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Chronic Care Management

Improving chronic care can help reduce costs and boost quality of life. What can we do to provide the best care and the best outcomes for people with chronic illness?

New Evidence on Stemming Low-Value and Overprescribing - Nudgind Physicians Toward Better Prescribing Practices

New Marketplace

New Evidence on Stemming Low-Value Prescribing

New research suggests that deploying strong and surprising messages could help to address overprescribing of opioids and other drugs.

Idiopathic Pulmonary Fibrosis IPF Multidisciplinary Collaborative Care Model

Care Redesign

From Consulting to Caring: Care Redesign in Idiopathic Pulmonary Fibrosis

A multidisciplinary collaborative model to address the palliative care needs of patients with idiopathic pulmonary fibrosis resulted in improved end-of-life care and decreased hospital deaths.

The Patient Engagement Capacity Framework

Patient Engagement

The Patient Engagement Capacity Model: What Factors Determine a Patient’s Ability to Engage?

Patient engagement assessments often don’t dig deep enough to identify why patients don’t participate in their own health care. We present a new model to help providers pinpoint the reasons for lack of engagement and address them more effectively.

Fisher02_pullquote hypertension guidelines

Care Redesign

Hypertension Guidelines: Achieving 90% Success

Focused and innovative health systems are managing to control blood pressure for 9 in 10 patients, which is well above the national average of 50% to 60%.

Hip or Knee OA Care Management - Musculoskeletal Institute and Bundled Payment Program at Dell Medical

New Marketplace

Bundled Payments Are Moving Upstream

Dell Medical School at The University of Texas at Austin has improved outcomes and reduced costs for musculoskeletal care with a multidisciplinary Musculoskeletal Institute and bundled payment model.

Treatment Authorization Increases and Rapid Boost in New Mexico Medicaid Members Treated for Chronic HCV

Care Redesign

A Collaborative Model to Expand Medicaid Treatment Coverage for Chronic Hepatitis C Virus

How managing the benefit coverage expansion for the treatment of HCV in New Mexico was successfully achieved after less than 2 years.

What High-Need, High-Cost Patients Say About How to Reduce High Utilization of ED and Inpatient Services

Patient Engagement

High-Need, High-Cost Patients Offer Solutions for Improving Their Care and Reducing Costs

More home health care and after-hours clinics, telemedicine, and home delivery of medications are among top solutions.

Top Physician Pain Points Identified by Chronic Patients

Patient Engagement

Unmet Needs: Hearing the Challenges of Chronic Patients with Artificial Intelligence

With natural language processing and machine learning, researchers are identifying patient emotional and medical needs that are not being met by clinicians and patient advocacy groups.

odel for Complex Gynecologic Care Team at the Women's Health Institute

Care Redesign

An Innovative Approach to Treating Complex Gynecologic Conditions

How the Women’s Health Institute at The University of Texas at Austin designed their clinic to provide comprehensive, team-based, and patient-centered care for women.

Discharge Rates and Follow-Up Internval Dashboard for One Provider at MGH Dermatology

New Marketplace

A Successful Pilot to Improve Access by Adjusting Discharge and Follow-Up Rates

Actionable data and modest financial incentives can help motivate clinicians to adjust their behavior around scheduling follow-up appointments.

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