Archive for January, 2013

Infographic: Population Health Management Reduces Risk and Spend Across Care Continuum

January 22nd, 2013 by Jackie Lyons

Healthcare’s value-based purchasing increasingly favors a population-centric approach to health management, identifying risk across the care continuum. To control costs, healthcare organizations and employers are turning to population health management (PHM), defined as the management of integration and outcome measurements of any program affecting the health and productivity of a specific population or group.

Surveying patients regularly about their experience and using electronic medical records are just a few PHM strategies. This new infographic from the Healthcare Intelligence Network outlines key analytics, barriers, tools and workflows to ensure successful management of specific populations, drawing from responses from our 2012 Population Health Management survey.

Among the data points presented in this infographic are:

  • Top areas for data analysis, including clinical, utilization and adherence data;
  • Use of PHM delivery models: telephone, Internet, portal, print or smartphone app;
  • PHM payoffs, such as increases in medication adherence and decreases in hospital readmissions; and
  • Ideas for successful PHM, including face-to-face management with immediate referral from health center providers.

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 PHM is reflected in 2012 Healthcare Benchmarks: Population Health Management.

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Infographic: Benefits of Workplace Wellness

January 21st, 2013 by Patricia Donovan

The concept of workplace wellness programs is increasing in popularity, with many employers making a change with education programs, wellness incentives and other strategies to help boost health benefits. Not only are there morale-boosting benefits for staff that take part in these programs, but employers often also receive specific cost-savings benefits as well.

This infographic from Florida Health Care Plans illustrates how wellness programs can help improve the health of employees as well as the business. Successful programs range from simple educational seminars to more robust health and wellness improvement seminars.

workplace wellness

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Infographic: Mobile Device Use by Nursing Faculty

January 18th, 2013 by Patricia Donovan

Among nurse educators holding advanced degrees, 71 percent own a smartphone, 47 percent own a tablet computer, and 39 percent own an eBook reader. These were some of the results from a Springer Publishing Company survey illustrated in its new infographic, which reveals key findings on the use of technologies among nursing professors.

The annual survey polled 1,281 nurses on their ownership and usage of mobile devices, their preferences for nursing and medical apps and eBooks, and their social media use.

nurse mobile devices

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Infographic: 4 Arguments for Medicaid Expansion

January 17th, 2013 by Patricia Donovan

With big changes on the way under federal healthcare reform, one major decision facing lawmakers is whether or not to opt in to one of health reform’s biggest provisions: expansion of Medicaid.

This infographic from the Washington State Budget & Policy Center identifies four reasons why federal expansion of Medicaid is a good deal for states. For example, in Washington state, it would expand coverage to hundreds of thousands of uninsured and save the state money.

Medicaid expansion

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Infographic: Impact of ACA’s Age Rating Restrictions

January 16th, 2013 by Patricia Donovan

The Affordable Care Act (ACA) strictly limits how much healthcare premiums can vary based on a person’s age, which will result in significantly higher premiums for younger individuals and families. This increases the likelihood that younger, healthier people will choose to wait to purchase health insurance until after they get sick or injured, thus driving up costs for everyone else.

A new infographic from America’s Health Insurance Plans (AHIP) highlights the impact of the ACA’s age rating restrictions.

ACA age rating

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Infographic: Hospital-Acquired Infections

January 15th, 2013 by Patricia Donovan

Hospital-acquired infections (HAIs) can have a substantial effect on patients, staff or anyone else that enters through the doors of a hospital or medical center, and significantly impacts healthcare costs. For example, the annual cost of an HAI is $25,000 per person.

The number of deaths resulting from HAIs can be reduced by implementing a few simple suggestions from this infographic published by CHG Hospital Beds.

hospital-acquired infections

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Video: Population Health Management Earns Spot on Industry Radar for 2013

January 14th, 2013 by Patricia Donovan

Population health management is one of the top 10 industry issues to watch in 2013, according to PwC’s Health Research Institute.

Our newest video brings to life data on the latest population health management activities at more than 100 companies, including metrics on PHM team members, program modalities, challenges and outcomes. The data is drawn from our 2012 e-survey on population health management.

The video is narrated by HIN COO and Executive Vice President Melanie Matthews, with important advice on building an effective PHM program from healthcare consultant Patricia Curran, principal in Buck Consultants’ National Clinical Practice.

Population health management is a cog in the well-documented shift in healthcare from rewarding quantity over quality toward a more value-based approach, managing health across the risk continuum.

