Integrated Case Management: The Surprise Question That Can Improve Timeliness of Hospice Referrals

Laura OstrowskyFor patients with cancer, palliative care should begin at diagnosis to help them shoulder the disease’s emotional, physical and financial burdens, explains Laura Ostrowsky, director of case management at Memorial Sloan Kettering Cancer Center (MSKCC). However, for multiple reasons, referrals to hospice frequently happen too late for MSKCC patients to derive full benefit from that service.

In this episode of HealthSounds, Ms. Ostrowsky shares some key questions for integrated case managers to ask providers to improve timeliness of hospice referrals, patient and family satisfaction with hospice service, and awareness of end-of-life care. The strategy is one way MSKCC uses integrated case management to validate its worth in a value-based system: providing the best care in a quality-effective manner.

During Integrated Case Management: A New Approach to Transition Planning, an August 2017 webinar now available for replay, Ms. Ostrowsky outlines MSKCC’s use of a team-based case management model that follows patients as they transition across the health system.


Length: 3:06 minutes

4 Foundational Behaviors Forge Framework for UnityPoint Health Patient Experience Improvement Plan

Paige MooreTo engage staff in its patient experience improvement action plan, UnityPoint Health defined four foundational behaviors expected of every team member (not just providers) across the organization.

In this podcast, Paige Moore, director of patient experience at UnityPoint Health, describes the rationale and rollout for the four behaviors, which are based on patient and visitor feedback and comments.

During Improving the Patient Experience: Engaging Front-line Staff for a System-Wide Action Plan, a July 2017 webinar now available for replay, Ms. Moore shares how the deployment of department-specific service action teams facilitated the switch from a top-down, leadership-driven patient experience improvement approach to one that engages front-line staff to own the process.


Length: 3:56 minutes

CMS’ Physician QRUR Tables Highlight High-Value Referral Patterns for Medicare Population

William HoldingAmong other data, detail tables in a physician practice’s Quality Use and Resource Reports (QRURs) pinpoint specialist referral networks for Medicare beneficiaries, explains William Holding, consultant, PDA, Inc., which can help physician practices determine their highest value referral pathways.

In this audio interview, Holding explains the benefits of tapping CMS-generated QRUR reports to enhance performance under Merit-Based Incentive Payment Systems (MIPS), one of two payment paths for physician reimbursement under MACRA.

During Physician MACRA Preparation: Using QRUR and Other CMS Data To Maximize Your Performance, a January 2017 webinar now available for replay, Holding and colleague Nancy Lane, president of PDA, Inc., share the critical steps physician practices should take when analyzing their QRUR data, along with details on other CMS data points that can help practices improve MIPS performance.


Length: 3:07 minutes

Trends Shaping Healthcare in 2017: Employ Technology for Patient Engagement

Steven ValentineThe engagement of patients, particularly those with multiple chronic conditions, continues to challenge healthcare providers.

However, as Steven Valentine, vice president of advisory consulting services for Premier Inc., explains in this podcast, clinicians actually have a host of tools at their fingertips to engage patients—tools they must employ in order to succeed in value-based healthcare.

During Trends Shaping the Healthcare Industry in 2017: A Strategic Planning Session, a November 2016 webinar now available for replay, Steven Valentine provides a roadmap to the key issues, challenges and opportunities for healthcare organizations in 2017.


Length: 2:52 minutes

MACRA Prerequisite: Procure QRUR Performance Data to Maximize MIPS Success

Barry AllisonPrior to enrollment in MACRA’s Merit-Based Incentive Payment System (MIPS), physician practices should request their confidential Quality Use and Resource Report (QRUR) from the Centers for Medicare and Medicaid Services (CMS) for crucial performance feedback, advises Barry Allison, chief information officer, the Center for Primary Care.

In this podcast, Allison explains how to obtain a QRUR report, the origins of QRUR quality and cost data, and the benefits of leveraging QRUR feedback to improve the quality and efficiency of care delivered to attributed Medicare fee-for-service beneficiaries and ultimately prosper under MACRA’s multi-pronged approach.

During Physician Chronic Care Management Reimbursement: Setting MACRA’s MIPS Path for 2017, an October 2016 webinar now available for replay, Mr. Allison shares his organization’s chronic care management reimbursement strategy and how this is guiding their preparation for MIPS in the year ahead.


