Infographic: EHR Trends in Nashville

September 19th, 2014 by Melanie Matthews

Seventy-four percent of physician offices in Nashville have implemented electronic health records, according to a new analysis by Technology Advice. Nashville is often seen as a bellwether city for the healthcare industry and its EHR adoption rates mirror national estimates by the National Center for Healthcare Statistics.

EHR adoption rates and trends are analyzed in a new infographic by Technology Advice, which looks at office-based EHR usage, EHR satisfaction rates, top EHR providers, specialty EHR use and meaningful use attestation in Nashville.

EHR Trends in Nashville: Insights from an Emerging Market

Electronic Health Records: Strategies for Long-Term Success Electronic Health Records: Strategies for Long-Term Success is a comprehensive reference for the design, implementation, and optimization of electronic health records (EHRs). The authors offer a detailed road map for avoiding common pitfalls during conversion and achieving higher-quality care after system implementation. A glossary of important terms and references to additional resources are also included in the book.

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10 Things to Know About Reducing Avoidable ER Visits in 2014

September 18th, 2014 by Cheryl Miller

Despite expanded coverage available under the Affordable Care Act (ACA), the hospital emergency room (ER) remains a refuge for those unable to visit their primary care physician (PCP)— whether due to lack of access, insurance, or time, according to results from the latest Reducing Avoidable ER Visits Survey by the Healthcare Intelligence Network (HIN).

But more than half of respondents (65 percent) are confident CMS’s easing of telemedicine regulations (e.g. mandates for physician on-site hours) will help to reduce avoidable ER visits.

In the three years since HIN last administered this survey, health organizations have stepped up ER discharge follow-up efforts. Almost one-third of respondents (31 percent) in 2014 say they contact patients within 24 hours of their ER visit, versus 22 percent of respondents in 2011 who made provider appointments before discharge, and 18 percent who conducted phone follow-ups within two days of a visit.

Here are more metrics derived from the 2014 Reducing Avoidable ER Visits Survey:

  • Staffing solutions to reduce avoidable ER visits have changed: case managers, social workers and disease-specific care coordinators are increasingly utilized in the ED, replacing health educators, coaches, and nurse-only advice lines used in 2011.
  • The challenge of redirecting non-emergent patients, while still a primary barrier, decreased in priority from 29 percent in 2011 to 18 percent in 2014.
  • Insufficient care access remains a challenge, growing from 16 to 21 percent in 2014, along with PCP collaboration, which was still among the top three challenges, but decreased from 24 percent in 2011 to 18 percent in 2014.
  • The prevalence of programs to reduce avoidable ED usage remained relatively stable from 2011 to 2014, with nearly three quarters of respondents reporting such initiatives.
  • Among populations reported to generate the majority of avoidable ED visits, ER use by dual eligibles increased five-fold in the last four years, from 2 to 11 percent, while other populations — high utilizers, Medicare and Medicaid — remained roughly the same.
  • Chronic disease replaced pain management as the most frequently presented problem, at 54 percent.
  • Education and risk-based telephonic outreach are the top two patient-centered strategies used to reduce avoidable ER visits in 2014.
  • Behavioral health issues and privacy are considered two top legal and compliance obstacles in reducing avoidable ER visits, respondents say.

Source: 2014 Healthcare Benchmarks: Reducing Avoidable ER Visits

Stratifying High-Risk Patients


2014 Healthcare Benchmarks: Reducing Avoidable ER Visits
delivers actionable metrics from 125 healthcare organizations on their efforts to foster appropriate use of hospital ER departments. Enhanced with more than 50 easy-to-follow graphs and tables, this third edition of comprehensive data points presents year-over-year trends and best practices for engaging ER and hospital staff, primary care physicians, community providers and patients in reducing avoidable ED utilization.

Infographic: U.S. Hospital Administrative Costs

September 17th, 2014 by Melanie Matthews

Twenty-five percent of all U.S. healthcare spending is for administrative costs...the highest among eight other nations.

The Commonwealth Fund, in a new infographic, looks at the differences in administrative healthcare spending between the United States and the Netherlands, England and Canada, spending per person in these countries and the potential for savings if the United States could reduce its administrative costs.

U.S. Hospitals Have the Highest Administrative Costs

Data Sources for Rate-Setting in ACOs, Exchanges and Narrow NetworksGreater cost transparency and consumer engagement are front-and-center in the health insurance revolution that is underway, and the use of data is driving these monumental changes.

Data Sources for Rate-Setting in ACOs, Exchanges and Narrow Networks examines the various ways claims data can be used in the new health insurance marketplace. In addition to helping support the adjudication of out-of-network claims, claims data can provide the building blocks for ACO development, as well as the foundation for pursuing a narrow-network strategy, developing consumer-oriented tools to promote effective plan selection and plan management, and building internal dashboards for strategic decision making.

