Archive for October, 2014

Infographic: Apple HealthKit Versus Google Fit

October 31st, 2014 by Melanie Matthews

With the release of its’ HealthKit, Apple is now one of the largest digital health platforms in the world, according to TrueVault, a healthcare data storage company. HealthKit and Google’s alternative, Google Fit and Android Wear, mark the beginning of a megatrend in personal health technology.

TrueVault in a new infographic details the features of both platforms.

Apple HealthKit Versus Google Fit

Healthcare Trends & Forecasts in 2015: A Strategic Planning SessionCost, competition, collaboration and consolidation are continuing to define the healthcare industry this year and into 2015 as the health system continues its transformation from a volume-based to a value-based system. Healthcare providers and payors have been re-vamping their strategic plans to take advantage of the new opportunities and tackle the challenges.

During Healthcare Trends & Forecasts in 2015: A Strategic Planning Session, a 60-minute webinar on November 13, 2014, at 1:30 p.m. Eastern, Steven Valentine, president, The Camden Group, and Dorothy Moller, consultant, Navigant, will provide a roadmap to the key issues, challenges and opportunities for healthcare providers and payors in 2015.

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Rectifying System Disparities within ACO Improves Data Capture, Quality Reporting

October 30th, 2014 by Cheryl Miller

Addressing the disparity between data systems was one of the operational and information technology (IT) issues the John C. Lincoln (JCL) Accountable Care Organization (ACO) addressed at the end of its first year as a Medicare Shared Savings Program (MSSP) ACO, says Karen Furbush, business consultant with JCL ACO. Here she explains the steps taken to rectify the situation.

I was brought on board in July 2012 and was given the ‘playbook,’ or answers that John C. Lincoln provided to the Centers for Medicare and Medicaid Services (CMS) on how they would structure their ACO over the next three and a half years. It was my job to figure out from the IT perspective how to address all the new advancements with the Transition Coach program.

My job was to figure out this new EMR EPIC® system that was being installed, and how we were going to get data back out. It took us a while once we got our membership list from CMS to find addresses and do the mailing, which we decided to do. This is not required, but we wanted to get the information out to patients about what an ACO was; that we were now providing their basic primary care physician (PCP) services. And we wanted to communicate that as early as we possibly could.

Along with doing those initial mailings, we determined any additional data we needed from our system in order to respond to CMS reporting requirements for 33 quality measures. We took a two-day workshop in November 2012 and realized that not everyone was on the same EMR at the very beginning.

We have a lot of disparity between systems; not all data comes from one system to the next, due to business decisions. We had to go back and determine what we needed from each different system and how long this was going to take. Then we had to figure out how we would normalize or make sure that this data was specific for reporting back to CMS.

In this two-day workshop, we broke it down measure by measure. There are 15 different categories in which CMS places all of their reporting. We went through each — for example, for the emergency area, the hospital and in the physician practices — and asked ourselves what we were doing for each. Just because you’re on one EMR doesn’t mean the data capture model is the same. But I still needed to account for every time those things occurred; they are discretely reportable. That’s not always easy; even though you’re on one single platform, there are a lot of factors that play into why that’s very difficult to get to.

Source: Beyond the EMR: Mining Population Health Analytics to Elevate Accountable Care

Karen Furbush is a business consultant with John C Lincoln (JCL) Accountable Care Organization in Phoenix. She is responsible for coordinating and managing all things related to IT integration, data analysis and reporting for JCL’s CMS MSSP ACO and Employee ACO programs. She has over 20 years of technical program and IT management experience, and has held a wide variety of information technology roles in the healthcare industry.

Infographic: Assessing the Affordable Care Act

October 29th, 2014 by Melanie Matthews

There are a number of measures that could be used to evaluate the effectiveness of the Affordable Care Act, according to the Commonwealth Fund.

To date, the ACA’s implementation has been associated with significant progress, reflected in a new infographic by the Commonwealth Fund. The infographic looks at the ACA marketplaces and health insurance enrollment and uninsured trends since the ACA’s implementation.

Asessing the Affordable Care Act

Pursuing the Triple Aim: Seven Innovators Show the Way to Better Care, Better Health, and Lower CostsPursuing the Triple Aim: Seven Innovators Show the Way to Better Care, Better Health, and Lower Costs shares compelling stories that are emerging in locations ranging from Pittsburgh to Seattle, from Boston to Oakland, focused on topics including improving quality and lowering costs in primary care; setting challenging goals to control chronic disease with notable outcomes; leveraging employer buying power to improve quality, reduce waste, and drive down cost; paying for care under an innovative contract that compensates for quality rather than quantity; and much more. The authors describe these innovations in detail, and show the way toward a healthcare system for the nation that improves the experience and quality of care while at the same time controlling costs.

