Archive for September, 2014

Aetna Compassionate Care: “Advanced Illness Care Coordination Can’t Be Measured by Numbers Alone”

September 30th, 2014 by Patricia Donovan

In its new report, “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life,” the Institute of Medicine recommends the development of measurable, actionable, and evidence-based quality standards for clinician-patient communication and advance care planning to reflect the evolving population and health system needs.

Aetna’s Compassionate Care program, a case management approach for individuals in advanced stages of illness, breaks down barriers commonly encountered in this highly sensitive stage of the health continuum while positively impacting both healthcare utilization and spend. Here, Dr. Joseph Agostini, senior medical director, Aetna Medicare, shares some best practices from Aetna’s Compassionate Care Program.

There are several best practices. First, there is training, which is integral to the success of the Aetna Compassionate Care program.

Second, there is the proper selection, mentoring and ongoing learning opportunities for nurse case managers. These include such things as ongoing online tutorials, in-person training, where everyone gets training in change management and motivational interviewing techniques, regular ‘lunch and learns,’ medical director sessions including case-based rounds of cases that are in progress right now and feedback sessions. We bring in external entities to provide specialized expertise as necessary so that nurses get continuing education throughout the process.

Another best practice for us is having Aetna case managers manage all types of members. We don’t have a specialized unit that just specializes in advanced illness care needs. We think all of the nurse case managers should have developed this critical skill of being able to manage those with advanced illness, but also be able to identify support and be advocates for patients in all phases of their lives.

We also use a variety of functional status and prognosis tools. Many of these rating scales are scores focused on functional status. That’s important to follow over time, and can be predictive of outcomes. In our program we don’t necessarily use all of these scales, but we always capture some basic functional status over time and it’s useful and necessary to view that longitudinally.

A real-life example captures the heart of what we do. A case manager writes:

‘Wife stated member passed away with hospice. Much emotional support given to spouse, she talked about what a wonderful life they had together, their children, all of the people’s lives that he touched. They were married 49 years last Thursday and each year he would give her a piece of jewelry. On Tuesday when she walked into his room he had a gift and card lying on his chest, a beautiful ring that he had their daughters purchase. She was happy he gave it to her on Tuesday; on Thursday he was not alert. She stated through his business that he touched many people’s lives and they all somehow knew he was sick and he has received many flowers, meals, fruits, cakes. She stated her lawn had become overgrown and the landscaper came and cleaned up the entire property, planted over 50 mums, placed cornstalks and pumpkins all around. She said she is so grateful for the outpouring of love. Also stated that hospice is wonderful, as well as everyone at the doctor’s office and everyone here at Aetna. She tells all of her friends that when you are part of Aetna, you have a lifeline.”

And the case manager concludes, “Encouraged her to call with ongoing issues or concerns and closed to case management.”

You can really feel the depth of connection that develops between the Aetna member, or the family caregiver and the case manager. You can’t really make this happen; it occurs over time and I would suggest to everyone that advanced illness care coordination can’t be measured by numbers alone or on hospital admissions or the length of time in hospice. We need to develop quality measures that capture the degree of family, caregiver and patient support that a program like this engenders.

advanc care planning
Dr. Joseph Agostini is the senior medical director for the Aetna Medicare team. He is responsible for medical management strategy, clinical initiatives, and provider collaboration oversight for Aetna Medicare members.

Source: Case Management for Advanced Illness: Best Practices in End-of-Life Care

Infographic: Physician Adoption of Health IT

September 29th, 2014 by Melanie Matthews

Physician interest in mhealth is strong, according to Deloitte’s 2014 Survey of U.S. Physicians. Access to clinical information is the most cited benefit of health IT by physicians, the survey also found.

A new Deloitte infographic looks at the difference between physician users and non-users of health IT, patient support of health IT and analysis of meaningful use.

Physician Adoption of Health IT

Transforming Health Care: The Financial Impact of Technology, Electronic Tools and Data Mining The healthcare technology revolution is just around the corner. And when it arrives, it will change and enrich our lives in ways we can only begin to imagine. Doctors will perform blood pressure readings via video chat and nutritionists will analyze diet based on photos taken with cell phone cameras.

