Category Archives: Care Transitions

Pioneer ACO Results Year 2: Inpatient Utilization Down; Medicare Saves More Than $384 Million

The Pioneer Accountable Care Organization (ACO) Model has generated over $384 million in savings to Medicare over its first two years — an average of approximately $300 per participating beneficiary per year — and significantly decreased inpatient care, while continuing … finish reading Pioneer ACO Results Year 2: Inpatient Utilization Down; Medicare Saves More Than $384 Million

Posted in Accountable Care Organizations, affordable care act, Alternative Healthcare Coverage, Avoidable Hospitalization, Care Coordination, Care Transitions, Disease Management, dual eligibles, Elderly Care, Improving Patient Care, Medicare | Tagged , , , , , | Leave a comment

Better Communication Key to Lowering Healthcare Costs, Improving Patient Experience: Survey

Strengthening communication between caregivers and patients should be a top priority for reducing healthcare costs and improving patient experience, according to a new poll of U.S. healthcare quality improvement professionals conducted by ASQ, a global network of resources and experts. … finish reading Better Communication Key to Lowering Healthcare Costs, Improving Patient Experience: Survey

Posted in affordable care act, Behavioral Health, Care Coordination, Care Transitions, Healthcare Costs, Healthcare Information Technology, Healthcare IT | Tagged , , , | Leave a comment

‘Next Generation’ ACO Encourages Telehealth, Post-Discharge Home Services: CMS

In another step towards advancing models of care that reward value over volume, HHS announced the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery. A new initiative from CMS’s Innovation Center, the model is part of … finish reading ‘Next Generation’ ACO Encourages Telehealth, Post-Discharge Home Services: CMS

Posted in Accountable Care Organizations, affordable care act, Alternative Healthcare Coverage, Care Coordination, Care Transitions, Disease Management, dual eligibles, Elderly Care, Healthcare Costs, Healthcare Utilization, Home Healthcare, Medicare/Medicaid EHR Incentive, Skilled Nursing Facilities, Telehealth | Tagged , , , , | Leave a comment

Pilot Prevents Unnecessary Hospitalizations by Optimizing Transfers of Nursing Facility Residents

Designed to prevent unnecessary hospitalizations of nursing facility patients, a new study focuses on how to optimize transfers of these patients between facilities and acute-care institutions by improving care and communication, according to research from Indiana University (IU) and Regenstrief … finish reading Pilot Prevents Unnecessary Hospitalizations by Optimizing Transfers of Nursing Facility Residents

Posted in Avoidable Hospitalization, Care Coordination, Care Transitions, Case Managers, Case Managers and the Patient Experience, Disease Management, Elderly Care, Hospital Readmissions, Hospital Services, Hospital Training, Improving Patient Care | Tagged , , , | Leave a comment

Health Plans Foster Population Health with Care Coordination, Case Management

As population health management (PHM) finds its footing in value-based healthcare, PHM program focus, support tools and key players continue to shift, according to 129 respondents who participated in the latest Population Health Management Survey conducted in June 2014 by … finish reading Health Plans Foster Population Health with Care Coordination, Case Management

Posted in affordable care act, Care Coordination, Care Transitions, Case Managers, Case Managers and the Patient Experience, Disease Management, Population Health Management | Tagged , , | Leave a comment

Medicaid Medical Home Cuts 30-Day Readmissions, Healthcare Costs, Increases Follow-Up Visits

Since its implementation in 2012, a medical home for Medicaid patients showed a 130.4 percent increase in timely patient follow-up visits, a 25 percent decrease in 30-day hospital readmissions, and a decrease in the overall cost of care for each … finish reading Medicaid Medical Home Cuts 30-Day Readmissions, Healthcare Costs, Increases Follow-Up Visits

Posted in Avoidable Hospitalization, Care Coordination, Care Transitions, Comprehensive Primary Care Programs, Healthcare Costs, Healthcare IT, Hospital Readmissions | Tagged , , | Leave a comment

5 Documentation Requirements for Chronic Care Management Reimbursement

To be properly reimbursed by Medicare for select chronic care management (CCM) services not previously eligible for payment, documenting all conditions and satisfying requirements is critical, including the most challenging requirement, the ’20 minutes a month’ rule, says Rick Hindman, … finish reading 5 Documentation Requirements for Chronic Care Management Reimbursement

Posted in affordable care act, Care Coordination, Care Transitions, Disease Management, electronic health records (EHRs), Healthcare Costs, Healthcare IT, Healthcare Law | Tagged , , , | Leave a comment

CMS Hopes to Entice More ACOs with Proposed Risk, Rewards Models

Attempting to attract more accountable care organizations (ACOs) to participate in the Medicare Shared Savings Program (MSSP) without fearing penalties, CMS has released a set of proposed rules with updated penalties and incentives, plus a third new model to attract … finish reading CMS Hopes to Entice More ACOs with Proposed Risk, Rewards Models

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Data Science, Stratification Drives Patient-Centric Care, Quality Outcomes

Determining risk stratification can be arbitrary, unless patients are placed at the center of care and surrounded with data science and resources, whether it’s case managers, risk managers, registries, or more, says Mark Green, system AVP of transition management at … finish reading Data Science, Stratification Drives Patient-Centric Care, Quality Outcomes

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Embedding a Case Manager? Consider Workflow Changes, Training Needs

Continually monitoring skills and training needs and evaluating the workflow changes — operational, technological and cultural — inherent in an embedded environment are two important, ongoing challenges when working with embedded case managers, says Annette Watson, RN-BC, CCM, MBA, senior … finish reading Embedding a Case Manager? Consider Workflow Changes, Training Needs

Posted in affordable care act, Avoidable Hospitalization, Care Coordination, Care Transitions, Case Managers, Case Managers and the Patient Experience, Embedded Case Manager, Uncategorized | Tagged , , , | Leave a comment