Multi-Specialty Telehealth Collaborative Offers One-Stop Healthcare for Underserved, Remote Patients

October 24th, 2014 by Cheryl Miller

It’s all about the patient.

That’s what prompted Blue Shield of California and Adventist Health, both not-for-profit organizations, to collaborate on a telehealth program that could afford quality care to all Californians, when and where they need it, says Lisa Williams, senior director of strategic integration and execution, healthcare quality and affordability, Blue Shield of California, during Creating a Virtual Multi-Specialty Physician Network: A Payor-Provider Telehealth Collaborative, an October 15th webinar, now available for replay.

The presentation also featured Robert Marchuk, vice president of ancillary services at Adventist Health, and Christine Martin, director of operations, Adventist Health; all three shared the inside details on the collaboration and the shared mission and values that has led to the program's success.

Located in largely rural markets, access to specialists is especially critical for the program’s success, Ms. Williams says. The nine-site program, which launched in March, includes 11 specialties, ranging from cardiology to dermatology to orthopedics and rheumatology, which account for the majority of volume in pre-op and post-op care. Specialists are all board-certified and credentialed. The program will expand to an additional 16 sites by the end of this year, with plans to add telepsychiatry, she says.

Central to the program is its care coordination center, a full-service, virtual, multi-specialty physician practice with robust patient and provider supporting services, says Mr. Marchuk. Similarly to a one-stop shopping site, when patients enter a site, clinicians make one phone call regarding that patient to the center, which coordinates all aspects of that patient’s care, from scheduling an appointment with the provider and the clinic itself, ensuring all patient records are available and uploaded to their electronic medical record (EMR), to scheduling follow-up ancillary services and physician appointments and billing. “It’s been very successful,” says Mr. Marchuk, “and really sets us apart from other programs.”

Identifying gaps in their markets, and then finding the right specialty and specialist for that market are big parts of the process, Mr. Marchuk continues. "There are physicians out there that can be wonderful on a face-to-face visit and very, very good clinically, but don't necessarily lend themselves well to a video interaction, so we screen very carefully."

Clinician engagement, extensive training, and communication at all points of contact are also important, says Ms. Martin. “You can never over-communicate,” she says. Patients, staff, local providers and specialty providers all need to know what’s going on, so the experience can be as seamless as possible.

Reimbursement for telehealth is still on the negotiation table, Mr. Marchuk adds. But ultimately, it pays to invest in the technology now for the future.

“It’s one of the fastest growing growing fields. It’s affordable, accessible, and cost-effective. Telehealth really can enhance the physician and patient relationship.”

Listen to interviews with Robert Marchuk and Lisa Williams.

Infographic: Accountable Care Strategies to Improve Quality and Lower Costs

October 24th, 2014 by Melanie Matthews

There are four key strategies for healthcare organizations to improve the quality of care they provide and lower costs in an accountable healthcare model, according to a new infographic by The Commonwealth Fund.

Accountable Care Strategies to Improve Quality and Lower Costs

7 Patient-Centered Strategies to Generate Value-Based Reimbursement Healthcare companies seeking a roadmap to richer reimbursement should begin with the seven value-based healthcare priorities for 2014 identified by the healthcare C-suite: population health management, care coordination, integrated care delivery, e-health and telehealth, access to care, health and wellness, and dual eligibles. 7 Patient-Centered Strategies to Generate Value-Based Reimbursement explores the seven healthcare areas ripest for development in 2014, prioritized by 136 respondents to HIN’s ninth annual Trends & Forecasts survey.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you'd like featured on our site? Click here for submission guidelines.

5 Features of the Patient-Centered Medical Home

October 23rd, 2014 by Cheryl Miller

Patient-centered medical homes (PCMHs) are not about pigeon-holing certain diseases or illnesses, says Terry McGeeney, MD, MBA, director at BDC Advisors, but about delivering acute and chronic care prevention and wellness. Dr. McGeeney reiterated the five essential features of the medical home as the groundwork for a medical neighborhood.

Given many of the initiatives of the Centers for Medicare and Medicaid Services (CMS), coupled with the Triple Aim, many have gotten bogged down and probably overly focused on the name: patient-centered medical home (PCMH). What’s important are the features or attributes of the PCMH: first, its patient-centeredness, a partnership among practitioners, patients and their families that ensures and respects the decisions of the patients and ensures patients have the education and support they need.

Secondly, in a PCMH, the care needs to be comprehensive. It’s a team of care providers who are wholly accountable for a patient’s physical and mental healthcare needs, including prevention and wellness, acute care, and chronic care.

