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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?

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.

Collapse of Two Online Health Communities as Result of Removal of Users Starting from Superusers

Patient Engagement

Online “Superusers” as Allies of the Health Care Workforce

Three proposed steps for integrating peer-driven online health communities with traditional services to improve health outcomes for people with chronic conditions.

Berns01_pullquote nephrologists dialysis facility joint venture conflicts of interest

New Marketplace

Dialysis-Facility Joint-Venture Ownership — Hidden Conflicts of Interest

Despite potential benefits, joint ventures between nephrologists and dialysis companies raise legal and ethical concerns because of participants’ conflicts of interest and lack of transparency.

Evidence Needed for Health Systems Change to Address Social Determinants of Health and Obesity and Diet-Related Diseases in Turn

Care Redesign

Better Clinical Care for Obesity and Diet-Related Diseases Requires a Focus on Social Determinants of Health

To more effectively treat the problems of obesity and diet-related conditions, health systems need to restructure the traditional medical model of care delivery to address the social determinants of health.

People Living with Dementia Around the World - Value-Based Chronic Illness and Dementia Care

Care Redesign

Value-Based Care Must Strengthen Focus on Chronic Illnesses

To effectively control costs and improve value, new models must address our increasingly older patients and chronic care patients, especially those with Alzheimer’s and related dementias.

Sample Report Comparing Individual Patient-Reported Outcome Measures with FORCE-TJR National Norms

New Marketplace

The Essential Role of Patient-Centered Registries in an Era of Electronic Health Records

Smartly designed patient-centered registries capture longitudinal data to augment EHRs and enhance quality improvement, policy, and research efforts.

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