Archive for May, 2011

How to Form an Accountable Care Organization

May 26th, 2011 by Jessica Fornarotto

Collaboration and culture change are prerequisites for an accountable care organization (ACO), according to Greg Mertz, senior project director with the Healthcare Strategy Group.

Forming an ACO is a multi-step process. One step is inventory and establishing your resources, people, data systems, leadership and clinical leadership. What do you have, and what do you have to get in order to meet the requirements that are going to be in the application process? The regulations indicate necessary elements --- the description of the quality assurance program, the data system and leadership, for instance.

Collaboration --- physicians working with physicians, primary care with specialists and physicians with hospitals --- is going to be hard because that is a cultural change. The practices in the CMS Physician Group Practice Demonstration have been around for decades and decades. The culture is established, and there is a history of physicians working together in patient management.

Simply creating an ACO is not going to get you to where you need to be. Whether you decide to put in an application or not, it is never too soon to get started in learning the collaborative model.

How much money is going to be required? When you look at your gap analysis and then start to look at what it’s going to cost to buy the systems to attract and retain the people, it may easily come up to $1 million to $1.5 million.

Pharmacists’ Motivational Interviewing Can Boost Medication Adherence Levels

May 25th, 2011 by Cheryl Miller

Medication non-adherence accounts for nearly $290 billion in avoidable medical spending each year, according to a recent New England Healthcare Institute estimate.

But a recent pilot study found that training community pharmacists in the art of motivational interviewing could boost medication adherence levels in the patients who visit them.

The study, a collaboration between the University of Pittsburgh School of Medicine, Highmark Blue Cross Blue Shield and Rite-Aid pharmacies, was discussed in “Improving Medication Adherence Benchmarks Through Community Pharmacist Interventions,” a webinar sponsored by the Health Intelligence Network. According to Janice Pringle, Ph.D., director of the program evaluation research unit at the university, and guest speaker, the three primary reasons causing medication non-adherence were patients’ beliefs that:

    Medication costs too much
    Medication will do more harm than good
    Medication is not needed

The study deployed motivational interviewing training to 120 participating pharmacies. Results showed that standardized screening and brief (2 to 5 minutes long) therapeutic conversations between patient and pharmacist helped to reduce patient risk. Pharmacists were taught overall interviewing techniques and strategies for dealing with patients’ resistance to taking medication.

This isn't the first time Screening and Brief Intervention (SBI) has proved valuable in health management. Studies have shown that SBI has been effective in alcohol problems, and for smoking, diabetes, and HIV adherence.

And, many of the pharmacists surveyed in the program were eager to shed their often inaccessible image for a more accessible one. Said one pharmacist of the training: “All of us have been trained to work with patients, and we have not been able to do that. This is the chance we have been looking for to have more contact with our patients and make a difference in their lives.”

CMS Seeks ACO Pioneers for Summer Launch

May 23rd, 2011 by Patricia Donovan

Do you have what it takes to be a pioneer? CMS is seeking up to 30 vanguard healthcare companies for its Pioneer ACO program set to launch this summer ahead of the January 2012 Medicare Shared Savings Program. Only those practiced in care coordination and willing to accept financial accountability and performance incentives need apply. This week's Healthcare Business Weekly Update contains more details as well as a link to the application, which must be submitted by July 18.

For the rest of the industry, healthcare consultant Greg Mertz spells out a few prerequisites for creating an accountable care organization.

Patient satisfaction is among the many metrics by which patient-centered delivery systems such as the ACO and medical home will be judged and compensated. We invite you to take our Patient Experience and Satisfaction survey and share how your organization is reshaping the healthcare experience for your population. You'll be e-mailed a summary of the responses.

Patient Satisfaction: What’s It Worth to Your Organization?

May 23rd, 2011 by Patricia Donovan

There's a lot of heated debate about whether patient satisfaction ratings should figure into healthcare quality and reimbursement models. The fact is, CMS already posts patient satisfaction ratings in 10 key areas on its Hospital Compare site. It's only a matter of time before the Physician Compare site follows suit.

We've just launched a new survey on Improving Patient Experience and Satisfaction. Please tell us how your organization is working to improve patients' and members' experience and satisfaction with their care by June 20. We'll e-mail you a free summary of survey results once it is compiled in mid-July. We'll be sharing some of the most impressive strategies in future blog posts and publications.

In the meantime, we've heard about a hospital that claims to be the first in the nation to solicit and publish patient reviews. Hill Country Memorial in central Texas integrates online rating and review tools into its Web site. Patients can rate the Patient Experience, Quality of Care, or any of a number of hospital departments. The published reviews capture the good, the bad and the ugly...and Mark Peterson, the hospital's director of customer experience, responds to many of them.

