Archive for April, 2015

Infographic: The Connected Patient

April 17th, 2015 by Melanie Matthews

The healthcare industry is still lagging behind patient expectations in terms of technology use and accessibility, according to a new report by

The report found millennials prefer to engage with their providers through modern technology, and this will pressure healthcare providers to embed more social, mobile, and cloud technologies in their day-to-day interactions with patients. An infographic by examines how patients currently connect with providers and what the future of health will look like.

Remote Patient Monitoring for Chronic Condition Management: Leveraging Technology in a Value-Based System Encouraged by early success in coaching 23 patients to wellness at home via remote monitoring, CHRISTUS Health expanded its remote patient monitoring (RPM) enrollment to 170 high-risk, high-cost patients. At that scaling-up juncture, the challenge for CHRISTUS shifted to balancing its mission of keeping patients healthy and in their homes with maintaining revenue streams sufficient to keep its doors open in a largely fee-for-service environment.

Remote Patient Monitoring for Chronic Condition Management: Leveraging Technology in a Value-Based System chronicles the evolution of the CHRISTUS RPM pilot, which is framed around a Bluetooth®-enabled monitoring kit sent home with patients at hospital discharge.

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PHOs Let Quality, Cost Guide Them Toward Value-Based Reimbursement

April 16th, 2015 by Cheryl Miller

Instead of focusing on volume, physician-hospital organizations (PHOs) are concentrating on value-based care, says Travis Ansel, senior manager with the Healthcare Strategy Group. The once revenue-based organizations are now focused on quality and cost, realizing that if they can’t manage those two things, their reimbursement will go down.

Why is the PHO model going to work now? We always get this question. This comes more from doctors than it does from administrators: why are PHOs going to work now, when they didn’t work before? The simple answer is that before, PHOs were revenue-focused. They were about getting the biggest number of physicians into the model regardless of their quality. It was run by the hospital as a methodology for increasing rates. Then fee-for-service (FFS) didn’t really give anybody the incentive to work together.

They gave everybody the incentive to sign their name on the contract and hope for better rates. What we’re seeing PHOs focus on now is quality and cost, with the idea that if they can’t manage those two things, their reimbursement is going to go down. We have clinical integration guidance from the Federal Trade Commission (FTC), which gives everybody the framework for developing joint contracting capabilities and defines legally how we can work together. What we’re seeing now, since there’s more of a clinical than a revenue focus for PHOs, is that they are more dominated by physician leadership. The hospital keeps control over the purse strings, but gives the governance of the group to physicians. They are letting them take the leadership on the cost and quality protocols that they need to develop to be successful.

There is also the way that payment reform is transitioning the incentives. They’re focused on getting quality and cost across populations or across episodes of care. They’re giving the right incentives for collaboration, which the PHO model provides the forum for.

Source: Physician-Hospital Organizations: Framework for Clinical Integration and Value-Based Reimbursement

Home Visits

Physician-Hospital Organizations: Framework for Clinical Integration and Value-Based Reimbursement describes the relevance of the PHO model to today’s healthcare market, offering strategies to leverage the physician-hospital organization for maximum clinical outcomes, competencies and value-based reimbursement.

Making a Case for Embedded Case Management: 13 Factors Driving Onsite Care Coordination

April 16th, 2015 by Patricia Donovan

Compliance with Triple Aim goals, participation in CMS pilots to advance value-based care, formation of multidisciplinary teams and avoidance of CMS hospital readmissions penalties are among the factors driving placement of case managers at care points, according to HIN’s 2014 healthcare benchmarks survey on embedded case management.

Participation in the Medicare Physician Group Practice Demonstration, the Comprehensive Primary Care Initiative, and the Multi-Payer Advanced Primary Care Practice demonstration has prompted a number of the survey’s 125 respondents to embed case managers in primary care practices, hospital admissions and discharge departments and emergency rooms, among other sites.