Transforming Health Care: The Financial Impact of Technology, Electronic Tools and Data Mining combines healthcare, technology, and finance in an innovative new way that explains the future of healthcare and its effects on patient care, exploring the emergence of electronic tools that will transform the medical industry.

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Infographic: The “Digital” Patient

September 26th, 2014 by Melanie Matthews

Mobile technology, broadband networks and a greater emphasis on patient accountability in healthcare is creating “digital patients,” according to CDW Healthcare.

In a new infographic, CDW Healthcare examines what constitutes a digital patient and the keys to mhealth success.

Today's Digital Patient

Social Media in Healthcare: Connect, Communicate, Collaborate, 2nd edition Social Media in Healthcare: Connect, Communicate, Collaborate, 2nd edition describes the major social media applications and reviews their benefits, uses, limitations, risks, and costs. It also provides tips for creating a social media strategy based on your organization’s specific needs and resources. Through real-world examples and up-to-date statistics on social media and healthcare, this book illustrates how social media can improve the efficiency, effectiveness, and marketing of your healthcare organization.

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Community Linkages Support HCSC’s Holistic Approach to Duals

September 25th, 2014 by Cheryl Miller

Meeting the holistic needs of the individual, and not treating them as a diagnosis has been key to Health Care Services Corporation’s (HCSC) work with dual eligibles. Here, Julie Faulhaber, HCSC’s vice president of enterprise Medicaid, describes the organization’s innovative use of community care connections to engage the unique challenges of this largely older adult and disabled population in population health management.

Question: What are some examples of HCSC community connections and how do these linkages benefit Medicare-Medicaid beneficiaries?

Julie Faulhaber: Our community connections are really critical to the success of our program. We work with a number of different community agencies in our state: the community mental health centers, the public health agency, and also with those types of agencies that deliver long term care services or have worked with those with mental health concerns.

We work across the board. All of these agencies catch our members, and we try to have relationships with them in order to gain access to our members, for example to better understand the types of services and support that our members truly need and where to access them. That’s been a key component of our program. We also look for community health workers who have backgrounds in the cultural needs of our members, which helps to engage them initially and maintain engagement.

HIN: What are the most common behavioral health issues your duals face and how has HCSC addressed these issues?

Julie Faulhaber: Our members have the full range of behavioral health issues that one would expect in a dual eligible population. Of course, the majority of individuals are experiencing depression and those types of concerns are often in conjunction with some physical disability. Referring back to the previous question on community linkages, we develop relationships with community agencies that support people with mental illness.

Other behavioral health concerns include those agencies that help people with recovery from addiction. We also worked with an integrated team in our own model of people with behavioral health backgrounds as well as our traditional physical healthcare model. That integration has been important for us in meeting the holistic needs of the individual and not treating them as a diagnosis.

dual eligibles care
Julie Faulhaber, vice president, enterprise Medicaid for Health Care Service Corporation (HCSC), a $52 billion health insurance company with 13.2 million members operating in five states, is responsible for the leadership and oversight of HCSC’s Enterprise Medicaid Business. This includes expansion of Medicaid programs across HCSC’s Blue Cross Blue Shield plans in Illinois, Montana, New Mexico and Texas.

Source: Dual Eligibles Care and Service Planning: Integrative Approaches for the Medicare-Medicaid Population

Infographic: ADL Limitations Among Older Adults

September 24th, 2014 by Melanie Matthews

Nearly half of older adults—18 million people—have difficulty or get help with daily activities, according to a new study by researchers from the University of Michigan and the Urban Institute.

A new infographic on the survey results examines the number of adults 65 years of age and older who have self-care, mobility and household activity limitations.

Care Needs of Older Adults

Remote Patient Monitoring for Enhanced Care Coordination: Technology to Manage an Aging Population In Remote Patient Monitoring for Enhanced Care Coordination: Technology to Manage an Aging Population, Gail Miller, vice president of telephonic clinical operations in Humana’s care management organization, Humana Cares/SeniorBridge, reviews Humana’s expanded continuum of care aimed at improving health outcomes, increasing satisfaction and reducing overall healthcare costs with a more holistic approach.

