Archive for November, 2011

Q&A: CDPHP Embedded Case Managers Usher In New Era of Healthcare

November 30th, 2011 by Jessica Fornarotto

From the perspective of the health plan-provider relationship, CDPHP embedded case managers are an example of both parties working together in partnership, explains Lisa Sasko, MA, MBA, director of clinical transformation at CDPHP. Prior to their presentation on The Role of Embedded Case Managers in Clinical Transformation, Sasko, along with Charlene Schlude, director of case management, describe the functions of an embedded case manager, target populations and issues to address prior to embedding a case manager in a practice.

HIN: A news release on the CDPHP physician practice transformation program mentioned that the embedded case managers help practice staff better facilitate medical, behavioral and pharmaceutical services for patients. Can you provide, in more detail, their functions in these areas?

(Charlene Schlude): We have embedded RN case managers that work in the practices and their primary function and role is to assist the physicians and staff in the practice to identify, engage and outreach patients in their practice, whom they believe have many chronic and complex medical issues that may require special coordination of care. The addition of social work, perhaps because there may be some social concerns and financial constraints around having a chronic illness or maybe the loss of a job, help people to engage in a self-management plan. After the case management experience is over, the patients should be able to continue on with the education, adherence techniques, the understanding of their diagnosis and having a list of questions to bring with them to speak to their doctor about regarding their condition. The patient should be empowered and ready to help self-manage their chronic condition on an ongoing basis.

HIN: You mentioned complex patients as targets for the case management program. Are there other target populations, such as by disease state?

(Charlene Schlude): Yes, we target any patient with a complex illness. That could be someone in our commercial product or our self-insured product line; people who may have had a trauma or a catastrophic illness or event. We work closely with our transplant patients because they have significant social and emotional needs as well as medical and pharmaceutical needs. We work with anyone who has a great deal of barriers to self-managing their care, which could be that they have a situation in their home where they’re the caregiver for another patient or another member of their family.

HIN: What are the operational and cultural issues to address before embedding case managers in the practice?

(Charlene Schlude): We found that when we were going into the medical home as embedded case managers, we were going to have to be very flexible and open to the different nuances of each practice. We know that the underlying concepts around medical homes are the transition of the practice so that everyone has an integral part on the team. We knew that we had to be very open to the workflows in the practice. Our case managers are sensitive to that, but they do need to become an integral part of that practice as a member of the team. While they’re employed by the health plan, the message to the practice and to the members is that they are a part of that team and are involved with all of the decisions; they sit in on conferences and talk with the physicians directly. But again, we are being sensitive to the workflows because we did not want to go in and prescribe how things were going to be in one medical home to the other, and say that it had to be consistent.

(Lisa Sasko): From an operational standpoint — from a plan and provider relationship standpoint — some of the issues that were important for us to address, focused on recognizing and working with our practices to recognize that this is a new era of healthcare. We need to work together in partnership. CDPHP is supporting these practices to become these enhanced primary care practices through practice transformation, through the use of consultants, etc. In addition, CDPHP is putting these practices on a new payment model that gets them away from fee-for-service onto a risk-adjusted base capitation, which offers a lucrative, to some degree, bonus potential based on improving quality of care for the members and improving the efficiency of the resources utilized.

Got an Idea? CMS Offers $1 Billion in Health Care Innovation Challenge

November 28th, 2011 by Cheryl Miller

The CMS continues to reward innovation in healthcare; the latest initiative, the New Health Care Innovation Challenge, plans to award up to $1 billion in grant money to organizations that come up with creative ways to deliver healthcare, improve care and lower costs. The agency will take notice of projects that can be up and running within six months and that can hire, train and deploy workers rapidly. Funded by the PPACA, it's a push for both creative healthcare solutions and increased healthcare job opportunities in as short amount of time as possible, contrary to the Innovation Advisors initiative launched in October, which seeks healthcare solutions over a year long, labor intensive period. All segments of the healthcare industry are encouraged to apply for the Innovation Challenge; December 19th is the cut off date for LOIs.

A quick, innovative, effective solution is also needed to alter the latest statistics on diabetes furnished by the IDF on World Diabetes Day (November 14th): studies show that one adult in 10 will have diabetes by 2030. Far too many are already afflicted with the preventable disease, including 78,000 children suffering with type 1; this despite the fact that the greatest number of diabetics fall within 40 to 59 years of age. The IDF is hoping that continued international awareness of this problem will help; and the agency is in the midst of a five-year campaign to promote diabetes education and prevention programs. Ironically, the CMS cited one health system that worked with community partners to decrease the risk of diabetes with nutrition programs as inspiration for its Healthcare Challenge initiative. Food for thought.