To help organizations make the case for embedded case management, here are nine more program drivers, in respondents’ own words:

  • “Face-to-face contact with complex patients and their family to build trust and relationships, working directly with providers and staff.”
  • “Five to 8 percent of patients account for 40 to 60 percent of costs. It is logical. Second, ED visits and discharges represent at-risk patients where interventions can make a difference. Third, focus needs to be placed on fostering better screening results. Effort to reduce utilization.”
  • “Pursuing medical home model and team-based care, along with continuum care coordination.”
  • “Integration work between medical and behavioral healthcare.”
  • “Employer, health system, and payor collaboration to provide population health management in a medical home-like model. Also working on reducing readmissions for high-cost, high-risk conditions such as heart failure, and hospital wanted to develop an ambulatory component to reduce readmissions and improve patients’ quality of life and satisfaction.”
  • “Increased care fragmentation related to transitions in care, challenges in utilization between military and civilian network access-to-care, increased need for complex care coordination, etc.”
  • “We felt we needed to ensure the case managers were considered a part of the patient-centered medical home (PCMH) team.”
  • “Research shows [case managers] embedded at the point of care caring for the whole person in all healthcare environments produces better outcomes.”
  • “As a rural hospital, it made sense to make the best use of resources.”

Source: 2014 Healthcare Benchmarks: Embedded Case Management

2014 Healthcare Benchmarks: Embedded Case Management provides actionable data from 125 healthcare organizations leveraging embedded or co-located case management to improve healthcare quality, outcomes and spend—including those applying a hybrid embedded case management approach.

Infographic: Big Data in Healthcare

April 15th, 2015 by Melanie Matthews

Big data holds a lot of promise for the healthcare industry, according to a new infographic by Mana LLC.

Precision medicine, biopharmaceutical R&D productivity, mobile health and telemedicine have already seen impacts from big data. The infographic takes an in-depth look at the potential for reduced spending with big data use and the greatest big data opportunity in healthcare.

2015 Healthcare Benchmarks: Telehealth & TelemedicineThe world of digitally enabled care is exploding: the number of patients using telehealth services will rise to 7 million in 2018, according to IHS Technology; healthcare apps and ‘wearables’ are trending in technology circles; and CMS’s new ‘Next Generation ACO’ model features modifications to expand telehealth coverage.

2015 Healthcare Benchmarks: Telehealth & Telemedicine delivers actionable new telehealth metrics on technologies, program components, successes and ROI from more than 100 healthcare organizations. This 60-page report, now in its fourth year, documents benchmarks on current and planned telehealth and telemedicine initiatives, with historical perspective from 2009 to present.

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3 Goals of Hospital Home Visits: Reconciliation, Red Flags and Re-Education

April 14th, 2015 by Cheryl Miller

Hospital-initiated home visits conducted during post-discharge follow-up significantly curb avoidable admissions, readmissions and ER visits, according to findings from the Healthcare Intelligence Network’s 2013 Home Visits e-survey.

The hospital sector is almost twice as likely to conduct home visits than other sectors, and to focus on three key aspects of the discharge care plan: medication reconciliation, red flag recognition and patient/caregiver education.

Hospitals are much more likely to conduct home visits to conduct post-discharge follow-up than overall respondents, our survey found. Almost two-thirds of hospitals, which comprised 27 percent of the survey 155 respondents, visit patients at home following discharge, versus 43 percent overall. Hospital-initiated home visits are also half as likely to include a home assessment as visits by the overall surveyed population (16 percent of hospitals versus 37 percent of respondents overall).

A case manager most often conducts the home visit on behalf of the hospital; this sector is only one-fourth as likely to send a nurse practitioner on this visit (5 percent of hospitals versus 16 percent overall). The visits focus on key aspects of the discharge care plan: medication reconciliation, red flag recognition and patient/caregiver education.

