Archive for January, 2013

12 Questions to Measure Population Health Management Performance

January 31st, 2013 by Jessica Fornarotto

If a population health management (PHM) program can’t demonstrate its value, it’s unlikely it will continue to get funding from senior leadership. That’s why it’s important to build a business case for continued investment in population health management initiatives by monitoring and measuring PHM programs, suggests Patricia Curran, principal in Buck Consultants’ National Clinical Practice.

Within four dimensions for measuring success — attitudes, engagement, outcomes and performance — Ms. Curran suggests the following questions as a starting point for organizations to begin to measure their program successfully. She also suggests sample measures for each dimension:

Attitudes:

  • Did we increase interest?
  • Did we change opinions?
  • Did we build confidence?

Sample measures include:

  • Perceived value of programs, resources
  • Increased levels of knowledge
  • Perceived ability to make better decisions
  • Member satisfaction survey

Engagement:

  • Did we motivate program participation?
  • Did we change lifestyle health habits?
  • Did we mobilize grass-roots efforts?

Sample measures include:

  • Increased wellness and health management participation
  • Web site visits
  • Shifts to high-quality providers

Outcomes:

  • Did we enhance health status?
  • Did we improve healthcare outcomes?
  • Did we improve treatment compliance?

Sample measures include:

  • Reduced risks (e.g., BMI, cholesterol, physical inactivity)
  • Compliance with evidence-based treatment protocols
  • Use of preventive services

Performance:

  • Did we reduce costs?
  • Did we increase efficiency?
  • Did we improve competitiveness?

Sample measures include:

  • Reduced healthcare cost trend
  • Lower absence rates
  • Reduced presenteeism
  • Increased productivity
  • Reduced turnover

The PHO in 2013: More Flexibility, Less Risk Than Eighties Model

January 31st, 2013 by Patricia Donovan

Unlike the hospital-dominated physician-hospital organization (PHO) prominent 30 years ago, today’s PHOs are largely physician-centric, notes Travis Ansel, manager of strategic services for the Healthcare Strategy Group. And make no mistake: in the new fee-for-value healthcare universe, payors and employers understand that physicians are the one that control process and control cost, he asserts.

“Hospitals and physicians have a great incentive right now to figure out how they should be working together going forward, and how they need to align legally and what model to use in order to engage those populations,” Ansel notes. Providers unable to provide efficient quality care that’s going to help hospitals survive under value-driven reimbursement will face losses in market share and reimbursement, he continues.

Ansel and Greg Mertz, director of Healthcare Strategy Group, recently explored the key contractual elements to consider when creating a PHO during a webinar on Physician Hospital Organizations: Developing a Collaborative Structure for Shared Savings Agreements.

Today’s PHOs are jointly governed by physicians and hospitals, they explain, with the common goals of quality and cost management and the sharing of savings from any joint contracts or arrangements — elements that weren’t necessarily part of the eighties’ PHO equation.

Compared to other emerging shared savings arrangements — the Medicare Shared Savings Program, commercial accountable care organizations (ACOs) and public and private bundled payments — PHOs offer more flexibility, notes Mertz. For example, a PHO has the option of expanding into an ACO in the future, as well as target multiple populations, something that can be more challenging in an ACO due to its reporting requirements. “Today’s PHO is scalable. It can start with a single client and grow to ACO.”

But flexibility doesn’t preclude serious considerations around forming a PHO, he continues, including its legal structure, number and type of participating physicians, size of the patient population, compensation plans, data support, and most importantly, evidence-based protocols against which to measure PHO performance. And while cost reduction is paramount, patient satisfaction levels are getting equal attention.

“The big difference between today’s programs and the gatekeeper HMO’s back in the eighties is that nobody worried about whether the patient was happy with the HMO,” says Mertz. “Now within public programs, there’s a formal process of monitoring and reporting on patient satisfaction.”

What will the typical PHO look like? Owner physicians and hospitals, plus contracted providers such as imaging, pharmacy and other ancillary services. The PHO team will also rely heavily on nurse case managers, nurse navigators to really interact with the patients as they help to coordinate their care. “It’s cheaper to intervene now than in the emergency room,” Mertz notes.

It is also important to have an accurate picture of the patient population. “Diabetes, pulmonary, cardiac, and depression are the top cost drivers, but dual eligibles (Medicare-Medicaid patients) and patients with behavioral issues are chronically non-compliant and are the biggest cost consumers. It’s important to identify those people up front and develop a patient registry-managed plan for those patients.”

Of course, key to any shared savings model is quantifying the cost of services and then savings gleaned from the PHO’s clinical protocols and quality efforts — then distributing the savings equitably.