Another area of concern is the number of seniors receiving the wrong medication during their home healthcare visits. The Journal of General Medicine recently published a study stating that nearly 40 percent of patients 65 and over are prescribed potentially inappropriate medications (PIMs) at rates three times higher that patients who visit a medical office. Some of the blame can be placed on our fragmented healthcare system, researchers said: home health-based patients see multiple physicians who don't communicate with each other, resulting in the wrong medication. Perhaps most troubling about this study is that the majority of these patients are taking 11 medications on average, and nearly half of them are taking at least one PIM, researchers say.

And lastly, one quick fix that should boost care access for patients: a new clinical affiliation between CVS Minute Clinics and Emory Healthcare. The stand alone clinics are open seven days a week in select areas throughout metropolitan Atlanta and have nurse practitioners on hand to administer wellness and preventive services and tend to common family illnesses. Patients who need care not provided at the clinics will be referred to Emory Healthcare. Both CVS and Emory hope to streamline the process with the use of EMR systems. These stories and more in this week's issue of Healthcare Business Weekly Update.

Mini Medical Homes Open Door to Disease-Based Patient-Centered Care

November 22nd, 2011 by Patricia Donovan

Call it Medical Homes 2.0: disease-specific 'mini' medical homes for high-risk, high cost patients with chronic diseases.

"We do see a trend right now with the medical home; especially in the Medicare area where the patient is assessed up front," noted Steve T. Valentine during HIN's eighth annual healthcare industry forecast. This approach generally focuses on but is not limited to the 'big five' chronic diseases: ischemic heart disease, diabetes, COPD, asthma and heart failure, Valentine said.

"For example, let’s just pick diabetics and move them into their own mini medical home. They would have a multidisciplinary team focused around those complex patients," said the president of The Camden Group. "We see that as a bigger change that’s beginning to come. This model does help with throughput in terms of primary care in the medical home.

"A focus on population management and delivering superior value become critical strategies as we begin to move forward," Valentine predicted during the healthcare publisher's annual industry forecast.

The disease-specific approach is gaining followers as the industry navigates away from a fee-for-service environment toward a more evidence-based, protocol-driven approach that rewards not only clinical outcomes but an organization's ability to deliver value-based healthcare.

HealthCare Partners Medical Group of California, which is experiencing its lowest hospital readmission rates in its history, uses a predictive modeling tool, a dollar tool predictor, and a hierarchical condition categories (HCC) or HCC-like modeling tool to risk-stratify their patients before placing them in the medical home that best suits their needs, explains Dr. Stuart Levine, corporate medical director.

This could be hospice and palliative care, or a home care program where teams of physicians, nurse practitioners, case managers and social workers take care of chronically frail patients at home, meeting all of their needs, Dr. Levine said.

HealthCarePartners also has a medical home program for patients with end-stage renal disease (ESRD). "All patients are seen at the dialysis center, and that’s where their medical home is. They no longer come into offices. They are seen by nurse practitioners with backup nephrologists.

"They’re not only getting their renal disease managed, but way more importantly, they’re getting all their primary care needs met."

Some diabetes-focused medical homes are being constructed with a little help from corporate sponsors. The GE Foundation recently awarded a $3M grant to establish a Care Management Medical Home Center for 10,000 Miami Dade patients suffering from chronic diabetes and its costly and debilitating side effects. The grant is part of the GE Foundation's Developing Health initiative.

The grant will enable Health Choice Network of Florida and its seven participating health centers to provide a centralized model staffed with medical professionals who will assist the health center teams in providing high quality, effective and efficient care management services that will decrease costly hospitalizations and emergency room visits.

In addition to the new jobs the funding will add, the center will leverage existing data warehouse infrastructure and electronic medical records to deploy real-time disease-specific patient panels, identify health trends and expects to improve diabetic patient outcomes by 10 to 20 percent in the first year.

The Camden (N.J.) Coalition of Healthcare Providers and the Cooper Foundation will receive $3.45 million over five years from the Bristol-Meyers Squibb Foundation to strengthen community-based components of its Camden Citywide Diabetes Collaborative care model by focusing on patient self-management, education and support, care coordination, food access and physical activity programs, and behavioral health and community engagement activities in order to bend the curve of the diabetes burden and healthcare costs in the city.

