Archive for February, 2015

BCBSM Physician Incentives Target 5 Root Causes of High-Cost Healthcare

February 17th, 2015 by Cheryl Miller

Designed to target underlying reasons for high-cost healthcare, Blue Cross Blue Shield of Michigan’s (BCBSM) Physician Group Incentive Program (PGIP) rewards and incentivizes providers to enhance the delivery of care. To address poorly aligned incentives, for example, they developed tiered fees based on performance measured at the population level, not just at the individual physician level or patient’s level, says Donna Saxton, BCBSM’s field team manager of BCBSM’s value partnerships program.

How has the program evolved? The several root causes of high-cost healthcare within our system were readily apparent: poorly aligned incentives, a lack of population focus, very fragmented healthcare delivery, a lack of focus on process excellence or process improvement and a weak primary care foundation. As we’ve developed our Physician Group Incentive Program (PGIP) initiative, we were strategic and deliberate in how we were going to address the root causes of our high-cost system, keeping in mind the tenets and the philosophy of the PGIP program.

To address poorly aligned incentives, we developed tiered fees based on performance measured at the population level, not just at the individual physician level or patient’s level.

Tiered performance fees also addresses the lack of population focus and places emphasis on all patients and payor registries.

The one thing that really makes our PGIP program unique is that we are payor-agnostic. The incentive dollars we have distributed through the life of the program readily help and incentivize other payors in the state, because if these capabilities are implemented, they ultimately serve all the patients in our state. We’re very proud of that because we feel that that is part of the servant leadership we need to do for patients and members in our state.

To attack the fragmented healthcare delivery, we’ve organized our systems of care, aligning our incentives for primary care physicians, hospitals and specialists.

We also have collaborative quality initiatives, which help sharpen our physicians, specialists and care delivery people on the science of process improvement.

Our PCMH initiative is our pinnacle initiative, which we believe has strengthened our primary care foundation across the state.

generating medical home savings
Donna Saxton, field team manager of Blue Cross Blue Shield of Michigan’s (BCBSM) value partnerships program, currently oversees the team of representatives that support the statewide collaborative relationships with 44 physician organizations (PO) and 39 organized systems of care (OSCs) that participate in the BCBSM Physician Group Incentive Program (PGIP).

Source: Generating Medical Home Savings and Quality Improvements Through Outcome-Based Measures

Infographic: HIEs Supporting Meaningful Use Stage 2

February 16th, 2015 by Melanie Matthews

An increasing number of HIEs are supporting meaningful use stage 2 requirements, according to a new infographic by HIMSS.

The infographic looks at the percentage of HIEs able to support CPOE, patient reminders, secure messaging and data protection.

Health Care System Transformation for Nursing and Health Care Leaders: Implementing a Culture of CaringHealth Care System Transformation for Nursing and Health Care Leaders: Implementing a Culture of Caring features successful examples of how various units of the healthcare system can apply specific strategies to their inter- and intra-professional work, and how to engage and sustain authentic dialogue among and between stakeholders.

Health Care System Transformation for Nursing and Health Care Leaders: Implementing a Culture of Caring reflects the interests of such major stakeholders as patients and families, nurses, physicians and other primary and adjunctive care providers, ancillary service providers, administrators and managers, and all other individuals involved in the many aspects of organizational models and delivery of healthcare and human resource functions and outcomes.

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Infographic: Consumer Understanding of Health Insurance Coverage

February 13th, 2015 by Melanie Matthews

While the ACA has encouraged the U.S. healthcare system to become more consumer-focused, a recent online survey, conducted by Harris Poll on behalf of SCIO Health Analytics®, revealed that many insured Americans do not have a clear understanding of what healthcare services are covered under their current plan, and have avoided visiting a doctor for a general health concern within the past 12 months because of cost concerns.

An infographic by SCIO Health Analytics delves into the study’s findings, with a look at the number of individuals who did not seek medical care due to cost concerns, the impact of this avoidance and how health plans can use big data to provide appropriate guidance to healthcare consumers.

Narrow Network Strategies and Trends for Health Plans and PBMsNarrow 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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How Bon Secours Gets Paid for Providing Value-Based Healthcare

February 13th, 2015 by Patricia Donovan

ACO

Bon Secours 'Good Health' ACO is one of the largest in CMS's Medicare Shared Savings Program (MSSP).