In an April 2011 post on patient satisfaction, a blogger for Better In Emergency Medicine describes how he has come to view that there is value in pursuing a goal of more satisfied patients:

Needless to say, as I mature in my practice, I have come to realize that there is a lot of truth to the statement, "They don't care how much you know until they know how much you care." With that in mind, I want to share some key points from a nice review of customer satisfaction that I stumbled upon from the Emergency Medicine Clinics of North America.

So why pursue a goal of having more satisfied patients?

There are multiple demonstrating benefits from hospitals which perform better:

  • Staff morale improves (Turnover decreases, work is more enjoyable)

  • Malpractice risk decreases (Happy patients sue less frequently)
  • Patients respond better to treatment (Patients follow instructions when they believe that they received good care)
  • Hospital finances improve (Patients recommend the facility and will come back)

We came across this brief video from HcPro on improving patient satisfaction. While geared to hospitals, the six tips contained herein can be adapted for physician practices as well as health plans.

Tool for Talking about End-of-Life Care

May 20th, 2011 by Cheryl Miller

There’s no question that physicians’ primary role is to improve their patients’ survival.

But what about those patients whose options have run out?

A recent article on the lack of palliative care in HemOnc today reveals that patients who make a plan for end of life care experience less pain, fear and stress; death is less stressful on the family and costs are less overall. And physicians benefit significantly as well. According to a 2008 survey published in the Journal of Palliative Medicine, physicians who engaged in palliative care reported feeling greater satisfaction about the role they played with a dying patient and the patient’s family.

However, surveys show that training is still poor and physicians are uncomfortable discussing death and dying with their patients.

Part of the problem is that palliative care as a discipline only began appearing in medical school curricula in the past 15 years or so. Results from a national survey presented at the 2009 American Society of Clinical Oncology (ASCO) showed that:

    only 25 percent of respondents had completed a palliative care rotation

    42 percent of the respondents had not received explicit education about telling a patient he or she is dying

And a 2010 Journal of the American Medical Association (JAMA) survey revealed that:

    only 38 percent of National Cancer Institute designated centers had a palliative care fellowship program

    only 18 percent of the programs had five or more fellows.

What to do? The Hospice of Michigan has an innovative answer. They have developed a toolkit called Have You Had the Talk?™; it provides a thorough guide for decision-making related to end-of-life wishes, a central place to document medical history, organize physician contacts and legal documents, and tips for starting the conversation with loved ones. Among the contents of the toolkit are:

    A bright orange envelope to keep important medical information and related documents.

    A Ziploc bag to protect toolkit documents, including the Durable Power of Attorney. The large label has room to write key information on whom to contact in the event of an emergency.

    A large magnet for the freezer with room to write whom to contact in the event of an emergency and the location of important medical documents.

    A thin-tipped marker to fill out contact info on the magnet.

    A wallet card, which will help in the event of a medical emergency. It has a place to write contact information, physicians, and other important information.

    Simple-to-execute documents that you and your family will need in the event of an emergency.

It sounds like a good place to start.

Incenting Physicians to Improve the Patient Experience

May 17th, 2011 by Jessica Fornarotto

Practices that exceed patient satisfaction metrics will be rewarded at bonus time, explains Bruce Nash, MD, MBA, senior VP of medical affairs and CMO for Capital District Physicians’ Health Plan Inc. (CDPHP).

Our bonus model is $50,000, and we based it on the Institute for Healthcare Improvement (IHI) Triple Aim. We are looking for improved satisfaction, and we want improvements in value, quality and cost.

We approach satisfaction by dealing with it as a threshold measure. If the practice drops below a certain level, they are not eligible for the bonus at all. It is an important safeguard if one is going to move to a mostly capitated type of payment, because every payment model has its own perverse incentives. We want to make sure the patients are receiving an appropriate experience.

As a health plan, when it came to creating the approach for the quality and cost pieces, in order for this to be sustainable and scaled, we needed to be sure that measurements in those areas that we were rewarded on resulted in savings to the plan, because otherwise we wouldn’t achieve our goals. Therefore, we created this idea that by hitting your quality metrics, you created the bonus opportunity. However, you didn’t earn it unless you hit the efficiency metrics. We chose 18 specific Healthcare Effectiveness Data and Information Set (HEDIS®) measures along the line. We are not trying to say these are the ‘be all and end all,’ but we do have a scoring methodology. These 18 measures get scored on a grid. It is weighted, and depending on how they do compared to last year, they end up with an overall score. Our overall score at a particular practice hit 66.9 percent of the $50,000. Each physician created an opportunity for $33,448 of bonus payments.

As we look at efficiency, we are an Ingenix® client. Our efficiency model is based on a customized version of an efficiency score. We are comparing everybody to the overall network. It is a relative model that we are using. Any practices in the top 10th percentile would be eligible to earn the full $50,000, if they created that opportunity with their quality. If they are in the bottom 10th percentile, they are not eligible for a bonus. In between, we multiply the efficiency score times the bonus and add this in as a kicker for improvement year to year.

