Archive for March, 2011

Patient-Centered Care Is Getting Results

March 30th, 2011 by Patricia Donovan

Two examples this week of patient-centered interventions that reduce cost growth and avoidable utilization. First, CDPHP’s medical home pilot chalked up an impressive $32 PMPM savings at the end of its first year as well as significant reductions in ER visits and hospital admissions. Its physicians are happier, too, thanks to a novel reimbursement approach that CDPHP’s Dr. Bruce Nash shared with us in a recent interview.

Higher physician satisfaction has already been reported from the Guided Care model, a physician-nurse team approach to primary care for the elderly with multiple chronic illnesses. In this week’s Healthcare Business Weekly Update, you’ll get the latest results from its 20-month randomized controlled trial, including its effect on the numbers of home health visits, SNF admissions and hospital readmissions by the populations it serves. Prior to the start of the trial, Dr. Chad Boult explained how Guided Care differs from the medical home approach.

As our fourth annual health and wellness incentives survey winds down, it looks like gift cards are the most popular incentive but not the most effective. To see what more than 150 healthcare organizations are doing in this area, take the survey by March 31.

Use of Expensive Prostate Cancer Treatments Among Medicare Patients

March 28th, 2011 by Jessica Fornarotto

This week’s issue of the DM Update looks at newer, expensive cancer treatments being adopted by Medicare patients, along with the effect of stem cell treatment on MS patients.

Also this week, learn which online behavior was ignited by the 2009 cigarette excise taxes.

ACO Advice: Don’t Wait for Final Rule

March 24th, 2011 by Patricia Donovan

With a little flexibility, payors and physicians can profit from the ACO model now, without waiting for CMS’s final rule, advises Greg Mertz, senior project director with the Healthcare Strategy Group.

Mertz, who will analyze CMS’s anticipated guidelines for accountable care organizations during an April 21, 2011 webinar, shared some advice in an interview this week with Melanie Matthews, HIN executive VP and chief operating officer:

Melanie Matthews: What should healthcare organizations be doing now in the absence of any clear direction from CMS on ACOs?

Greg Mertz: Everybody’s focused on and waiting for HHS, which obviously impacts the Medicare ACO model, but no other model. It’s entirely likely that you’re going to have the commercial side of the ACO initiative and you’re going to have the public side, and I don’t think they’re going to be the same thing. So to have people just focusing on, “What do I need to do to either wait for, or understand, or comply with the federal side of this model…” I think if they see ACOs as an opportunity, they’re going to miss a lot more flexibility on the commercial side.

Yes, the regulations are important and will give guidance to a lot of people. There are a lot of people who are like deer in the headlights now, not doing anything but waiting for the message from Washington. But they’re going to have a whole lot more creativity available to them on the commercial side if they’ve got a good partnership with the payor.

Melanie Matthews: What do you see happening in the marketplace on that front now?

Greg Mertz: The first one is Humana in Kentucky, which is partnering with Norton Healthcare to develop an ACO. This ACO was developed as part of the ACO Pilot Project Project of The Engelberg Center for Health Care Reform at the Brookings Institution and The Dartmouth Institute for Health Policy and Clinical Practice.

Health systems with some initiative can get a better model. One of the concerns I’ve got with the government’s accountable care model is this whole concept of freedom of choice. People can slip in and out of the accountable care network; if you’re trying to control costs when people aren’t constrained to like-minded providers, the outcome is kind of up in the air. It’s like being an HMO, but not being in the HMO.

On the commercial side, I don’t think that the payors in the world are going to have the same political need to give their members total flexibility as to what provider they go to. These payors are going to say, “Okay, you sign up. You’re in this network. And you have to stay in the network if you want to be covered by your health benefit.” That’s going to give the provider a whole lot more control over the care that’s delivered, the quality of the care that’s delivered and the cost of the care that’s delivered. That’s going to be more successful than perhaps the public program is going to be.

Melanie Matthews: Humana has launched some initiatives, as have Cigna and UnitedHealthcare. What recommendations would you give to other health plans?

Greg Mertz: They’ve really got to expand the number of demonstration projects, and with the ACO or the network sponsors. Most of the originals—the large physician organizations and the California IPA types —have been partnering with health plans for years but really haven’t dramatically lowered the cost of care. For example, Blue Cross Blue Shield individual policy premiums went up 50 percent this year. So in a matured managed care market, you still have dramatic annual deltas in the cost of care. It isn’t working all that well. Hospitals really aren’t in those systems. The commercial payors are going to have to say, “Okay, we need to look at multiple models in multiple markets, not just health systems sponsors.”

