Archive for December, 2014

Infographic: CMS’ Quality Improvement Programs

December 31st, 2014 by Melanie Matthews

Ninety-two percent of eligible hospitals and 75 percent of eligible healthcare professionals have received an incentive payment for meaningful use, according to an infographic by CMS.

The infographic also examines the progress on other CMS’ quality improvement programs, including: ACOs; physician quality reporting system; ICD-10; and electronic funds transfer.

Physician Quality Rewards for Population Health ManagementHumana recently distributed $76.8 million in quality awards to approximately 4,700 physician practices through Humana’s Provider Quality Reward programs. The program is designed to support providers where they are in their practices as they move through the continuum of care programs focused on the Triple Aim.

Physician Quality Rewards for Population Health Management a 45-minute webinar on December 16th, now available for replay, Chip Howard, Humana’s vice president of payment innovation in the provider development center of excellence, shares how Humana’s program supports physicians’ transition from volume to value and helps them become successful population health managers.

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12 Core Competencies for the Hybrid Embedded RN Care Manager

December 30th, 2014 by Cheryl Miller

Core competencies for a registered nurse (RN) are different than those for an RN care manager, says Mary M. Morin, RN, NEA-BC, RN-BC, vice president, nurse executive with Sentara Medical Group. When Sentara officially converted to a hybrid embedded case management model, RN care managers’ job descriptions had to be rewritten; to be successful in this new model, they didn’t necessarily have to have care management experience; instead, having a strong clinical background and experience doing patient assessments were more important.

To get RN care management away from the embedded telephonic model, we had to rewrite the job descriptions, and if you’re going to rewrite job descriptions, have a new position. This is different work.

We found out people will hear it, but until they go through it, until they feel it, they’re all for it until it actually happens. If I were to do this again, I would make everybody reapply for their job because this requires a certain type of individual. These people need to be able to engage patients for a long-term relationship. They have to know how to work with hospital-based caregivers, home health, life care and not just within our own healthcare system.

We established core competencies. Core competencies for an RN care manager are different than those for an RN. We have an ambulatory-based RN. We were looking for people that didn’t necessarily have previous care management experience, but who had experience doing patient assessments. They also had to have a strong clinical background.

Following are 10 more core competencies for the hybrid embedded RN care manager:

  • Job descriptions: BSN requirement
  • Maintain patient lists by populations
  • Accept assignments
  • Meet expectations
  • Send patient letter from primary care physician (PCP)
  • Engage patients
  • Send contact letter, brochure
  • Standardize work flow
  • Use SMG, Optima (Health Plan), and clinically integrated network (CIN) electronic medical record (EMR)
  • Hold meetings with home health and inpatient care coordinators
  • Complete education/training
  • Achieve specialty certification

value-based reimbursement
Mary M. Morin, RN, NEA-BC, RN-BC, is a nurse executive with Sentara Medical Group, where she is responsible and accountable for non-physician clinical practice within the Sentara Medical Group (160 clinics/practices) to ensure integration and alignment with Sentara Healthcare, regulatory compliance, standardization of nursing practice/care, and patient safety.

Source: Hybrid Embedded Case Management: New Model for Cross-Continuum Care Coordination

Infographic: Patient Portal Adoption

December 29th, 2014 by Melanie Matthews

In its annual survey on electronic health record use, Xerox found many Americans are open to getting medical records online if given instruction on how to obtain access by their medical providers.

A new infographic by Xerox illustrates the survey results, including details on the factors that would make consumers more likely to use a patient portal, differences between millenial and baby boomer use of portals and patient engagement strategies.

Population Health Framework: 27 Strategies to Drive Engagement, Access & Risk Stratification Faith-based integrated delivery system Adventist Health is on a mission to improve population health status with a wellness-based approach it estimates will eventually net $49 million in savings.

Population Health Framework: 27 Strategies to Drive Engagement, Access & Risk Stratification walks through the elements of Adventist’s population health management program that engages individuals to modify behaviors and prevent illness in the future.

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The Year in Healthcare Intelligence: Reimbursement, Value-Based Results Resonate with Readers

December 29th, 2014 by Patricia Donovan

Newswise, fee-for-value healthcare initiatives eclipsed fee-for-service models.

