Archive for October, 2010

6 Key Elements of the Health Coaching Call

October 29th, 2010 by Jessica Fornarotto

Calls made by health coaches have six key components, defined here by Roger Reed, former executive VP and chief health officer at Gordian Health Solutions and currently a member of Onlife Health's scientific advisory board.

The telephonic coaching call has several components. First, we review information from the previous session. We're always building on what that individual has learned about themselves in a previous call. We assess the “stage of change” at every call, and try to monitor their progress in becoming more ready to make personal changes. We then update and reassess their perceived barriers to reaching their goals and see if we’re making progress in knocking those down.

We provide emotional support, informational support and encouragement. We highlight their strengths, promote commitment and encourage them to continue with self-evaluation. It becomes a collaborative process between the coach and the individual to re-set clear, specific, personalized, short-term and long-term goals, and the individual must take ownership and accountability for those.

Before the call ends, the individual can always ask questions or schedule an ad-hoc coaching call if they need to.

Diabetes Cases to Double, Triple by 2050

October 29th, 2010 by Jessica Fornarotto

According to the CDC, the prevalence of diabetes in the United States is expected to double or triple by 2050. Learn more about the CDC's research in this week's issue of the DM Update, along with two new recommendations for stroke prevention. And staying with the subject of prevention, learn how Kaiser Permanente's heart disease prevention program is saving lives and reducing costs.

Two Cost Reduction Strategies Built Into Healthcare Reform

October 25th, 2010 by Patricia Donovan

Midway through our sixth annual healthcare trends e-survey, the outlook is cautiously optimistic, with two-thirds of respondents reporting that 2010 was better business-wise than 2009. Anticipating the first phases of reform, cost containment is their top concern related to the Patient Protection and Affordable Care Act (PPACA).

To alleviate these woes, healthcare should look at cost reduction opportunities in accountable care organizations (ACOs), recommended The Camden Group's Steven Valentine during last week's annual Healthcare Trends and Forecasts webinar. Alluding to the NCQA's draft of seven core capabilities for ACOs, a featured story in this week's Healthcare Business Weekly Update, and the imminent CMS Medicare ACO project, Valentine had this advice:

We’re not telling you right away to implement an ACO, but we’re telling you prepare and put in place the organization, the care models, the delivery network and the infrastructure you’re going to need, so that in a couple of years as you begin to exploit this, you’ll be in a good competitive position.

ACOs also figure into integrated health management, one of seven macro trends driving the healthcare industry, as seen by Cognizant Business Consulting's William Shea. He shared these thoughts:

ACOs are among the capabilities and solutions that begin to make healthcare organizations look more like integrated delivery models. Experiment with new delivery models, taking advantage of the incentives coming from the regulatory area in reform to experiment with these models, like the patient-centered medical home and accountable care organizations.

Can Telephonic DM Improve Health of Rheumatoid Arthritis Patients?

October 22nd, 2010 by Jessica Fornarotto

In this week's issue of the DM Update, learn how yoga and exercise can play a role in disease management for fibromyalgia and breast cancer patients, respectively. Plus, learn how telephonic disease management can improve the health of rheumatoid arthritis patients.

Physicians Define 21 Principles for Accountable Care Organizations

October 20th, 2010 by Patricia Donovan

Four physician groups have defined 21 principles to consider when building the administrative and payment structures of accountable care organizations (ACOs). The American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Physicians (ACP) and the American Osteopathic Association (AOA) —, which represent a total of about 350,000 physicians, released their recommendations in a recent press release.

The principles developed by the four groups reflect attributes they believe essential for the effective implementation of the ACO model within the healthcare system. The principles state that primary care should be the foundation of any ACO and that the recognized patient and/or family-centered medical home is the model that all ACOs should adopt for building their primary care base.

The new joint principles include:

Structure of the ACO

  • They provide accessible, effective, team-based integrated care based on the Joint Principles of the Patient Centered Medical Home for the defined population they serve.

  • They demonstrate strong leadership among physicians and other healthcare professionals.

  • Organizational relationships and all relevant clinical, legal, and administrative processes within ACOs are clearly defined and transparent.

  • They include processes for patient and/or family panel input in relevant policy development and decision- making.

  • They include a commitment to improving the health of the population served through programs and services that address needs identified by the community.

  • They provide incentives for patient and/or family engagement in their health and wellness.

  • Participation by physicians, other healthcare professionals, and patients/families is voluntary.

  • Nationally accepted, reliable and validated clinical measures are used to measure performance and efficiency and evaluate patient experience.

  • They implement clinically integrated information systems to provide relevant information at the point of care and assist in care coordination.

  • Barriers to small practice participation are addressed and eliminated.

  • They are adequately protected from existing antitrust, gain-sharing and similar laws that currently restrict the ability of providers to coordinate care and collaborate on payment models.

  • They promote processes to reduce administrative complexities.

Payment

  • The payment models and incentives implemented align mutual accountability at all levels.

