to calculate the costs of including the testing in a patient’s care. To do so, he and colleagues set up a cost-impact model looking at how universal (100%) molecular testing of patients with GIST associated with mutations of 

 exon 9 would affect the overall cost to insurers. At present, an estimated 60% of patients with 

 exon 9 mutations undergo molecular testing, and just 49% of those with 

The model assumed that patients with other types of mutations, and those for whom testing was not performed, received the standard therapy of imatinib (Gleevec) 400mg. Those with 

 exon 9 mutations were assumed to receive a higher, 800 mg dose of imatinib in the model. Those with 

 exon 18 mutations were modeled based on receiving best supportive care, since an effective therapy has yet to be found for patients with the most common of these mutations.

The model assumed the bulk of patients (69%) were on commercial insurance plans; the remaining patients in the simulation were assumed to be on Medicare (23%) and Medicaid (9%). The rate of GIST cases in the study was set at 11 per million members.

As noted above, increasing molecular testing rates to 100% for these patients increased the cost per million members per year by just more than $15,000. Within that number were a mix of increased and decreased costs. Testing costs increased by $2,748, but adverse event costs were $293 lower.

The main influence of the overall increased cost were pharmacy costs, which rose $12,758. Proudman and colleagues said the higher pharmacy costs were due to higher dosages among patients with 

 exon 9 mutation, as well as increased duration of therapy for those patients because of longer progression-free survival. If patients with 

 exon 9 mutations were excluded, overall costs would actually drop slightly due to the decision to treat patients with 

 exon 18 mutations with best supportive care instead of the standard 400 mg dose of imatinib.

Proudman and colleagues said the cost increases were minimal regardless of plan type.

“Increased molecular testing in GIST is associated with minimal additional costs and a meaningful increase in the number of patients receiving optimized treatment,” Proudman and colleagues concluded.

Researchers cost-impact model calculates the cost to be 15 centers PMPY.


Boosting Molecular Testing in Patients with GIST Would Have Minimal Cost Impact, Study Finds

Videos

Jim Beiermann, CFO, and Danny Irland, senior vice president of network operations and chief network officer of Southwestern Health Resources discuss their focus of value-based care through ACO and Next Generation Programs within the company with Managed Healthcare Executive Senior Editor, Peter Wehrwein.

Jim Beiermann, Danny Irland of Southwestern Health Resources Talk ACO, Next Gen. Programs (Pt. 2)

More than a third of American adults now have symptoms that are consistent with anxiety and depressive disorders, according to the 

Using survey data collected by the U.S. Census Bureau in June, the foundation's research calculated that 36.5% of American adults are reporting anxiety and depressive systems compared with 11% in 2019.

The foundation's own polling has shown that a large proportion of Americans say they are worried about, and have stress related to, COVID-19.

Louisiana (42.9%), Florida (41.5%), Oregon (41.3%), Nevada (39.1%), and Oklahoma (39%) are the states with the highest percentage of adults with anxiety and depression systems, according to the foundation.

Wisconsin (27.2%), Minnesota (30.%), Nebraska (30.6%), North Dakota (30.9%) and South Dakota (315) are the states with the lowest percentage. 

KFF: More Than A Third of Americans Have Anxiety, Depression Symptoms

An Oregon Medicaid program that paid community health centers on a fixed, per member, per month basis decreased  the use of primary services by 42%, mainly by reducing the use of imaging, according to research results reported in the July issue of 

The results may help rehabilitate the somewhat tattered reputation of the patient-centered medical home (PCMH) beause they suggest that the problem with PCMHs is not inherent to the delivery model but continued fee-for-service payment that undermined its goals of making care more coordinated.

The Oregon Medicaid program introduced the fixed, per member, per month payment scheme in 2013. During 2013-2018, 15 community health centers with a total of about 150,000 members elected to participate in the program, which is called the Alternative Payment and Advanced Care Model (APCM). The fixed payment was pretty limited and covered primary care services; it did not include behavioral health, dental or obstetrical services provided at the clinics nor did it include any services provided outside the clinic, such as emergency department visits, specialists, or hospital visits.

, an assistant professor at the Oregon Health & Science Science University in Portland, compared patients at the community health centers participating in APCM to patients at centers those that didn't. Lindner aused price-weighted volume of services to compare the APCM Medicaid beneficiaries to the non-APCM Medicaid beneficiaries. 

The price-weighted volume of traditional primary care services average $35.20 per member, per month prior to APCM. In the second year afterward, the relative difference in the price-weighted volume between the APCM and the non-APCM beneficiaries was $14.90, almost all of it due to reduced use of imaging. Importantly, further analysis showed that reduced imaging wasn't because the beneficiaries decided to get the imaging services elsewhere. 

"These types of easily quantifiable and billable services are often overused when payment structures incentivize a high volume of services, and they are leading contributor to low-value care," wrote Lindner and his fellow researchers. An earlier 

 indicated that flat fee payment was associated with greater use of e-visits and telephone consultations

A single study isn't going to rehabiliate the reputation of the patient-centered medical home entirely but these findings are another indication fee-for-service and reform of American healthcare are incompatiable. 

Study of program in Oregon suggests that fee-for-service may be the reason for the underwhelming results for patient-centered medical homes. 

Patient-Centered Medical Home Repair: Flat Fee Reduces Imaging Volume

CMS announced today that it was providing additional resources to nursing homes in COVID-19 hotspots. Specifically, the federal health agency plans to deploy Quality Improvement Organizations across the country to provide immediate assistance to nursing homes in hotspots as identified by the White House Coronavirus Task Force.

QIOs are CMS contractors who work with healthcare providers to help them improve the quality of healthcare they provide to Medicare beneficiaries, according to the 

: Beneficiary and Family Center Care (BFCC) QIOs that help with beneficiary complaints and the like, and Quality Innovation Networks (QIN) QIOs that are focused on data-driven efforts to improve patient safety. 

CMS is also working to target facilities with known infection control issues by providing resources and support that will help them improve quality and safety and protect vulnerable Americans, the press release says.

 especially hard, and federal and state governments have been criticized for not acting sooner to put protective policies and practices in place. 

 in U.S. nursing homes was identified as a problem prior to COVID-19.  for The CMS moved to require nursing homes to report their deaths to the agency, and the website that CMS set up to keep a count says today that 35,517 nursing home residents died COVID-19-related deaths. Media outlets that have organized their own databases have published higher numbers. 

Federal agency is dispatching Quality Improvement Organizations to hotspots.

CMS Says Agency Is Sending Quality Improvement Help to Nursing Homes In COVID-19 Hotspots

Tabula Rasa HealthCare (TRHC), a healthcare technology company advancing the field of medication safety, recently announced its expansion of clinical services to include special needs and high-risk patients enrolled in Medicare Advantage (MA). The healthcare tech company will assist health plans in meeting Care for Older Adults (COA) requirements.

The healthcare tech company will assist health plans in meeting Care for Older Adults requirements.