Archive for April, 2013

Infographic: The Patient’s Healthcare Perspective

April 30th, 2013 by Melanie Matthews

In the new patient-centered healthcare delivery models, patients are taking a much more proactive role in their healthcare. Lab42 examines in a new infographic, how patients select physicians and insurance, why and when patients access healthcare services, along with insight on patients’ views of healthcare bills and the cost of prescription drugs.

A Patient Look at Healthcare

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You may also be interested in this related resource: Case Management in Value-Based Healthcare: Trends, Team-Building and Technology.

Risk Assessment, Case Management Help to Improve Dual Eligibles’ Health

April 30th, 2013 by Jessica Fornarotto

“When you look at some of the characteristics of the dual eligibles, in the under 65 population, 66 percent have only a chronic condition and have no functional impairments. But as you move up to the older ages, there’s fewer frailty and a bit more of the chronic conditions,” according to Dr. Timothy Schwab, chief medical officer of SCAN Health Plan. SCAN has a strategic approach to serving the dual eligible market, and Dr. Schwab recently discussed how they get this population to complete health assessments as well as the role of case managers in deciding who needs nursing home services. He also discusses how case managers work with the most extreme health condition cases.

Question: SCAN-risk stratifies individuals to determine those at highest risk, using HRAs, claims data and other assessment tools. How does SCAN encourage or incent completion of HRAs and other assessments in what can sometimes be a transient or hard-to-reach population?

Response: Getting completion of the HRA instrument is a challenge in any population, but more so in a very diverse population like the dually eligible. We initially mail our HRA to all new members. Then we follow up with reminder postcards. If we still don’t receive a response, we have a shortened risk assessment form that we ask them to complete through telephonic interactive voice response (IVR). Even with that, we still probably have a 30 percent failure rate to get the HRA done in a timely fashion.

We try to supplement that with information from our physicians. On the first visit to the physician, we can gather information and ultimately supplement it with our claims data on both the medical side and importantly the pharmacy side. We get a lot of valuable information, which makes up for people who don’t complete the HRA.

There are two groups that usually don’t complete it. The first is the group in long term institutions, like nursing homes. There’s a low response rate there. We also have a lower response rate in populations with mild dementia who are living on their own. But we also have a fairly low response rate from very healthy individuals. It’s important to recognize in the dual population that there are a group of duals that are relatively healthy. The only reason they’re a dual is because of financial conditions qualifying them for that. They could be out and about and just not concerned about completing the HRA.

We do not currently provide incentives for the general population to complete the HRA. We have tried some minor incentives with subsets of the population; for example, years ago with our diabetic population we offered a small gift of a foot care program if they completed a mini risk assessment. But in general, we haven’t found it effective.

Question: What percentage of your dual eligibles require disability support and what particular challenges would a case manager working with this subset of beneficiaries encounter?

Response: For our over 65 dual population, about 40 percent are what we classify as nursing facility level of care, or individuals who live in the community but have deficiencies in usually three or more activities of daily living (ADLs). They are frequently getting services for some of those deficiencies and are at high risk of ending up in a nursing home for long-term care, unless interventions are placed.

Of that 40 percent, probably about half are getting some sort of home-based services that are non-Medicare covered; things like personal care, homemaking, bathing assistance, and transportation assistance. For our case managers to make these assessments, do the in-home visits, and develop a care plan, we focus on hiring social workers, geriatric social workers and geriatric nurse practitioners. We spend a lot of time training them, both in how to identify the needs in the home, and how to identify the needs when talking with the caregiver, who is frequently an important part of this conversation.

We also offer on the job training for working with the rest of the team when they present these cases at our team meetings and the interdisciplinary care team meetings.

Question: How can care managers work with the most extreme cases that have multiple physical health and behavioral health, chronic and acute conditions?