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5 Requirements for Highmark Pay-for-Performance Participation

October 28th, 2014 by Patricia Donovan

Highmark Inc.’s well-established physician pay for performance program, Quality Blue, continues to evolve, providing its 6,300 enrolled primary care physicians the opportunity to earn bonus payments across a variety of measure sets. Here, Julie Hobson, RN, BSN, manager of provider engagement, performance and partnership at Highmark Inc., describes minimum requirements for physician participation in the program.

Our program is open to all the primary care providers (PCPs) in our network. However, there are some participation requirements. The incentive payment is rewarded to the practices based on their total score and is in addition to their fee-for-service (FFS) schedule.

There are over 113 evaluation and management (E&M) claims, both outpatient/inpatient, that we provide the incentive monies to. The quality scores are calculated on a quarterly basis and the incentive payment that the practice receives is paid for on that particular quarter.

There are five requirements that must be in place to be able to participate in our program. First, there has to be a participating provider agreement signed and in Highmark’s hands; second, an incentive participation agreement must be completed as well.

The third requirement is IT capabilities: the practice must have a Web-based provider application in their office. This is the Web-based application that we choose and it allows for real-time transactions. It is HIPAA-compliant and allows for sending and receiving of information to us and from us, as well as to them and from them.

Fourth, the practice must meet certain thresholds of E&M claims and electronic claims submission in a 12-month period.

And finally, they must achieve a minimum total score within the program.

Source: Guide to Value-Based Reimbursement: Profiting from Payment Bundling, PHO Shared Savings, and Pay for Performance

Julie Hobson, RN, BSN, is a manager in Highmark Inc.’s provider engagement, performance, and partnership department, which is accountable for advancement and deployment of strategic design and development of provider driven health management transformation.

Infographic: Telemedicine Enhances Health Care Delivery

October 27th, 2014 by Melanie Matthews

Telemedicine is becoming a mainstay in the healthcare delivery system, according to a new infographic by Accenture. While in its early stages, telemedicine is expected to grow rapidly and could provide alternatives for some physician office visits and urgent care and ER visits.

Accenture released an infographic on the topic that looks at the potential of telemedicine, the role of employers in telemedicine adoption and where telemedicine fits into the telehealth spectrum.

Telemedicine Enhances Health Care Delivery

2013 Healthcare Benchmarks: Telehealth & Telemedicine More than 10 million Americans directly benefited from a telemedicine service during the past year, according to American Telemedicine Association estimates. Telehealth’s broad reach encompasses telemedicine — the use of telecommunications technology to deliver clinical diagnosis, services and patient consultations — as well as the exploding field of mobile health.

2013 Healthcare Benchmarks: Telehealth & Telemedicine is packed with actionable new information from more than 125 healthcare organizations on their utilization of telehealth & telemedicine. This 60-page report, now in its third year, documents trends and metrics on current and planned telehealth and telemedicine initiatives and includes a year-over-year comparison of telehealth trends from 2009 to present.

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Guest Post: Living Better, Not Just Longer: Worksite Wellness at Any Age

October 27th, 2014 by Tanja Madsen

Population health management

Living healthier, more productive years is the goal of population health management.

Just 20 years ago, about one in 10 workers was over the age of 55; today, it’s one in five. We are aging as a nation. We are living longer than our forebears a century ago, but can effective population health management push back the serious effects from chronic disease so we can live healthier, more productive years?

In the typical lifespan, there is a point at which an individual first becomes chronically ill or disabled, and a further point at which a person dies. On average, the time between those two points is about 20 years, according to healthy aging pioneer James Fries. Fries envisions a world in which we may not add many more years to the end of life, but we can “compress morbidity,” or shorten the number of years we suffer from illness.

The key question is: how can we maximize the healthy years of our lives? It’s not just a question important to individuals; it’s critically important to our economy as well. Population health and a nation’s financial health are inextricably linked. This is the focus of the World Economic Forum’s Healthy Living initiative, which found that more than 60 percent of global deaths are due to diseases associated with preventable lifestyle risk: cardiovascular diseases, diabetes, cancer and chronic respiratory diseases.

Closer to home, CEOs of some of the nation’s largest companies unveiled a new initiative, Building Better Health: Innovative Strategies from America’s Business Leaders, to leverage their market power to identify an evidence-based approach to population health.

