Learning health for Michigan: The path forward

In the United States, health care purchasers, consumers, and policymakers are demanding improvements in the quality and efficiency of medical care. A promising approach to meet this demand is the development of what is known as a learning health system (LHS). A learning health system has the capability to continuously study and improve itself. Among many types of benefits it can bring about, the learning health system makes it possible for providers to make faster and better decisions about which treatment options would produce the best outcomes for patients. Today, the Michigan-based stakeholder initiative, Learning Health for Michigan (LH4M), is proposing the use of a learning health system approach to address persistent health care problems in Michigan. Unwarranted and costly hospital readmissions—which are discussed in this paper—are one example of a problem that could benefit from a learning health system approach.

In 2013, the Center for Healthcare Research and Transformation (CHRT) convened a group of patients, clinicians, researchers, public health professionals, and payers to discuss ways to apply the idea of the learning health system at a state level: to turn Michigan into what might be called a “learning health state.” The initiative was named “Learning Health for Michigan,” or LH4M. Later convenings of the LH4M stakeholder group were organized by the Michigan Health Information Network (MiHIN) Shared Services and the Department of Learning Health Sciences at the University of Michigan Medical School.

Michigan has many resources that are key ingredients for a state-wide learning health system.

Read the full brief, Learning Health for Michigan: The Path Forward.


Creating Sustainability through Public-Private Partnerships: The Future of New Primary Care Models

As the U.S. health care system places a growing emphasis on improving the value of health care, many states and the federal government have increasingly invested in primary care to improve health outcomes and lower health care costs. Unlike “traditional” primary care settings, newer primary care models strengthen primary care providers’ role in expanding access to care and providing comprehensive, coordinated services to help improve patients’ experiences. In recent years, states have used federal funding to test new approaches to primary care through Patient-Centered Medical Home (PCMH) and other such initiatives.

Many of these efforts were originally funded through time-limited Centers for Medicare and Medicaid Services (CMS) demonstration projects that encouraged or required commitments from commercial payers and/or state Medicaid programs. As these initial demonstration grant periods end, public-private partnerships and other creative funding approaches are emerging to continue and/or expand PCMH efforts. New leadership at CMS appears poised to move the focus toward local solutions and governance that leverage private sector partnerships.

This brief, developed with support from the Commonwealth Fund, describes the major elements of PCMH initiatives and sustainability efforts in four states—Michigan, Vermont, Colorado, and Arkansas. The efforts undertaken by these four states provide valuable learnings for all states considering the future of their own initiatives.

Read more in Creating Sustainability Through Public-Private Partnerships.


Uncoordinated prescription opioid use in Michigan

Prescription opioids such as morphine, oxycodone, and hydrocodone provide pain relief to patients with chronic pain. However, these drugs also pose safety risks to patients. Opioid use can cause respiratory depression, resulting in overdose or death.

As prescription opioids have been used more extensively for pain control in the past two decades due to changing practice guidelines, overdose deaths surged in both Michigan and the United States. Notably, the majority of opioid-related disabilities and deaths result from patients taking opioids as prescribed, rather than from deliberate abuse or misuse. Furthermore, opioid-related deaths are frequently associated with concurrent use of prescribed antidepressants or benzodiazepines like Valium and Zanax.

Pain control is an essential part of patient care, and opioids are one of the primary pain treatments available. While most opioids are used and prescribed appropriately, a small number of patients receive numerous prescriptions from separate prescribers within a short period of time. This lack of coordination increases patients’ risk of accidental overdose and death. This issue brief analyzes accidental deaths from opioid overdoses in Michigan, uncoordinated opioid prescribing among privately insured Michigan patients in 2013, and policy options to improve safe prescribing in the state.

Key Findings

  • Uncoordinated opioid prescribing is a critical patient safety issue in Michigan, particularly for patients who receive a large volume of opioids from multiple prescribers. It is essential that patients receive appropriate pain control, which may include the use of opioids, but pain treatment should not jeopardize patient safety.
  • Accidental overdose deaths involving opioids (including prescription drugs and heroin) increased sixfold in Michigan between 1999 and 2013 (from 81 to 519 deaths). These opioid-related deaths represented 38 percent of all accidental drug deaths in 2013, up from 23 percent in 1999.
  • Accidental overdose deaths involving prescription opioids represented 43 percent of total opioid deaths in 2013. The remaining 57 percent of deaths were from heroin, which is noteworthy since some patients first become addicted to prescription drugs and then turn to heroin, the strongest form of opioid.
  • In 2013, over 600 privately insured Michigan patients in the study group were defined as having uncoordinated opioid prescriptions (0.3 percent of all patients using prescription opioids). These patients filled at least ten opioid prescriptions from four or more providers within three months. As a result, they ran a higher risk of accidental overdose and death because their providers may not have been aware of all their opioid prescriptions.
  • In October 2015, the Michigan Prescription Drug and Opioid Abuse Task Force released its findings and recommendations.

Key recommendations to address these issues include:

  • Expanding provider education on safe opioid prescribing;
  • Requiring providers to have a bona-fide relationship with patients before prescribing controlled substances;
  • Launching a public awareness campaign;
  • Increasing access to the lifesaving overdose reversal drug naloxone;
  • Exploring the possibility of limiting criminal penalties for people who report or seek medical attention for overdoses; and
  • Improving the state’s database of controlled substance prescriptions and increasing its use by providers and pharmacists.

Read Full Brief Here

Care transitions: Best practices and evidence-based programs

Poorly coordinated care transitions from the hospital to other care settings cost an estimated $12 billion to $44 billion per year. Poor transitions also often result in poor health outcomes. The most common adverse effects associated with poor transitions are injuries due to medication errors, complications from procedures, infections, and falls.

Many providers are focused on improving transitions, due in part to reimbursement changes under the Affordable Care Act. This paper summarizes best practices in care transitions, including:

  1. comprehensive discharge planning,
  2. sending discharge summaries to outpatient providers,
  3. assessing financial barriers to filling prescriptions,
  4. using a “teach back” method to ensure patient understanding,
  5. following up with outpatient providers, and more.

Read the full brief

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