That said, hospital case managers are more likely than their industry counterparts to offer palliative care during the visit (35 percent versus 29 percent overall), but only about half as likely to discuss nutritional status (29 percent versus 52 percent overall) or assess activities of daily living or ADL (24 percent versus 40 percent overall).

Chart reviews and EHRs comprise responding hospitals’ primary method of identifying patients in need of home visits. This sector is twice as likely to conduct home visits for 10 percent or less of its patient population (65 percent versus 37 percent overall).

Despite the frequency with which it conducts home visits, hospitals are twice as likely to report no return on investment from home visit programs (17 percent versus 9 percent overall), and are twice as challenged by home visit funding/reimbursement (61 percent versus 36 percent overall) and technology limitations (11 percent versus 6 percent overall).

Source: 2013 Healthcare Benchmarks: Home Visits

Home Visits

2013 Healthcare Benchmarks: Home Visits examines the latest trends in home visits for medical purposes, from the populations visited to top health tasks performed in the home to results and ROI from home interventions. This 40-page report analyzes the responses of 155 healthcare organizations to HIN’s inaugural industry survey on home visits.

Infographic: Should You Outsource Healthcare Billing to Prepare for ICD-10?

April 13th, 2015 by Melanie Matthews

As the deadline to ICD-10 approaches, some physician practices may decide to outsource healthcare billing, according to CureMD.

CureMD has created an infographic to highlight the expected impact of ICD-10 and help physician practices determine if they’ll need to outsource their billing for the code changes.

ICD-10-CM/PCS Implementation Action PlanOf all the tapes and books on the market about ICD-10, this important book by an Approved ICD-10 CM-PCS Trainer is a standout. Hospital, physician practice, ambulatory surgery center, freestanding clinics, and long-term care staff who are primary or secondary users of medical coding data will want it as their constant companion as they begin the implementation of ICD-10 at their facility.

ICD-10-CM/PCS Implementation Action Plan goes beyond its comprehensive coverage of ICD-10 CM/PCS to provide you with training tools, as well. This 135-page book also includes an 81-page customizeable document, as well as a customizeable spread sheet log.

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Infographic: Social Media in Healthcare

April 10th, 2015 by Melanie Matthews

Social media has the potential to enhance collaborative care, according to a new infographic by CitiusTech.

The infographic details which sites are accessed most for health related information, key healthcare social media indicators and powerful healthcare use cases driven by social media.

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. This expanded best-seller provides an overview of the social media tools healthcare organizations are using to connect, communicate, and collaborate with their patients, physicians, staff, vendors, media, and the community at large.

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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Behavioral Health Diagnoses Can Inflate Readmissions Rates, Hinder Self-Management

April 9th, 2015 by Cheryl Miller

Preliminary data from a Care Transitions Task Force found that when patients with behavioral health diagnoses are excluded from readmissions rates, those rates fall by nearly 4 percent, says Michelle Schneidermann, MD, task force member and Associate Clinical Professor of Medicine for the division of hospital medicine at the University of California, San Francisco, and Medical Director of the San Francisco Department of Public Health, Medical Respite and Sobering Center. Part of the reason for this is this patient population’s inability to follow through on self-management instructions once they leave the hospital.

Question: Among your discharge patients there’s a number of behavioral health diagnoses. Are there any considerations, or challenges to this patient population during care transitions, and any unique follow-up that your organization is doing?

Response: (Dr. Michelle Schneidermann) Yes, this patient population provides a very distinct challenge. The patients are challenged by so many other competing priorities, in addition to having a significant and severe mental health disorder, that it interferes with their ability to organize and follow through with the self-management requirements we place on them when they leave the hospital and their ability to manage chronic illness in general. So, from the patient perspective, it’s incredibly difficult.

From the systems perspective, although we are an integrated network health system, there are limitations on the number of outpatient behavioral healthcare clinics and providers. Plus, we don’t always have providers who are culturally concordant or language concordant, although the network is trying very hard to make that happen.