Third, you will hear discussions about the PCMH being about a certain disease or illness. Please note that it’s acute and chronic care prevention and wellness. Pigeon-holing conditions, while important, is more of a chronic quality improvement initiative and not PCMH.

Fourth, under the PCMH, care needs to be coordinated. Care is organized across all elements of the broader healthcare system, including specialists, hospital, home healthcare, community service and support. There’s a lot of debate now about what we call ‘post-acute care’ or ‘transitions in care.’ Jonathan Blum, principal deputy administrator of CMS, recently spoke on the importance of post-acute care. This is what coordinated care particularly is all about.

Care has to be accessible. Patients are able to access services with shorter waiting times, after-hours care with access to EHRs, etc., and there has to be a commitment to quality and safety. Clinicians and staff need to enhance quality improvement with the use of health IT and other tools that are available to them.

We also need to be very careful that quality care is not equated with lower cost of care. Sometimes those two have a tendency to get muddled.

Source: Blueprint for a Medical Neighborhood: Building Care Coordination Between Specialists and PCPs

http://hin.3dcartstores.com/Blueprint-for-a-Medical-Neighborhood-Building-Care-Coordination-Between-Specialists-and-PCPs_p_4967.html

Blueprint for a Medical Neighborhood: Building Care Coordination Between Specialists and PCPs provides a framework in which to evaluate the patient-centered medical neighborhood (PCM-N) model. Pictured here is Terry McGeeney, MD, MBA, director of BDC Advisors, who navigates the landscape of the medical neighborhood, from the value-based payment realities of healthcare today to identifying and engaging specialists in a medical home neighborhood.

Infographic: Concierge Medicine

October 22nd, 2014 by Melanie Matthews

There was a notable increase in the number of concierge physician practices in cardiology, dental and pediatrics, according to a new infographic by Concierge Medicine Today.

The infographic also examines the number of concierge physicians in the United States; states with the greatest concentration of demand, what's included in a concierge practice and demographic data on the typical concierge patient.

Concierge Medicine

The Business of Medical Practice: Transformational Health 2.0 Skills for Doctors, Third Edition The Business of Medical Practice: Transformational Health 2.0 Skills for Doctors, Third Edition presents a progressive discussion of management and operation strategies. It incorporates prose, news reports, and regulatory and academic perspectives with Health 2.0 examples, and blog and internet links, as well as charts, tables, diagrams, and Web site references, resulting in an all-encompassing resource.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you'd like featured on our site? Click here for submission guidelines.

Strong Signals Favor Bundled Payments to Reduce Cost of Care

October 21st, 2014 by Patricia Donovan

Besides piloting the use of bundled payments to enhance healthcare quality and efficiency, CMS's 2013 introduction of CPT codes for physician management of care transitions after discharge signals the federal payor's increased comfort with episodic-based reimbursement. Jay Sultan, associate vice president and chief product portfolio architect for TriZetto® offers his perspective on the future of bundled payments in healthcare.

Healthcare is such a cyclical industry. Anybody who says this is the new movement and it’s here to stay has a better ability to read the future than I do.

I believe that bundled payment is going to continue to increase adoption. And then I think we’ll see a pullback in rate of adoption that will be caused by two things: one will be just the fact that we’ll have picked off all the low fruit, and what’s left is harder. I’m sure there’s somebody out there who wants to do a bundle of fibromyalgia, but I don’t want any part of that. The second reason they’ll pull back is because they’ll learn some negative lessons.

One of the things about payment bundling to date, at least in the prospective payment bundling (think model four of the CMS program), is that many commercial programs are just getting started right now. One lesson to date is there just are no negative examples. There’s negative examples in retrospective payment bundling. For prospective payment bundling, we haven’t had failures yet. Those are inevitable and they’re going to come. And as they come, I think that will create a somewhat inhibiting effect.

But overall, it’s hard to imagine. What payment bundling does is change the inner purchase. We’re saying, we’re tired of buying CPT codes of services. Instead, we want to start buying longitudinal care as an episode, as a bundle. And that trend is exactly where capitation takes them, exactly where partial capitation takes us. It’s where our provider-run health plans take us. It’s just another point along the continuum of how much risk providers are taking.

I don’t think bundled payments are going to go away. CMS is signaling very, very strongly that this is part of its future, for a basic reason. It’s one of the few tools it has that can actually reduce the cost of care. For those who think that this is going to go away, I’d harken you back to the onset of DRGs. Today, DRG-based care is pretty pervasive. But it certainly doesn’t cover all of care. It doesn’t even cover all of hospital care. It doesn’t cover all of CMS hospital care.

value-based reimbursement
Jay Sultan is the associate vice president and product manager for value-based reimbursement at TriZetto®. With more than 12 years of consulting and development experience in the payer and hospital settings, Sultan is responsible for developing innovative solutions such as payment bundling and other forms of value-based reimbursement. He is also providing leadership on the adoption of clinical analytics into TriZetto solutions.