One of the goals of the diabetes collaborative is to Increase the capacity of community-based, primary care practices to provide comprehensive, proactive care to their patients with diabetes.

The Camden collaborative was one of eight organizations to receive grants from the Bristol-Meyers Squibb Foundation grants.

The mini medical home approach is not limited to the big five chronic diseases. Last week, Priority Health and Cancer and Hematology Centers of West Michigan (CHCWM) announced their intention to jointly explore an innovative oncology patient-centered medical home. The goal of the oncology medical home is to integrate and coordinate the many office visits, medical professionals, high-tech services and care decisions encountered by cancer patients to help streamline their care while ensuring better outcomes, Priority Health said in a press release.

“This project is a natural evolution of our extensive experience with medical homes,” said John Fox, M.D., Priority Health's associate vice president of medical affairs. “Cancer patients experience complex medical needs and rely on an extensive network of interdisciplinary healthcare specialists. Having a medical home can ensure cancer patients receive optimal care.”

Both organizations have agreed to payment reforms and care enhancements. Under this new model, oncologists will be paid a care management fee and will share in savings resulting from reductions in emergency room visits, imaging and hospitalizations. Current fee structures pay physicians based on the costs of drugs administered, which results in higher payments for more costly drugs, not necessarily the physician’s time, expertise or resource utilization.

The care management fee will go directly for patient support services, such as end-of-life and financial counseling, case management, medication therapy management, survivorship programs and social work services.

Q&A: Prepping a Practice for a Case Manager

November 21st, 2011 by Jessica Fornarotto

Physician engagement is step one in the process of embedding case managers, says Robert Fortini, VP and chief clinical officer at Bon Secours Health System. There is much value in embedding a case manager in a primary care practice, including their influence on patients' medication compliance. Prior to presenting for HIN’s August 10 webinar on Embedded Case Management in the Primary Care Practice: Program Design and Results, Fortini discussed preparing a practice for the arrival of a case manager.


HIN: How do you prepare a physician practice for the case manager’s arrival so that a supportive environment is created?

(Robert Fortini): We don’t do anything at the practice level until we have provider engagement. Any changes that are made to the workflow are thoroughly vetted through the entire provider staff — whether mid-level or physician — and we get consensus and agreement. Typically, we have an initial meeting where everything is thoroughly explained about the case manager’s role; everyone is given a copy of the job descriptions and workflows, protocols, goals and objectives, as well as competency checklists. And everybody is thoroughly prepared in advance.

Only at that point when we have consensus from the providers, do we then proceed with the HR hiring action. By the time that’s complete and the person gets on board, the practice is completely prepared for their role.


HIN: In the January issue of the “Healthcare Finance News,” you were quoted as saying that “newly formed Bon Secours care teams of doctors and nurses and the embedded case managers would do workflow rehearsals to make sure that all teams were performing care uniformly.” Can you talk about these rehearsals and any issues or challenges that they identify?

(Robert Fortini): This concept is more of a structured manner of doing an old concept. Not all the rehearsals are pertinent to the case managers. One of the workflow rehearsals is for a standard rooming protocol for support staff. In this particular event, we’re using EPIC, an electronic medical record platform. We will rehearse with a medical assistant or a licensed practical nurse (LPN) responsible for rooming the patient what the minimum data set to be captured will be. We want to make sure that weight and height is recorded, so BMI is calculated. We want to make sure that tobacco cessation screening and counseling are addressed. We want to make sure their vital signs are done appropriately, that a past medical history and past surgical history is captured, that medication reconciliation occurs, and that refills that are due are pended for the physician to sign. This way, by the time a physician gets in the room, all the busy work is done and most of the documentation has already been started. This streamlines the physician’s role. As you can see, a case manager might not be engaged in that workflow.

Another workflow that we rehearse is the concept of a daily huddle. This is literally a team meeting at the start of the day that runs for 7-10 minutes in the hallways that we expect the case manager to be a part of. This is a review of the day’s schedule — what’s coming in that day. This way, every member of the team is prepared in advance, including the case manager, who might have specific case management functions. For example, with an elderly patient coming in at 10 a.m. with multiple co-morbidities, poly-pharmacy and who is struggling, the expectation is that the physician is going to come in and address immediate medical needs and build a relationship with that patient.