Response: Those are the tough ones to work with. The first step is to find the right care manager for that individual. For example, if the primary issue is behavioral health, choose a care manager that excels in behavioral healthcare. That care manager then works with others to resolve the other issues. These people will require more time. You may also need to engage the help of the personal care workers or those in the home, so that they become both the physician and the care manager’s eyes and ears there. Teach them ways to pick up very subtle changes or differences in that person so that you can quickly provide new interventions if the person starts to show signs of deterioration. It’s a classic example of ‘one size doesn’t fit all;’ if your model says we will contact an individual monthly, some may need weekly and some may need daily contact. You may need to figure out ways to get that contact in an easy, efficient way for that individual.

Healthcare Update Week in Review: Medical Homes for Teens, Healthcare Spending Slow

April 29th, 2013 by Cheryl Miller


A majority of mental health issues emerge in adolescence, with 14 being the most prominent age, according to a new study from UCSF’s Department of Pediatrics.

It’s a frightening statistic; at a time when kids are dealing with real life situations (grades, peer pressure, pimples) they also have to struggle with less tangible conditions, like anxiety, depression, even learning disorders.

Yet, despite the widely known prevalence of this, nearly half of today’s adolescents lack a medical home, which could provide them with the appropriate treatment, researchers say. The medical home’s comprehensive, team-based care could be the best way to help teens and families through this scary time. More on how this healthcare model can be effective inside this issue.

Assessing the effectiveness of team-based care delivery methods is also the subject of a new study published in Population Health Management.

Researchers from George Washington University, Virginia Commonwealth University, and Carilion Family Medicine conducted case studies of small primary care practices to assess three team-based care models and to see if they can improve primary care delivery and patient outcomes. Improving patient care, practice workflows, and patient and physician satisfaction, researchers say, are competencies that have become expected of physicians as the healthcare landscape evolves.

The art of appreciative inquiry, a health coaching tool that is becoming more accepted in the medical community, can also help improve patient care and satisfaction. While all coaching tools are used to help inspire and engage people, appreciative inquiry is particularly effective because it builds on a person’s strengths instead of weaknesses, says Dennis Richling, MD, chief medical and wellness officer for HealthFitness. Too often attention goes into fixing what’s broken instead; by tapping into what’s already positive, the person is empowered to continue to make positive changes.

Fixing the nation’s economy is key to the record slow growth in health spending in recent years, say analysts in a new Kaiser Family Foundation report.

Based on statistical modeling and analysis by health cost experts at the Foundation and Altarum Institute’s Center for Sustainable Health Spending, studies find that the economy is responsible for 77 percent of the slowdown in health spending, a category encompassing what individuals, employers and governments collectively spend. The remaining 23 percent results from changes in the healthcare system, including higher deductibles and other cost-sharing that dampen patients’ use of services, as well as various forms of managed care and delivery system changes.

Though the recession will likely continue to dampen health spending growth over the next couple of years, the study projects that expected economic growth will drive up health spending in years ahead, gradually adding 3.5 percentage points to the annual growth rate by 2019. This would push the annual growth rate in health spending back over 7 percent, which is much closer to historical averages.

And lastly, current methods for estimating the costs and savings of federal health legislation also need to be fixed, because they are missing billions of dollars in potential long-term returns from effective obesity prevention policies, according to a new study released by the Campaign to End Obesity.

Changing the way cost estimates are created would give policymakers a clearer picture of costs and savings, the report concludes.

Infographic: America’s Health (Dis)Advantage

April 29th, 2013 by Melanie Matthews

While the United States spent $2.6 trillion on healthcare in 2010 — more than any other country in the world — Americans live shorter lives and experience more injuries and illnesses than people in similar high-income countries, according to the National Academy of Sciences.

An infographic created by the web site, Best Master of Science in Nursing Degrees, explores the United States’ health (dis)advantage.

America's Health (Dis)Advantage

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You may also be interested in this related resource: Health Care Operations and Supply Chain Management: Strategy, Operations, Planning, and Control.

Infographic: Global Lessons in Managing Prescription Drug Costs

April 26th, 2013 by Melanie Matthews

Prescription drug prices and spending are higher in the U.S. than in other industrialized nations. The Commonwealth Fund’s infographic on the subject looks at how other nations control costs while ensuring access to needed medications.