Length: 3:12 minutes

MACRA for Small Physician Practices: Don’t Let the Technology Intimidate You

Eric LevinRather than threatening to drop Medicare volumes or open a concierge practice, small and solo physician practices daunted by MACRA technology requirements should sit tight and avail themselves of current and promised education and training from CMS to support the transition, advises Eric Levin, director of strategic services, McKesson.

In this audio interview, Levin describes what’s at risk for practices that don’t engage in at least one physician reporting program and four benefits of tapping into MACRA technical assistance from CMS.

During a July 2016 webinar, The New Physician Quality Reporting: Positioning Your Practice for MACRA’s Merit-Based Incentive Program, now available for replay, Levin offers a brief MACRA overview and outlines 2016 focus areas for practices to help them avoid reimbursement penalties in 2017 based on the proposed rule.


Length: 4:00 minutes

For Success in Accountable Care Models, Educate Providers on the Ground

Travis AnselWhether an ACO is assessing readiness for CMS’s Next Generation ACO model or is already a Medicare Shared Savings Program (MSSP) participant, face-to-face education of non-executive providers living the day-to-day ACO reality is critical to that accountable care organization’s viability, advises Travis Ansel, senior manager of strategic services for Healthcare Strategy Group.

Even within experienced MSSP ACOs, providers often don’t understand MSSP quality goals, the relationship of their actions to cost management or MSSP data requirements, noted Ansel.

In this broadcast, Ansel describes the two biggest barriers to success across all ACO models, and offers two tips to organizations wishing to prosper in the value-based care reimbursement world.

During an April 2016 webinar, Next Generation ACO: An Organizational Readiness Assessment, now available for replay, Ansel and colleague Walter Hankwitz, senior accountable care advisor at Healthcare Strategy Group, provide a value-based risk contract roadmap to determine organizational readiness for participation in the Next Generation ACO Model in particular and in risk-based contracts in general.


Length: 3:26 minutes

Horizon BCBSNJ Episodes of Care: No-Risk Retrospective Model Paves Way for Value-Based Migration

Lili BrillsteinWhile it does not immediately eliminate fee for service, a retrospective upside-only payment model is helping to transform the spirit of the payor-provider relationship, notes Lili Brillstein, director of the Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) Episodes of Care (EOC) initiative where this methodology has been implemented.

Listen as Ms. Brillstein describes how Horizon’s application of retrospective methodology across all episodes expands the program’s reach and opportunities while fostering a no-risk environment conducive to collaboration.

During a March 2016 webinar, Episodes of Care: Improving Clinical Outcomes and Reducing Total Cost of Care Through a Collaborative Payor-Provider Relationship, now available for replay, Ms. Brillstein shares details behind the health plan’s EOC program, from the episodes they have bundled to goals and results from the program.


Length: 4:12 minutes

Data Analytics Drive Medicare Annual Wellness Visits, Boost Beneficiary Attribution, Retention

Elena TkachevBeyond facilitating business decisions and improving quality of care and patient experience, data analytics help Collaborative Health Systems (CHS) to close gaps in preventive care within its 24 accountable care organizations (ACOs), explains Elena Tkachev, CHS director of ACO analytics.

One key preventive metric for the largest U.S. sponsor of Medicare Shared Savings Programs (MSSPs) is the Medicare Annual Wellness Visit (AWV), which CHS has set as a core goal. In this audio interview, Ms. Tkachev describes the rationale behind this goal, how data analytics drives AWVs, and the dramatic correlation between AWVs and patient attribution.

During a January 2016 webinar, Data Analytics in Accountable Care: Strategies and Case Studies, now available for replay, Elena Tkachev shared her organization’s experience in using data analytics effectively to improve ACO results.


Length: 3:37 minutes

Trends Shaping Healthcare for 2016: Rethink the Patient Experience in Response to Consumerism

Laura JacobsThe patient experience begins before an individual even thinks about going to the doctor or hospital, notes Laura Jacobs, executive vice president for GE Healthcare Camden Group, and patient satisfaction has moved beyond what is measured on surveys. As such, healthcare organizations should thoughtfully craft communications and care delivery strategies to meet rising consumer expectations and boost quality metrics. In this audio interview, Ms. Jacobs suggests how to better manage the consumer experience across the care spectrum and respond to the proliferation of consumer-generated healthcare data via apps and social media.

During a November 2015 webinar, Trends Shaping the Healthcare Industry in 2016: A Strategic Planning Session, now available for replay, Ms. Jacobs and Paul Keckley, managing director of Navigant, provided a roadmap to the key issues, challenges and opportunities for healthcare providers and payors in 2016.


Length: 3:35 minutes