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7 Lessons from a Health Network’s Home Visit Program

September 23rd, 2014 by Melanie Matthews

Home visits to patients with complex care needs can provide huge returns by identifying patient compliance barriers that are only apparent when seeing a patient in their home. Dr. Larry Greenblatt, M.D., director for the chronic care program at Durham Community Health Network for Duke University Medical Center, shares organizational lessons from using home visits as part of a care transition program to reduce avoidable hospital readmissions and emergency room utilization.

With our patient population, none of these patients in the program have simple or single diagnosis. We learned that Care Partners providing intensive and frequent service with a strong face-to-face component backed by an interdisciplinary support team can help high-utilizing patients receive their care in more effective and efficient outpatient settings.

Second, when using previous programs that focused on telephone education and advice, we discovered that the face-to-face interactions have a direct impact on these patients and their ability to change their care model.

Third, we discovered that, if effective on a larger scale, our care model could be used nationally as a significant means of reducing healthcare costs.

Fourth, this intervention reduced unplanned admission days by 77 (71 percent) in three months. This reduction greatly benefits the medical patients and gives us increased capacity for new admissions. It also improves the life and the care of those patients who are involved in the program.

Fifth, most of our pilot patients had unmet mental health and substance abuse problems and had difficulty obtaining needed services. That was another benefit of having the multidisciplinary team sitting around the table as we did care conferences on our patients on a weekly basis. We actively addressed the mental health needs to help get a patient’s medical issues taken care of and result in higher benefits from our care being linked to all of the care.

Sixth, this multidisciplinary approach, direct face-to-face contact and ongoing telephone contact is the secret in making this program work.

And finally, patients often did not have a primary care provider at the beginning of the pilot and they benefited from being linked with one. Finding them a medical home was important and made the patients feel more comfortable with continuing to keep outpatient appointments.

home visits
Dr. Larry Greenblatt, MD, is the medical director for the chronic care program at Durham Community Health Network. Dr. Greenblatt is also an associate professor of medicine at Duke University Medical Center, where he has been on the faculty since 1994. Dr Greenblatt focuses on postgraduate medical education and primary care.

Source: Home Visit Handbook: Structure, Assessments and Protocols for Medically Complex Patients

Guest Post: What the United States Can Learn from Healthcare Delivery Abroad – And at Home

September 23rd, 2014 by Shan Padda

How can the United States provide its citizens with the best healthcare in the world, while also managing costs?

Many reports over the years have pointed out how much more Americans pay for medical procedures versus those in other countries. The European model functions in a way that less care provides more outcomes for patients, whereas the U.S. model offers more care, but yields fewer outcomes.

What drives such a divide in care systems between all of these nations? In this guest post, Shan Padda, CEO of Health Integrated, details the strategic care coordination that is essential for a balanced healthcare system and how healthcare outcomes can become streamlined between the United States and European nations.

As a healthcare company executive who has traveled extensively and observed healthcare delivery in a variety of regions, including Cuba, France, Germany, the Middle East, Switzerland and the Asia-Pacific area, I’ve had an opportunity to see what works—and what doesn’t—from an outcomes and efficiency perspective.

Most healthcare executives know that the United States spends twice as much per capita as any other nation on healthcare without a corresponding realization of outcomes. Clearly, we need to change the way we deliver healthcare, and via the Affordable Care Act (ACA) and other reform measures, efforts are underway to achieve improvement.

Singapore and New Zealand Healthcare Models

But have we learned the right lessons? And are we following the appropriate models? Of all the healthcare delivery systems I’ve had the opportunity to observe, two stand out as models for excellence that are worthy of emulation: New Zealand and Singapore. Both maintain public and private systems. The public systems aren’t built on a single-payor model yet manage to provide a baseline level of care to their populations.

Through a combination of community-based care and other delivery methods, both New Zealand and Singapore make certain their citizens have the full spectrum of non-acute care, including preventive treatment. This ensures that treatable conditions don’t worsen and require a costly ER visit or hospitalization.

