As groundwork for participation in CMS’s Bundled Payments for Care Improvement initiative, St. Vincent’s Health Partners (SVHP) formed a cross-functional cross-boundary Transitions Leadership Group to map what happens to patients moving along their care journeys, explains Colleen Swedberg, MSN, RN, CNL, director for care coordination and integration.
In this audio interview, Ms. Swedberg describes the structure and goals of the Transitions Leadership Group and some tools and protocols it developed to set standards for any post-acute provider wishing to join the SVHP network.
Physician engagement is one of three top challenges of the Medicare Pioneer ACO model, along with performance improvement and care management, explains Kelly Clements, Pioneer program director for Steward Health Care Network, which operates Promise, a top-performer in CMS’s Medicare Pioneer ACO program.
To drive engagement in its accountable care organization at the provider level, Steward offers a range of physician tools and supports, including road shows and report cards, which Ms. Clements describes in this audio interview.
The use of a care coordinator boosts the quality of care a physician practice provides and thus its potential for earning incentives in Humana’s Physician Quality Rewards program, explains Chip Howard, Humana’s vice president of payment innovation in the provider development center of excellence.
Here, Howard describes the value Humana places on the care coordination function, and describes the support and training available to physician practices at each level of the three-tiered rewards program, a hallmark of Humana’s Accountable Care Continuum.
Chip Howard will share how Humana’s program supports physicians’ transition from volume to value and helps them become successful population health managers during a December 16, 2014 webinar, Physician Quality Rewards for Population Health Management, a 45-minute program sponsored by The Healthcare Intelligence Network.
Given changing reimbursement incentives and collaborative models for physicians and hospitals, Greg Mertz, managing director of Physician Strategies Group, LLC, discusses why the Congressional proposal “Better Care, Lower Cost Act” of 2014 is financially more attractive to providers than ACO models and whether he thinks it will be passed. He also deconstructs CMS’ recently reported financial results for such health reform delivery initiatives as Medicare ACOs, Pioneer ACOs, and the Physician Group Practice demonstration, and weighs in on which, if any, model he considers the most sustainable.
There are three key benefits to prudent sharing of performance data among physicians, notes Cynthia Kilroy, senior vice president of provider strategy and business development at Optum, who suggests a four-step systematic approach for data dissemination that moves companies away from simply creating “metrics in a box.” Besides the electronic health record, she recommends three other data sources to mine for provider performance metrics.
Despite the migration of some Pioneer ACOs to CMS’s Medicare Shared Savings Program (MSSP), expect the surge in commercial accountable care organizations to continue in 2014, predicts Steven Valentine, president, The Camden Group. In this audio interview, Valentine suggests improvements to patient handoffs, an area in which ACOs have disappointed, in Valentine’s view, as well as expectations for the other much-modeled care delivery platform, the patient-centered medical home (PCMH).
In both the ACO and the PCMH, Valentine anticipates specialists will be critical parts of the solution, especially when it comes to emerging payment models, quality and performance.
There’s education, there’s experience, and then there’s the ‘right stuff’ the indefinable personality traits that earmark an individual as a change agent, collaborator and ambassador of case management, says Annette Watson, senior vice president of community transformation for Taconic IPA (TIPA), of TIPA’s requirements for the RN case managers it hires for its advanced patient-centered medical homes.
Then there are the not insignificant contributions of the RN case manager to accountable and patient-centered care, which Ms. Watson describes in this interview.
While staff-buy-in and communication continue to challenge the embedded case manager model, the participant in CMS Innovation Center’s Comprehensive Primary Care (CPC) initiative says reimbursement for embedded case management is less of an obstacle today than in the past, due to funding-friendly care models and pilots descending from healthcare reform.
Lauded for its care coordination service, Monarch had to overcome a few challenges when retrofitting the Naylor Transition of Care (TOC) model for the ACO among them insufficient patient access, patient skepticism and resource limitations. By focusing on readmissions reductions and four disease management conditions ESRD, COPD, CHF and diabetes and creating a care coordination team that included the newly created care navigator, case managers, and pharmacist, the organization has improved patient compliance, reduced negative drug interactions and hospital days and improved patients access to community services.
During Medicare Pioneer ACO Year One: Lessons from a Top-Performer, a September 18th webinar at 1:30 pm Eastern, Colin LeClair, executive director of ACO for Monarch HealthCare, shared first year lessons from its Medicare Pioneer ACO experience, how it evolved in year two and the impact on its organization’s participation in other accountable care organizations.
When tracked within its electronic medical record, key interventions like transitional care coaching and an expanded Patient Health Questionnaire not only improve the care provided to John C. Lincoln ACO’s population but provide a clearer picture of the accountable care organization’s performance, note Karen Furbush, business consultant, and Heather Jelonek, chief operating officer of the John C. Lincoln Network ACO.
Additionally, the ACO’s Physician Advisory Network, made up of its leading physicians, tracks patterns and trends within the ACO and helps the care team to adhere to best practices in evidence-based medicine. Monthly webinars with the physician advisory network and its EMR specialists provide opportunities for evaluation and training in these best practices. Karen Furbush and Heather Jelonek shared how the John C. Lincoln Network ACO has modified its reporting process, from workflow changes to customizations within its EMR to improve performance results during a July 17, 2013 webinar, Performance Quality Measurement and Reporting for Accountable Care, a 45-minute program sponsored by The Healthcare Intelligence Network.
When health coaches employ motivational interviewing during patient encounters, expect upticks in medication adherence, weight loss, HbA1c levels and overall engagement, notes Alicia Vail, RN health coach for Ochsner Health System. Ochsner’s eight health coaches focus on patients with diabetes, hypertension and obesity who have come to their attention by way of physician referrals, health screenings and pre-chart reviews.
In this podcast, Ms. Vail describes how Ochsner Health System incorporates health coaches in its clinic structure and describes the benefits that result from the coaching intervention.