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Navigators and in-person assisters continue to play a key role in helping consumers get coverage through the insurance Marketplaces. ... Not only is the consumer-assistance process time- and resource-intensive, but navigators and assisters do not necessarily have the expertise to address some of the new issues they are facing. ... Leveraging relationships with [insurance] brokers can help fill some gaps in consumer assistance and leave time for navigators to focus on the hard-to-reach populations and tough cases. More specific training on the nuances of eligibility determination, immigration, and policy changes would help navigators address some of the hard questions they are facing. (Goodell, 9/28)

With today’s emphasis on population health strategies to address “upstream” factors affecting health care, such as housing and nutrition deficiencies, there is growing interest in the potential role of hospitals to be effective leaders in tackling upstream factors ....The [Washington Adventist Hospital] experience highlights several challenges .... Among these: The full impact of a hospital’s community impact – especially beyond health impacts – is rarely measured and rewarded, leading to insufficient incentives for hospitals to realize their full potential. Creative approaches require regulatory and budget flexibility, especially at the state and county level, which is often lacking. Data sharing is needed for effective partnerships, but interoperability problems and privacy laws hamper this. (Butler, Grabinsky and Masi, 9/28)

To explore financial and nonfinancial access barriers [to health care] in the wake of the ACA coverage expansions, we used data on a nationally representative sample of nonelderly adults (ages 18 to 64) from the March 2015 round of the Urban Institute’s Health Reform Monitoring Survey .... compared with [insured] adults who did not report a disability, those who [are insured and] reported a disability were significantly more likely to report trouble finding a doctor (7.4 percent versus 3.5 percent) and getting an appointment as soon as needed (20.5 percent versus 9.7 percent). ... adults with disabilities were about three times as likely as other full-year insured adults to report an unmet need for care because a doctor or hospital would not accept their health insurance. (Karpman and Long, 9/24)

[Researchers sought to] compare patient experiences and disparities for older adults with depressive symptoms in managed care (Medicare Advantage [MA]) versus Medicare Fee-for-Service (FFS). ... Data came from the 2010 Medicare CAHPS survey, to which 220,040 MA and 135,874 FFS enrollees aged 65 and older responded. ... Beneficiaries with depressive symptoms reported worse experiences than those without depressive symptoms regardless of coverage type. For measures assessing interactions with the plan (but not for measures assessing interactions with doctors), the disadvantage for beneficiaries with versus without depressive symptoms was larger in MA than in FFS. ... Efforts are needed to identify and address the barriers these beneficiaries encounter to help them better traverse the managed care environment. (Martino et al., 9/25)

In 1993, the U.S. mandated that women and minorities be included in clinical trials funded by the federal government. More than 20 years later, it has become clear just how critical that law was: Studies have shown that not only do men and women experience certain diseases differently, but also their response to treatments can vary considerably. (Westervelt, 9/26)

The Joint Commission (JC) wants healthcare facilities to pay more attention to falls and fall-related injuries and to implement proven prevention strategies. Falls resulting in injury are a "prevalent patient safety problem," and not just among the elderly and frail, the JC notes in a Sentinel Event Alert issued September 28. ... Each year, "hundreds of thousands" of patients fall in hospitals, resulting in injuries in up to half of cases — injuries that often require additional treatment and time spent in the hospital. The average cost for a fall with injury is about $14,000, the JC notes. Falls with serious injury are consistently among the top 10 sentinel events reported to the JC's Sentinel Event database, and most of these falls happen in hospitals. (Brooks, 9/30)

Current cervical cancer screening practices remain less cost-effective and are linked to less health benefit then they would be if current guideline recommendations were followed, according to a model-based cost-effectiveness study published online September 29 in the Annals of Internal Medicine. Overscreening, underscreening, losing track of women in follow-up, and poor management of care for women with abnormal test results have all contributed to approximately 12,000 new cases and 4000 deaths from cervical cancer annually, report Jane J. Kim, PhD, from the Center for Health Decision Science at the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and colleagues. (Haelle, 9/28)

Injuries and violence cost Americans $671 billion in medical and work-loss costs in 2013, according to two studied released Wednesday by the U.S. Centers for Disease Control and Prevention. The cost associated with fatal injuries was $214 billion; with nonfatal injuries, $457 billion. Each year, more than 3 million people are hospitalized, 27 million people treated in emergency departments, and more than 192,000 die as a result of injuries. (Hughes, 9/30)

Medical literature has overstated the benefits of talk therapy for depression, in part because studies with poor results have rarely made it into journals, researchers reported on Wednesday. Their analysis is the first effort to account for unpublished tests of such therapies. Treatments like cognitive behavior therapy and interpersonal therapy are indeed effective, the analysis found, but about 25 percent less so than previously thought. (Carey, 9/30)

Specialized clinics for childhood cancer survivors may help reduce the odds these patients will need emergency medical care as adults, a Canadian study suggests. Researchers followed almost 4,000 adult survivors of childhood cancers in Ontario for two decades. Compared with survivors who never used the specialized clinics, patients who went at least once were 19 percent less likely to visit the emergency department, the study found. (Rapaport, 9/30)

A gene test used to guide treatment for early-stage breast cancer proved effective in enabling certain women to safely forgo chemotherapy, in a study that illustrates how genomic information is reshaping cancer care. Researchers said the findings provide validation for the test, called Oncotype DX, which is already in use helping women decide whether chemotherapy should be part of their treatment. The test provides a score based on a tumor’s genetic signature that describes the risk that the cancer will recur. (Winslow, 9/27)

One reason autism research hasn’t made more progress is a shortage of brains available for study. Brain scans can only take researchers so far—they need to work with donated brains to gain a deeper understanding of the condition. That’s why four research institutions have formed the Autism BrainNet to reach out to potential donors. (Sadik, 9/26)