The interesting thing is that the whole ACO concept is physician-driven. They’re the foundation of the model that’s going to make this thing work or not work. Physicians really don’t have a lot of experience being in control of initiatives like that. So the payor is dealing with the more sophisticated negotiator, which is the organized health system. Nobody is sitting down with the folks that are actually going to make this thing successful — the doctors — in those kinds of settings to say, “How can we empower you? How can we help you create the kind of physician network?” Because if the physician network works, it can work with any hospital system. It doesn’t make any difference, because the doctor is driving the bus. The health system can’t be successful unless it has good forward-thinking innovative physician partners. The commercial organizations are talking to the wrong end of the spectrum. They need to be much more focused on getting like-minded physicians together in developing those networks.

Melanie Matthews: That’s an initial step. Are there any other steps that these physicians have to take?

Greg Mertz: One of the big questions that a lot of people have is what kind of infrastructure is going to be necessary, what’s it going to take to run one of these ACOs? Yes, you’re going to need fairly sophisticated date systems. Yes, you’re going to need the ability to collect financial information and make payments to physicians and hospitals and other ancillary providers. So maybe the next step for physicians is to attain the ability or the technical assistance to develop that infrastructure, whether they do an ACO management product, where the UnitedHealthcares of the world can go to any market and say, “You put together the provider network. We’ve already got the infrastructure, and we can layer this over whatever you’ve got in your network. Rather than reinvent the wheel, here’s a model that works. We’ve got the data system. You go deliver the care.”

I think that would make them a welcome partner at this point. Physicians are hearing about horrendous cost requirements. Data systems in the seven- and eight-figure range to put adequate clinical data systems in place, with no understanding of how that’s going to integrate with financial data collection systems. If the commercial payors are seriously wanting to get into this business, they’ve got to help make that happen by addressing some of the business concerns as well as just the provider, clinical delivery concerns.

Assessing Effectiveness of a Home Visit Program

March 22nd, 2011 by Jessica Fornarotto

Pam Aldridge, manager of care management at Durham Regional Hospital, explains how her organization measures the effectiveness of its outpatient care program.

To assess the effectiveness of our Care Partners program, we had individual balanced scorecards developed for each patient utilizing the balanced scorecard format. The metrics were developed based on historical cost data; targets were developed and discussed with Care Partners and the oversight committee for our pilot patients.

Patients who demonstrated compliance with the program and had no unplanned admissions during Phase One were eligible and invited to graduate into a less intensive Phase Two. These patients in Phase Two continued to be in contact with their case managers. If they have no unplanned readmissions and wish to continue with the program, they will graduate to a Phase Three, which represents a period of maintenance and self-direction for the patients. Ultimately, our program strives to empower patients to effectively manage their own healthcare needs.

We created the Care Partners Pathway, which marks a successful transition from Phase One to Phase Two. The patients who moved among the phases had continued compliance with their established outpatient care program, successfully engaged in Phase Two for six months, had no unplanned readmissions and had fewer than two ED visits in a three-month period. In Phase Two, the patients received one contact per month and one face-to-face visit within three months.

If the patients demonstrated continuous compliance with the established outpatient care programs, had no unplanned readmissions and had fewer than two ED visits in another three-month period, they moved to Phase Three. In Phase Three, they had one contact with their case manager per quarter and then graduated from the Care Partners program. At any time during these phases, the patients could call their case manager for advisement, to talk to them and to get information.

Simple Blood Tests Hold Key to Future Healthcare Utilization

March 21st, 2011 by Patricia Donovan

Two separate blood tests can predict heart patients at risk for readmissions as well as individuals who may develop diabetes, according to two new studies.

New Johns Hopkins research suggests that an inexpensive, routine blood test administered at hospital discharge could reveal why some patients with congestive heart failure do well after discharge and why others risk relapse, costly readmission or death within a year.

And Boston scientists say a simple blood test could help predict the onset of Type II diabetes up to 10 years ahead of any symptoms.

Johns Hopkins researchers tested heart failure patients on admission and discharge for levels of a protein that’s considered a marker for heart stress. In previous studies, the levels of this protein, N-terminal pro-B-type natriuretic peptide (NT-proBNP) have been correlated with heart failure symptoms and have been associated with an increase in adverse outcomes.

They found that patients whose protein levels dropped by less than 50 percent over the course of their hospital stay were 57 percent more likely to be readmitted or die within a year than those whose levels dropped by a greater percentage.

Meanwhile, after following more than 2,400 patients for 12 years, researchers at Massachusetts General Hospital’s Cardiovascular Research Center reported that 201 of the subjects eventually developed diabetes, according to a report in Nature Medicine. They found that five amino acids had “highly significant associations with future diabetes.”

Patients with the highest levels of amino acids were five times as likely to develop diabetes, they reported.