ACO Rule Gets Thumbs Down from Industry Influencers

May 16th, 2011 by Patricia Donovan

Late last week, 10 healthcare heavy hitters rejected CMS's proposal for ACOs on the grounds that it would prove too costly for many providers to implement. One pricy example cited by Geisinger Health System, Dartmouth-Hitchcock and the eight other co-signers: the investment required to report on the 65 quality measures specified in the ACO rule. It will be interesting how the feedback from this group influences CMS, which has given the industry until June 6 to comment on its guidelines for accountable care organizations.

In the meantime, two Texas health systems are going ahead with plans to collaborate in a multi-provider ACO. This week's Healthcare Business Weekly Update provides the details.

Today is the last day to respond to our fifth annual Patient-Centered Medical Home Survey. Join the more than 110 organizations that have already described their medical home's health IT tools, patient education, team members, metrics, ROI and more. Besides receiving a free e-summary of the survey results, you'll also be eligible to win a copy of our newest medical home resource, Guide to Physician Performance-Based Reimbursement, excerpted in this week's issue.

How Patient-Centered Care Redefines Patient-Physician Roles

May 9th, 2011 by Jessica Fornarotto

Patient-physician dynamics change when a practice opts to deliver team-based care, explains Barbara Wall, J.D., president of Hagen Wall Consulting.

The relationship between the patient and physician alters in a patient-centered practice. In shared decision-making, the patient and physician roles have more give and take than in traditional practice, and more patient involvement in developing the treatment plan. In essence, the physician discusses the following issues with the patient:

  • The patient’s understanding of the diagnosis and options for treatment;
  • The patient’s belief and concerns about their illness and treatment options;
  • The challenges they anticipate; and
  • Practical ways to help them with these difficulties.

The patient is encouraged to take a more active role in the visit and to define the type of physician-patient relationship they want, talk with the physician about their health issues, their feelings and their expectations; ask the physician to clarify anything they don’t understand, and participate in care planning and articulate any doubts they have about their ability to follow through on the plan.

In most groups, the adoption of a shared decision-making practice style is influenced by the opinions of formal or informal leaders within the group. Physicians must believe that the approach will have a positive clinical outcome for their patients for them to consider pursuing it. Start with a physician champion with an interest in this practice style, and allow them to lead the way by sharing some journal articles on the subject of their choosing. The most persuasive evidence will probably be the early success stories from your physician champion as they implement the approach. Physician training in shared decision-making focuses on feedback to the physician based on observation of the physician’s interview technique.

To Engage Patients, Meet Them Where They Are — On The Internet

May 9th, 2011 by Patricia Donovan

Online interaction with patients will engage them in health management, setting up healthcare providers for success in patient-centered models such as the medical home and ACOs. That's one of 10 tips for patient engagement in a new Institute for Health Technology Transformation report profiled in this week's Healthcare Business Weekly Update.

Health IT also links patients in rural areas to health services they might not otherwise be able to access. CMS's new telemedicine rule, another featured story this week, simplifies the credentialing and privileging processes among providers to enhance access to telemedicine by remote patients.

Didn't have a chance to read the results from our 2011 Telehealth and Telemedicine survey? Download the executive summary here.

7 Emerging Trends in Healthcare Case Management

May 6th, 2011 by Patricia Donovan

Not only are more healthcare organizations utilizing case managers, but the practice of embedding case managers at the point of care is intensifying, according to the second annual Healthcare Case Management survey conducted in January 2011. For example, the number of case managers working in hospital admissions offices nearly doubled from 2010 to 2011.

Additionally, the contemporary case manager’s job description is much more likely to include home visits, crisis management and quality improvement responsibilities in 2011 than it did in 2010.

Other trends identified in this survey support emerging models of integrated health delivery such as the patient-centered medical home and the accountable care organization (ACO):

  • The use of patient satisfaction as a key metric in evaluating case manager programs, followed by improvement in patients’ clinical status;

  • Uptick in embedded or co-located case managers, especially by hospitals in admitting areas;

  • Increased case management activity by hospitals;

  • More focus on case management of the Medicaid population;

  • More hands-on chart review to identify patients for case management;

  • Bigger case loads for case managers (twice as many at within the 150-199 and 200 to 249 ranges);

  • Slight drop in the targeting of diabetes by case management.

Despite the many value-based care delivery models being examined, the Triple Aim objectives outlined by the Institute for Healthcare Improvement (IHI) serve as a benchmark for accountable care. A carefully constructed case management program will also help organizations adhere to these standards:

  • Improve the health of the population;

  • Enhance the patient experience of care (including quality, access, and reliability); and

  • Reduce, or at least control, the per capita cost of care.

Get more details on 2011 Healthcare Case Management Trends.