Infographic: High-Performing Medical Groups

August 22nd, 2014 by Melanie Matthews

For physician practices to succeed in emerging healthcare delivery and financing models they have to forgo traditional practice management models, according to a new infographic by The Advisory Group.

The Advisory Group identifies the 16 steps to becoming a "high-performance medical group."

16 Steps to a<br />
High-Performance Medical Group

Improving Healthcare Team Performance: The 7 Requirements for Excellence in Patient CareTeams and collaboration have become an expectation in most healthcare facilities and environments. It is accepted that high performance, patient-focused teams are critical to quality patient care. However, there is often a wide gap between traditional practices and the new behaviors and practices required for teamwork and collaboration. Improving Healthcare Team Performance: The 7 Requirements for Excellence in Patient Care goes beyond theory to provide the knowledge, tools, and techniques required to develop a single team, or to develop an organization-wide team-based culture, from which exceptional patient care emerges.

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8 Challenges to Medical Home Success

August 21st, 2014 by Cheryl Miller

"The reality of today is that the healthcare world as we know it is changing more than any time since the advent of Medicare," says Dr. Terry McGeeney, director of BDC Advisors. System coordination, patient-centeredness and patient engagement are some of the new industry goals, he says, which bring new challenges, chief among them being physician reluctance to change.

  • First, there are some real challenges to making the changes to patient-centered medical homes (PCMHs). A lot of physicians are reluctant to change. Physicians have been trained to be change-averse and variable-averse to avoid making mistakes at two o’clock in the morning, etc.
  • Second, physician leadership and physician champions are critical, and again, sometimes this has to be trained and taught.
  • Third, there’s a culture that is very traditional in healthcare; we need to think and talk about that. There is also a culture within individual practices and health systems that creates barriers to successful transformation.
  • Fourth, some providers are not able to function effectively in a team environment and this needs to be supported and transformed with the appropriate training provided.
  • Fifth, communication is critical at multiple levels. Successful medical neighborhoods and clinically integrated neighborhoods (CINs) are built around communication, care plans, care that’s delivered, data, quality metrics, lab data, etc.
  • Sixth, there has to be trust between all of the entities as systems are transforming and payor data becomes more critical. Partnerships with payors around shared savings or shared risk are becoming more common. Trust is critical, and again, that hasn’t always existed.
  • Seventh, we need to make sure there are aligned incentives; you can’t ask people to do more work for the same compensation. You can’t ask them to assume more risk for the same compensation. Incentives need to be aligned around what is now called ‘value-proposition’ or ‘pay-for-value,’ or to where there is an expectation to improve quality and lower cost.
  • And finally, there needs to be full recognition that PCMH transformation is not easy. It’s very difficult, it’s time consuming, but at the end it’s highly rewarding.

value-based reimbursement
Terry McGeeney, MD, MBA, is a director at BDC Advisors. He was recently appointed a visiting scholar in Economic Studies for the Brookings Institute in Washington, D.C.

Source: Driving Value-Based Reimbursement with Integrated Care Models

Infographic: Healthcare Consumer Evolution

August 20th, 2014 by Melanie Matthews

As healthcare technology and patient accountability continue to grow, healthcare consumers are taking on a much more active role in their healthcare.

This new infographic by Vitals looks at how healthcare consumers are evolving and five habits of highly-evolved patients.

Evolution of the Healthcare Consumer

The Patient-Centered Payoff: Driving Practice Growth Through Image, Culture, and Patient ExperienceLearn the steps your practice can take to reap the many payoffs of achieving high patient-centered standards without having to make a big financial investment. In The Patient-Centered Payoff: Driving Practice Growth Through Image, Culture and Patient Experience, authors Cheryl Bisera and Judy Capko, explain how healthcare professionals and organizations can thrive in the new patient-centered environment.

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Benchmarking Embedded Case Management Across the Population Health Continuum

August 19th, 2014 by Patricia Donovan

With care coordination by healthcare case managers driving clinical and financial outcomes in population health management, the industry continues to see an increase in case managers—not just in newly launched initiatives but co-located in nursing homes, long-term care (LTC) and assisted living settings. We wanted to see which organizations are embedding or colocating case managers at care sites.

Co-location of healthcare case managers alongside providers continues to be a trend in population health management.

As demonstrated by the above figure, HIN's 2013 Healthcare Case Management e-survey documented that more than half—53.8 percent—embed or colocate their case managers at care sites.

In additional details about embedded case management, the survey found that 56.8 percent of organizations embed case managers in the primary care practice, and 52.3 percent in hospitals.

Additionally, one survey respondent said that the most notable improvement or innovation resulting from embedded case management is the decrease in avoidable hospital admissions.