If this topic interests you and you haven’t already signed up for our new e-newsletter, Population Health Monitor, you can subscribe free here.

Lower Readmissions for Hospitals with Good Nursing Work Environment

January 14th, 2013 by Cheryl Miller

No one could argue that nurses do more than their fair share of work. But now a new study is documenting that work environments that are beneficial for nurses are also beneficial for hospitals in terms of readmissions rates.

Researchers at the University of Pennsylvania School of Nursing found that Medicare patients treated in hospitals with a good work environment for nurses had up to 10 percent lower odds of readmission than those treated in hospitals with a poor work environment.

Researchers suggest that improving nurses’ work environment and reducing their workloads are organization-wide reforms that could result in fewer readmissions. All hospitalized patients are exposed to bedside nursing throughout their stay and combining targeted transitional care, the coordination of healthcare during the transition from hospital to home, with high-quality inpatient nursing care will produce more positive outcomes for all patients, and help reduce overall healthcare costs. Preventable hospital readmissions cost the United States more than $15 billion annually, and Medicare is now penalizing hospitals with excessive rates of readmissions.

This study parallels another recent news story documenting nurses/case managers’ role in reducing readmissions by dispensing phone calls within 48 hours of discharge to high risk patients. The study, from Cigna, followed nearly 4,000 high-risk gastrointestinal, heart and lower respiratory patients and found that prioritized, telephonic outreach by health plan case managers after hospital discharge reduced future readmissions by 22 percent. This subject is currently a hot topic on our new LinkedIn forum, CaseTalk – a Forum for Care Coordinators. You can join in the discussion group here.

How to find the right nurse/case manager? Robert Fortini, vice president and chief clinical officer of Bon Secours Health System, tells us that they should posess both creativity and critical thinking skills, in our story excerpted from our new book, Profiting from Population Health Management: Applying Analytics in Accountable Care. Bon Secours’ nurse navigator program was so successful that they were planning on doubling their budget for them within 18 months.

And in other news, the increased use of EMRs and other related tools have failed to fulfill the financial promise of HIT, according to a new RAND Corporation analysis. One of the major reasons is that systems deployed are neither interconnected nor easy to use. Some changes to reverse this are documented in our story.

And don’t forget to take our new survey on Medication Adherence.

Infographic: How Rising Health Insurance Costs Strain Family, Employer Budgets

January 14th, 2013 by Patricia Donovan

Rising health insurance premiums and higher cost-sharing continue to strain the budgets of working families and employers, according to this infographic from The Commonwealth Fund.

For example, between 2003 and 2011, premiums for family coverage increased 62 percent across states while deductibles more than doubled.

insurance costs

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Meet Healthcare Case Manager Patti Tipton: Former Air Force RN Empowers Patients On the Ground

January 14th, 2013 by Cheryl Miller

Patti Tipton, BSN, RN, LNC, CCM, National Care Management, Richfield Dedicated Unit

Tell us a little about yourself and your credentials.

I am a registered nurse (RN), and achieved my BSN in 1988. I have over 24 years of experience in the nursing industry, which includes intensive care unit (ICU), trauma level emergency room (ER), labor and delivery, long term nursing, home healthcare, management, and case management. I am certified in case management by the Commission for Case Manager Certification, and also completed the legal nurse consultant certification program in 2000.

What was your first job out of college and how did you get into case management?

With great pride, upon graduation from nursing school, I entered into active duty as an RN in the United States Air Force (USAF). I served active duty during Desert Storm, from 1988 to 1991. Thereafter, I remained in Indefinite Ready Reserve, until I was honorably discharged from the USAF in 2005.

Like most nurses, I acquired a variety of nursing experiences before transitioning into case management. My initial case management experience began as a perinatal case manager in the home health industry in 1996, when I transitioned from the labor and delivery unit of a university-based hospital system to their home health division; I was an integral part of the creation of their first perinatal home health program, PerinatalConnection. Due to the need for more flexible hours to care for my family and an elderly parent, I returned to the trauma ER for a nursing agency, until I began working for Aetna as a RN case manager in October 2006.

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

I have had many defining moments in my career, all of which support my reasons for going into the healthcare field: the desire to help others. One of my first defining moments was while in nursing school, picking glass from a 20-something year old man’s head and face, while he lay in his ICU bed after his auto accident. He looked at me and said, “You are a Christian, aren’t you? I can tell that you care just by the way you treat me.” I thought to myself, “Wow…actions do speak louder than words,” and I knew I had chosen the field that was for me.

In brief, describe your organization.

