Archive for March, 2009

Rewarding Health & Wellness Activity

March 10th, 2009 by Melanie Matthews

Early data from HIN 2009 Health & Wellness Incentive Survey:

  • Majority of respondents offer incentives, but strategies, items and eligibility differ by sector;
  • Amidst the usual cash and tokens, benefit-based incentives taking hold;
  • Under the heading of “unusual incentives,” one respondent offers a medical home;
  • Some going beyond participation to reward behavior change (e.g. weight loss) but many difficulties associated with that;
  • Economy straining program funding even while participation is up;
  • Suprising results in ROI measurement.
  • Going Extra Mile Helps ER Frequent Flyers Where They Live

    March 9th, 2009 by Melanie Matthews

    Philadelphia hospitals are reducing utilization and costs attributed to ER “frequent flyers,” according to Philadelphia Inquirer Magazine:

    These troubled people, struggling with chronic illness – and often with homelessness and addiction – routinely appeared at Camden hospitals, racking up huge bills and straining already crowded emergency rooms.

    One person was seen at a local ER 324 times over five years. Another sought emergency care 115 times in a single year. Yet another racked up $3.5 million in hospital bills, paid by Medicaid and Medicare, from 2002 to 2007.

    Then last year a pilot program employing a nurse practitioner, a social worker, and a community health worker began closely following these top users – even tracking them down in homeless shelters to help find them places to live. The team made sure patients checked their blood sugar, if necessary, and took their medications.

    Early data show promising results: a significant reduction in ER visits, and huge savings. The effort could become a model for other cities.

    Health Reform Forum Members Put Concerns on Table

    March 9th, 2009 by Melanie Matthews

    National momentum for healthcare reform continued to build with last week’s White House Forum on Health Reform. The event brought together more than 100 doctors, patients, business leaders and insurers to discuss ideas on how to bring down healthcare costs and increase coverage. I watched a breakout session — one of five — moderated by Domestic Policy Council Director Melody Barnes and Dr. Bob Kocher of the National Economic Council. Session participants — a mix of legislators, providers and community stakeholders — had a chance to present their constituencies’ major concerns, which included a larger role for preventive care, provider reimbursement, health IT, quality improvement and care access. You can follow healthcare reform on the new HHS Web site healthreform.gov, the creation of which is a featured story in this week’s Healthcare Business Weekly Update. HHS has posted the top five concerns of 30,000 Americans who participated in healthcare community discussions late last year:

    • Cost of health insurance (31 percent)
    • Cost of healthcare services (24 percent)
    • Lack of emphasis on prevention (20 percent)
    • Difficulty of finding health insurance due to pre-existing conditions (13 percent)
    • Quality of care (12 percent)

    Seems like reformers and consumers are on the same page, at least for now. As reform moves forward, it will be interesting to see whether this alignment continues.

    PQRI Not About the Money

    March 6th, 2009 by Melanie Matthews

    Quality is the cornerstone of PQRI, says AAFP’s Dr Bruce Bagley in a new podcast, and bonus payments physicians receive for reporting are just by-products of the process. The medical director of quality improvement for the American Academy of Family Physicians also shares his views on the value of patient registries and other healthcare IT for PQRI, and has some advice for physicians who may be frustrated by their PQRI experiences.

    Childhood Obesity

    March 5th, 2009 by Melanie Matthews

    In this week’s Disease Management Update, find out how the state of New Jersey is doing their part in the fight against obesity, as well as the obstacles that obese adolescents face.

    HIN Trends Expert Tells CNN about Costs of Uninsured, Underinsured

    March 5th, 2009 by Melanie Matthews

    Dr. David Chin, who said healthcare is “no longer recession-proof” during HIN Trends ’09, told CNN today about factors contributing to rising healthcare costs.

    In a response to a report on expenses generated by growing numbers of uninsured and underinsured, Dr. Chin, a national partner in the Health Industries Advisory Practice of PricewaterhouseCoopers LLP and the managing partner of PwC’s global Healthcare Research Institute, told CNN that “Many people without adequate insurance are also delaying or forgoing medical care until it becomes an absolute emergency.” The report estimates that in addition to rising numbers of uninsured, nearly 25 million Americans can’t afford to cover the gap between what their insurance covers and their medical bills demand.

    Late last year, Dr. Chin described the global implications of these costs during Healthcare Trends & Forecasts in 2009:

    Our 2007 Global CEO survey found that 83 percent of global CEOs feel that the high cost of healthcare can cause U.S.-based employers to be less competitive, compared to international counterparts that don’t have the burden of employer-based health insurance. Even before the recession, the ability of global companies to pass on cost increases to the consumer were relatively limited. Globally, we’ve seen a real pressure on prices for all sectors of the economy.

    Looking at employers’ trends in cost management approaches, the number one strategy is helping employees manage their own health to reduce costs. The second is providing adequate coverage or access but then limiting their costs — i.e. increasing copays — and then having employees take on more responsibility, which is a combination of both providing employees tools to manage their own healthcare and giving them more skin in the game.

    For providers in particular, there’s going to be a lot of pressure on eligibility and revenue cycle processes, to make sure that those paying patients in fact are paying patients and that you get the maximum reimbursement. You can expect to see more pay for performance programs; if you don’t have the infrastructure to gear up for that, you will need it. Also, if you look at the waste in healthcare, a lot of it is in the variations in practice.

    The Medical Home in 2009: Have You Moved In Yet?

    March 4th, 2009 by Melanie Matthews

    In less than five years, the patient-centered medical home (PCMH) model has quickly grown from a pediatrics-based concept to an approach embraced by thousands of healthcare organizations hoping to improve quality and efficiency of healthcare delivery. Complete HIN’s third annual survey on the PCMH’s role in your organization and get a FREE executive summary of the compiled results.

    Can New Care Models for Chronic Illness and Comorbidity Help to Heal Healthcare?

    March 3rd, 2009 by Melanie Matthews

    Our new president has given the healthcare industry a lot to digest. A week after designating a sizeable piece of the economic stimulus package for the uninsured, medical research, health IT and preventive care, President Obama is proposing a federal budget that takes aim at drug companies, Medicare spending and hospital reimbursements while creating a $634 billion reserve for healthcare reform. The budget backs up his Congressional address promise to “find a cure for cancer in our time” with a sizeable increase in NIH funding for cancer research. While we wait for the fine points, it’s becoming pretty clear that healthcare delivery as we know it is in for a shake-up — organizations will face stricter eligibility and reporting requirements on many payment fronts.

    In this week’s Healthcare Business Weekly Update, we describe a model of care that is showing great promise for the complex health needs of the elderly and one hospital’s new strategy for handling behavioral healthcare cases in the ER. And as the focus on patient-centered care heats up, we ask for your feedback in our third annual e-survey on the Medical Home model at work in your organization.