The Impact of Patient Engagement: 10 Metrics to Know

October 6th, 2015 by Patricia Donovan

A formal patient engagement program elevates patient satisfaction, care plan adherence and overall quality scores, say three-fifths of healthcare organizations.

While more than 60 percent of healthcare organizations report their patient engagement programs have elevated patient satisfaction, care plan adherence and overall quality metrics, populations with low health literacy or behavioral health conditions are more resistant to efforts to engage them in self-care.

These findings were among the benchmarks identified by an inaugural survey on Patient Engagement by the Healthcare Intelligence Network. The August 2015 survey also determined that 79 percent of respondents are striving to improve patient engagement, employing an arsenal of tactics and e-tools.

Asked to identify some hurdles of engaging patients, half of the survey's 133 respondents reported that the behavioral health population is the most challenging to engage. And “high utilizers”—individuals with frequent ER visits or hospitalizations—are top candidates for engagement efforts, say 52 percent of respondents.

Today’s value-focused healthcare models theorize that engaged patients not only are healthier and more satisfied but may incur fewer costs than the non-engaged, which is why many programs make patient engagement a priority, such as Medicare’s mandate that accountable care organizations (ACOs) develop processes to promote patient engagement.

Patient and caregiver education is the top strategy deployed to engage patients, say 72 percent of survey respondents. In this area, technology plays a pivotal role, the survey found.

Whether patient engagement translates to good business remains to be seen. In the meantime, the HIN survey found that organizations are testing the impact of health coaching, embedded case management, a team-based approach and telephonic follow-up, among other tactics, on overall population health engagement.

Here are five more metrics from the 2015 Patient Engagement Survey:

  • Sixty-six percent of respondents have a patient portal, whose top use is education.
  • Almost half of respondents—48 percent—possess an electronic health record (EHR) that helps to identify patients most in need of engagement.
  • Low health literacy is the top barrier to patient engagement, say 20 percent of respondents.
  • The case manager has top responsibility for patient engagement efforts, say 28 percent of respondents.
  • Of those respondents with no formal initiative to foster patient engagement, 65 percent will launch an effort in the coming year.

Download an executive summary of the 2015 Patient Engagement survey results.

Longitudinal Care Plans, Risk Scores Raise Patient Engagement for MSSP ACO’s Complex Population

October 6th, 2015 by Patricia Donovan

A top-performing MSSP in 2014, the Memorial Hermann ACO has successfully engaged its Complex Care population via a collaborative care coordination approach.

The Memorial Hermann ACO may have been one of 2014's top-performing Medicare Shared Savings Programs (MSSPs), but the health system's commitment to achieving quality outcomes was solidified more than eight years ago, when its own physicians asked for a clinically integrated physician network.

Memorial Hermann complied, developing a set of tools, training and care models to not only support the physicians but also reflect payors' needs: chief among them, initiatives that could boost patient engagement.

Today, the Memorial Hermann ACO has a patient-centered care delivery strategy built on teamwork and collaboration. The Texas ACO is proud to point to a patient engagement rate of 74 percent for individuals enrolled in Complex Care, an initiative for individuals with long-term, multiple chronic conditions that has significantly reduced cost and hospital lengths of stay for participants.

This patient engagement measure represents members who consent to participate in the program and remain engaged for 30 days, explained Mary Folladori, RN, MSN, FACM, CMAC, system director of care management at Memorial Hermann Physician Network and ACO, during Care Coordination in an ACO: Managing the Population Health Continuum from Wellness to End-of-Life, a September 2015 webinar from the Healthcare Intelligence Network now available for replay.

Ms. Folladori provided an overview of the ACO's care coordination strategy that in 2014 generated savings of nearly $53 million in the MSSP program, resulting in a health system payout of almost $23 million. The ACO's performance earned Memorial Hermann a MSSP quality score of 88 percent.

Some high points from Memorial Hermann's ACO strategy include the following:

  • Embedding of care coordinators into the 'micro culture' of a physician practice, its community and the members served by the practice;
  • Strategic use of a data warehouse to identify vulnerable members early and link them with needed health services;
  • Development of comprehensive risk scores derived from multiple sources for Complex Care patients; and
  • Creation of longitudinal care plans that follow Complex Care patients for up to 18 months and help to transition them back to a baseline level of functioning.

In wrapping up observations on Memorial Hermann's quality-driven approach, Ms. Folladori quoted its CEO, Chris Lloyd: "The success that has been found within our ACO is deeply based on a collaborative approach to care. It has been cultivated over eight years with our commitment to clinical integration. We all strongly believe that without that strong clinically integrated physician network, without our physicians driving those quality outcomes, we would not have been as successful as we have."