Bon Secours Medical Group isn’t waiting for CMS to fully transition Medicare to pay-for-performance reimbursement models to get paid for providing value-based healthcare.

Instead, the 600-provider medical group has aligned itself closely with healthcare payment reform, applying a broad mix of patient-centered team-based care, technology and retooled care delivery systems to maximize quality and clinical outcomes and reduce spend associated with its managed patients.

Highlights of Bon Secours’ patient-centered approach were presented by Jennifer Seiden, administrative director, population health, and Lu Bowman, population health market program manager, during the recent webinar, Positioning for Value-Based Reimbursement: Workforce Development for Transitional Care, Chronic Care Management, now available for on-demand replay.

“The HHS’s historic announcement [of Medicare’s value-based payment timeline] was a clear signal to the industry and to the market that we better align ourselves and set ourselves up for it,” noted Ms. Seiden.

As far back as 2009, the prescient medical group had several pay-for-performance programs in place; in 2015, Bon Secours Good Health accountable care organization (ACO) is one of the largest participants in CMS’s Medicare Shared Savings Program (MSSP).

Today, most Bon Secours tactics emanate from the principles of the patient-centered medical home (PCMH), she said, with a focus on taking a population-wide view and closely managing “below-the-waterline” patients, guiding them to the most appropriate care settings and following up on them post-discharge.

The multidisciplinary care team is so essential to this patient-centered approach Bon Secours has constructed a business case to justify the team, she added, using a “Back to Basics” ROI equation developed by Robert Fortini, vice president and chief clinical officer.

Lauding Fortini’s efforts, Seiden explained the motivation behind his formula. “We had to develop a return on investment equation for the care team, because if you’re an independent practice or even if you’re employed, you’ve got to justify the expense of that additional overhead. That labor is not cheap.”

Results, revenue and key metrics like the number of post-discharge office visits and readmissions are tracked via electronic dashboards and rolled into the ROI equation.

Other strategies, including integration of behavioral health, embedding of case managers (nurse navigators) and EMTs, the use of ambulatory registries to stratify high-risk patients and a foray into retail healthcare contribute to Bon Secours’ impressive results, like a readmission rate of 2.08 percent for patients heavily monitored and managed by nurse navigators.

Ms. Bowman then described Bon Secours’ cohesive Care Management Services, which are divided into chronic care management services and complex chronic care management services. Nurse navigators are already working with Medicare’s new Chronic Care Management codes, another stepping stone in the federal payor’s volume-to-value transition.

“Nurse navigators are already providing chronic care management to patients. It was the natural next step for us to utilize these care management codes. The education for our team was focused on meeting the criteria, documentation and making sure the patient is always aware of and included in the care plan, which is so important to patient-centered care,” concluded Ms. Bowman.

Listen to comments from Jennifer Seiden.

6 Health Plan Trends in Remote Patient Monitoring

February 12th, 2015 by Patricia Donovan

CHF and COPD are the health conditions most frequently targeted by health plan remote monitoring programs.

Frequent emergency room users, individuals with chronic comorbidities and members recently discharged from the hospital are the populations most often monitored remotely by health plans, according to 2014 market data.

Payors comprised 16 percent of respondents to the Healthcare Intelligence Network’s 2014 survey on remote patient monitoring.

The survey identified the following payor trends in remote care management:

  • Forty percent of health plans said they had a remote monitoring program in place, versus a high of 64 percent for case management and a low of 24 percent for hospital/health systems.
  • Health plans principally rely on case management assessments to identify remote monitoring candidates (80 percent) a fraction more than case management organizations themselves (78 percent). They were also most likely to depend upon direct member/patient referrals—a high of 44 percent versus a low of 0 percent for health plans and a median of 25 percent for hospital/health systems.
  • Health plans were most likely to monitor frequent hospital/ER utilizers remotely (100 percent) versus a low of 55 percent for case management and a median of 75 percent for hospital/health systems. They were also most likely to monitor those patients recently discharged (80 percent) versus a low of 44 percent for case management and a median of 50 percent for hospital/health systems.
  • Of the top five chronic diseases monitored by remote technologies (CHF, COPD, asthma, hypertension, and stroke), health plans were most likely to monitor CHF (100 percent versus a low of 25 percent for hospital/health systems and a median of 89 percent for case management); COPD (100 percent versus a low of 50 percent for hospital/health systems and a median of 67 percent for case management); and asthma (80 percent versus a low of 44 percent for case management and a median of 50 percent for hospital/health systems.
  • In terms of payor challenges associated with remote monitoring, patient education was a strong concern (60 percent) versus a low of 25 percent for hospitals/health systems and a median of 56 percent for case management, as was reliability of self-reported data (60 percent) versus a low of 25 percent for hospitals/health systems and a median of 44 percent for case management.
  • Across the board, all three sectors (100 percent) said telephonic case management was key to remote monitoring.