Source: 57 Population Health Management Metrics: Assessing Risk to Maximize Reimbursement

population health metrics


57 Population Health Management Metrics: Assessing Risk to Maximize Reimbursement
is designed exclusively for the C-suite executive who seeks a high-level summary of population health trends and metrics. This report delivers charts and tables on 57 actionable metrics carefully curated from 2012 and 2013 market research data by the Healthcare Intelligence Network.

Infographic: Healthcare and Big Data

August 18th, 2014 by Melanie Matthews

Over 63 percent of stakeholders in the United States believe big data has a positive impact on healthcare, according to a new study by APCO.

The study results, highlighted in the infographic below, also found that most United States respondents do not believe big data can improve individual health outcomes either by monitoring patient or by provider behavior, but believe that it can expand new product development by analyzing research data and improve healthcare transparency.

Healthcare & Big Data

Stratifying High-Risk, High-Cost Patients Benchmarks, Predictive Algorithms and Data AnalyticsHealthcare organizations employ a variety of tools and analytics to identify high-risk, high-cost patients for targeted population health interventions. Stratifying High-Risk, High-Cost Patients: Benchmarks, Predictive Algorithms and Data Analytics presents a range of risk stratification practices to determine candidates for health coaching, case management, home visits, remote monitoring and other initiatives designed to engage individuals with chronic illness, improve health outcomes and reduce healthcare spend.

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Infographic: Behavioral Health Service Utilization Among Foster Children

August 15th, 2014 by Melanie Matthews

Nearly one in three children within the United States' foster system use behavioral health services, representing only three percent of all children in Medicaid, but 15 percent of those using behavioral health services and 29 percent of Medicaid expenditures for children’s behavioral health services.

This infographic from the Center for Health Care Strategies compares behavioral healthcare use and expense for Medicaid-enrolled children in general versus those in foster care.

Behavioral Health Service Utilization Among Foster Children

Implementing Evidence Based Practices in Behavioral HealthIn this innovative and reader-friendly guide, Implementing Evidence Based Practices in Behavioral Health, leading researchers from the Dartmouth Psychiatric Research Center examine the implementation of evidence-based practices in behavioral health and offer practical strategies for bringing these practices into routine clinical settings. They look at implementation as a specific process, a set of activities and responsibilities designed to successfully launch a practice and integrate it into routine care, using strategies carried out across many levels of an organization and at various stages.

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Yale Online Forum Helps Teens with Diabetes “Not Look Like a Jerk”

August 14th, 2014 by Cheryl Miller

Being a teenager is hard enough; when it’s complicated by a chronic disease like type 1 diabetes, it’s even harder.

Enter telehealth, in the form of a monitored discussion board for teens with the disease.

Margaret Grey, DrPH, RN, FAAN, Dean and Annie Goodrich Professor at the Yale School of Nursing, has spent the majority of her career helping patients and families manage chronic conditions, and helping kids — teenagers in particular — manage their diabetes through their teen years so they can reduce their risk of long-term complications.

“I’ve been studying these kids for 30 years,” says the pediatric nurse practitioner, who, prior to assuming the deanship in 2005, served as associate dean for scholarly affairs and was the founding director of the school's doctoral program and the NIH-funded Center for Self and Family Management and a related pre- and post-doctoral training program. “Kids have black and white thinking — and have to manage how to 'not look like a jerk' by being given the skills to manage their disease, to think about it in a different way.”

Grey and other researchers conducted several clinical trials: an advanced diabetic education project and a life skills program, which showed that teens with diabetes' overall health and quality of life were better after going through both programs. Results showed that intensive therapy and better metabolic control reduced the incidence and progression of microvascular and neuropathic complications from diabetes from 27 percent to 76 percent.

But how to maintain those results? According to researchers, "Metabolic control tends to deteriorate as a combined result of insulin resistance that accompanies the hormonal changes of adolescence and lower adherence to the treatment regimen often associated with the desire for autonomy.”

“So we took those interventions and developed an online program kids could do at their leisure," Grey says. It incorporated a monitored discussion board that allowed kids to communicate with others like them. Teens with diabetes overcome their fear of being stigmatized by logging onto the Web site,­ called TeenCope, ­with other teens with diabetes and engaging in self-management exercises. The online program simulates situations teenagers with diabetes might encounter by using graphic novel animations that illustrate coping skills lessons from the animated characters. “As kids transition to adolescence, they require more effort and thought,” Grey says.

Peer support is an important component of maintaining a healthy lifestyle, as adolescents face pressures such as not wanting to reveal medical equipment in a social setting, or reveal their medical conditions in a social situation.