But before the patient leaves the practice, he or she will sit with the case manager for medication management and adherence education. This is why the RN case manager should be prepared in advance for what’s coming in that day. The other value to that is that the immediate clinical support staff is also prepared. They all know in advance if that patient needs to have an EKG done. And so before the physician gets in the room, the EKG has been performed and the results are available for interpretation. It streamlines the visit and improves the efficiency.

The specific workflow can get more sophisticated as the team matures. Those are standard workflows. But then we have disease-specific protocols that we also rehearse with the staff.


HIN: To add to your response, are all of these workflows, especially the more specific ones, documented?

(Robert Fortini): Absolutely. We have a protocol for each one. And the expectation of performance is very clearly established with the staff; this is what the staff will do every single time a patient arrives.


HIN: You also said in the article that medication compliance would be a focus of these care teams. Do the embedded case managers have any duties in this area?

(Robert Fortini): Yes, and the example that I just used in my answer to the second question illustrates this. It is not uncommon, especially in a well-established internal medicine practice, for the needs of the geriatric patient to be prominent. Usually that means poly-pharmacy. If you’ve ever been in a situation where you’re taking more than two or three medications a day, it can be confusing. That 20 minutes of education that the case manager will perform with the elderly patient about what each medication does and how they should be taken is invaluable. We go right down to the basics. The case managers also set up pillboxes with the patients to help make complying with a medication regimen simple.

That’s just one illustration of medication compliance. We acknowledge the fact that 30 percent of all prescriptions are never filled and that of the remaining 70 percent, probably half of them are taken incorrectly, pills are split or days are skipped. Compliance with a medication record is of paramount importance for managing a chronic illness, and in certain categories, preventing readmission.

NCQA Launches ACO Accreditation Program

November 21st, 2011 by Cheryl Miller

Following a period of public comment, the NCQA launches its ACO accreditation program today. According to the NCQA, ACO accreditation is an independent evaluation of healthcare delivery organizations’ ability to coordinate the high-quality, efficient, patient-centered care expected of ACOs. The program provides a roadmap for provider-led organizations to demonstrate their ability to reach the triple aim: reduce cost, improve quality and enhance the patient experience.

According to PwC’s recent annual report on the top issues facing the health industry in 2012, healthcare and the national deficit rank equally as the second most pressing election concern after job creation on the minds of the American public.

The economy made a major impact on the minds of respondents to our own ongoing survey, Healthcare Trends for 2012, with one respondent stating that “Businesses still faced major economic issues and as a result either closed their doors, downsized their staff or significantly reduced benefits.” You can still voice your opinion on the state of the healthcare industry in our survey; all participants receive a free, downloadable copy of the executive summary once our responses are compiled.

CMS continues its Million Hearts initiative with expanded coverage for the prevention of cardiovascular disease. Medicare will now cover one face-to-face visit each year to allow patients and their providers to determine the best way to prevent cardiovascular disease, according to the CMS. The initiative aims to prevent 1 million heart attacks and strokes in the United States by 2017.

Effective October 13, 2013, healthcare entities must have updated the codes they use regarding diseases and conditions from ICD-9 to ICD-10. It’s a long, involved process, which is why Blue Cross Blue Shield of Michigan (BCBSM) has developed an ICD-10 transitional roadmap, in order to help other organizations reduce the time and effort of implementation. But it’s a necessary process: organizations not ready by the transition date will not be reimbursed for claims. More in this issue of the Healthcare Business Weekly Update.

The mHealth revolution continues, with two out of three healthcare providers saying they will continue to embrace mobile technology, in particular, EMR/EHR systems. Future uses for telemedicine, which garnered only lukewarm interest from survey respondents, include videoconferencing for patient interaction.

Clinical Integration Update: APP Embeds Case Managers in Select Practices

November 16th, 2011 by Patricia Donovan

In an expansion of its highly regarded clinical integration program, Advocate Physician Partners (APP) has embedded 60 outpatient case managers in select physician practices.

“The case managers are focused on the sickest 2 to 3 percent of our population,” explained Mark Shields, MD, MBA, APP senior medical director and VP of medical management for Advocate Health Care, in a recent interview. "There is active discourse between the physicians and RNs about which patients should participate in the case management program.”

