Archive for October, 2014

Infographic: Opportunities for Wearables in Preventative Healthcare

October 10th, 2014 by Melanie Matthews

An estimated 25.1 percent of U.S. adults use a fitness tracker or smart phone app to track their health, weight or exercise, according to a new study by TechnologyAdvice.

Highlights from the survey are depicted in a new infographic, which also examines the reasons why people don’t use apps or trackers and factors that would drive adoption.

Wearable Technology and Preventative Healthcare

E-Healthcare Systems and Wireless Communications: Current and Future Challenges The goal of E-Healthcare Systems and Wireless Communications: Current and Future Challenges is to explore the developments and current/future challenges in the successful deployment of future e-Healthcare Systems. The book combines the research efforts in different disciplines from pervasive wireless communications, wearable computing, context-awareness, sensor data fusion, artificial intelligence, neural networks, expert systems, databases, security and privacy. E-Healthcare Systems and Wireless Communications: Current and Future Challenges will be a pioneer reference in this field and will resonate sharply with researchers who have been craving a unified reference in the field of e-Healthcare Systems.

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Maturity of Physician Compensation Models from Fee-for-Service to Value-Based

October 9th, 2014 by Cheryl Miller

To be successful, a physician compensation model must mature slowly, as it moves from fee-for-service (FFS) to a productivity-based model to salary with performance incentives, where many organizations are today, says Cynthia Kilroy, senior vice president of provider strategy and business development at Optum. Here, she describes the steps that need to be taken.

As you move and mature from a clinical transformation perspective, you need to balance the financial risk transformation as well. If you get off kilter on any of those, then you are going to be off balance.

Early on in clinical and financial risk transformation, you are seeing more of the FFS and a FFS with pay-for-performance (PFP). When you start to move up, organizations typically start with salary guarantee. That salary is driven by productivity. It is usually a year that organizations support that, then you move up to productivity with a guarantee.

Finally, organizations are providing compensation based on productivity. As you start to move into these risk contracts and as the market matures, you need to look at productivity with a performance incentive. These are systems to find their alliance with the market, and they should be aligned with your payor contracts. Each payor typically likes to have its own incentives. You need to align the incentives the payor is focusing on and have your physicians focus on them as well, because if they are not in sync, you are not going to meet your ultimate goals of shared savings or even gain-sharing.

The other key question is, what can the organization achieve? We can put numbers out there and measure incentives, but if we do not think we are going to be able to achieve it, we need to be realistic about what can be measured. What is realistic to change reimbursement for compensation from a physician perspective? That is a key area as you start that inflection point.

Ultimately you start to see a larger percent of incentives. This is where you start to shift from maybe 5 or 10 percent, where there is more skin in the game. Organizations said change in behavior does not happen until 20 to 25 percent of compensation is tied to incentives.

Then what I see is the employed model, which is a salary with a performance incentive, then moving up to a larger percentage of the salary with the larger percentage from the incentive model.

Regarding the salary with the population incentives, as you start to look at maybe taking capitation, how does that tie into population incentives around efficiency and quality?

dual eligibles care
Cynthia Kilroy is the senior vice president of provider strategy for Optum Accountable Care Solutions, where she is responsible for business development, go-to-market strategy, strategic consulting, solution design and cross-company relationships. Her focus is on helping providers navigate the transformation to value-based reimbursement and accountable care models.

Source: 6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability

Infographic: 5 Elements of an Effective HIPAA Audit Program

October 8th, 2014 by Melanie Matthews

The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) upcoming permanent HIPAA audit program demonstrates a more aggressive approach to investigating compliance, according to a new infographic by Coalfire.

The infographic outlines the five key elements for a comprehensive, vigilant HIPAA compliance program.

5 Elements of an Effective HIPAA Audit Program

HIPAA Compliance Manual The customized HIPAA Compliance Manual contains the policy and procedure documentation required by the HIPAA privacy and security rules and HITECH. Operating forms are included in the manual for ease of customization for your office. The manual also includes state laws and regulations that interface with HIPAA and state identity theft laws.

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Bon Secours Blueprint for Advanced Medical Home: From Mortar to Measurement

October 7th, 2014 by Patricia Donovan

The building of Bon Secours Health System’s Advanced Medical Home1 began with a walk-through—an assessment of bricks and mortar, explains Robert Fortini, vice president and chief clinical officer at Bon Secours Health System.

In Phase 1 of our Advanced Medical Home project, my team goes into a practice and does a basic workflow discovery—an assessment of bricks and mortar. Oftentimes, the physical plant is not effectively used.