As our working-age population grows older, it’s critical that employers seize the opportunity to address the factors that influence health and can enhance productivity in older workers. For those of us who work in health promotion and prevention, that starts with a change in how we define the concept of “health.” Taking a cue from public health research, we must recognize that health is more than the absence of disease and take a whole-person approach to total well-being. Public health literature points to physical, social, economic, environmental and genetic “determinants of health” that combine to affect the health of individuals and populations. Using a more expansive term for this view of health, the Centers for Disease Control and Prevention notes that well-being includes, at a minimum, positive emotions, satisfaction with life, fulfillment and positive [physical] functioning.

This fuller definition of well-being comes into play as employers focus on the value of this aging workforce. Older workers offer tangible benefits for employers to keep them healthy and productive. Researchers found that older workers (over age 65) make fewer serious errors than their younger colleagues (age 20 – 31); they also offer experience, consistently high motivation, a balanced daily routine and stable mood.

The University of Louisville’s program, “Get Healthy Now,” opens health coaching to all interested employees, regardless of whether they are at low-, medium- or high-risk for chronic disease. Care-giving workshops are designed to help everyone from new parents to sandwich-generation Baby Boomers caring for elderly parents; elements include legal, financial and social factors. Mindfulness, yoga and relaxation are among the many classes offered to promote well-being. ROI analysis found the UofL program returned a benefit cost ratio of 7.16 to 1 after four years, and it has become a model for a statewide strategic wellness initiative called “Get Healthy Kentucky.”

Evidence-based workplace health management programs that offer tools to support healthy aging can help older workers maintain active, productive lives. Some interventions, such as in-person health coaching, are particularly effective for those over age 40. In addition to a continued focus on the key behaviors that can help delay the onset of health problems (avoid tobacco, exercise regularly, and maintain a healthy weight), it becomes more important than ever to invest in programs that enhance the emotional, physical, social and financial well-being of all workers—no matter their age.

Tanja Madsen

Tanja Madsen

About the Author: A veteran of health education and health management product development, Tanja Madsen is director of product management for HealthFitness. She is involved in the development of the innovative HealthFitness technology platform, the Persona™ behavior change model, a short, engaging health assessment and a new approach to coaching. A certified health educator, Tanja works with a team that includes registered dietitians, health educators, exercise physiologists and behavior-change experts who are responsible for the development and management of national programs to improve population health.

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.

Multi-Specialty Telehealth Collaborative Offers One-Stop Healthcare for Underserved, Remote Patients

October 24th, 2014 by Cheryl Miller

It’s all about the patient.

That’s what prompted Blue Shield of California and Adventist Health, both not-for-profit organizations, to collaborate on a telehealth program that could afford quality care to all Californians, when and where they need it, says Lisa Williams, senior director of strategic integration and execution, healthcare quality and affordability, Blue Shield of California, during Creating a Virtual Multi-Specialty Physician Network: A Payor-Provider Telehealth Collaborative, an October 15th webinar, now available for replay.

The presentation also featured Robert Marchuk, vice president of ancillary services at Adventist Health, and Christine Martin, director of operations, Adventist Health; all three shared the inside details on the collaboration and the shared mission and values that has led to the program’s success.

Located in largely rural markets, access to specialists is especially critical for the program’s success, Ms. Williams says. The nine-site program, which launched in March, includes 11 specialties, ranging from cardiology to dermatology to orthopedics and rheumatology, which account for the majority of volume in pre-op and post-op care. Specialists are all board-certified and credentialed. The program will expand to an additional 16 sites by the end of this year, with plans to add telepsychiatry, she says.

Central to the program is its care coordination center, a full-service, virtual, multi-specialty physician practice with robust patient and provider supporting services, says Mr. Marchuk. Similarly to a one-stop shopping site, when patients enter a site, clinicians make one phone call regarding that patient to the center, which coordinates all aspects of that patient’s care, from scheduling an appointment with the provider and the clinic itself, ensuring all patient records are available and uploaded to their electronic medical record (EMR), to scheduling follow-up ancillary services and physician appointments and billing. “It’s been very successful,” says Mr. Marchuk, “and really sets us apart from other programs.”

Identifying gaps in their markets, and then finding the right specialty and specialist for that market are big parts of the process, Mr. Marchuk continues. “There are physicians out there that can be wonderful on a face-to-face visit and very, very good clinically, but don’t necessarily lend themselves well to a video interaction, so we screen very carefully.”

Clinician engagement, extensive training, and communication at all points of contact are also important, says Ms. Martin. “You can never over-communicate,” she says. Patients, staff, local providers and specialty providers all need to know what’s going on, so the experience can be as seamless as possible.