With so much emphasis on quality and outcomes, it's no wonder participation today in the Memorial Hermann ACO is by invitation only—and only after a practice has passed an assessment.

Infographic: Using Big Data To Save Lives

October 5th, 2015 by Melanie Matthews

Healthcare organizations are challenged by the large amounts of healthcare data they collect, according to a new infographic by IBM.

The infographic examines the amount of data that healthcare organizations receive and the potential for that data to save lives.

Using Big Data To Save Lives

From home sensors that track daily motion and sleep abnormalities to video visits via teleconferencing, Humana's nine pilots of remote patient monitoring test technologies to keep the frail elderly at home as long as possible. When integrated with telephonic care management, remote monitoring has helped to avert medical emergencies and preventable hospitalizations among individuals with serious medical and functional challenges.

In Remote Patient Monitoring for Enhanced Care Coordination: Technology to Manage an Aging Population, Gail Miller, vice president of telephonic clinical operations in Humana's care management organization, Humana Cares/SeniorBridge, reviews Humana's expanded continuum of care aimed at improving health outcomes, increasing satisfaction and reducing overall healthcare costs with a more holistic approach.

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Infographic: HIPAA Data Breaches on the Rise

October 2nd, 2015 by Melanie Matthews

HIPAA Data Breaches on the RiseHIPAA data breaches are rising, according to research conducted by Privacy Analytics Inc. for a new infographic, HIPAA Breaches 2009-2015.

Culling data from the Office of Civil Rights, Privacy Analytics found over 1,286 reported incidents affecting 153 million individuals at the time of publication. The largest breach was earlier this year from Anthem Insurance, reporting over 78 million records being breached. According to the Guide to the De-identification of Personal Health Information, the costs incurred for a breach – including notification, legal fines, legal fees, forensics, PR and more – is approximately $208 per person. The average data breach was over 100,000 records and cost $24 million. States with the highest number of individual records breached were Indiana, California and Washington State.

The infographic looks at breaches by type, the need for more HIPAA organizational knowledge and training and new data privacy and security challenges as the use of secondary health data grows.

HIPAA Training for Employees DVD
HIPAA Training for Employees DVD provides training on the following: privacy rule basics; use and disclosures; patient rights; employee behaviors to safeguard patient information; security rules; safeguards to protect patient information electronically; HITECH; breach identification and notification; enforcement; and level of fines.

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Infographic: Delivering Quality Care Through Remote Patient Monitoring

September 30th, 2015 by Melanie Matthews

With remote patient monitoring, patients can share vital healthcare information using mobile devices at anytime from anywhere.

A new infographic from Vigyanix looks at expected growth in the remote patient monitoring market, the major players in the remote monitoring space, how remote patient monitoring can be used to improve healthcare delivery and the barriers to implementation.

Delivering Quality Care Through Remote Patient Monitoring

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

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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Infographic: Coordinated Care Models Needed for Cancer Care

September 28th, 2015 by Melanie Matthews

Coordinated Care Models Needed for Cancer Care

Overall satisfaction among cancer patients and caregivers with the care they received has improved significantly since the 2012, according to new data from the 2015 Cancer Experience: A National Study of Patients and Caregivers, reflected in a new infographic.

The survey results also mirror the ongoing national healthcare debate and reveal significant gaps between patients' expectations and the quality of care they receive. While having access to advanced oncology therapies is important, survey respondents indicated that healthcare providers need to address their dissatisfaction with the lack of care coordination, confusion and frustration surrounding healthcare terminology (literacy), and the inability to obtain timely information from their care team.

The infographic drills down on these survey results and examines how healthcare providers can respond to these patient concerns.

Anthem's Cancer Care Quality Program: Pathways to Improve Care and Reduce CostsDespite enormous innovations in the field, average costs for oncology drugs are skyrocketing and thousands of people in the U.S. die from cancer each week. Some payers, including Anthem, Inc., have turned to the use of pathways in an effort to make sure patients get the most appropriate evidence-based care that is still cost-effective.

Anthem's Cancer Care Quality Program: Pathways to Improve Care and Reduce Costs discusses the specifics of the insurer's Cancer Care Quality Program, its expectations in terms of outcomes and cost control, lessons it has learned and changes already made in the initial plans.

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Infographic: 4 Key Steps to Increasing Physician Practice Revenue

September 25th, 2015 by Melanie Matthews

There are several key steps physician practices can take to help grow their practice revenue, according to a new infographic by MedLanding News.