The challenge for fledgling PHOs will be changing provider behaviors. “Participants have to believe that the PHO is better than the alternative,” says Mertz. “Creating a culture of collaboration is key; success hinges on provider engagement.”

And not just the physicians that are part of the PHO. “The PHO is really a vehicle to involve all physicians, including community doctors,” concludes Ansel. “Community physicians that aren’t a part of employed networks are just as important and have just as much insight as to how the industry succeeds under this new reality.”

Listen to an expanded interview with Travis Ansel and Greg Mertz about today’s physician-hospital organizations.

Infographic: Engagement Strategies for Employee Health

January 31st, 2013 by Patricia Donovan

Since the wellness program at Eastman Chemical Company first launched in 1991, it has evolved into a strategic initiative focused on creating a healthier, more productive workforce. The company’s robust program today includes health coaching, health assessments, screenings and condition management, as well as physical activity, weight management and stress management programs.

A return on investment analysis of Eastman’s health management program showed a $3.20 return for every $1 spent, giving Eastman a $6.38 million total medical and drug claims savings during a three-year period.

A key driver of success for Eastman’s program has been its approach to engagement. This HealthFitness infographic highlights effective strategies used by Eastman to gain and sustain participation in healthy behaviors.

international care coordination

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Infographic: Care Coordination Problems Common Across Countries

January 30th, 2013 by Patricia Donovan

An international survey of primary care physicians in 10 countries finds progress in the use of electronic medical records (EMRs) — particularly in the United States, though the nation still lags behind several countries where EMR adoption is near-universal. American doctors report their patients continue to have problems paying for healthcare, with well over half saying patients often cannot afford care.

In each nation, physicians contend with communication and care coordination challenges. For example, in each country, only a minority of primary care doctors reported always receiving timely information from specialists to whom they have referred patients, while less than half said they always know about changes to their patients’ medications or care plans.

U.S. physicians were the most negative about their country’s health system, with only 15 percent saying the system needs only minor change.

international care coordination

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Q&A: Predicting 2013 Healthcare Trends

January 29th, 2013 by Jessica Fornarotto

“There will be a significant investment in EHRs in 2013,” predicts Dennis Eder, managing director of Strategic Health Group. Eder also expects there will be more physician-run ACOs in 2013 compared to 2012.

Prior to their presentations during an October webinar on Healthcare Trends & Forecasts in 2013: A Strategic Planning Session, Eder, along with Hank Osowski, managing director of Strategic Health Group, and Steven Valentine, president of The Camden Group, shared the changes they see coming in 2013 for the healthcare industry, including future payment models, ACO administration, and demands for services.

HIN: Physician payment models are getting a lot of retooling — from the addition of pay for performance incentives for hitting quality metrics to care coordination payments for patients and members in medical homes. Is this going to change much in 2013? Are we going to see a shift toward shared savings or another payment model in the coming year?

(Hank Osowksi): Watching the trends over the last year or two and many of the innovations that are being tried, the industry is moving toward value-based purchasing and population risk-based purchasing. We think this is going to accelerate as we look at 2013, 2014 and beyond.

(Dennis Eder): I would agree with Hank. We believe with the events of 2012 and the significant interest in ACO participation, it will mature and continue into the future.

HIN: In comparing some results from our 2011 and 2012 surveys on accountable care organizations, we noticed a sizeable shift in ACO administration from hospital-run to physician-administered. Why do you think so many hospitals backed away from this role when the ACO model seemed so promising?

(Dennis Eder): One of the reasons we think this may be occurring is that hospitals administering ACOs is not part of their core competency. Many of the characteristics of an ACO are a health plan or a management service organization (MSO). And this is not what hospitals do, for the most part. In addition, hospital margins are thin, and have even become thinner, so any overhead that they can offload is a good thing. Physician organizations do this and they’re the ones who are responsible for the medical management and other care management in an ACO. I think it makes logical sense to have the physician organization take on more of an administrative role for an ACO.

(Hank Osowski): I think the point Dennis made is critically important. It is the physician organization that is controlling the array of services that the beneficiary is receiving. It makes sense for them to take a lead in running an ACO. They are the ones who best understand how all the pieces fit together and where the opportunities are to get efficiencies to improve quality and reduce the costs of care.

HIN: The IOM has recommended better and shared use of health data, particularly at the point of care, where key health decisions are made. What will be the technology to invest in or embrace in 2013 to improve data analytics for population health management?

(Dennis Eder): We’re going to continue to see a significant investment in EHRs. We know that it’s an important tool in some health plans. Kaiser, for example, is gaining significant market share. We see further investments in that particular area.