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Bundled Payments Opportunity to Practice Proactive Population Management

September 16th, 2014 by Patricia Donovan

Assuming financial risk for the cost of post-acute services not only helps healthcare organizations avoid value-based readmissions penalties but also provides a chance to proactively manage a population, notes Kelsey P. Mellard, vice president of partnership marketing and policy with naviHealth.

We have been called almost a concierge-type service in the way we think about management and engagement with the patient, their family, and their caregivers. We proactively provide a road map to our beneficiaries based on their functional score. Our tools and technology identify their functional abilities upon discharge from the hospital and use that as a driver for identification of a post-acute care setting.

Our functional score is comprised of three domains: basic mobility, applied cognition and daily living skills. Through the assessment of the patient, we identify a patient in our database just like the patient in front of us and say, ‘Patients just like this patient have gone to skilled nursing facilities (SNFs) or home health and have had this level of functional improvement over the course of this length of stay, this many therapy hours per day, and this patient presents with X% of a risk for readmission. Through that prediction, based on historical real patients in our database, we can identify and help target the level of acuity and care this patient actually needs in a post-acute care setting.

Often we discharge patients to a higher level of acuity and care than they actually need. This gives us a tool. It’s not a rule. It’s not the be-all, end-all in our hospital partner settings, but it does create another piece of information based on real patients to help inform the discharge planning process.

We see the level of excitement and engagement our hospital partners exhibit on the ground floor, because right now they’re discharging based on community knowledge or because a case manager really likes one facility or they’re financially interested, from an organizational standpoint, in one facility. This negates all of those conversations and says this is an evidence-based model we’re going to be able to deliver at the bedside.

Source: Bundled Payments: Opportunities in Effective Retrospective Acute and Post Acute Care Bundles

Bundled Payments


Bundled Payments: Opportunities in Effective Retrospective Acute and Post Acute Care Bundles
First quarter experiences from these pilot programs, along with the current bundled payment opportunities for organizations not yet participating in CMMI's pilot program.

Infographic: Aetna’s Approach to Value-Based Healthcare

September 15th, 2014 by Melanie Matthews

With a new focus on quality of healthcare over quantity, Aetna is reporting improvements in outcome-based measures and reduced costs. In its new infographic, Aetna details its value-based healthcare options and results its achieving.

Quality over Quantity

Value-Based </p>
<p>Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and MethodologyIf one trend has transformed the healthcare industry post-ACA more than any other, it is the market's new business model rewarding value over volume.

Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and Methodology provides a framework for healthcare's new value proposition, with advice from thought leaders steeped in the delivery and reimbursement of value-based care.

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Infographic: 7 Ways to Improve Patient Satisfaction

September 12th, 2014 by Melanie Matthews

With healthcare transparency and the patient experience playing a larger role in not only the rating of healthcare organizations, but also reimbursement formulas, healthcare providers are playing closer attention to patient satisfaction levels.

Leading Reach, a patient engagement company, outlines seven strategies for healthcare providers to improve patient satisfaction levels.

7 Ways to Improve Patient Satisfaction

Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and MethodologyIf one trend has transformed the healthcare industry post-ACA more than any other, it is the market's new business model rewarding value over volume. Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and Methodology provides a framework for healthcare's new value proposition, with advice from thought leaders steeped in the delivery and reimbursement of value-based care.

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6 Ways to Overcome Pushback to Embedded Case Management

September 11th, 2014 by Cheryl Miller

Change always incites pushback, and when Sentara Medical Group went from an embedded case management program to a hybrid approach, patient and provider pushback prevailed, recalls Mary M. Morin, RN, NEA-BC, RN-BC, nurse executive with Sentara Medical Group. Among the six ways Sentara overcame resistance was to establish and maintain patient-centered relationships, by conducting comprehensive initial and ongoing assessments with patients, and developing plans of care and coaching education for both patients and their caregivers.

  • We maintained patient lists by populations within our electronic platforms. We came up with a standardized screen or view for all care managers. There was a lot of pushback against standardization but the key is standardizing the workflows. Should someone go out on family and medical leave, you can transfer your patient list. It all looks the same.
  • They were given and are still given assignments. We set expectations, which is critical. We send patient letters from the primary care physician (PCP) on behalf of your primary care provider that state we have this resource to help you should you be admitted to the hospital. We’re very focused on engaging patients. We have a brochure, and each care manager has a bio form that talks about their background.
  • We built workflow within the practices, within care management and within our electronic platform. We had issues: Optima, our health plan, is on a different EMR, as are the practices within our clinically integrated network. Unfortunately, the ambulatory-based care managers, the medical group care managers have to move between these two other platforms as well as our platform.
  • We held many meetings with home health and in-patient care coordination. Putting a face to a name is very helpful, as is lots of education and training. We had to do the electronic medical record (EMR) training. We discussed how to engage and motivate patients. What’s motivational interviewing? We have a requirement that within two years case managers are required to have their specialty certification.
  • We defined the care manager's role. The main piece is to establish and maintain patient-centered relationships. They conduct comprehensive initial assessments and ongoing assessments, identify ongoing needs of the patients and possibly their caregiver, developing care plans and then providing coaching support to the patient, caregivers, and family members.
  • We managed resources such as transportation. We contract with the taxi service for our few patients that don’t drive but need to get to their appointments or to keep them out of the EDs in the hospitals. They manage transitions of care. They conduct advanced care planning.

