The only way to revamp the existing healthcare system is to “change the places and the ways in which we deliver care,” advised Eric Dishman, Intel Fellow and director of health innovation and policy, during Tuesday's opening session of the MGMA 2011 annual conference.
To illustrate, Dishman held aloft a small computer about the size of a pedometer that Intel gave to homebound elderly to wear. The computer generated data on their gait, information the scientific community can use to better understand how to prevent falls in this population, he explained during “Changing Practices: Home- and Community-Based Care Technologies for Independent Living.”
It's just one of the ways Intel is studying the entire “human” system to better design the technologies to support their care, Dishman said.
Out in the conference exhibit hall, home monitoring technology by Alere supports the shift in care delivery locations that Dishman is proposing. The technology allows patients who take the anticoagulant Warfarin to test PT/INR levels regularly. Keeping PT/INR levels within a safe range can help individuals to avoid serious complications such as bleeding or stroke.
“These rapid and real-time diagnostic tests in home allow for more frequent testing, which provides additional data,” explained Clint Brown, Alere home monitoring national business director. “We can catch an INR drifting out of range, which is the essence of preventive care."
By helping to reduce risk and adverse events, the technology helps to reduce the likelihood of readmissions, Brown added, “while contributing to the efficiency conversation.”
Patient portals were also part of the efficiency conversation at the conference, since they help to optimize EHR use, enhance patient engagement and clinical information exchange and shift some care management tasks to the patients themselves everything from making appointments to paying bills to reviewing lab results. Most EHRs have a portal component that can be activated.
The conference's Healthcare Innovations Pavilion featured a case study Tuesday on patient portal use, co-presented by Intuit and St. Vincent Medical Group. The 34-site, 150-physician multispecialty group launched the portal in May, explained Patti Ballman, St. Vincent's director of operations, but is already experiencing improved patient flow, a decrease in telephone calls and an ability to see more patients.
The portal, which the medical group has branded “MySV,” positions the group well for the patient engagement requirement of meaningful use, but that wasn't the primary driver for portal implementation, noted Ballman.
“We wanted to improve the care experience for the patients in the office. The online portal allows us to focus more on the patients who are in front of us rather than the ones on the phone.”
Physician practices considering the use of a patient portal should start collecting patients' e-mails now to make the launch easier, Ballman recommended.
Portals are just one of the technologies that are helping physician practices to improve collections by providing a more private transaction. Another is automated voice messaging, contributes Marc Tumminello, vice president of healthcare practice sales for Televox, another exhibitor at the conference.
"Using automated reminders for accounts receivable is far less costly than call centers," noted Tumminello. "Practices can also build in the option to speak to a live person. Giving the patients various payment options reduces the potential embarrassment of this transaction."
Phreesia, which calls itself "The Patient Check-in Company," puts this transaction back in the waiting room by building payment options into the self check-in process. Patients can check themselves in on the company's bright orange portable tablets, then render their co-pay or outstanding balance by swiping their credit card on the side of the tablet. The technology verifies eligibility, and also offers customized disease management education at the end of each transaction.
Patients have been receptive to this technology, notes Phreesia representative Katie Ray, who was demonstrating the tablet. "Patients are used to self-service in other aspects of their lives; why not in healthcare?"
On the clinical side, several presenters described how they are embedding case managers in the primary care practice. In separate sessions, both Advocate Physician Partners (APP) and Marshfield Clinic said they have embedded case managers in physician practices in the last year.
Sixty colocated outpatient case managers were added to APP's clinical integration program in early 2011, explained Dr. Mark Shields, senior medical director and vice president of medical management for Advocate Physician Partners and Advocate Health Care. "They will focus on the sickest 2 to 3 percent of our population."
Marshfield Clinic has embedded 55 nurse care coordinators in its 35 NCQA-recognized level III patient-centered medical homes, explained Dr. Theodore Praxel, medical director of quality improvement and care management. On average, the nurse care coordinators have been working for about six months in the practices, which have been very positive about this addition to the care team.
Watch this blog for more detail on these hot topics for practices as well some innovative strategies for coping with HIPAA compliance, physician shortages, acquisition, decreased reimbursements and other challenges.