APP placed the case managers in the practices in early 2011, after studying the success enjoyed by Geisinger Health Plan's embedded case managers.

The newly embedded case managers are accessing tools like “Active Advice,” which prompts the care managers with further data analytics, as well as a home-grown statistical tool employed to determine those patients at highest risk of readmission to the hospital as part of APP’s “Transitions” program.

Reducing avoidable ER visits is another mission for both outpatient and ER case managers, Dr. Shields notes. There are related incentives and training for providers, including the use of group visits, telephone visits and enhanced scheduling to impact this metric.

APP defines clinical integration as "physicians across specialties working together with hospitals to drive quality, patient safety and cost-effectiveness." APP's clinical integration has expanded in 2011 to include 3,800 physicians and 10 hospitals, who are subject to 147 individual performance measures. New measures added this year were chiefly in the areas of global cost of care, ambulatory conditions and readmissions, said Dr. Shields.

Looking ahead to future improvements, APP expects to roll out a fully operational patient portal in early 2012 to support meaningful use imperatives. Some APP sites are already trialing patient e-visits modeled after those in use by Group Health Cooperative, he said.

Keeping pace with other federal initiatives, Dr. Shields is leading the group analyzing CMS’s recently issued ruling on the Medicare Shared Savings program, which create accountable care organizations (ACOs) for Medicare beneficiaries.

“It’s a significant step,” said Dr. Shields of the revised rule. “It makes Shared Savings more approachable while still maintaining the rigor across many domains.

"It is the start of a universal set of metrics.”

Meet Health Coach Babs Hogan: Sees Coaching as Invitation for Change

November 10th, 2011 by Jessica Fornarotto

This month’s inside look at a health coach, the choices he or she has made on the road to success, and the challenges ahead.

Excerpted from the November 2011 HealthCoach Huddle.

Babs Hogan, certified wellcoach and health and fitness specialist certified through the American College of Sports Medicine.

HIN: What was your first job out of college and how did you get into health coaching?

Babs Hogan: I coached swimming in Los Angeles, Calif. After graduating from Texas A&M University, I headed west until I hit sand. Health coaching at the time wasn't invented yet.

Have you received any health coaching certifications? If so, please list these certifications.

I am certified through Wellcoaches, Inc.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road?

When I started reading articles by Margaret Moore, the CEO of Wellcoaches Corporation, in the American College of Sports Medicine's publications, I realized that I had been missing something important in my career as a personal trainer. At first, I thought that I was too rigid to become a wellcoach since I was always the one "in charge," as a fitness trainer. After 22 years of making decisions for clients, I was concerned about making the transition. It took a few months of reading to consider registering for Ms. Moore's well-established wellcoaching program. After the first day of class she asked, "What is your level of confidence that you will become a wellcoach?" I replied, "About 20 percent." In a few weeks, I turned around.

In brief, describe your organization?

As a wellcoach, my focus is on parents. I coach families too, but I mostly work with parents by helping them adapt healthy behaviors. As they take control of their health, the children benefit too. It's a trickle-down pattern of change.

What are two or three important concepts or rules that you follow in health coaching?

I try to heighten awareness of existing behaviors, assist clients in realizing how much control they have regarding their health and I identify a client's personal strengths and continuously shine light on them.

What is the single-most successful thing that your company is doing now?

Focusing on preventing childhood obesity. I am presenting community seminars on reaching goals. I use Heidi Grant Halvorson's book, Succeed: How We Can Reach Our Goals, as a guide. Last month, I started a book club in Arlington, Texas. I am also currently writing a book on childhood obesity and blogging about related issues. You can learn at my Web site. I am also presenting webinars on behavior change.

Do you see a trend or path that you have to lock onto for 2012?

Yes, I started a channel on YouTube called BabsWellcoach and most of my viewers are interested in the Les Mills Group Exercise videos. There are many great stories to be told and the Les Mills viewers are clearly tuned in. I will continue to create more videos about how people reach their health goals.

What is the most satisfying thing about being a health coach?

Helping people realize that wherever they stand right now is a great place to start. Wellcoaching discusses possibilities based on what you CAN do, not what you cannot. The mindset is always moving forward and not looking back. Once people realize that the power to change is in their hands and that they can move forward right NOW, amazing things begin to happen. The secret? Take small steps, gain confidence along the way, heighten awareness of the choices that are presented, and rely on your own strengths.

Where did you grow up?

I was born and raised in College Station, Texas.