(Hank Osowski): It’s also important to take a self-examination of us as an industry. We have mountains of data. We have very little intelligence about where the value is in our system. Where can we leverage the most efficient of the care providers and change some of the things that are inefficient, that don’t contribute to high quality care and that drive up the costs? It’s digging into that mountain of data and pulling out the real healthcare intelligence that we as a system, and as an industry, can use to provide better care to patients.

HIN: What’s ahead for population health management?

(Steven Valentine): We will begin to see more fierce competition, if you will, around population health management. People are going to try to concur and grab more populations to work with in their delivery systems. We’re expecting that we should have slightly soft demands for services. We would find that even with the population getting older, and with these new delivery systems and lower utilization rates, we don’t expect to see an uptick in volume — stable to a slight decline — which means you have to reduce your expenses and go after an additional market share population.

Infographic: Does a Tweet a Day Keep the Doctors Away?

January 29th, 2013 by Patricia Donovan

Social health is the mash-up of social media and healthcare, and it’s starting to gain traction. In fact, a third of all consumers use social media for matters regarding their health. Thanks to social networking sites and the increased availability of broadband and mobile technology, people are forming online patient support groups, becoming better educated on medical topics and diagnoses, and sharing doctor and product reviews — wherever and whenever they want.

This trend offers providers a great opportunity to jump into the social health fray. In a 2012 study, 24 percent of doctors said they used social media at least once a day to look for medical information while almost two-thirds think social media enhances their ability to care for their patients.

There are many benefits for providers who take part in social health as well, such as a way to connect with consumers in between visits and allowing healthcare organizations to receive immediate feedback on products and services.

This infographic created for Allied Health World provides valuable insights about this incredible new online movement.

social health

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Infographic: Spotlight on Embedded Case Management

January 28th, 2013 by Jackie Lyons

Case managers working inside patient-centered medical homes and accountable care organizations are taking on larger roles in primary care. About half of healthcare organizations embed or co-locate case managers at points of care, according to a new market research by HIN.

Thinking about adding a case manager to a primary care team? Assembling case manager criteria and finding the right practice are just a few steps that should be taken before embedding a case manager. This new infographic from the Healthcare Intelligence Network outlines top sites for ECMs, tools, protocols and workflows and typical duties of ECMs, drawing from responses from our 2012 Trends in Embedded Case Management survey.


Among the data points presented in this infographic are:

  • Top care sites for ECMs, such as primary care practices and clinics;
  • Ten steps to take before embedding a case manager;
  • Top ECM protocols, such as teaching patients to self-manage their health; and
  • Typical duties of an ECM, including medication management and reducing readmissions.

We invite you to embed this infographic on your own Web site using the code that appears beneath it. Also, share it via your social media channels. A deeper dive into the latest trends in case management is reflected in 2012 Healthcare Benchmarks: Embedded Case Management.

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Infographic: Facts About Depression

January 25th, 2013 by Patricia Donovan

Depression is a condition that reportedly affects one in 10 Americans at one point or another, but the incidence of depression is actually higher in some states than others. For example, Oklahoma, Louisiana and West Virginia are among the U.S. states with the highest rates of adults meeting the criteria for depression, as depicted in this infographic from Depression Facts.

Certain ethnicities also report higher depression rates than do others. Individuals currently diagnosed with some symptoms of depression incur medical costs of approximately $23,000 annually.

depression

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Infographic: 2013’s Most Significant Healthcare Issues

January 24th, 2013 by Patricia Donovan

More than two years after it was passed, healthcare reform topped the list of the most significant issues facing the healthcare industry in 2013, according to a poll of 2,800 LinkedIn users from the healthcare industry. As illustrated in this infographic from Zurich Insurance, 50 percent identified healthcare reform as the most significant issue, followed by the financial impact of reform (39 percent) and physician integration (5 percent).

Just under a third (31 percent) of respondents identified themselves as C-suite executives. Business owners made up 29 percent of respondents, with 12 percent identifying themselves as managers of healthcare.

healthcare issues

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Infographic: The True Cost of Smoking

January 23rd, 2013 by Patricia Donovan

Tobacco use remains the single largest preventable cause of disease and premature death in the United States, yet more than 45 million Americans still smoke cigarettes. As of 2010, there were also 13.2 million cigar smokers in the United States, and 2.2 million who smoke tobacco in pipes.

This infographic illustrates findings from the Tobacco Atlas, 4th Edition, that show the significant harm, both financial and physical, that tobacco use causes to the smoker and to society at large.

smoking cost

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