Source: Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and Methodology

Infographic: Using ICD-10 To Track Ebola Outbreak

October 20th, 2014 by Melanie Matthews

With the exception of the United States, all industrialized nations use ICD-10 to code morbidity and report disease data to the World Health Organization.

The following infographic below created by Coalition for ICD-10 illustrates the public health impact of ICD-10 in supporting the biosurveillance of the eBola outbreak.

Using ICD-10 To Track Ebola Outbreak

ICD-10-CM/PCS Implementation Action Plan ICD-10-CM/PCS Implementation Action Plan goes beyond its comprehensive coverage of ICD-10 CM/PCS to provide you with training tools, as well. This 135-page book also includes an 81-page customizeable document, as well as a customizeable spread sheet log.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you'd like featured on our site? Click here for submission guidelines.

Ochsner’s Standardized Risk Stratification, Care Coordination Protocols Boost Outcomes across Continuum

October 20th, 2014 by Patricia Donovan

Ochsner Health System's scaling of a successful transitional care model across one region not only reduced duplication of calls to recently discharged patients but also quadrupled its connect rate—from about 20 percent to nearly 98 percent of discharged patients—and decreased rehospitalizations by about 15 percent.

All while remaining salary-neutral.

To achieve these results and others like them, Ochsner uniformly applied scripts, templates and protocols to processes across its care continuum, even assuming clinical oversight for some providers in external facilities to ensure standardization, explained Mark Green, assistant VP of transition management at Ochsner, during Moving the Metrics: Financial and Quality Returns from System-wide Care Coordination and Risk Stratification, an October 2014 webinar now available for replay.

To replicate these achievements, the nine-hospital system looks up and down its continuum for opportunities to collaborate in care coordination and has elevated its approach to risk stratification. This culture shift is a prerequisite for success in today's value-based climate, Green estimates.

"A really critical step to understand is managing not only your 'rising risk' but also your 'falling risk' patient population," he said, categorizing 'falling risk' as those whose conditions are under control and who can be handed off to a lower risk medical home or chronic disease management environment.

Healthcare doesn't currently do a good job of moving 'falling risk' patients down the stratification model, he said, which leaves little room for newly diagnosed 'rising risk'—an out of control CHF patient, for example.

Risk stratification is scalable, Green emphasized, from single providers without an electronic medical record to a large health system or accountable care organization. As a nine-hospital system, Ochsner's risk segmentation approach relies heavily on automation and data analytics. For example, every Ochsner hospital patient is assigned a severity of illness (SOI) level that helps to guide individuals to the appropriate level of care. For example, all level 3 patients are automatically referred to complex case management.

During the webinar, Green shared several of Ochsner's collaborations in risk stratification and care coordination, including an automated post-discharge telephonic follow-up for emergency department patients that replaced its siloed approach and has reduced avoidable ER use in the range of 13 to 15 percent depending on the payor and the location.

"We are very cognizant of and careful that we're not driving too much business away from our emergency room if it's appropriate. We're just letting [staff] manage a higher risk population within their emergency room and giving them time to spend more of it with the patients."

Listen to an interview with Mark Green.

Infographic: The 2014 Ebola Outbreak

October 17th, 2014 by Melanie Matthews

A new infographic by the Henry J. Kaiser Foundation provides a snapshot of the 2014 Ebola outbreak in West Africa.

The infographic includes key facts about the Ebola virus, shows how the number of Ebola cases in the current outbreak outstrips the case total from all previous Ebola outbreaks, and offers a summary of the key U.S. agencies responding to the crisis and the roles they are playing. In addition, it provides a look at the growing 2014 Ebola case count in West Africa compared to U.S. government funding commitments.

The 2014 Ebola Outbreak

Nursing Policies and Procedures for Long Term Care Nursing Policies and Procedures for Long Term Care outlines administrative policies and standards of care for basic nursing care procedures and clinical practices. The director of nursing should review and update the manual at least annually to ensure it is comprehensive and accurate. Updates should also be made when applicable due to changes in regulations or nursing standards of practice. Other appropriate additions to the manual would be manufacturer guidelines and instructions for new equipment and devices.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you'd like featured on our site? Click here for submission guidelines.

