Archive for November, 2010

E-Tools Update ER Wait Times

November 29th, 2010 by Patricia Donovan

ER wait times: is there an app for that? If not, there soon will be. A group of nine Texas hospitals uses digital tools, including a planned iPhone app, to update average ER wait times — a tactic profiled in this week’s Healthcare Business Weekly Update. The hope is that patients with non-life-threatening conditions will review the average waits at local ERs and decide which ER to use.

It’s a great idea, but one that could be taken a step further. Why not link to a health advice line so patients could determine the most appropriate venue for care, which may be the ER but could also be an urgent care center or next-day physician visit? Nurse advice lines such as the one operated by Optima Health are helping to reduce avoidable ER use and rehospitalizations, according to Patricia Curtis, Optima’s director of operations, clinical care services, while boosting patient and physician satisfaction scores. Stay tuned. We’ll have an interview with Ms. Curtis in next week’s issue, or follow us on Twitter to access the interview as soon as it ‘s available.

Two Tactics That Are Reducing Readmissions

November 24th, 2010 by Patricia Donovan

This month’s ReadmissionsRx looks at two award-winning efforts to reduce hospital readmissions: Thomson Reuters’ top 50 cardiac hospitals (a more elite list than its 100 top hospitals of the past) that are reducing readmissions and length of stay in this population, and the first health system in the nation certified as Level II transition coaches by the creator of the care transition model.

This issue also charts the top health coaching IT tools and delivers the latest benchmarks and benefits of health coaching programs.

Hot Healthcare Intervention Adds Weight at Bargaining Table

November 23rd, 2010 by Patricia Donovan

Last week CMS launched its new Center for Medicare and Medicaid Innovation, a by-product of healthcare reform. You can read about the center’s four key targets in this week’s Healthcare Business Weekly Update, along with the United States’ continued dismal ratings in healthcare accessibility, coverage and efficiency compared to the rest of the world. Of note is the finding that while two-thirds of Dutch, New Zealand and British patients say it’s easy to get after-hours care without going to the ER, two-thirds of U.S. patients (and those in France and Canada as well) said it was difficult.

Also last week, we spoke to Advocate Physician Partners senior medical director Dr. Mark Shields in preparation for an upcoming webinar on framing an ACO through clinical integration of independent physicians. Three of Advocate Physician Partners’ 41 performance measures are related to tobacco cessation and prevention efforts, said Dr. Shields. “Smoking cessation is one of the ‘hot’ interventions to improve health and reduce cost,” he said. “It also has given us the ability to be successful at the bargaining table with managed care organizations.”

Are you focused on smoking cessation and prevention, or do you want to learn what others are doing in this field? Take this month’s survey and receive an executive summary of the results.

Four-Point ‘Call First’ Campaign Cuts Avoidable ER Visits

November 19th, 2010 by Jessica Fornarotto

A multi-pronged member education program is helping to route patients to the most appropriate healthcare venue, explains Sara Tracy, senior manager of emergency services at Kaiser Foundation Health Plan of Colorado.

When we looked at contact for members prior to the accessing services in the ED, we found that 46 percent of our members contacted us prior to going to the ED. Our first strategy in reducing avoidable ED visits was trying to get our members to call us first. We know that when they talk to us, we are more likely to get them to the correct venue, either to our contracted hospital or to an after-hour service if that’s necessary, or even home treatment. The goal in that strategy is to educate our members on their advice options.

We have four tactics to try to meet that goal. The first tactic was member education in a quarterly member newsletter. This newsletter includes articles on nurse advice and reminders of a 24-hour service that’s available to them. Additionally, we put magnets in all of our new member packets that promote the advice service. There is a magnet in their new member kit that advertises our 24/7 nurse advice and how we can help them. Those same magnets were also put on our medical office front desks that advertise the service to remind members that they always have options in order to access advice when they’re not sure what to do.

Finally, we standardized scripting at the end of phone calls and visits in all of our offices regarding the availability of our 24-hour advice service. When a member is seen in the office or talks to someone on the phone, before they conclude the call, the nurse or the physician reminds them that if their condition changes or worsens, they can always call us back 24 hours a day. They then give the member the phone number to call.

HHS Finds Way to Get Smokers to Quit

November 19th, 2010 by Jessica Fornarotto

November 18th was the 35th annual Great American Smokeout. This week’s issue of the DM Update provides the latest stats on adult smoking and HHS’s bold move to get smokers to quit and prevent non-smokers from starting. You will also learn about St. Jude Children’s Research Hospital’s smoking cessation program for cancer survivors.

Fittingly, our e-survey this month is Tobacco Cessation and Prevention Programs. Take the survey and describe your efforts in this area.

The 3 Targets of RWJF Hospital Quality Network

November 15th, 2010 by Patricia Donovan

A new 139-hospital quality network will develop methods to reduce hospital readmissions, improve emergency room throughput and enhance provider-patient communications. As they brainstorm over the next 18 months, the hospital quality teams should consider the multi-pronged educational approach taken by Kaiser Foundation Health Plan to curb avoidable ER use. Both the quality network launched by the Robert Wood Johnson Foundation and Kaiser’s strategy are profiled in this week’s issue of the Healthcare Business Weekly Update.