Reimbursement for telehealth is still on the negotiation table, Mr. Marchuk adds. But ultimately, it pays to invest in the technology now for the future.

“It’s one of the fastest growing growing fields. It’s affordable, accessible, and cost-effective. Telehealth really can enhance the physician and patient relationship.”

Listen to interviews with Robert Marchuk and Lisa Williams.

Infographic: Accountable Care Strategies to Improve Quality and Lower Costs

October 24th, 2014 by Melanie Matthews

There are four key strategies for healthcare organizations to improve the quality of care they provide and lower costs in an accountable healthcare model, according to a new infographic by The Commonwealth Fund.

Accountable Care Strategies to Improve Quality and Lower Costs

7 Patient-Centered Strategies to Generate Value-Based Reimbursement Healthcare companies seeking a roadmap to richer reimbursement should begin with the seven value-based healthcare priorities for 2014 identified by the healthcare C-suite: population health management, care coordination, integrated care delivery, e-health and telehealth, access to care, health and wellness, and dual eligibles. 7 Patient-Centered Strategies to Generate Value-Based Reimbursement explores the seven healthcare areas ripest for development in 2014, prioritized by 136 respondents to HIN’s ninth annual Trends & Forecasts survey.

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5 Features of the Patient-Centered Medical Home

October 23rd, 2014 by Cheryl Miller

Patient-centered medical homes (PCMHs) are not about pigeon-holing certain diseases or illnesses, says Terry McGeeney, MD, MBA, director at BDC Advisors, but about delivering acute and chronic care prevention and wellness. Dr. McGeeney reiterated the five essential features of the medical home as the groundwork for a medical neighborhood.

Given many of the initiatives of the Centers for Medicare and Medicaid Services (CMS), coupled with the Triple Aim, many have gotten bogged down and probably overly focused on the name: patient-centered medical home (PCMH). What’s important are the features or attributes of the PCMH: first, its patient-centeredness, a partnership among practitioners, patients and their families that ensures and respects the decisions of the patients and ensures patients have the education and support they need.

Secondly, in a PCMH, the care needs to be comprehensive. It’s a team of care providers who are wholly accountable for a patient’s physical and mental healthcare needs, including prevention and wellness, acute care, and chronic care.

Third, you will hear discussions about the PCMH being about a certain disease or illness. Please note that it’s acute and chronic care prevention and wellness. Pigeon-holing conditions, while important, is more of a chronic quality improvement initiative and not PCMH.

Fourth, under the PCMH, care needs to be coordinated. Care is organized across all elements of the broader healthcare system, including specialists, hospital, home healthcare, community service and support. There’s a lot of debate now about what we call ‘post-acute care’ or ‘transitions in care.’ Jonathan Blum, principal deputy administrator of CMS, recently spoke on the importance of post-acute care. This is what coordinated care particularly is all about.

Care has to be accessible. Patients are able to access services with shorter waiting times, after-hours care with access to EHRs, etc., and there has to be a commitment to quality and safety. Clinicians and staff need to enhance quality improvement with the use of health IT and other tools that are available to them.

We also need to be very careful that quality care is not equated with lower cost of care. Sometimes those two have a tendency to get muddled.

Source: Blueprint for a Medical Neighborhood: Building Care Coordination Between Specialists and PCPs

Blueprint for a Medical Neighborhood: Building Care Coordination Between Specialists and PCPs provides a framework in which to evaluate the patient-centered medical neighborhood (PCM-N) model. Pictured here is Terry McGeeney, MD, MBA, director of BDC Advisors, who navigates the landscape of the medical neighborhood, from the value-based payment realities of healthcare today to identifying and engaging specialists in a medical home neighborhood.

Infographic: Concierge Medicine

October 22nd, 2014 by Melanie Matthews

There was a notable increase in the number of concierge physician practices in cardiology, dental and pediatrics, according to a new infographic by Concierge Medicine Today.

The infographic also examines the number of concierge physicians in the United States; states with the greatest concentration of demand, what’s included in a concierge practice and demographic data on the typical concierge patient.

Concierge Medicine

The Business of Medical Practice: Transformational Health 2.0 Skills for Doctors, Third Edition The Business of Medical Practice: Transformational Health 2.0 Skills for Doctors, Third Edition presents a progressive discussion of management and operation strategies. It incorporates prose, news reports, and regulatory and academic perspectives with Health 2.0 examples, and blog and internet links, as well as charts, tables, diagrams, and Web site references, resulting in an all-encompassing resource.

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