How Other Nations Manage Drug Costs

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You may also be interested in this related resource: Infection Control in Ambulatory Care.

Advice from 5-Star Medicare Advantage Plans: Engage Low-Performing Providers, Members

April 25th, 2013 by Patricia Donovan

Webinar Replay: Best Practice Approach to Improve CMS Star Quality Ratings

Medicare Advantage health plans in search of higher Star Quality Ratings should follow the lead of five-star MA plans, suggests Joe Johnson, vice president of L.E.K. Consulting.

Five-star best practices for improving all-important clinical performance markers include mailings and telephonic outreach to low-performing member cohorts, notes Johnson, as well as shared savings, profit-sharing goals and even provider report cards. The latter is likely to spur low-performing providers into aligning with health plan quality improvement efforts, which can help to raise ratings.

Provider engagement is critical, since the majority of the Star Quality Ratings’ 37 measures, which span five domains, is influenced by the work done by providers, such as in closing gaps in care and managing chronic conditions, and are weighted most heavily by CMS. For example, the monitoring of care transitions to prevent readmissions is one area where five-star plans shine, he says.

During a recent webinar on A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings, Johnson suggested MA plans map out an enterprise-wide Star Quality Ratings strategy to target improvement opportunities and identify the most addressable gaps in the organization — giving priority to those that will give the plan the most ‘bang’ for its buck.

Reimbursement for MA plans is tied in part to awarding of stars for patient care and satisfaction. Factoring in the bonus structure for high-performing plans, L.E.K Consulting estimates that moving from a three-star to four-star rating is roughly worth $50 PMPM — or $6 million in revenue per year for a 10,000-member plan.

Of the five domains in the Star Quality Ratings Program, management of chronic conditions is ripest for MA plan innovation and improvement, Johnson notes. Plans should identify the size and magnitude of conditions presenting in their member populations, and prioritize efforts based on potential for economic impact.

The designated “Star Czars” team (individuals spearheading the quality ratings improvement effort) should be cross-functional and analytical but also speak the requisite clinical language to inform and engage providers, advises Johnson.

Johnson also shared a half-dozen other strategies for Star Quality Ratings improvement from five-star plans, including benchmarking of local competitors, and examined some of the changes CMS is considering for 2014 and 2015 Star Quality Ratings.

Listen to an in-depth interview with Joe Johnson here.

Infographic: Can Healthcare Data Be Secure in the Cloud?

April 25th, 2013 by Melanie Matthews

Healthcare organizations are moving infrastructure and data to the cloud at a fairly rapid pace. A recent study suggests the cloud computing market in healthcare is expected to reach $5.4 billion by 2017.

Learn the benefits of the cloud offers for healthcare organizations, along with best practices for healthcare security and privacy in the cloud in an infographic by Gazzang.

Can Healthcare Data Be Secure in the Cloud?

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You may also be interested in this related resource: Healthcare Business Intelligence: A Guide to Empowering Successful Data Reporting and Analytics, + Website.

TTYL Craving: Texting Helps Smokers Kick Butts, Healthcare Costs

April 25th, 2013 by Cheryl Miller


Remember the Marlboro Man, who filled black and white TV screens and magazine pages back in the day, always holding a cigarette in his calloused hands?

Initially designed to counter public opinion that filtered cigarettes were for women, he appeared to be the quintessential macho man, unafraid of anything, whether it was errant horses, lawless poachers, or even the front lines of war.

Not surprisingly, the Malboro Man got a makeover of sorts over the years; revealing that he was afraid of something, and that something was chemotherapy. It was one of California’s arsenal of ads they’ve been pummeling the public with for the last few decades. And they’re working; in a recent news story published here, the University of California SF reported that the state’s tobacco reform campaign, while costing California $2.4 billion since 1998, reduced healthcare costs by $134 billion, and reduced the sales of cigarette packs by 6.8 billion, amounting to a loss of $28.5 billion in sales to cigarette companies.