To provide access to basic care, Singapore creates coverage pools and makes healthcare coverage purchases mandatory, much like the controversial individual mandate in the ACA. People in Singapore who want to upgrade their plans at their own expense can purchase additional health insurance coverage on the free market.

The Singapore healthcare system also features elements of consumerization. For example, all hospitals in Singapore are required to post costs for common procedures on their Web sites. Since the mandatory baseline health coverage has coinsurance features that give patients a financial stake in the pricing, they have an incentive to review hospital information from a cost perspective as well as from a quality of care standpoint.

Israel’s Centralized Records Model

Outside of the New Zealand and Singapore models, another country that has handled one facet of the healthcare delivery process particularly well is Israel. That country has successfully transitioned to an electronic, centralized medical records model. This enables medical professionals in Israel to instantly access their patients’ entire medical history, which streamlines care coordination and enables better population health management. EMR adoption in Israel also allows for longitudinal collection and evaluation of one’s medical record both on an individual basis for the physician and on a de-identified manner for research and innovation purposes

Americans are rightly proud of their achievements in healthcare: U.S. innovators have made invaluable contributions to medical research, vaccine development and technically advanced treatment tools. But we still lag behind the rest of the world in delivering access to healthcare coverage for our population and in optimizing healthcare data to improve treatment.

Despite its error-prone rollout, the ACA is now expanding access to coverage, and some of the effects can already be seen: A recent Gallup poll shows that the uninsured rate in the United States fell to a historically low 13.4 percent in the second quarter of 2014 as millions of people received coverage under exchange plans and Medicaid expansion. A Commonwealth Fund survey in California found that ACA coverage cut the number of uninsured Californians in half.

Improving access to coverage and preventive care is an excellent first step in controlling overall costs, as it can promote early intervention to prevent treatable conditions from worsening. But as the experience of other countries demonstrates, there are additional techniques the United States could adopt to improve outcomes, including encouraging patients to take a more active role in managing their care and accelerating the adoption of electronic medical records, which would generate data that is invaluable for both population health management initiatives and for individual treatment plans.

One of the most important elements of healthcare reform is the shift away from a fee-for-service model to a system that emphasizes quality. Countries that have embraced this model, including New Zealand and Singapore, have experienced better outcomes and have controlled costs far more effectively than the United States currently does.

Acknowledging this, U.S. healthcare reformers are focused on achieving a similar shift by offering incentives for population health improvement and establishing Accountable Care Organizations (ACOs). Provider groups and plan administrators are also exploring innovative new ways to improve patient compliance, such as identifying and addressing the individual psycho-social factors that increase a patient’s sense of isolation and negatively affect their ability to actively manage their own care.

By combining the lessons we can learn from how other nations successfully manage healthcare delivery with America’s legendary spirit of innovation, there’s no reason we can’t come together and provide our citizens with the best healthcare in the world, while also managing costs.

About the Author: Shan Padda is chairman and chief executive officer of Health Integrated, where he provides the overall strategic leadership and visionary direction for Health Integrated and has a consistent track record of leadership and success in the healthcare industry. Before joining Health Integrated, Shan cofounded and directed a number of companies in the medical technology area, one of which approached $70 million in annual sales and had market capitalization of approximately $450 million. Shan currently sits on a number of private company boards and is a graduate of Harvard University.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

Infographic: 7 Cities with Highest Readmission Rates

September 22nd, 2014 by Melanie Matthews

The seven cities with the highest hospital readmission rates include: Chicago, Brooklyn, Philadelphia, Baltimore, Manhattan, Boston and Los Angeles, according to a new analysis by Kaiser Health News, depicted in an infographic by Becker’s Healthcare.

Nineteen hospitals in Chicago exceeded the national average readmission rate. The infographic details how many hospitals in each of the other cities exceeded the average.