Source: 2014 Healthcare Benchmarks: Remote Patient Monitoring

Infographic: Patient Self-Scheduling

February 11th, 2015 by Melanie Matthews

Many healthcare organizations are implementing digital patient self-scheduling tools to enhance patient engagement and satisfaction, improve efficiencies and differentiate themselves.

An infographic by Accenture projects how many consumers and organizations will use self-scheduling tools by 2019 and the value created through these tools.

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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Guest Post: Building the Right Health Management Program

February 10th, 2015 by Ann Wyatt, Regional Vice President, HealthFitness

 Ann Wyatt

Ann Wyatt, Regional Vice President, HealthFitness

While Sibson’s Healthy Enterprise Study found that 40 percent of all health management programs are not effective, research shows that organizations adopting the most effective programs—those in the top 25 percent– experienced 16 percent lower healthcare costs and a 35 percent lower rate of increase in costs than the rest.1,2

Well-designed programs lead to improved retention, better employee morale and increased productivity. Reams of data support that.3,4,5

It would seem the answer is simply to build a good program. However, it’s not that simple; what works varies by workplace, income, age and a host of other factors. The task is to develop the right program for your target group. Research6 published in September found comprehensive workplace programs do work, but their success depends on program goals, design and implementation. The program must fit into the organization’s culture.

For instance, a focus group conducted for a client of HealthFitness – a large manufacturing plant population, found that some of wellness program names sounded too “feminine” to attract the rural, blue-collar, mostly male workers. Messages about the importance of good health weren’t effective, but “Get fit for hunting season” was.

Another example: A technology company with employees making six figures launched a health management program. The incentive to complete a health assessment and attend a biometric screening? A $25 gift card. The participation rates were dismal.

Employees want meaningful and relevant programs.7,8

It needn’t be costly, and success isn’t reserved for the mega-firms. Kramer Beverage, a small company in New Jersey, earned American Heart Association recognition for its efforts to keep employees healthy. The company provides gym membership discounts, offers healthful food options at meetings and in vending machines, and has created a walking track outside the building.

Another small company with a limited budget wanted to test the wellness program waters but was concerned it didn’t have the funds to make a big splash. The company started by putting a bowl of fruit in every break room once per week. The buzz it created revealed that employees were hungry for health.

It comes down to finding out what employees are “hungry” for and “feeding” them the means to reach their goals. That can vary widely, from shaving 10 seconds off a 5K time to being readier to hunt. You don’t have to build the perfect health management program–just the right one.

1Healthy Enterprise Study, Sibson Consulting, (Winter 2011)

2Steven F. Cyboran and Sadhna Paralkar, MD. “Wellness Program ROI Depends on Design and Implementation” Society for Human Resource Management, July 26, 2013

3Parks, K., et al. “Organizational Wellness Programs: A Meta-Analysis.” Journal of Occupational Health Psychology, 2008

4Goetzel RZ, et al. “Do workplace health promotion (wellness) programs work?” J Occup Environ Med. 2014 Sep;56(9):927-34

52013 Aflac WorkForces Report conducted by Research Now

6J Occup Environ Med. 2014 Sept. op. cit.

7Aon Consumer Health Mindset,

8“Five voluntary trends to watch in 2014.” BenefitsPro , Dec. 13, 2013

Is a Population Health Management Approach Sustainable?

February 10th, 2015 by Cheryl Miller

Beyond the undeniable imprint of big data on the field of population health management (PHM) and the emergence of primary care on the PHM team, the most ringing endorsement of population health management derived from the Healthcare Intelligence Network’s second annual PHM survey is the resounding belief by almost all respondents (92 percent of hospital/health systems, and 100 percent of health plans) that a population health management approach is sustainable.