  • The payment models and incentives implemented adequately reflect the relative contributions of participating physicians and other healthcare professionals.

  • The payment models used recognize effort required to involve family, community/educational resources and other pertinent entities and activities related to care management/care coordination of patients with complex conditions.

  • Recognition and rewards for the ACO’s performance are based on processes that combine achievement relative to set target levels of performance.

  • Practices participating within ACOs that achieve recognition as medical homes by NCQA or other nationally accepted certification entities should receive additional financial incentives.

  • The structure adequately protects ACO physicians and other healthcare professional participants from “insurance risk.”

  • They employ a variety of payment approaches to align the incentives for improving quality and enhancing efficiency while reducing overall costs.

Three Tech-Free Ways to Provide Better Preventive Care

October 15th, 2010 by Patricia Donovan

Three of the four ways that doctors can provide better preventive care to healthy patients identified in a new Kaiser Permanente study can be done without an electronic medical record (EMR). The strategies are linked to the use of Kaiser Permanente's Panel Support Tool (PST) — a Web-based tool that extracts data from an EMR.

According to study findings published online in Population Health Management, the four best ways to improve care using PST are the following:

  • Sending standardized letters or secure e-mail messages around the time of members’ birthdays that identify all needed care;
  • Having medical assistants or nurses call patients to schedule screening tests;
  • Having pharmacists review patients’ records for needed care when refilling medications.
  • Querying the system for care gaps for the entire panel every two to four weeks;

With a little advance planning and a rudimentary patient registry — on paper or in an Excel® spreadsheet — solo and small practices without EMRs could implement the first three processes.

The study involved 207 primary care teams that were using the PST to manage the care of 263,509 adult patients, some whom were relatively healthy and others who have chronic diseases. The study looked at 13 different care recommendations and found that after 20 months, the PST improved performance from 72.9 percent to an average of 80 percent. Researchers found that during the first year of tool use, performance in delivering the care recommendations improved to a statistically significant degree every four months.

The study noted that while the PST is a great tool to help physicians take better care of their patients, it does not override shared decision-making between doctor and patient.

The Role of IT in Preventive Care

October 15th, 2010 by Jessica Fornarotto

According to RAND Corporation researchers, Americans are experiencing a higher rate of diabetes than the English. Learn more about this finding in this week's DM Update issue, along with why some Parkinson's patients die sooner than others. And find out how IT is being used in two different ways for preventive care.

The First Step To Reducing Avoidable Utilization

October 14th, 2010 by Jessica Fornarotto

Some simple analysis before launching a chronic care management program can help an organization to reduce avoidable utilization, advises Ariel Linden, Dr.P.h., M.S., and president of Linden Consulting Group.

Believe it or not, few organizations ever do a needs assessment. Often, they decide it makes sense to do a program for chronic heart failure (CHF) because CHF appears to have the largest ROI. However, if you don’t have any CHF patients in your population, then it doesn’t make any sense to implement a CHF program. First, you have to ask some basic questions about the makeup of the population. Then, ask what the utilization looks like in this population. If you have a well-managed population, it may not make sense to develop a disease management program because your providers are doing a good job. Focus on the acute utilization profile in your population and how much of that utilization is avoidable. For example, you could have acute utilization, but because everyone is end stage, there’s very little of that you could reduce, unless you triage everybody to an end-of-life program.

If your goal is to improve clinical measures — if there’s opportunity to expand that — then conducting a Numbers Needed to Decrease (NND) analysis is important. If you do not make a person self-efficacious and able to handle their own disease self-management and teach them how to interact with their healthcare system, they will not know what to do in an emergency. They will end up in the ER and after that, in the hospital. To determine whether there is an opportunity for an ROI, you need to do two things. First, do an NND analysis. Look at your rates for utilization — how much a program costs — to see if there is an opportunity to reduce it by the admissions to an extent, based on how much it’s going to cost you to implement the program and whether it’s internal or external. You also need to do some sample size and power calculations.

Telephonic Care Management Reduces Hospital Admissions

October 11th, 2010 by Jessica Fornarotto

A new study on the effect of telephonic care management, presented in this month's Health Coach Huddle, found that it reduced both medical costs and resource utilization. Learn how telephonic care management and patient engagement reduced hospital admissions, as well as which intervention was more effective in improving outcomes of heart failure patients — remote monitoring or teaching the patients self-management skills.

Breaking the Cycle of Hospital Readmissions

October 11th, 2010 by Patricia Donovan

To reduce avoidable use of hospital emergency departments, healthcare organizations are doing everything from surveying ED patients post-discharge to embedding a case manager in the ED. In this week's Healthcare Business Weekly Update, Ariel Linden details the essential first step to reducing avoidable healthcare utilization. And on a related note, we present new Johns Hopkins research that questions whether increased use of MRIs and CT scans in the ER is contributing to longer ER visits and increasing the risk of medical error.

You'll also learn why 16 states will be taking a closer look at evidence-based care transition models that will help break the cycle of hospital readmissions.