When survival of healthcare providers hinges on payment for services rendered, it’s not surprising our 2014 readers closely tracked news of emerging payment models and results from patient-centered, quality-based initiatives.

Here is a retrospective of stories that dominated our readers’ news feeds over the last 12 months:

  • We reported on results from many accountable care organizations (ACO) over the last year, but few generated interest like the Anthem Blue Cross-Healthcare Partners accountable care collaboration that saved more than $4 million. The program succeeded by sharpening its focus to those with two or more chronic diseases—the population that research shows can most effectively be helped by coordinated care, officials state. A dedicated staff of care managers and care coordinators identify hospitalized ACO patients, coordinate transitions of care, and ensure patient care and healthcare resources are accessible.

  • Heads also turned when the Centers for Medicare and Medicaid Services (CMS) proposed updated penalties and incentives for its Medicare Shared Savings Program (MSSP), an accountable care initiative for Medicare beneficiaries. The proposed rules are designed to strengthen MSSP by placing greater emphasis on primary care services and promoting transitions to performance-based risk arrangements. CMS is also suggesting a third ACO model,” track 3,” which integrates some elements from the Pioneer ACO model.

  • The patient-centered medical home (PCMH) model, a stepping stone to an ACO, garnered its share of readership, especially when the National Committee for Quality Assurance (NCQA) added five measures to its medical home criteria, the gold standard for patient-centered measurement.

    In its third iteration of PCMH standards since 2008, the NCQA added behavioral health integration and care management for high-need populations, among other new criteria.

  • The patient-centered model suffered a setback, however, when one of the first, largest, and longest-running multipayor trials of PCMHs in the United States was associated with limited improvements in quality and was not associated with reductions in use of hospital, emergency department (ED), or ambulatory care services or total costs of care over three years. Research by Rand Corporation and colleagues centered on patient-centered activities in the Southeastern Pennsylvania Chronic Care Initiative.

  • There was good news on the medical home front, however: A study published in September, 2014 attributed reductions in emergency room visits, principally by patients with chronic illness, to the PCMH approach. Research by Independence Blue Cross (Independence) and CTI Clinical Trial and Consulting Services (CTI), and published by Health Services Research, found that transitions to a medical home were associated with a 5 to 8 percent reduction in ED utilization. This finding is specific to patients with chronic illness(es) having one or more ED visits in any given year. These reductions were most evident among patients with diabetes.

  • Readers also paid attention when Geisinger Health System, an early adoptor of care coordination for chronic illness, announced that its all-or-none or “bundled” approach to primary care for patients with diabetes produced better health outcomes, and the benefits happened quickly for the more than 4,000 patients in the study. The system-wide approach was not easy, warned Geisinger: the model requires constant evaluation, and must be scalable across a variety of practice settings.

  • Also raising the bar for physician practices was Highmark, which shared six requirements for the “best practices” element of its successful pay-for-performance initiative. Physician practices can earn additional rewards for completion of an office-based best practice project, essentially a small pilot, that involves measurement and reporting.

  • On the flip side, reporting of some questionable hospital pricing strategies rated some page views as well. Data released early in 2014 by National Nurses United (NNU) and the Institute for Health and Socio-Economic Policy (IHSP) found that some U.S. hospitals charge more than 10 times their cost, or nearly $1200 for every $100 of their total costs. Public oversight or regulation seems to help constrain excessive pricing, researchers found; Maryland, probably the most regulated state in the United States, has the lowest average charges of all the states among its 10 most expensive hospitals.

  • Cost savings aside, readers seemed especially attuned to new approaches or technologies designed to streamline healthcare delivery and enhance the patient experience, such as an uptick in remote monitoring.

    One hundred percent of respondents to the Telehealth in 2013 Survey by the Healthcare Intelligence Network monitor weight and vital signs, up from a respective 79 and 77 percent in 2010. The health conditions monitored remotely remain the same from 2010, the top three being heart failure, COPD and diabetes.