One respondent went so far as to say, “Nothing comes close [to population health management] in terms of managing systemic healthcare costs.”

Still, compared to conventional care management, PHM is still in its infancy, despite the plethora of analytics harnessing healthcare data for PHM consumption. Many respondents are careful to bear in mind the individual patient behind the electronic health record or health risk assessment, balancing the use of risk stratification tools like predictive modeling with a hands-on approach.

Underscoring this, a half-dozen respondents pointed to specially trained case managers, human communication, and interdisciplinary conversations as their most successful PHM tools, along with a host of behavior change techniques employed in telephonic and face-to-face interventions: motivational interviewing, intrinsic coaching and patient activation.

While these approaches are gaining ground in terms of reducing avoidable utilization and healthcare costs, the survey indicated that engagement of patients in population health management remains a significant challenge for almost a third of 2014 respondents (although it is less a barrier now than two years ago, when almost half of respondents struggled with patient engagement).

Perhaps with more primary care physicians on the front lines of PHM, reluctant patients will become less of an issue. As one respondent noted, “For PHM to work, it requires both physician and patient engagement for a selected population. Being all things for all people is not sustainable.”

Source: 2014 Healthcare Benchmarks: Population Health Management

http://hin.3dcartstores.com/2014-Healthcare-Benchmarks-Population-Health-Management-_p_4926.html

2014 Healthcare Benchmarks: Population Health Management Now in its second edition, this 50-page resource analyzes the responses of healthcare organizations to HIN’s second comprehensive industry survey on PHM trends administered in June 2014. It delivers the latest metrics and measures on current and planned PHM initiatives, providing actionable data on the most effective PHM tools and workflows, risk identification strategies, tools to boost health plan member and consumer engagement, modalities for program delivery, and much, much more.

Infographic: The Healthcare Social Shakeup

February 9th, 2015 by Melanie Matthews

Hospitals, clinical practices and physicians of all ages are becoming more and more active on social media, according to a new infographic by CDW Healthcare.

Patients are using social media channels to search health information and become more informed about their care, rate the quality of care they receive from providers and reach out to their peers to ask for health advice. Physicians are seeing increasing value in social for their own health and research discussions with colleagues — utilizing it to become more informed on patient care resources and for career development and networking. In fact, 60% of doctors say social media improves the quality of care delivered to patients.

This infographic examines how healthcare organizations, physician practices and patients are using social media in healthcare.

The Patient-Centered Payoff: Driving Practice Growth Through Image, Culture, and Patient ExperienceFor the first time medical practices and organizations are about to see their income either increase or decline based on regulations that directly measure patient care and satisfaction. CMS has now made the patient experience its business.

Learn the steps your practice can take to reap the many payoffs of achieving high patient-centered standards without having to make a big financial investment. In The Patient-Centered Payoff: Driving Practice Growth Through Image, Culture and Patient Experience, authors Cheryl Bisera and Judy Capko explain how healthcare professionals and organizations can thrive in the new patient-centered environment.

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Infographic: Social Media Sites Outrank Physician and Hospital Websites in Search Results

February 6th, 2015 by Melanie Matthews

As Americans enroll in healthcare through the Affordable Care Act for the second year in a row, a new study reveals how physicians are being evaluated by prospective patients. The study released by Mercury360®, which helps companies manage their online reputation, found that for over half of physicians observed the first link on a search engine results page (SERP) is a social media site and the percentage is even higher for physicians practicing in several medical specialties. The study has implications for how physicians manage their reputation, communicate with their patients, and how patients come to learn about their doctor.

An infographic by Mercury360® looks at the importance of patient reviews and SERPs by physician specialty.

Establishing, Managing and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical PracticesOnline health information combined with social media channels like Twitter and Facebook has created a new generation of patients. They are empowered. They have a voice in their own care that they never had before, and more are using social media and physician review sites to choose their doctor or medical practice. Given these stakes, you can’t afford to leave your online reputation to chance.

Kick off your social media efforts today with Establishing, Managing and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices, a comprehensive resource. In addition to unique insights from practicing physician and social media pioneer Kevin Pho, MD, this book offers doctors a step-by-step guide on how to use social media to manage an online reputation. It also provides insider tips on how to respond to online ratings and a guide to work with all of the major physician review sites.

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