Our objective in a primary care practice is to give each physician at least three or four exam rooms whenever possible. We will do that in a number of different ways, even if it means putting up walls or moving charts out now that we are electronic, or eliminating sample medication closets. We will do whatever it takes to achieve those three rooms per physician.

Next, we review the staff that is providing clinical support. We have developed competency assessment tools for patient service representative (PSR) staff, medical assistant (MA) staff, several different levels of licensed practical nurse (LPN) and our registered nurse (RN) navigator, which is the embedded case manager.

Third, we do an analysis of the physician’s panel size and risk acuity levels and form teams. Team formation is a difficult thing to do because you not only have to assess skills, licensures, panel size and patient acuity, but you also have to take personalities into consideration as well. That is the single most difficult obstacle to being effective.

Fourth, we introduce equipment and training on that equipment so the staff has tools they can use. We do wave testing point of care again, the objective being to eliminate that patient behavioral component and capture an actionable result on the spot before they leave the office. Their hypoglycemic agent or their Coumadin® dose could be titrated accordingly.

Fifth, we do optimization training with the use of our electronic medical record (EMR). We make sure everyone knows how to navigate and is comfortable with the documentation we require. We also use a coding training for the physician’s staff.

Finally, we have a set of metrics to establish baseline so we measure performance.

1. The Advanced Medical home is a model developed by the American College of Physicians involving the use of evidence-based medicine, clinical decision support tools, the Chronic Care Model, and other strategies to manage a patient population.

embedded case management

Robert Fortini, PNP, is vice president and chief clinical officer for Bon Secours Medical Group in Richmond, Virginia. He is responsible for facilitating provider adoption of EMR, coordinating clinical transformation to a patient-centered medical home care delivery model, and facilitating participation in available pay for performance initiatives as well as physician advocacy and affairs.

Source: Case Managers in the Primary Care Practice: Tools, Assessments and Workflows for Embedded Care Coordination

Infographic: Provider Payments Trends

October 6th, 2014 by Melanie Matthews

The healthcare payments industry is changing rapidly due to consumerism and regulatory mandates, according to the fourth annual Trends in Healthcare Payments Report by InstaMed. Patient payments to providers have increased 72 percent since 2011 due to these market forces.

InstaMed’s new infographic based on the report looks at how patient provider payments are changing administrative requirements by providers, the need for payment plans and how credit card and mobile will impact provider payments in the future.

Provider Payment Trends

The New Hospital-Physician Enterprise: Meeting the Challenges of Value-Based Care Shifting reimbursement models are forcing hospital executives to rethink their approach to physician relationships. New cost and quality demands require hospitals to explore all alternatives—including tighter alignment with physicians. The New Hospital-Physician Enterprise: Meeting the Challenges of Value-Based Care provides expert advice on structuring and sustaining hospital-physician relationships in the post-reform environment.

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Infographic: 10 Harbingers of Healthcare Change

October 3rd, 2014 by Melanie Matthews

As the global market for prescription drugs surpasses $1 trillion this year, the push for value-based healthcare delivery and reimbursement is just one of the factors that will drive disruptive change in the healthcare industry in the coming years, according to a new report by the IMS Institute for Healthcare Informatics.

The study, Harbingers of Change in Healthcare, identifies 10 recent events that represent turning points in the role of medicines in advancing healthcare. The 10 events are highlighted in a new infographic by the IMS Institute.

Physician Adoption of Health IT

Narrow Network Strategies and Trends for Health Plans and PBMs Narrow networks — for both medical and pharmacy providers — are gradually becoming more accepted by carriers, plan sponsors and patients. Smaller provider networks allow payers to manage overall healthcare costs while still maintaining access to benefits — an important consideration as plan designs become more commoditized in the age of public and private health insurance exchanges.

Narrow Network Strategies and Trends for Health Plans and PBMs outlines the tactics health plans are using to restrict medical and pharmacy networks while still maintaining adequate access to care and positive relationships with providers. It also summarizes case studies of health plans and PBMs that have formed narrow networks and the results they’ve seen.

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WellPoint Referral Preparedness Tools Support Physician-Specialist Care Compacts

October 2nd, 2014 by Cheryl Miller

With the help of care compacts that drive accountability between primary care physicians and specialists, WellPoint has launched a medical neighborhood pilot for three specialties with clear care coordination alignment opportunities with primary care medical homes. Here, Robert Krebbs, director of payment innovation at WellPoint, Inc., discusses how Wellpoint supports the care compact model with Referral Preparedness Tools— add-ons devised for physician/specialist patient handoffs.

One thing we found interesting was the uniform request from physicians for what we call ‘Referral Preparedness Tools.’ That’s a name we made up. These are add-ons to care compacts that call out common conditions for a given specialty, the conditions for which they often get referrals or consult requests from PCPs. It specifies for that condition what the specialist would like to see for the initial consult or regular repeating referral, and what they want the PCP to do first and send to them and specifically, what they want the PCP not to do—that is, things to avoid before sending the patient over.