In addition, the program will also integrate an online educational program aimed at problem-solving for teens with diabetes. Adolescence is a time when patients neglect self-monitoring, dietary recommendations, and pharmacologic treatments — not because of a lack of knowledge, but due to the decision-making difficulties characteristic of this life stage. Studies show that poor metabolic control in the teen years correlates to reduced self-management in adulthood, making adolescence a key period for developing healthy behaviors. And once teenagers can get a handle on their diabetes, they improve not only their own health, but their families’ quality of life.

“This is a way to give them the skills to think about their condition in a different way,” Grey says.

Infographic: Telehealth Benefits, Delivery, and Outcomes

August 13th, 2014 by Melanie Matthews

Deficiencies in access to healthcare, combined with physician shortages is driving growth in telehealth, according to a new infographic from Excalibur Healthcare.

The infographic examines predicted physician shortages and demand over the coming years, along with how telehealth can improve care coordination and telehealth delivery models and benefits.

Telehealth Benefits, Delivery, and Outcomes

Recent market data on telehealth in general and the patient-centered medical home in particular identified remote monitoring as a key care coordination strategy for individuals with complex illnesses as well as a host of vulnerable populations.

Implementing Evidence Based Practices in Behavioral Health

2014 Healthcare Benchmarks: Remote Patient Monitoring delivers a comprehensive set of metrics from more than 100 healthcare organizations on current practices in and ramifications of remote monitoring for care management of chronic illness, the frail elderly and remote populations.

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Guest Post: With Rise of Remote Healthcare, Are Physicians Equipped for Engaged Patients?

August 13th, 2014 by Scott Zimmerman

More engaged patients will expect more responsive healthcare professionals.

Thanks to a proliferation of wireless health monitoring tools, healthcare providers must prepare for a new breed of patient who is more tech-savvy and engaged in the management of their own health, advises guest blogger Scott Zimmerman, president of TeleVox Software.

Is your healthcare organization ready for a new breed of patient? Individuals who want or need to play a more active part in their health, and who expect their physicians to do the same?

If it’s not, it may be time to start prepping. Think about consumers’ growing interest in smart devices, sensors and mobile apps for tracking fitness levels. IHS Technology has predicted that global market revenue for sports, fitness and activity monitors will rise by 46 percent, to $2.8 billion, from 2013 through 2019.

That trend is accompanied by employers’ trying to lower their own healthcare costs, by having employees take on higher deductibles or paying only fixed amounts for certain tests or procedures. That’s creating a consumer class more conscious of securing the best health services at the best prices. Increasing personal responsibility in this area may well have a spillover effect, motivating people to become better overall managers of their own health. We may see the same result, too, as more businesses offer wellness incentives that give employees rebates for engaging in better health practices.

Also taking on greater healthcare accountability are individuals with chronic conditions, especially those using wireless home health monitoring tools to track and even transmit EKG, sugar levels and other health statistics to their providers’ systems. IHS Technology has studied this area, too, finding that worldwide revenue for telehealth devices and services used for monitoring diseases and conditions will grow to $4.5 billion in 2018, up from $440.6 million in 2013.

What Have You Done For Me Lately?

As consumers become more savvy and more engaged participants in their healthcare, they may have increased expectations about how providers will respond to their efforts. As they become better equipped to remotely transmit healthcare data to their doctors, for example, they may naturally assume providers are equally well-equipped to provide feedback on that information in real-time—or at least something close to it.

After all, while it’s nice to have direct feedback from a wireless activity wristband on daily calorie intake, that data may be even more useful if a physician can analyze it in context with other patient data—such as information in the EMR that the individual has Type 2 diabetes and blood glucose levels recorded by a home health monitoring device. The healthcare practitioner may conclude from all these measurements that calorie intake should actually be reduced now that blood glucose control has improved, in order to avoid weight gain. It’s understandable if the patient would like to be informed of that as soon as the conclusion is reached, rather than waiting for the next scheduled appointment.

Just-in-time patient engagement, then, is the direction in which healthcare providers must move. Consider that three in ten U.S. consumers responding to TeleVox’s Healthy World Research Survey said that receiving text messages, voicemails or e-mails that provide patient care between visits would increase feelings of trust in their provider. Of those who have received such communications, 51 percent reported feeling more valued as a patient, and 34 percent reported feeling more certain about visiting that healthcare provider again.