Well, a new ad might appear on the sun-drenched horizon soon, featuring the older, wiser Marlboro Man holding a smart phone instead of a lasso, and reading one of many specially timed texts to help him quit smoking.

Agile Health recently announced Kick Buts 2.0, a major upgrade to their Kick Buts high touch, low cost smoking cessation program. Kick Buts delivers personalized text messages to smokers who need advice, support and encouragement as they try to quit smoking. It sends messages at scheduled intervals over a six-month period to help them develop the knowledge, motivation and behavioral skills necessary to drive sustained behavior change.

It also responds immediately to key words from participants requesting help to overcome cravings, slip-ups or relapse. So, someone can text “Craving” and they will receive a pep talk on how to ride the craving out.

It seems like a perfect way to hook the smokers who are already hooked on their smart phones — in particular, kids who’ve found their way to a cigarette despite the worldwide glut of anti-smoking campaigns. According to our recent survey on mHealth, smart phone apps are the most widely used technology tool today, with text messaging coming in a close second.

“These days I prescribe a lot more apps than medications,” says Dr. Eric Topol, who was profiled on Rock Center with Brian Williams recently, and is author of The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. He points to the smartphone as a leading breakout tool, with the eventual ability to detect cancer cells circulating in the blood or warn patients of an imminent heart attack or monitor glucose levels through a sensor implanted in the body which, when activated, sends a signal to the patient’s smart phone.

“A ninety-year-old can leave the hospital and be monitored remotely like he’s still in the ER,” says Dr. Topol, and it is this kind of remote technology that could save the healthcare industry millions in prescription drugs and unnecessary tests.

2 Common Missteps of Healthcare Social Business Strategies

April 24th, 2013 by Patricia Donovan

May 1 Webinar: Social Business Strategy Adoption with Social, Mobile and Cloud Technologies

Just because healthcare is deploying social business tools at an incredible rate — up to 72 percent of companies have launched social or mobile tools, according to a report from McKinsey — doesn’t mean they’re working.

The two most common errors companies make in this area are focusing on the technology before nailing down a complete strategy, and failing to measure results, explains Andrew Dixon, senior vice president of marketing and operations for Igloo Software.

In regards to the first misstep, Dixon has this advice: “It’s tempting to jump in by introducing a Facebook page externally and maybe a microblogging tool internally. This allows a company to feel as though it is making progress,” says Dixon. “However, companies need to first identify the problem they want to address, such as a desire to connect more directly with patients or engage providers.”

He suggests healthcare companies do three things at the outset:

  • Examine their technology decisions.
  • Review the cultural makeup of its audience.

  • Assess the operational aspect by asking whether the tools actually work.

As for the lack of measurement, Dixon encourages healthcare companies to measure the effect of their current solution before deploying any new technology. This creates a benchmark against which to judge future efforts.

In this audio interview, Dixon describes what’s driving the aggressive growth of interactive patient care communities and suggests how responsibility for social strategy — which he defines as both an internal and external communications strategy — should be assigned.

Dixon will discuss the key elements of an effective social strategy, along with and best practice guidance from healthcare social strategies having a bottom line impact during a May 1, 2013 webinar, Healthcare Social Business Strategy: Driving Adoption with Social, Mobile and Cloud Technologies, a 45-minute program sponsored by the Healthcare Intelligence Network.

Infographic: The Rise of HIAs in the United States

April 24th, 2013 by Melanie Matthews

The major health issues that cause chronic health conditions — obesity, asthma, heart disease and diabetes and injuries — can be shaped by living and workforce conditions. To improve wellness, a growing number of cities and states are conducting health impact assessments.

Pew’s Health Impact Project’s infographic on the subject looks at the growing number of assessments and the areas they are assessing.

The Rise of HIAs in the United States

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You may also be interested in this related resource: Derryberry’s Educating for Health: A Foundation for Contemporary Health Education Practice.