value-based reimbursement
Mary M. Morin, RN, NEA-BC, RN-BC, is a nurse executive with Sentara Medical Group, where she is responsible and accountable for non-physician clinical practice within the Sentara Medical Group (160 clinics/practices) to ensure integration and alignment with Sentara Healthcare, regulatory compliance, standardization of nursing practice/care, and patient safety.

Source: Hybrid Embedded Case Management: New Model for Cross-Continuum Care Coordination

Infographic: Large Employers Lead the Way With Worksite Wellness

September 10th, 2014 by Melanie Matthews

As a growing number of employers realize the impact that employees' health has on the bottom line, the number of employer-sponsored wellness programs has increased with larger employers leading the way.

An infographic by MBA Healthcare examines the types of wellness programs that employers are offering and the impact the programs have on employee health.

Big Companies Leading the Way in Preventive Care

7 Patient-Centered Strategies to Generate Value-Based ReimbursementHealthcare 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.

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Community Health Network Retools Readmissions Ruler for High-Risk Heart Failure Patients

September 9th, 2014 by Patricia Donovan

From the many evidence-based health risk stratification tools available, Community Health Network has adapted a popular hospital readmissions indicator for use with medically complex patients at high risk of readmissions. Deborah Lyons, MSN, RN,NE-BC, network disease management executive director for Community Health Network, describes the adaptation process.

HIN: Where do home visits for heart failure patients enter the picture?

Deborah Lyons: We do a high-risk home assessment while we have patients in the hospital. Fully 100 percent of our patients that are admitted to inpatient status are automatically screened and ranked in terms of readmission risk. That’s where we use the LACE/ACE tool. We embedded that tool in our software so it can predictively tell us which patients to focus on.

HIN: How did you decide on the LACE tool? Is the ACE tool different than the LACE tool?

Deborah Lyons: The LACE itself is evidence-based. We work with the advisory board. And they had just done an analysis of all the predictive models out there in terms of readmission risk when we started this work. There were only two tools that were moderately predictive for risk. LACE was one of them. LACE looks at length of stay (L), acute admission (A), (meaning they came in through the emergency room), their Charleston Comorbidity score (C) and the number of ED visits (E) they’ve had in the past six months.

All this information was easily available to us at the time that we did this because we were on a different computer system. But the concern was that the L factor (length of stay), might lead us to place the patient at high risk when they were leaving the hospital. Maybe they started at low risk and then on the fourth day of stay, because they had been there four days, now they moved to high risk but they’re being discharged. You really can’t do anything at day of discharge. We first set a threshold for LACE, which we tested and validated and then ran a correlation and asked ourselves, “If this threshold is a LACE high risk, what would a correlating threshold be if we dropped the length of stay?” That’s how we moved to an ACE score.

Source: Stratifying High-Risk, High-Cost Patients: Benchmarks, Predictive Algorithms and Data Analytics

Stratifying High-Risk Patients


Stratifying High-Risk, High-Cost Patients: Benchmarks, Predictive Algorithms and Data Analytics
Reviews 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.

Infographic: Creating Digitally “Mature” Healthcare Providers

September 8th, 2014 by Melanie Matthews

While consumers are taking charge of their digital health by downloading health apps and searching for health data online, only 33 percent of healthcare providers are digitally "mature," according to a new survey by Capgemini Consulting.

Capgemini highlights the survey findings in a new infographic that looks at the differences between digitally mature and non-digitally mature healthcare providers and provides strategies for moving up the digital curve.

Is the Healthcare Industry Digitally Fit?

2013 Healthcare Benchmarks: Mobile HealthUsed a smartphone app for health reasons lately? Chances are your patients and health plan members have, too. The use of mobile health technologies (not simply wireless) to monitor health is revolutionizing the exchange and consumption of healthcare data. From mobile apps that monitor blood sugar and heart rhythms to text-based medication reminders, mHealth technologies could save from $1.96 billion to $5.83 billion in healthcare costs by the year 2014, some studies indicate. 2013 Healthcare Benchmarks: Mobile Health delivers a snapshot of mobile health (mHealth) trends, including current and planned mHealth initiatives, types and purpose of mHealth interventions, targeted populations and health conditions, and challenges, impact and results from mHealth efforts.

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