Archive for September, 2010

IT During Care Transitions Can Curb Readmissions

September 28th, 2010 by Patricia Donovan

The use of devices during post-acute care transitions that remind patients to take meds, store prescription data and monitor patients remotely has the potential to reduce hospital readmissions, according to a new Center of Technology and Aging report featured in this month's issue of ReadmissionsRx. Also this month, Sutter Health's case management director describes Sutter's approach to medication reconciliation, and Melanie Matthews, HIN's executive VP and COO, shares the latest market metrics on reducing avoidable ER use — much of which is attributed to patients recently discharged from the hospital.

Haven't taken our second annual telehealth survey yet? Respond by September 30 and you will be e-mailed a summary of the compiled results. Learn how more than 100 healthcare companies are using telehealth in clinical and non-clinical areas. For example, 56 percent of respondents thus far monitor patients remotely.

Hospitals Should Try Patient-Centered Approach

September 27th, 2010 by Patricia Donovan

A patient-centered approach can be as effective in a hospital setting as it is in the primary care office, says a new study from Geisinger Health System. In a featured story in this week's Healthcare Business Weekly Update, Geisinger reports that its Continuum of Care model — timely, coordinated, risk-stratified care of hospitalized patients — could save nearly 100,000 hospitalized patient lives each year as well as significant healthcare dollars. Earlier this month, Geisinger reported that its ProvenHealth Navigator, its self-developed medical home model, is capable of reducing admissions by 18 percent and readmissions by 36 percent for its Medicare Advantage members.

Risk stratification factors heavily into Kaiser's handling of high and ultra-high ED users, as you'll read in another of this week's stories. And in the first of our new monthly podcasts on healthcare market metrics, HIN's Melanie Matthews delivers the just-published results on reducing avoidable emergency room use.

Using Narcotics Contracts to Manage ED High Utilizers

September 27th, 2010 by Jessica Fornarotto

Sara Tracy, senior manager of emergency services at Kaiser Foundation Health Plan of Colorado, describes a formula for identifying high utilizers of the ED.

Resource intensive members --- they have also been called “frequent fliers” --- are classified as our high utilizers. High utilizers are members who are identified as low, medium or high. Our low members are those that had two ED visits in three months, our medium were those that had either three, four or five visits in six months and our ultra-high utilizers were those that had six or more visits in a year. We did a data pull based on claims data that helped to identify those that had a connection with either chemical dependency, behavioral health or no connection at all. Our data pull included information on the primary care physician (PCP), the EDs they’ve visited including the dates and the diagnosis, the top prescriptions that were prescribed for the member and the dollars that were spent on these members.

We identified approximately 1,000 members that fall within these guidelines. The first group we looked at was those individuals that have a known association with chemical dependency. Those are members who have had a referral or a visit with someone in our chemical dependency department within the last year. Many, if not most, of these members were patients who had issues with narcotics. We pulled a chart review of 25 members to identify those that had a current narcotics contract --- an agreement between the physician that’s prescribing the narcotics and the patient on the parameters for the prescription. Often, these members would request early refills; they may show up to the ED in pain requesting IV narcotics, so the narcotics contract is very critical to helping keep these members compliant. In our review, we found that only 20 percent of that population had a contract. When these members subsequently show up in the ED and there’s no contract, the ED does not have much guidance in how to treat this member.

We reviewed our current narcotic contract format and decided that it was very lengthy, rather robust and not user-friendly. We have worked with our chemical dependency department to revise that contract so that it is a one-page contract. It is very succinct and it includes 10 bullet points that the member initials, and it has all the parameters under which the physician will prescribe narcotics for that patient.

Asthma Treatment Trends

September 23rd, 2010 by Jessica Fornarotto

In this week's Disease Management Update, we focus on asthma medication and management. Find out if asthma medication can benefit MS patients as well as if pediatricians are using recommended methods of diagnosing and managing asthma in children.

And have childhood immunization rates increased or decreased? Get the answer in this issue.

NY Learning Collaborative Preps Providers for Medical Home, Health IT Dollars

September 20th, 2010 by Patricia Donovan

Our children are not the only ones back in school this month. A new learning collaborative that will prep providers at 12 New York City community health centers to meet standards for the patient-centered medical home and meaningful use of health IT, making them eligible for billions of dollars in state and federal incentives is featured in this week's Healthcare Business Weekly Update. Through a mix of classroom-style learning, virtual learning tools and one-on-one coaching, the collaborative hopes to bring providers up to speed on key patient-centered initiatives and high-tech tools while improving healthcare care delivery and quality in the process.

In another group effort, the Iowa Collaborative Safety Net Provider Network has fashioned a virtual medical home in which local primary care providers work with other community-based organizations to deliver a full continuum of healthcare services to underserved populations. Two members of Iowa's virtual medical home will share lessons learned from the collaborative process during a webinar this Thursday.

Interesting in providing more high-tech healthcare? Learn what inroads more than 75 organizations are making in this area by taking this month's e-survey on telehealth and telemedicine. Respond by September 30 and you'll be e-mailed a summary of the results.

ERs Reluctant Primary Care Providers for 28 Percent of Americans

September 13th, 2010 by Patricia Donovan

The hospital ER is the de facto primary care provider for 28 percent of Americans seeking acute care, according to a study published in this month's Health Affairs. Patient-centered medical homes and accountable care organizations — reforms featured prominently in the Patient Protection and Affordable Care Act — are intended to eventually improve access to acute care. In the meantime, the healthcare industry is taking a three-pronged approach to reduce avoidable ER visits, according to new market research featured in this week's Healthcare Business Weekly Update.

For example, Kaiser Permanente in Colorado took a very hard look at its ED utilization across its population and found that avoidable and preventable ED visits accounted for upward of 20 percent of its approximately 72,000 ED visits per year. In a recent webinar on redirecting patients to more cost-effective care settings, Sara Gray, senior manager of emergency services at Kaiser Foundation Health Plan of Colorado, shared more than two dozen population-specific strategies Kaiser is using to maximize the time, energy and resources expended by ER staff.

In response to our July 2010 e-survey, 90 healthcare companies told us how they are reducing avoidable ER use and the impact their efforts are having on emergency department utilization. Get a free summary of the results here.