7 Cities with Highest Hospital Readmission Rates

2014 Healthcare Benchmarks: Reducing Hospital Readmissions2014 Healthcare Benchmarks: Reducing Hospital Readmissions documents the latest key initiatives and partnerships to reduce readmissions by patients with these costly conditions and others by more than 100 healthcare organizations. This 60-page report, now in its fourth year, for the first time provides details on partnerships with post-acute care to reduce readmissions from these care sites.

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Infographic: EHR Trends in Nashville

September 19th, 2014 by Melanie Matthews

Seventy-four percent of physician offices in Nashville have implemented electronic health records, according to a new analysis by Technology Advice. Nashville is often seen as a bellwether city for the healthcare industry and its EHR adoption rates mirror national estimates by the National Center for Healthcare Statistics.

EHR adoption rates and trends are analyzed in a new infographic by Technology Advice, which looks at office-based EHR usage, EHR satisfaction rates, top EHR providers, specialty EHR use and meaningful use attestation in Nashville.

EHR Trends in Nashville: Insights from an Emerging Market

Electronic Health Records: Strategies for Long-Term Success Electronic Health Records: Strategies for Long-Term Success is a comprehensive reference for the design, implementation, and optimization of electronic health records (EHRs). The authors offer a detailed road map for avoiding common pitfalls during conversion and achieving higher-quality care after system implementation. A glossary of important terms and references to additional resources are also included in the book.

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10 Things to Know About Reducing Avoidable ER Visits in 2014

September 18th, 2014 by Cheryl Miller

Despite expanded coverage available under the Affordable Care Act (ACA), the hospital emergency room (ER) remains a refuge for those unable to visit their primary care physician (PCP)— whether due to lack of access, insurance, or time, according to results from the latest Reducing Avoidable ER Visits Survey by the Healthcare Intelligence Network (HIN).

But more than half of respondents (65 percent) are confident CMS’s easing of telemedicine regulations (e.g. mandates for physician on-site hours) will help to reduce avoidable ER visits.

In the three years since HIN last administered this survey, health organizations have stepped up ER discharge follow-up efforts. Almost one-third of respondents (31 percent) in 2014 say they contact patients within 24 hours of their ER visit, versus 22 percent of respondents in 2011 who made provider appointments before discharge, and 18 percent who conducted phone follow-ups within two days of a visit.

Here are more metrics derived from the 2014 Reducing Avoidable ER Visits Survey:

  • Staffing solutions to reduce avoidable ER visits have changed: case managers, social workers and disease-specific care coordinators are increasingly utilized in the ED, replacing health educators, coaches, and nurse-only advice lines used in 2011.
  • The challenge of redirecting non-emergent patients, while still a primary barrier, decreased in priority from 29 percent in 2011 to 18 percent in 2014.
  • Insufficient care access remains a challenge, growing from 16 to 21 percent in 2014, along with PCP collaboration, which was still among the top three challenges, but decreased from 24 percent in 2011 to 18 percent in 2014.
  • The prevalence of programs to reduce avoidable ED usage remained relatively stable from 2011 to 2014, with nearly three quarters of respondents reporting such initiatives.
  • Among populations reported to generate the majority of avoidable ED visits, ER use by dual eligibles increased five-fold in the last four years, from 2 to 11 percent, while other populations — high utilizers, Medicare and Medicaid — remained roughly the same.
  • Chronic disease replaced pain management as the most frequently presented problem, at 54 percent.
  • Education and risk-based telephonic outreach are the top two patient-centered strategies used to reduce avoidable ER visits in 2014.
  • Behavioral health issues and privacy are considered two top legal and compliance obstacles in reducing avoidable ER visits, respondents say.

Source: 2014 Healthcare Benchmarks: Reducing Avoidable ER Visits

Stratifying High-Risk Patients

2014 Healthcare Benchmarks: Reducing Avoidable ER Visits
delivers actionable metrics from 125 healthcare organizations on their efforts to foster appropriate use of hospital ER departments. Enhanced with more than 50 easy-to-follow graphs and tables, this third edition of comprehensive data points presents year-over-year trends and best practices for engaging ER and hospital staff, primary care physicians, community providers and patients in reducing avoidable ED utilization.