An Eye Toward the Future

Today, tens of thousands of healthcare providers already have started down that road of between-visit engagement, with automated appointment, prescription and treatment notification and reminder systems that use the patient’s medium of choice—e-mail, text or voice. In fact, TeleVox’s survey showed that more than 35 percent of patients who don’t follow exact treatment plans said they would be more likely to adhere to directions if they received reminders from their doctors via these methods. Though the outreach is automated and one-to-many, the systems feel one-to-one, as they are personalized with the patient’s name and other details drawn from providers’ practice management systems.

Ochsner Health System in Louisiana is among healthcare providers who have successfully leveraged this technology. It deployed an automated phone campaign to 3,000-plus patients who had been ordered to have colonoscopies and upper endoscopies, but had not scheduled the exams. The phone messages even offered patients the option to book the appointment by pressing a key while on the line. Of the patients reached, close to 20 percent made the appointment.

This was a win-win for patients and providers. Colon cancer detected and treated early has a nearly 100 percent success rate. These patients told Ochsner that without the automated notification, they never would have completed the test. As for the health system, Ochsner generated more than $600,000 in revenue from conducting the exams.

Today, the industry is just scratching the surface of how it can use communications technology to help healthcare providers better engage with patients between visits. The future holds the promise for more providers to obtain more data from EMRs, sensors, wearable medical devices, and home health monitoring tools; feed this data into patient engagement systems, and use business rules to trigger just-in-time customized patient engagement communications. A worrisome remote ECG reading transmitted from a heart disease patient’s home monitoring device, for example, can drive a follow-up action such as a time-sensitive outbound call to the first available specialist.

While getting to this level might sound a little daunting, it doesn’t have to be. Providers can take on the project in stages, moving from general reminders about preventive tests to follow-up messages aimed at those with chronic conditions, before they tackle real-time or near real-time responses to data submissions generated via remote healthcare devices. For instance, daily text messages could be scheduled to go out to obese patients querying them about whether they have met their daily walking goal. Or, treatment protocol compliance reminders, such as retinal and foot exams for diabetic patients, could be scheduled at regular intervals.

All that said, I suspect most providers are looking to this future less with trepidation than with excitement. They’re in the healthcare business, after all, because they want to help people. Now, the doors are open for them to have more regular and proactive contact with their patients, as well as respond more quickly to potentially dangerous situations.

About the Author: Scott Zimmerman is a regularly published authority on utilizing technology to engage and activate patients. He also spearheads TeleVox’s Healthy World initiative, which leverages ethnographic research to uncover, understand and interpret both patient and provider points of view with the end goal of creating a healthy world, one person at a time. Healthier World promotes the idea that touching the hearts and minds of patients by engaging with them between healthcare appointments will encourage and inspire them to follow and embrace treatment plans, and that activating these positive behaviors leads to healthier lives. Zimmerman possesses 20 years of proven performance in the healthcare industry, and currently serves as the president of TeleVox Software, Inc, a high-tech engagement communications company that provides automated voice, e-mail, SMS and web solutions that activate positive patient behaviors by applying technology to deliver a human touch. www.televox.com

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

Severity Index Drives Patients’ Touch Points with Nurse Navigators

August 12th, 2014 by Patricia Donovan

Beyond telephonic outreach, assessment and education, nurse navigators in Bon Secours Health System Advanced Medical Home also manage a case load for face-to-face patient work, explains Robert Fortini, vice president and chief clinical officer at Bon Secours Health System. Here, he describes the process of assigning patients to nurse navigators.

Based on our learning experiences with the Geisinger system, it becomes difficult for an RN to handle more than about 150 patients, depending upon the complexity of the patient.

We also give back-line access, and the RNs all have beepers as well. They have the license to give that beeper number to the more complex patients—the frequent flyers who are going to need more attention. Or they can give that access to our colleagues on the managed care side who might be engaged in managing patients with a severe illness. To our case management team in the hospital, it just allows for more bandwidth and clearer communication across the spectrum of care delivery.

How does a patient get into a case load? It is by the physician’s decision. For example, Mr. Smith has seven different major active problems. He is on 18 different medications, he is 87 years old and he has a touch of Alzheimers. That individual needs hand-holding, so that would be the first way to give the patient case management. We also take referrals from the hospital and from our managed care colleagues. We are also using some predictive modeling tools provided to us by insurers to identify patients who need closer following.

How frequently a patient is touched, brought in for face-to-face care or called on the phone depends on the severity index. We use a tool my colleague designed that will calculate a relative readmission risk index based on several sets of criteria: number of medications, length of stay in the hospital, the acuity level of the patient in the hospital and whether or not they are in intensive care unit (ICU) initially, etc. How frequently they are touched depends on how high up the severity index they are.

Excerpted from: Case Managers in the Primary Care Practice: Tools, Assessments and Workflows for Embedded Care Coordination