  • And finally, as all eyes focus on care management interventions that span the healthcare continuum, many readers responded to a story on a CMS pilot that would give hospice patients more options in the type of care they wish to receive at the end of life. Under the Medicare Care Choices Model, individuals who meet Medicare hospice eligibility requirements could receive palliative care services from certain hospice providers while concurrently receiving services provided by their curative care providers.

Were these stories on your news radar in 2014? Stay up-to-date in 2015 with the latest healthcare news, trends and benchmarks with a free subscription to the Healthcare Business Weekly Update.

Infographic: 12 Ways Secure Texting Is Used in Healthcare

December 26th, 2014 by Melanie Matthews

With 87 percent of healthcare professionals using their smartphones in the workplace, several organizations have turned to secure texting to streamline conversations around patients while managing compliance risks, according to a new infographic by TigerText.

The infographic examines 12 ways healthcare organizations are using secure texting in their daily workflows.

Electronic Health Record: Standards, Coding Systems, Frameworks, and InfrastructuresThe increased role of IT in the healthcare sector has led to the coining of a new phrase “health informatics,” which deals with the use of IT for better healthcare services. Health informatics applications often involve maintaining the health records of individuals, in digital form, which is referred to as an Electronic Health Record (EHR). Building and implementing an EHR infrastructure requires an understanding of healthcare standards, coding systems, and frameworks.

Electronic Health Record: Standards, Coding Systems, Frameworks, and Infrastructures provides an overview of different health informatics resources and artifacts that underlie the design and development of interoperable healthcare systems and applications.

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Infographic: The Challenge of Serving Dual Eligibles

December 24th, 2014 by Melanie Matthews

Individuals dually eligible for Medicare and Medicaid are among the sickest and poorest individuals covered by healthcare in the United States. They are also likely to have mental health needs and live in nursing homes.

A new infographic by HealthX examines dual eligible healthcare spending, the challenges of serving dual eligibles and strategies for best serving this market.

Dual Eligibles Care and Service Planning: Integrative Approaches for the Medicare-Medicaid Population To locate, stratify and engage dual eligibles, Health Care Services Corporation (HCSC) takes a creative approach, employing everything from home visits to ‘street case management’ to coordinate care for Medicare-Medicaid beneficiaries.

Dual Eligibles Care and Service Planning: Integrative Approaches for the Medicare-Medicaid Population describes HCSC’s innovative tactics to engage this largely older adult and disabled population in population health management with support from a range of community partners and services.

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Humana Physician Quality Rewards Boost Population Health across Accountable Care Continuum

December 23rd, 2014 by Patricia Donovan

Humana offers primary care physicians a four-tiered value-based rewards program.

You can’t argue with the data: the total cost of care for Humana’s Medicare Advantage members treated in accountable care settings in 2013 was 19 percent lower than MA members receiving care in traditional Medicare fee-for-service (FFS) environments.

Humana’s successful approach is honed from twenty-six years of experience with value-based reimbursement, explained Chip Howard, Humana’s vice president of payment innovation in the provider development center of excellence, during a December 2014 webinar on Physician Quality Rewards for Population Health Management.

Today, Humana not only offers physicians four levels of participation and rewards in fee-for-value programs but supports their shift from an episodic to population health mindset with training and reporting.

This stepped approach has paid off for the payor and its Medicare Advantage (MA) members in other areas as well, including higher HEDIS® scores, fewer ER visits and hospital admissions, and improved clinical management and screening compliance levels for Medicare Advantage members.

Howard walked webinar participants through the four models, from Humana’s Star Rewards program that incents providers who meet a subset of NCQA HEDIS goals, to its Medical Home program for high-functioning physician practices with a well-developed infrastructure, a physician population health champion and a robust team approach.

Each value-based option across Humana’s Accountable Care Continuum supports the Triple Aim objectives of improving care, improving health outcomes and lowering cost—with the bonus of enhancing the overall patient experience, Howard noted.

Participating physicians are exposed to Humana’s population health management initiatives, including the Humana at Home program for high-risk patients, with its goal of keeping MA members healthier, out of the hospital and safe in their homes; a 30-day Transitions program that reduced readmissions by 39 percent less than expected; and a bank of technologies and data tools that help providers become better population health managers.