On the flip side, the tool lists for that condition what the specialist intends to send back to the PCP. The practice will work on this together for common conditions. The tool doesn’t list everything that could possibly happen, but rather specifies the patient flow for common conditions.

We didn’t initially include this tool in our care compact expectations. The practices asked us for this; they see this as a true opportunity to drive improvement and efficiency in the system, to avoid unneeded care and to make sure that the correct care is provided for all patients.

We’re going to monitor development of these tools throughout the pilot to determine common themes so we can provide a good template starting place on this run as well as for future pilot practices in this program. We’re excited that specialists have made this template their own. They’re hard at work identifying what they’d like to see in these scenarios.

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Robert Krebbs is the director of payment innovation at WellPoint where he has accountability for the design, development and rollout of value-based payment initiatives. He works directly with network physicians and facilities on innovative performance measurement programs aimed at delivering healthcare value by promoting high quality, affordable care.

Source: Care Compacts in the Medical Neighborhood: Transforming PCP-Specialist Care Coordination

Caldwell UNC Healthcare Embedded Case Managers Count Outreach, Not Cases

October 2nd, 2014 by Patricia Donovan

embedded case management

Visibility is the embedded case manager's greatest asset.

A frequently sought metric in case management is the optimal case load. However, embedded case managers at Caldwell UNC Healthcare don’t count cases, they count outreach, explains Melanie Fox, director of Caldwell Physician Network’s Embedded Case Management program.

For Ms. Fox’s team of case managers embedded in seven primary care practices and two work sites, outreach is mostly telephonic, but may also include visits to patients’ homes if they see the need.

“We will do anything to make sure patients get to where they need to be. A lot of our home visits occur because of confusion with medications,” she explained during Embedded Case Management in Primary Care and Work Sites: Referral, Stratification and Protocols, a September 2014 webinar now available on-demand.

Typically, the embedded case management team averages about a thousand outreaches per month, Ms. Fox estimates. Telephonically, they reach almost all patients within 48 hours of discharge, and most ED discharges, running down a multi-item checklist, from medication and home health needs to scheduled follow-up appointments and advanced illness management (AIM), formerly referred to as palliative care, which was frequently misunderstood as strictly hospice, she noted.

Caldwell is working to establish that reporting linkage with skilled nursing facilities as well.

Medication is a large part of that telephonic conversation, Ms. Fox adds, as is a focus on new Transition Care Management Codes, where practices can be reimbursed for non-face-to-face care provided when patients transition from an acute care setting back into the community.

The visibility of embedded case managers in a practice is a great asset to both providers and patients, she says. “We seem to be more accepted by providers, staff and patients because they see us as part of the team.”

At the two work sites, the case manager works alongside a nurse practitioner, where the goals are preventive care and chronic disease management.

With extensive RN experience in home health and schooled in the Geisinger Healthcare System model of embedded case management known as ProvenHealth Navigator℠, Ms. Fox joined Caldwell three years ago to develop and launch the program. Referrals to embedded case managers come from hospital discharge and ED reports, as well as provider and even self-referrals.

Although relatively new, Caldwell’s embedded case management approach has helped to halve 30-day hospital readmissions in its Medicare population— from 19.16 percent in second quarter 2012 to 9.09 percent in fourth quarter 2013, she said. Buoyed by this success, Ms. Fox’s team is targeting ED visits as its next metric.

During the program, Ms. Fox also shared six qualities of an effective embedded case manager, advantages of embedding case managers in care sites, and tactics for engaging physicians and staff in the embedded model.

Click here for an interview with Melanie Fox.

Infographic: Health Insurance Affordability Through ACA’s Marketplaces

October 1st, 2014 by Melanie Matthews

Sixty-one percent of adults paying health insurance premiums through the Affordable Care Act’s marketplaces are reporting they are somewhat or very easy to afford.

The Commonwealth Fund summarizes the experiences of health insurance marketplace customers in terms of affordability and plan satisfaction in a new infographic.

Physician Adoption of Health IT

Public Exchanges Data: Premium Analysis and Carrier Participation for 2014 As health plan operators last year were preparing to offer plans on the state-run and federally facilitated health insurance exchanges, they could only guess at the age and health of the population that would enroll, and they had no information about how their competitors would price their plans.

Now that open enrollment is over, Public Exchanges Data: Premium Analysis and Carrier Participation for 2014 takes a look at how it all played out. This report offers a highly detailed overview of where carriers participated, the types of products they offered and how their prices stacked up against their competitors.

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