One of the things we’re working on right now is to tease out what our readmission rate looks like when we pull out all patients who have a behavioral health code. Just initial, very crude, back of the envelope calculations show a significant difference in our readmission rate.

When patients with behavioral health diagnoses are included, our hospital-wide, 30-day all-cause readmission rate is around 12 percent. When you remove patients with the behavioral health diagnosis, the readmission rate goes down to about 8.5 or 9 percent. Again, preliminary data, but it shows you the impact that this patient population has on readmissions and tells the story about the challenges that they personally face when they’re leaving the hospital.

cross-continuum care transitions
Dr. Michelle Schneidermann completed her primary care internal medicine training at UCSF and joined the UCSF faculty in 2003, where she is a member of the Division of Hospital Medicine at San Francisco General Hospital (SFGH). Through her inpatient clinical work and work with ambulatory programs, she has been able to directly witness the successes and challenges of patients’ transitions and generate feedback to the providers and systems that manage their care.

Source: Cross-Continuum Care Transitions: A Standardized Approach to Post-Acute Patient Hand-Offs

Infographic: The Realities of Patient Engagement

April 8th, 2015 by Melanie Matthews

Mobile health apps have the ability to help improve patient engagement and the patient experience, according to a new infographic Boston Technology.

The infographic examines the gaps in patient engagement and how mobile apps can close those gaps.

Population Health Framework: 27 Strategies to Drive Engagement, Access & Risk StratificationFaith-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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Home Health on Care Transitions Management: Focus on Post-Acute to Home Handoff

April 7th, 2015 by Patricia Donovan

With the hospital-to-home care transition deemed the most critical by half of healthcare organizations, home health sits on the front lines of care transitions management.

An overwhelming majority of home health organizations, which comprised approximately 10 percent of respondents to HIN’s 2015 survey on Care Transitions Management, have a care transition management program in place: 80 percent versus 67 percent overall, and of those that don’t, 100 percent intend to implement one in the next 12 months, versus 56 percent overall.

Contrary to overall respondents, this sector considers the hospital to post-acute care transition key (50 percent versus 24 percent overall) as well as the post-acute care to home handoff (50 percent versus 9 percent overall).

Heart failure is the top health condition targeted by home health organizations (87 percent of respondents, versus 81 percent overall). This sector also targets acute myocardial infarction, or AMI (62 percent versus 51 percent overall), and the frail elderly, a top concern for 75 percent of this sector versus 44 percent overall.

Half of home health organizations surveyed self-developed care transitions programs (50 percent versus 34 percent overall). Similarly to most respondents, programs include medication reconciliation (87 percent versus 75 percent overall) and transition/handoff training (87 percent versus 39 percent overall). This sector also relied on telephonic follow-up (87 percent 79 percent overall) in their care transition programs.

Transition coaches were primarily responsible for coordinating care transitions, according to 37 percent of home health respondents, versus 25 percent overall.

Some ways home health organizations improved transitions of care included creation of community partnerships with acute care facilities, development of post-acute networks, and collaborations with all clinical and hospice providers.

Successful strategies for this sector included separating data input from hands-on patient discharge paperwork so clinicians doing the transition could focus more on the patient, and not typing. Also, maintaining open communication with all staff and following up on communication with the patient and/or caregiver to ensure they transitioned appropriately into the new setting helped them to identify any concerns in the hopes of avoiding an unnecessary hospitalization.

Provider engagement remains the biggest challenge to this sector’s transition management efforts, say 37 percent of home health organizations, versus 13 percent overall.

Source: 2015 Healthcare Benchmarks: Care Transitions Management

2015 Healthcare Benchmarks: Care Transitions Management HIN’s fourth annual analysis of these cross-continuum initiatives examines programs, models, protocols and results associated with movement of patients from one care site to another, including the impact of care transitions management on quality metrics and delivery of value-based care.