4 Key Steps to Increasing Physician Practice Revenue

Lessons from a Leading Pioneer ACO: Value-Based Gains from Physician Engagement, Performance Improvement and Care ManagementFollowing Pioneer ACO Year 3 results released by CMS in August 2015, Steward Health Care Network continues to make good on its Promise to provide coordinated, high-quality and cost-efficient care to its 80,000 Pioneer-aligned Medicare beneficiaries. Promise, Steward's top-performing Pioneer ACO, has generated $30 million of savings in its first three years of participation, according to recently published data.

Lessons from a Leading Pioneer ACO: Value-Based Gains from Physician Engagement, Performance Improvement and Care Management provides veteran advice from Kelly Clements, Pioneer Program Director, Steward Health Care Network. Steward is one of 20 accountable care organizations remaining in the Pioneer program and one of 15 reporting savings for year 3 (2014).

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ACO Trends for Hospitals & Health Systems: 9 Metrics to Know

September 24th, 2015 by Patricia Donovan

Of all healthcare sectors, hospitals and health systems are the most engaged in ACO activity, with 72 percent belonging to an accountable care organization (ACO), versus 50 percent of overall respondents to the 2015 Accountable Care Organizations survey by the Healthcare Intelligence Network.

Hospitals and health systems made a strong showing in HIN's fourth annual ACO activity and trends snapshot.

Moreover, respondents in this sector are united on many ACO fronts, reporting 100 percent commitment to the following: use of electronic health records (EHRs); inclusion of population health management and care coordination in their ACOs; adoption of NCQA guidelines for ACO recognition; review of clinical outcomes, health claims and health utilization data to measure ACO success; and designation of program rollout as the chief challenge of ACO creation.

And while not unanimous, hospital ACOs are almost twice as likely to be administered by a physician-hospital organization (60 percent, versus 28 percent overall); and to incorporate telehealth into their ACO framework (60 percent versus 34 percent overall).

This fourth comprehensive accountable care snapshot by the Healthcare Intelligence Network also found that ACOs within the hospital/health system sector, which comprised 11 percent of 2015 survey respondents, are twice as likely to employ 100 to 500 physicians (a metric reported by 60 percent of hospitals and health systems, versus 29 percent overall).

Also, hospitals have the largest number of pending ACOs, with half of those not already in an ACO expecting to be part of an ACO launch in the next twelve months, as compared to 25 percent overall.

Additionally, 40 percent of hospital-reported ACOs say they will participate in the Next Generation ACO Model, the latest Medicare Accountable Care Organization introduced by CMS, as compared to 21 percent of overall respondents, the survey found.

On the payment front, the hospital sector reports the highest use of a “fee for service + care coordination + shared savings” reimbursement model within their ACOs (60 percent versus 45 percent overall), the survey found.

Return on investment for hospital ACOs also tended to be healthier, with responding hospitals almost four times more likely to report ACO ROI between 3:1 and 4:1 (20 percent of hospitals versus 5 percent overall).

Finally, despite robust value-based activity, this sector expressed the most skepticism over CMS’s ability to shift half of Medicare payments to value-based models, with 71 percent doubting Medicare would meet this 2018 goal, versus 46 percent of responding healthcare organizations overall.

Source: 2015 Healthcare Benchmarks: Accountable Care Organizations

Infographic: The Growing Demand for Case Management

September 23rd, 2015 by Melanie Matthews

The Growing Demand for Case ManagementThe increase in insured populations combined with a growing number of Medicare beneficiaries underscores the need for inpatient case management services, according to a new infographic by McBee Associates.

The infographic outlines the four key reasons why an adequately staffed case management department is important for hospitals.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations Asked by its C-suite to quantify contributions of its multidisciplinary care team for its highest-risk patients, AltaMed Health Services Corporation readily identified seven key performance metrics associated with the team. Having demonstrated the team's bottom line impact on specialty costs, emergency room visits, and HEDIS® measures, among other areas, the largest independent federally qualified community health center (FQHC) was granted additional staff to expand care management for its safety net population.

The Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations chronicles AltaMed's four-phase rollout of care coordination for dual eligibles—a population with higher hospitalization and utilization and care costs twice those of any other population served by AltaMed.

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Guest Post: 7 Ideas to Improve Communication and Coordination between Care Sites

September 22nd, 2015 by Richard A. Royer, CEO, Primaris

With access to some of the most highly educated and trained medical professionals in the world, providing Americans with the best patient care possible should be simple. Unfortunately, that’s not often the case. Poor communication between specialists, duplicate tests and unnecessary procedures are frequently the norm rather than the exception, leading to costly, dangerous and sometimes deadly consequences. With so many specialists and resources readily on hand, how is this happening?

The problem is a lack of care coordination. Simply put, care coordination is the idea that all specialists treating a patient should communicate and share information to ensure that everyone acts as a team to meet patient needs. This includes reporting all results back to a primary care practice or to someone coordinating patient care, and ensuring that labs, specialists, hospitals, and long-term care facilities work together to communicate information quickly and appropriately. It’s about primary care physicians, nurses, technicians, specialists, and caregivers collaborating on patient care rather than working as separate entities.