Also this week, read about the larger warnings and disturbing color graphic images depicting smoking’s negative health consequences that cigarette makers may have to place on cigarette packages in the next few years. The proposed warnings are part of HHS’s broader tobacco cessation and prevention effort.

If your organization has a program on tobacco cessation and prevention or just wants to find out what’s happening in the field, take this month’s e-survey on tobacco cessation and prevention programs. More than 40 healthcare organizations have responded so far. You’ll get a free summary of the results.

Post-Election, Healthcare Reform May Feel Funding Delays

November 9th, 2010 by Melanie Matthews

Analysts are asking how huge Republican victories in last week’s midterm elections will impact healthcare reform.

“Minimal change, maybe some delays in funding,” contributed Steven Valentine, president of The Camden Group, in a follow-up to a recent webinar on healthcare trends for 2011.

“We have to remember, Medicare was putting a lot of these initiatives through ahead of Obama. We would have seen some of the bundled payments, new risk and payment methodologies and the Medicare reductions coming forward anyway.”

Valentine noted that Obama can still veto whatever changes the new Republican-heavy House of Representatives serves up. Any tweaks to the healthcare reform bill must be approved by both houses, and the President still has a Democratic majority in the Senate (albeit one that is somewhat reduced).

While federal monies are still available, five states that act fast can take advantage of HHS ‘Early Innovator’ grants to fund development of IT systems for state health insurance exchanges. The application process is featured in this week’s Healthcare Business Weekly Update. Also this week, learn how an IT-infused toolkit is preventing up to 90 falls per year by older adults in short-stay hospitals.

Risk Profiles Help Break Cycle of High-Cost, Unplanned Utilization

November 5th, 2010 by Jessica Fornarotto

Predictive modeling can help healthcare organizations break the cycle of unplanned utilization, explains Rebecca Ramsay, senior manager of care support and clinical programs at CareOregon.

Recently, CareOregon found that 12 percent of its membership was utilizing 60 percent of their resources. This is a very familiar pattern that doesn’t change from year to year.

Those 12 percent are medically complex with multiple comorbid conditions. We did a simple calculation and discovered that if we focused on improving the health and thus reducing the cost of care for this subpopulation, it would have a significant fiscal impact for us. We chose to start with the most costly and often the sickest members. We’ve since been able to intervene with a larger and more varied population as we have built capacity in the program.

The ROI for us often comes from those that are currently costing the health plan a lot of money because of the frequent and unplanned utilization. One of our early tasks was to figure out how to identify this high-risk, high-cost population as early as possible — ideally, before they reach that equity tipping point, because at that point it becomes even harder to improve their health, We needed tools to help us do this.

One of the first things we tried was the Adjusted Clinical Group (ACG®) predictive model designed at Johns Hopkins University. The idea behind a predictive model is that it uses information that is submitted on claims to create a risk profile for each member. The risk is usually of future utilization; our model looks at the constellation of diagnoses and medications that a member has on the claims that are submitted and creates a risk score.

We have been using this predictive model for a number of years and it has been successful in helping us identify members to reach out to what we may not have known about without the predictive model. But we have also learned about the limitations of predictive models; a predictive model can only predict risk based on information that is typically found on a claim. And a claim cannot identify when a member, for instance, is homeless or socially isolated. There is no diagnosis code for self-management deficits or for an unsafe living environment. Because of these limits, we have had to fill in the gaps and build additional reports and referral patterns. Our goal was to cast as broad a net as possible to decrease the likelihood that our high-risk patients would fall through the cracks.

Hyperactive Behaviors Linked to Obesity

November 5th, 2010 by Jessica Fornarotto

This week’s issue of the DM Update targets obesity and its effects on children. Can hyperactive behaviors in childhood trigger adulthood obesity, and did a “stealth” obesity prevention program benefit low-income, African-American children? Also this week, find out which hospital patients are at a higher risk for cognitive impairment.

Simple Interventions Sometimes Most Effective

November 1st, 2010 by Patricia Donovan

With so much reform-era emphasis on bending the spend curve, we sometimes forget that the simplest interventions are often the most effective. For example, follow-up phone calls to select patients is a low-cost tactic getting significant results in a variety of healthcare settings.

In a featured story in this week’s Healthcare Business Weekly Update, U-M researchers report that patients suffering from depression who received follow-up calls from a primary office’s care manager were more likely a year and a half later to have symptoms in remission and be more productive at work. And post-visit phone calls to ER high flyers, ER patients presenting with low-acuity complaints and patients recently discharged from the hospital are helping to reduce avoidable ER visits, according to results from July’s Reducing Avoidable ER Use survey. Download survey results here.

“Perhaps the most underutilized technology in modern medicine is the telephone,” noted Group Health Cooperative VP of Primary Care Services Michael Erikson during a recent webinar on staffing and roles of the medical home care team. He should know. Group Health’s successful medical home pilot, which relied heavily on telephone outreach, reduced ER visits by 29 percent and in-person office visits by 6 percent, according to results published last year in the American Journal of Managed Care.