Aetna is one of the nation’s leaders in healthcare, dental, pharmacy, group life, disability insurance, and employee benefits. Dedicated to helping people achieve health and financial security, Aetna puts information and helpful resources to work for its members to help them make better informed decisions about their healthcare. I am very proud to work for Aetna, and on a daily basis, embrace and connect with patients in their situations, and empower them with the knowledge to make educated decisions regarding their healthcare needs.

What are two or three important concepts or rules that you follow in case management?

First, I truly believe in treating people as you would like to be treated, embracing people as though they were your own family.
Secondly, I firmly believe that people can make better healthcare decisions when they have the appropriate knowledge. As a case manager, I ensure patients understand their medical benefits, as well as their medications and physician’s treatment plan.

Do you see a trend or path that you have to lock onto for 2013?

It is no surprise that healthcare needs to be more affordable for everyone. We need to advocate solutions that will support and motivate patients to be in charge of their own health. I know that for myself, I really think about what an ER visit will cost, versus waiting to see my primary care physician (PCP). This helps me to decide “is it really all that urgent?” As a case manager, I know that reduction of ER visits and avoidable hospital readmissions are one small part of decreasing healthcare costs. Having worked in ER departments, I have seen patients use the ER as their PCP, despite encouragement to select a PCP or follow up with their PCP. Patients many times use the ER because it is more convenient or accessible for them. Motivating patients to be more proactive with their health means promoting more cost effective ways that enable accessible and appropriate healthcare services.

What is the most satisfying thing about being a case manager?

It is all about the opportunity to connect with a patient and make a difference in their life. Sometimes, it is educating a patient about a medical benefit they did not know they had. Other times it is outreaching to the physician to make sure he/she understands their patient’s current situation, or assisting with the transfer of a member from a facility in one state to a facility in another state.

What is the greatest challenge of case management and how are you working to overcome this challenge?

Promoting self change in our members. It is obvious that someone who is obese should lose weight, someone who smokes should quit. Use of motivational interviewing techniques improves communication with patients to promote self change, where the patient identifies the agenda and goals.

What is the single most effective workflow, process, tool or form case managers are using today?

Motivational Interviewing (MI). Using MI techniques makes Aetna’s care management program different by encouraging engagement of the member when exploring the root cause of their health issues or concerns. MI is successful in guiding members to transition from unwillingness to discussing their issues to seriously considering self change. MI helps case managers improve health behaviors and outcomes, increase member engagement in Aetna programs, and improve member satisfaction.

Where did you grow up?

That is a loaded question! My father was a Methodist minister, so I moved a great deal; however, the majority of my childhood was in various towns in Tennessee. Cumulatively over my lifespan, I have lived in eight different states: Ga., Fla., Tenn., Colo., N.C., Ark., Ill., Ohio.

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

I received my Liberal Arts degree from Martin Methodist College in Pulaski, TN, then received my BSN from Tennessee Technological University in Cookeville, TN. In 2000, I completed the first Legal Nurse Consultant certificate program that was offered by Cuyahoga County Community College in Parma, OH.

I must admit nursing school was a tough and competitive program, sometimes feeling like it was a weeding out process of the strong versus the weak. Therefore, it was a huge accomplishment to complete nursing school as well as pass my state nursing boards. When I returned to college in 1999 for the Legal Nurse Consultant program, I found it to be a different level of learning for me. I did not feel it was a forced to learn situation; rather, I had the strong desire to learn something new and incorporate my nursing experience into the legal arena.

Are you married? Do you have children?

I have been married to my best friend, Michael Tipton, since 2003. We share a blended family of boys, ages 17 to 26.

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

Sewing, which I learned from my mother. At a very young age, I was making my own Barbie doll clothes, then my own clothes once I became a teenager. I enjoy the creativity and usually can’t wait to see the final product!!

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

The movie, “The Pursuit of Happyness.” I love Will Smith as an actor, and appreciated the challenges his character faced and overcame. It showed what desire, perseverance and integrity can achieve.

Any additional comments?

As I mentioned before, I am very proud to work for Aetna, and be part of their focus toward solutions for improved, affordable, and accessible healthcare systems. It is also rewarding for me to help our members realize that we, as case managers, are genuinely here to help them. It makes my day when I hear “Wow, you really do care….I guess the bad name that insurance companies have out there is not always true.” Every day, I strive to provide the core values of Aetna: integrity, caring, excellence, and inspiration.

Click here to learn how you can be featured in one of our Case Manager Profiles.