Post-Discharge Home Visits Get Second Look

March 21st, 2011 by Patricia Donovan

The healthcare industry used to write off home visits as too costly and resource-intensive, but now they’re getting a second look. This week’s Healthcare Business Weekly Update looks at an innovative home visit pilot for Medicaid and dually eligible patients that reduced unplanned hospital admission days by 71 percent in three months.

As programs such as these catch on, the job description of the contemporary healthcare case manager is much more likely to include home visits in 2011 than it did in 2010. These findings and more are included in a just-published downloadable white paper, 2011 Benchmarks in Healthcare Case Management.

To stay abreast of the changing role of the healthcare case manager, we invite you to visit our Case Management Connections information portal for the latest case management news, blog posts, Tweets, white papers, podcasts and more.

Managing Depression in Heart Disease Patients

March 18th, 2011 by Jessica Fornarotto

Can a collaborative care program help manage depression in heart disease patients? Find out in this week’s issue of the DM Update, along with three ways to reduce gaps in prevention use among elderly and diverse populations.

At the halfway point of this month’s survey on health and wellness incentives, the completion of a health risk assessment is the top health improvement activity incented by respondents. To receive a free e-summary of the results, complete the survey by March 31, 2011. Your responses will be kept strictly confidential.

6 Reasons to Include a Health Coach in an ACO

March 15th, 2011 by Patricia Donovan

In a very funny video about health reform and accountable care organizations that was recently brought to my attention (thank you, Health2 Resources), the computer-generated help clerk asks a bewildered healthcare executive what he knows about health coaches. It got me to thinking about the role of the health coach in an ACO, which led me to a very interesting discussion on the topic by Patrick T. Buckley, MPA, IHC, for HealthLeaders Media.

Buckley notes that “the challenge most providers face with accountable care organizations is not just how to manage risk, but also how to assist and coach individuals on making positive and sustained changes in their lifestyles.” One way to overcome this challenge is to engage the services of integrative health coaches within the ACO, who acts as a “conduit” between the physician and patient. Integrative health coaches encourage patients to change personal behavioral patterns, he explains, which ultimately leads to a healthier, more satisfied ACO member and patient — which makes the physician look pretty good when it’s time to measure and reward the doctors for patient outcomes.

Here are Buckley’s six reasons to add a health coach to an accountable care organization:

  • Coached patients learn how to effectively navigate the health system, resulting in increased customer satisfaction.

  • Coached patients are more committed to making permanent improvements in their lifestyle behaviors, which improves the physician’s performance on outcome measures.

  • There is significant improvement in the quality of the patient/provider relationship: patients are more engaged in and informed about their care options whereas providers are less stressed because they can more easily get positive results for their patients.

  • Coached patients generally show sustained health improvements and have less likelihood to require readmission to a hospital during the 30 days post-discharge.

  • Coaching provides patients with continuity before, during, and after engagement with the health system. It levels out the episodic nature of the care process, so that physician-patient interaction time can focus on productive solutions as opposed to re-hashing information in the exam room.

  • Integrative health coaching strengthens the loyalty of patients and helps to keep them from leaving the system due to fragmented and disjointed care coordination.

Near Consensus on HIT Benefits, But ‘Meaningful Use’ Elusive

March 14th, 2011 by Melanie Matthews

The gap is closing between early adopters of health IT and other organizations, particularly smaller medical practices, in benefits achieved from HIT. An ONC review of articles published on HIT benefits shows increased evidence of improved quality and efficiency of care and better access to care for leader and non-leader organizations alike.

Driven by incentives for HIT adoption, the number of healthcare organizations, including smaller practices, using HIT is increasing. However, concerns exist about the financial investment and clinician support necessary to achieve meaningful use of the technology, according to a new study by Beacon Partners. In this week’s Healthcare Business Weekly Update, read more about these challenges as well as concerns among healthcare industry professionals about the perception of health reform legislation changes.

The Business Case for Case Managers

March 7th, 2011 by Patricia Donovan

In a post-PPACA world, the healthcare case manager is not only a cornerstone of care delivery, but also a wise investment. In a featured story in this week’s Healthcare Business Weekly Update, Lutheran Medical Center’s Toni Cesta makes the business case for embedding a case manager in a hospital emergency department.

Many organizations are following the lead of organizations like Lutheran and co-locating case managers at the point of care. Another widely emulated example is Geisinger’s successful ProvenHealth NavigatorSM model, which embeds a nurse case manager in a primary care practice. This tactic is greatly reducing hospital readmissions and ER visits for the health system.

The practice of co-located case managers is on the upswing, according to preliminary data from our 2011 Case Management survey. For example, the number of case managers working in hospital admissions offices has doubled in the last year, according to more than 200 survey respondents. To receive an e-summary of 2011 case management trends once it is compiled, please e-mail