What college did you attend? Is there a moment from that time that stands out?

I attended Texas A&M University. The honor of "College All-American," which I received after 10 years and hundreds of miles of swimming, reinforced the old adage that hard work pays off.

Are you married? Do you have children?

I am married and have one grown son.

What is your favorite hobby and how did it develop in your life?

I like gardening. In my forties, I started paying attention to flowers. My next farming adventure will include growing herbs since my husband loves to cook.

Is there a book you recently read or movie you saw that you would recommend?

I'd recommend Heidi Grant Halvorson's "Succeed" book that I mentioned earlier. This book should be on everyone's coffee table.

Any additional comments?

Health coaching/wellness coaching/fitness coaching is not about forcing change. Change happens by choice. The process of coaching is an invitation for change carefully aligned with proper guidance and a gentle nudge along the way.

Q&A: How Ohio Reduces Avoidable ER Visits by Medicaid Beneficiaries

November 10th, 2011 by Jessica Fornarotto

An Ohio collaborative of Medicaid plans uses a rapid cycle quality improvement approach to reduce avoidable ER visits by its Medicaid population. In an interview prior to her presentation on Reducing Avoidable ER Visits by Medicaid Patients Through Quality-Based Interventions, Mina Chang, PH.D., provided details on the effort. Dr. Chang works for the Bureau of Health Services Research for the Ohio Department of Job & Family Services.

HIN: Why were these particular regions of Ohio chosen for the study?

(Dr. Mina Chang): The reason we focused on urban centers is that that’s where the hospital system is located. It’s high volume. We work with each of the regions and with about 30-40 healthcare leaders. It’s a local driven initiative. This group of participants would help us identify key populations that are unique, or a priority population that potentially can benefit from reducing avoidable visits. This group would also help Ohio Medicaid develop and test prevention or quality interventions that are meaningful for those populations that would be identified.

HIN: One of the five regions in the collaborative is Toledo, Ohio, which has the highest emergency department utilization in the nation. What methodology is used to reverse this trend?

(Dr. Mina Chang): We follow a methodology developed by the Institute for Health Care Improvement. It’s population-based and patient-centered. What is attractive about this methodology is that it adopted a rapid cycle, quality improvement approach that typically is focused on a very small subset of a population. With this methodology, you develop a quality improvement strategy and test it out until something is found to be effective. Then, you can in turn extend it to a larger population. It’s very different from a traditional research approach, where as you have to wait four to five years to find out that your investment has not worked.

HIN: How did you identify the priority populations for these interventions?

(Dr. Mina Chang): State Medicaid data has confirmed with what our practitioners see day in and day out in their practice. Medicaid populations predominantly are children. Many high-utilizers are upper respiratory tract infections and otitis media types of issues.

War on Prescription Drug Abuse: Michael Jackson’s Doctor Found Guilty of Involuntary Manslaughter

November 9th, 2011 by Cheryl Miller

We recently reported that more than 40 people die every day from overdoses involving narcotic pain relievers, a number that has more than tripled in the past decade, according to the CDC.

"Overdoses involving prescription painkillers are at epidemic levels and now kill more Americans than heroin and cocaine combined,” said CDC Director Thomas Frieden, M.D., M.P.H. in an agency press release.

Ironically, news of Michael Jackson's former physician, Conrad Murray, being found guilty of involuntary manslaughter in Jackson’s 2009 death, broke the same week as this news story.

Testimony indicated that propofol, in conjunction with other drugs in the singer’s system, had played the key role in Jackson's death on June 25, 2009; the Los Angeles County coroner’s office ruled that his death was caused by “acute propofol intoxication.”

According to the Drug Enforcement Administration (DEA,) propofol, a short acting intravenous anesthetic, is a prescription drug for use in human and veterinary medicine. It is to be used in hospital settings by trained anesthetists for the induction, maintenance of general anesthesia, and sedation of ventilated adults receiving intensive care, for up to 72 hours. In fact, propofol has been used in palliative care to sedate terminally ill patients suffering from severe agitation.

Prosecutors at Jackson’s trial said that Murray was guilty of criminal negligence by administering the propofol, and by not having the proper monitoring equipment, among other things. Defense attorneys argued that Jackson gave himself the fatal dose when Murray left the room.

