The future for health plans is not so much in plan design or call centers but in how they leverage their storehouses of healthcare data, advises Paul Keckley, managing director of Navigant. In this audio interview, Keckley talks about infomediation—the mining of membership data to determine factors influencing population health—and its influence on payor valuation, its role in shared risk arrangements, and why health plans’ ’embedded Intel’ uniquely positions them for success.
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.
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.
Adventist Health’s successful use of incentives to engage employees in population health sets a high bar for the program’s imminent rollout to patients at Adventist-owned White Memorial Medical Center, notes Elizabeth Miller, Adventist’s vice president of care management. In this interview, Ms. Miller describes the program’s target population as well as the incentive that engaged 95 percent of its employees in health management.
Elizabeth Miller shared the key features of the population health management program at White Memorial, the program’s impact on Adventist’s 27,000 employees and program rollout to its patient population during a January 22, 2014 webinar, Managing Risk in Population Health Management, a 45-minute program sponsored by The Healthcare Intelligence Network.
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.
A patient might expect a reminder about a missed colonoscopy during a primary care visit, but during a trip to the dermatologist? Providing health plan members with “consistent and ubiquitous reminders” via multiple touchpoints in their healthcare journey is one of Kaiser Permanente’s key population health management strategies, reports Jim Bellows, PhD, senior director of evaluation and analytics for Kaiser Permanente.
Another is the vigorous use of registries more than 50 in all, at last count even for relatively rare diseases. Dr. Bellows defines the criteria for registry creation, expands on the choice and availability of patient touchpoints and explains the evolution of other Web-based PHM tools in use by Kaiser Permanente.
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.
Primary care and the patient-centered medical home offer a great opportunity for health coaches to become allies with patients in improvement of their health, notes William Appelgate, executive director of the Iowa Chronic Care Consortium. Individuals with the highest health risks should be given priority, but those on the cusp of a serious health event also merit coaching assistance, he says. For providers new to the coaching conversation, Appelgate shares three benefits of incorporating health coaches in the care process including the upping of their ‘outcomes game.’
Enhanced reporting and efficiency, significant reductions in readmissions in congestive heart failure patients and added leverage at contract negotiation are just a few advantages Bon Secours is deriving from its EHR-based data collection tools, explains Robert Fortini, vice president and chief clinical officer at Bon Secours. Fortini talks about the health system’s shift from home-grown methodologies to the sophisticated IT knowledge base powering its population health management program, resulting in data that has a “compelling” effect at contract time.
Before shifting from a disease-focused to population health management (PHM) approach, healthcare organizations need to do their homework, advises Patricia Curran, principal in Buck Consultants’ National Clinical Practice — from researching the population’s culture to examining its patterns of healthcare usage and cost trends. In this interview, Ms. Curran describes the four key research areas, as well as some of the barriers encountered along the road to population health management. She also predicts what the no- or low-health-risk populations can expect in a population health management world that spans the health risk continuum — from incentives to provider and payor contact.