Practically Speaking
Winter 2021

GVP Awards

GVP Awards

At the end of 2020, Donaghue announced its four most recent awards in the Greater Value Portfolio grant program. This program funds research projects for two years with a maximum amount of $400,000 per award for the purpose of advancing promising approaches to achieve a higher value healthcare system. The goal of this program is to test approaches and tools that organizations can readily use to improve the value of the healthcare they provide to patients and communities. In addition, applicants must partner with an organization that delivers healthcare services or be a researcher based in a research unit embedded in a healthcare organization.

Hannah Cohen-Cline, PhD
Providence Health & Services
“Does a Rising Tide Lift All Boats? Assessing the Direct and Indirect Effects of APMs in Primary Care”
Partner Organization: Care Oregon

The cost of care continues to rise in the U.S. while health care quality varies unacceptably across providers, payers, demographic groups, and geographic areas. One way payers attempt to address these trends is through value-based payments that incentivize performance on quality, cost, or other outcomes. But evidence for the impact of value-based payments is mixed, especially in primary care. This study will evaluate a primary care payment model that has been implemented across approximately 130 primary care clinics in Oregon and is designed to meet several goals: improve quality and reduce overall costs for Medicaid and Medicare enrollees; increase capacity for value-based payments among participating clinics; and help the payer meet state requirements for use of value-based payments. The partnering health care organization implementing the primary care payment model is a non-profit insurance plan serving low-income Oregonians with a robust history of using research to inform its work. The study will use a mixed-methods design to address three questions: 1) How has the primary care payment model affected health care cost and quality at participating clinics? 2) To what extent has the primary care payment model had spillover impacts on cost and quality of care for clinic patients with other sources of coverage? 3) How do clinics’ experiences with the primary care payment model — including their level of performance or earnings — influence their interest in and readiness for additional value-based payments? Findings from the study will be used by the partnering organization’s value-based payments Steering Committee and external clinical advisory groups to optimize primary care payment model design in future iterations and inform their future value-based payments strategy more broadly.

Megan Cole, PhD, MPH
and June-Ho Kim, MD, MPH

Boston University School of Public Health
“Value and Equity of Telehealth for Low-Income Patients with Chronic Conditions at Federally Qualified Health Centers”
Partner Organization: Community Care Cooperative

The COVID-19 pandemic has transformed the primary care landscape with rapid shifts to telehealth. For low-income patients with chronic conditions — who have high utilization and costs — telehealth may have wide-ranging impacts on value and equity of care. It may lower costs and improve access for patients who previously experienced barriers to in-person visits. However, telehealth could exacerbate disparities, particularly for patients with inadequate access to technology or for whom English is not their primary language. Bringing together the Community Care Cooperative (C3) — the largest risk-bearing Accountable Care Organization (ACO) of Federally Qualified Health Centers (FQHCs) in the country — with experienced program evaluators and implementation scientists, this study will (1) evaluate the effects of telehealth on utilization of high-value chronic disease management services, quality outcomes, and spending among FQHC patients; (2) assess heterogeneity in effects across racial, ethnic and linguistic subpopulations; and (3) identify scalable best practices for optimizing value and equity of chronic disease management telehealth in low-income populations. Boston University School of Public Health will lead the study using quasi-experimental methods to analyze a unique, rich dataset of electronic medical record and claims data. Ariadne Labs will bring its extensive experience in translational research and implementation science and apply its proven model for designing scalable solutions for national and global spread. C3 will integrate evidence into its network of 19 FQHCs in Massachusetts and across the Massachusetts FQHC Telehealth Consortium — a group of 30 FQHCs that provides a platform to scale our research findings into practice and policy.

Fasika Woreta, MD
Johns Hopkins University School of Medicine
“Real-time Prescription Benefit Tools in the Electronic Health Record: Working towards greater value for prescribers and patients”
Partner Organizations: Froedtert and Medical College of Wisconsin, Yale New Haven Health System, and Johns Hopkins Health System

Prescription drug spending in the U.S. is greater than any other country in the world. Prior studies have demonstrated that greater out-of-pocket medication costs for patients increase rates of prescription abandonment at the pharmacy. In an effort to increase price transparency for patients and prescribers, the Centers for Medicare and Medicaid Services (CMS) mandated that Medicare Part D health plans adopt one or more electronic real-time prescription benefit tools by 2021. Real-time prescription benefit tools inform providers when lower-cost alternative therapies are available under the beneficiary’s prescription drug plan at the time a medication is prescribed. As a result, real-time prescription benefit tools have the potential to promote conservations regarding price between patients and providers, minimize out-of-pocket costs for patients, lower prescription drug costs, and improve medication adherence and health outcomes. We will assess the impact and utilization of real-time prescription benefit tools across three large and diverse health systems and investigate facilitators and barriers to prescriber adoption. Our goal is to establish methods to measure the impact of the tool nationally and to identify areas for improvement learned from these three institutions with early real-time prescription benefit implementation. Given the recent adoption of real-time prescription benefit tools and the impending CMS mandate, this work will generate insights for future studies of targeted interventions to improve the design and adoption of real-time prescription benefit tools nationwide. If this research demonstrates a positive impact of real-time prescription benefit tools for patients and providers, what is learned may support the expansion of price transparency tools to vulnerable populations and to diagnostic testing.

Sunitha Kaiser, MD
University of California, San Francisco
“The PIRCH Study: Pathways for Improving Respiratory Illness Care for Hospitalized Children”
Partner Organization: Value in Inpatient Pediatrics

Asthma, pneumonia, and bronchiolitis are the top causes of childhood hospitalization in the U.S., leading to >350,000 hospitalizations and ≈$2 billion in costs annually. Poor guideline adherence by clinicians contributes to poor outcomes for children hospitalized with these respiratory illnesses, including administration of unnecessary treatments and tests, as well as higher risks of prolonged recovery time and stays, transfer to intensive care, and readmission. Pathways are simple, visual diagrams that guide clinicians step-by-step through evidence-based care decisions. Most hospitals implement pathways for one medical condition at a time, but Seattle Children’s Hospital developed an intervention for simultaneously implementing multiple pathways for multiple pediatric conditions. This intervention improved guideline adherence and decreased length of stay and costs. This intervention has not been studied in community hospitals, which care for >70% of children nationally. The goal of this study is to evaluate the effectiveness and implementation of this intervention in community hospitals. In Aim 1, a cluster-randomized trial in 36 hospitals will be used to determine the effects of the intervention on guideline adherence and evidence-based practices for each condition: asthma, pneumonia, bronchiolitis). In Aim 2, barriers and facilitators of implementation will be assessed through a qualitative study of hospitals with higher and lower performance in improving guideline adherence. This study will provide evidence on an intervention that can leverage implementation resources by tackling multiple pathways and rapidly improving value of care for hospitalized children. Value in Inpatient Pediatrics, a quality improvement network of more than 450 hospitals, is the partner organization and will assist in the study and with disseminating, and potentially scaling the intervention broadly.