Chances are Murray’s role in Jackson’s death will be debated for quite some time. But regardless, the ruling was a statement to physicians to stop fueling their patients’ reliance on killer prescription drugs, said Steve Cooley, the Los Angeles County district attorney, after the verdict was announced.

At the very least, the ruling re-cast light on this growing problem in the country. As cited by the CDC:

In 2010, 1 in every 20 people in the United States age 12 and older—a total of 12 million people—reported using prescription painkillers non-medically, according to the National Survey on Drug Use and Health. Based on the data from the Drug Enforcement Administration, sales of these drugs to pharmacies and health care providers have increased by more than 300 percent since 1999.

Non-medical use of prescription painkillers costs health insurers up to $72.5 billion annually in direct health care costs.

Steps have been taken to address this problem. In April, the administration released an action plan designed to counter the prescription drug abuse epidemic. Titled “Epidemic: Responding to America’s Prescription Drug Abuse Crisis,” the plan includes the following:

  • Support for the expansion of state–based prescription drug monitoring programs,
  • More convenient and environmentally responsible disposal methods to remove unused medications from the home,
  • Education for patients and healthcare providers,
  • Support for law enforcement efforts that reduce the prevalence of "pill mills" and doctor shopping.
  • Already, 48 states have implemented state–based monitoring programs designed to reduce "doctor shopping" while protecting patient privacy, and the Department of Justice has conducted a series of takedowns of rogue pain clinics operating as “pill mills.”

    But until the problem is completely eliminated, hopefully this trial and its verdict will put a face on the more than 40 people who are dying everyday from prescription drug overdoses; 40 plus people that didn’t make the news because they didn’t have the fame or notoriety of Michael Jackson.

    Just the unfortunate commonality of searching for a drug to mute their pain, and then being unable to live without it.

    Healthcare Forecast 2012: 10 Trends to Watch in the Year Ahead

    November 9th, 2011 by Cheryl Miller

    ACOs and bundled payments will have major impacts on the healthcare industry in 2012, said Steve Valentine, president of The Camden Group, in a recent webinar, Healthcare Trends 2012, a Strategic Industry Forecast, during which he provided a first look analysis at the key trends and opportunities for healthcare organizations in the coming year.

    In 2012 and beyond, physicians will be the real "movers and shakers" in terms of changing the delivery system and curbing costs, Valentine continued. They will be especially key in the post-acute care continuum, if they can successfully move patients into lower cost sites through changed care models.

    Given this changing landscape, healthcare leaders will need to identify their geographical area’s healthcare needs and available resources, articulate their goals, and structure their network of care around these elements. Valentine cited the CalPERS pilot program in 2010 (the consolidation of Blue Shield of California, Hill Physician and Catholic Healthcare West in Northern California) as a prime example. The group generated savings by reducing 30-day readmission rates and reducing patients’ length of stay, and acknowledging that 12 percent of the population consumed 70 percent of the resources.

    "Typically it’s the old 20/80 rule where 20 percent of the populations account for 80 percent of the healthcare cost," Valentine said. Providers need to target this population, which is generally the chronically ill Medicare patients, up front, stratify them into levels of care, assign a proper multidisciplinary team and then manage that chronic disease, he continued.

    Another key trend for 2012 will be the utilization of embedded case managers, Valentine said. He recommended a centralized case management team, with the individual case managers placed in physician offices, or emergency departments, working “hand and glove” with the physicians and hospitalists, another key trend for the coming years, as hospitals and PCPs merge. The most effective case managers would reside with an ambulatory EMR, beside the patient and physician. Case managers would be least effective in the hospital space, where they tend to be used more for revenue reasons, Valentine added.

    Over the next few years, health organizations will also have to reevaluate their logistical operations, reassessing workdays and hours, and trying to maximize volume. “Strategists need to broaden their reach in order to capture as much population as they intend to manage," Valentine urged.

    Valentine stressed that repercussions from the current economy will impact the healthcare industry for the next few years. Continued unemployment levels will lessen demand for elective procedures; and create more price shopping for services.

    Other points from the webinar:

  • Co-management will be an attractive strategy for many organizations in 2012, especially as it is packaged with bundled payments.
  • Medical homes will continue to increase, with chronically ill patients, like diabetics, being moved into “mini medical homes.”
  • Health systems will need to target Medicare reimbursement by the year 2014.
  • Physician-hospital integration will have a high impact on ACOs, IDS/Health Plans, and a low impact on physician-owned hospitals and specialty institutes.