Adventist Population Health Management Incentives Engage Employees, Curb Costs

October 16th, 2014 by Cheryl Miller

If employees are healthier, they're more effective, engaged in their work, and more present, says Elizabeth Miller, vice president of care management at White Memorial Medical Center (part of Adventist Health). Presenteeism is part of the company's "Engaged Health Plan," a patient engagement strategy that is targeted to save as much as $49 million overall.

To engage patients, you can offer incentives. For example, at Adventist Health we outreach to our entire organization, our own employees, and we are on track to save millions of dollars with that. We call it ‘The Engaged Health Plan’ and it’s a reduced monthly cost on their health insurance. It is a bi-weekly reduction of $50, which is significant. They’re saving $100 a month. We engaged by taking their blood pressure, their weight and their blood glucose. We created an exercise plan for them with their consent, talked to them about their physical conditioning and what they wanted to see in their physical. We also talked about the ideal health population, and how we consider a healthy employee a more effective employee.

It’s costing our organization money to put this on; even though it’s our own health plan, it does cost. Why did Adventist Health go in this direction? You can see with the cost and the savings that it will save us $49 million. It is a mission. We are a faith-based organization, but it is a mission of ours to improve the health status. And it is also going to improve us financially. If our employees are healthier, they’re more effective, more engaged in their work, more present. You’ve heard of presenteeism. These are things that we’ve looked at.

dual eligibles care
Elizabeth Miller, RN, MSN, is the vice president of care management, diabetes program at White Memorial Medical Center, Adventist Health. Ms. Miller is accountable for the daily operations of the care management team, nurse care managers, social workers and the diabetes program, ensuring optimal patient flow through the healthcare continuum of care.

Source: Population Health Framework: 27 Strategies to Drive Engagement, Access & Risk Stratification

8 Ebola Emergency Preparedness Measures from CarePoint Health

October 16th, 2014 by Patricia Donovan

Ebola drills, preparation of 'grab-and-go bags" and targeted screening of callers requesting ambulances are some of the Ebola emergency preparedness measures announced by CarePoint Health this week In response to individual cases in the United States and elsewhere.

CarePoint Health has implemented the measures system-wide at its three New Jersey hospitals and its McCabe Ambulance service.

For example, patients arriving in a CarePoint ED will immediately be screened to determine their risk of exposure to Ebola. If a case is suspected, CarePoint Health has procedures, equipment and technology in place to help limit exposure and to safely care for the patient. “We will continue to refine our plan based upon the latest information available from clinicians treating Ebola patients," said Dr. Mark Spektor, chief clinical integration officer for CarePoint Health.

Also, McCabe Ambulance's call screening technology incorporates an Ebola screening tool that prompts dispatchers to ask all callers about recent travel and critical symptoms before an ambulance even arrives at the scene. If dispatchers suspect a patient may be at risk for Ebola, EMTs can safely transfer the patient and notify the receiving hospital.

Some other immediate Ebola-related safety measures CarePoint Health has implemented include the following:

  • Ebola Drills. CarePoint Health hospitals have each begun running unannounced Ebola drills to help prepare staff members for how to deal with a suspected Ebola case. These drills will continue until the recent outbreak has been contained.

  • Creation of Ebola 'Grab and Go' bags in emergency departments. Pre-packaged bags containing all necessary personal protective equipment (PPE), instructions for donning/doffing the PPE and a checklist of how to care for patients suspected of being infected with Ebola are available in all CarePoint Health emergency departments.

  • Technology. With the new electronic medical record system, changes have been made to the screening and triage of patients making it mandatory to document travel history at intake.

  • Internal Communications. CarePoint Health is providing updates about our processes, protocols and systems to all staff members via e-mail, town hall meetings, group huddles, text alerts, and other channels. There are also targeted communications for clinical staff, emergency room personnel, security guards, housekeeping staff, communications reps and senior leadership addressing their specific protocols.

  • Regular communications with CDC and state and local health departments. CarePoint Health is in constant communication with the CDC, New Jersey and local health departments so protocols and procedures can be adjusted based upon the latest clinical data.

  • Use of personal protective equipment. CarePoint Health is conducting department specific hands-on training on the proper use of personal protective equipment. This training includes donning and doffing of equipment as well as environmental issues surrounding waste disposal.

  • Multidisciplinary task force. CarePoint Health has convened a working group drawn from its departments of clinical services, environmental services, infection control, admitting, materials management, human resources, security and others to manage its Ebola response plan.

  • Staff education. Staff members will regularly receive written educational material developed by the CDC and compiled by the Departments of Infection Control and organizational education that will address many of the questions surrounding Ebola. Full educational in-services will be provided for those staff members and our affiliated physicians who may potentially have any involvement in either the direct or indirect care of an Ebola patient.