The average Medicare beneficiary interacts with seven physicians in four different practices during a single year, according to the New England Journal of Medicine. For those with chronic conditions, the numbers can be even higher. And, nearly one-fifth of Medicare patients who are hospitalized are readmitted within 30 days of discharge, and 75 percent of these readmissions could have been prevented by improved care coordination.

Too often, patients discharged from hospitals don’t get the support and encouragement they need to take their medicine, follow their diets, and adhere to the regimens doctors have prescribed during their stay. Many of these problems can be solved by improving care coordination, and that starts with communication between care sites.

Here are seven suggestions for improving communication between care sites—as well as across the care continuum:

  • Start the dialog: As a rule of thumb, improving communication between care sites begins with healthcare providers asking themselves what they know that others need to know, and sharing that information with the patient’s care team. What do patients need to know when they’re referred to a specialist? What do the specialists that patients are being referred to need to be aware of, e.g. what tests have already been completed? Has the primary care physician been informed?
  • Create a team and make it accountable: Organizations should start by assigning a team of people to be accountable for managing patient care. Define the extent of their responsibilities for key activities such as following up on test results and communicating information to other physicians. Establish when specific responsibilities should be transferred to other care providers—whether that means specialty physicians, long-term care facilities, or home care providers.
  • Designate care coordinators: Designate staff that will act specifically as care coordinators can help to reduce hospital readmissions. Before patients leave the hospital, care coordinators should meet with them to make sure they understand the treatment plans they need to follow at home as well as any changes to their medication regimens. The hospital care coordinators also must follow up on any pending labs and imaging studies and contact primary care physicians to communicate updated medications, treatment plans, and test results for their patients. The likelihood of readmission drops significantly when patients leave with a clear understanding of their treatment plans and when their primary care physicians know what is necessary during follow-up care.

    This same communication protocol should also apply to patients who leave the hospital for long-term care facilities. In this instance, the hospital care coordinator should communicate discharge instructions to the long-term care staff. As soon as residents return to the long-term care facility, staff there should meet with residents to review their discharge instructions, answer their questions, and communicate with the hospital if any further clarification is needed. Long-term care staff should also follow up regularly with these residents to ensure they continue to comply with instructions the doctor has recommended and intervene if any problems arise.

  • Standardize communication processes: Create a protocol for filling out patient charts in a standard way so they are easy to interpret and key elements aren’t overlooked. You also should standardize communication by using structured forms to ensure primary care providers, specialists, and long-term care providers all have the same and necessary information.
  • Develop a referral tracking system: Creating a system to internally track and manage referrals and transitions— including consultations with specialists, hospitalizations and ER visits, and referrals to community agencies—can go a long way towards improving communication between care sites. It will help to ensure patients are well prepared for their referral visit and know what to expect afterwards. And, it simplifies follow-up with referral providers about findings, next steps and treatment plans.
  • Follow up on referrals: When a primary care physician refers a patient to a specialist, for example, office staff should follow up to make sure the appointment was made and completed. In addition, office staff needs to ensure the specialist shares his findings with the primary care physician so he can be well versed on the patient's progress and any additional steps to be taken.
  • Notify providers in the patient's medical neighborhood: Similarly, when patients visit the emergency room or are admitted to the hospital, communication should be a priority. In this instance, hospital staff should notify the primary care practice so the primary care doctor can follow the patient’s progress through discharge and institute a care plan to prevent future admissions. In addition, the practice can reach out to patients when they leave the hospital to make sure they understand discharge instructions and schedule follow-up appointments. When the patient comes in for follow-up care, the primary care physician should have a complete history of specialists seen during the hospital admission, their recommendations, and tests performed, along with the results.

The healthcare industry can no longer simply “discharge” patients. Providers must now work collaboratively with all others across the continuum of care to transition and coordinate the ongoing care of every patient. That’s what care coordination is all about.

Richard Royer

About the Author: Richard A. Royer has served as the chief executive officer of Primaris since 2001. He has extensive administrative healthcare experience and is actively involved in several statewide healthcare initiatives. In 2006 he was appointed by the Missouri governor to the Missouri Healthcare Information Technology Task Force and chaired the resources workgroup. He also serves on the board of directors as treasurer for the Excellence in Missouri Foundation. In his over 35 years of medical business experience he has held positions as chief executive officer at Cuyahoga Falls, Ohio, General Hospital; executive director of Columbia Regional Hospital in Missouri; and founder and president of Avalon Enterprises, a medical financial consulting firm.

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.