Encouraged by gains from its pay-for-value strategy at the primary care level—the payor recently distributed $76.8 million in quality awards to approximately 4,700 physician practices— Humana is exploring programs to engage and incentivize specialists to achieve similar Triple Aim goals.

The intent would be to then promote interactions between the primary care physician, which Humana views as the “care quarterback,” Howard noted, and sub-specialists that result in high-quality, efficient healthcare delivery.

Click here to listen to an interview with Chip Howard on the value of care coordination in Humana’s Accountable Care Continuum.

11 Statistics About Remote Patient Monitoring

December 23rd, 2014 by Cheryl Miller

Remote monitoring of individuals with multiple chronic conditions reduced hospitalizations, hospital readmissions and ER visits for more than 80 percent of respondents and boosted disease self-management for nearly all of these monitored patients, according to the 119 respondents who participated in the Healthcare Intelligence Network’s inaugural survey on Remote Patient Monitoring in March 2014. Other targets of a remote monitoring strategy included frequent utilizers of hospitals and emergency rooms (ERs) (62 percent) and the recently discharged (52 percent).

Following are seven more statistics from the Remote Patient Monitoring survey:

  • Fifty percent of respondents rely on specific diagnoses sets to identify candidates for remote monitoring.
  • More than a quarter of respondents (27 percent) target the frail and/or home-bound with remote monitoring programs.
  • Reimbursement for remote monitoring, followed by the education of patients in this technology, were identified by respondents as the chief challenges of these remote care management efforts.
  • Two-thirds of respondents said remote monitoring reduced bed days.
  • Telephonic case management is a component of remote monitoring efforts for 71 percent of 2014 respondents.
  • About a third of respondents report the use of either a Web interface or a dedicated mHealth app to supplement remote monitoring.
  • A patient-centered touch, such as a follow-up phone reminder to use a monitoring device or a personal coaching session, was frequently cited as a noteworthy supplement to remote monitoring technology.

Source: 2014 Healthcare Benchmarks: Remote Patient Monitoring

http://hin.3dcartstores.com/2014-Healthcare-Benchmarks-Remote-Patient-Monitoring_p_4868.html

2014 Healthcare Benchmarks: Remote Patient Monitoring delivers a comprehensive set of metrics from more than 100 healthcare organizations on current practices in and ramifications of remote monitoring for care management of chronic illness, the frail elderly and remote populations.

Infographic: 2015 ACO Trends

December 22nd, 2014 by Melanie Matthews

Accountable Care Organizations (ACOs) as a model to deliver high-quality, cost-effective care across the continuum and improve population health management (PHM) has significantly increased, according to a new infographic by Perficient.

There are 700+ ACOs in the United States and two-thirds of the U.S. population now live in a region served by an ACO. The infographic also looks at ACO success factors and the role of data analytics in an ACO.

Beyond the EMR: Mining Population Health Analytics to Elevate Accountable CareWhile widespread adoption of electronic health records has generated new streams of actionable patient data, John C. Lincoln has taken data mining to new levels to enhance performance of its accountable care organization (ACO).

Beyond the EMR: Mining Population Health Analytics to Elevate Accountable Care reviews the concentrated data dig undertaken by John C. Lincoln to prepare for participation in the CMS Medicare Shared Savings Program (MSSP). In this 25-page report, Karen Furbush, business consultant, and Heather Jelonek, chief operating officer, accountable care organization, John C. Lincoln Network, describe the sources combed by the ACO to address operational and technological challenges during the pre-launch period, and how these efforts and resulting data enhanced quality measurement and reporting for the JCL ACO.

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Infographic: How Millennials Are Re-Shaping Healthcare

December 19th, 2014 by Melanie Matthews

When it comes to managing their health, millennials have more access to information, connectivity, and technology than any other generation. Yet, financial pressures mean tradeoffs between healthcare spending and other purchases, leading them outside the traditional system of care in an attempt to live in the moment and save money.

This new infographic by communispace health looks at millennials’ perception and use of the healthcare system.

Social Media in Healthcare: Connect, Communicate, Collaborate, 2nd editionThe growth of social networking has been dramatic, and the applications are quickly finding their way into healthcare organizations.

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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