Archive for November, 2015

Infographic: Patient-Driven Healthcare Through Mobile Technology

November 30th, 2015 by Melanie Matthews

The traditional healthcare environment is changing to one where information is handled more efficiently and consumers are taking more control of healthcare decisions.

A new infographic by Samsung examines how the use of mobile devices is changing healthcare consumer and provider behaviors and the benefits of mobile health.

From home sensors that track daily motion and sleep abnormalities to video visits via teleconferencing, Humana's nine pilots of remote patient monitoring test technologies to keep the frail elderly at home as long as possible. When integrated with telephonic care management, remote monitoring has helped to avert medical emergencies and preventable hospitalizations among individuals with serious medical and functional challenges.

In Remote Patient Monitoring for Enhanced Care Coordination: Technology to Manage an Aging Population, Gail Miller, vice president of telephonic clinical operations in Humana's care management organization, Humana Cares/SeniorBridge, reviews Humana's expanded continuum of care aimed at improving health outcomes, increasing satisfaction and reducing overall healthcare costs with a more holistic approach.

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Infographic: ACA’s Impact on Primary Care Practitioners

November 27th, 2015 by Melanie Matthews

Most primary care practitioners are reporting no change in their ability to provide quality care after the Affordable Care Act's (ACA's) major coverage provisions took effect in January 2014, according to a new Visualizing Health Policy infographic. Their opinions about the healthcare law are sharply divided along political party lines. Generally, primary care physicians have a more negative view of health reform's effect on the cost of patient care, but a more positive view of the law's impact on patient access to healthcare and insurance.

The infographic looks at the number of primary care clinicians who say they're seeing more newly insured patients or patients covered by Medicaid since the ACA's major coverage provisions took effect in January 2014.


Dual-Eligibles Demos: Early Results and Their Implications offers timely intelligence about efforts to provide integrated care programs for beneficiaries who are dually eligible for Medicare and Medicaid—so-called "dual eligibles"—a group of 9 million beneficiaries who account for more than $300 billion in annual health care spending.

Dual-Eligibles Demos: Early Results and Their Implications also includes a case study of the nation's largest CMS-backed duals demo in California—one that has many insurers participating, including national for-profit firms, large local non-profits and smaller plans.

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Infographic: Value-Based Models’ Impact on Humana’s Medicare Members

November 25th, 2015 by Melanie Matthews

Members treated under the care of providers in value-based reimbursement models with Humana experienced greater quality than those treated by providers in standard Medicare Advantage settings, according to a new infographic by Humana.

This infographic examines key performance indicators for these Medicare members, including inpatient admissions per thousand, emergency room visits per thousand, assessment rates for vulnerable populations, as well as the impact of these models on HEDIS measures, CMS Star Scores and healthcare costs.

Healthcare's inevitable shift from volume to value-based reimbursement is reflected not only in Medicare's alternative payment timeline but also in the waves of commercial payors now evaluating and rewarding providers on the basis of quality of care delivered rather than number of services provided. Adding to its roster of quality-centered payment models, CMS announced in 2015 plans to explore value-based reimbursement for Medicare Advantage and home health.

2015 Healthcare Benchmarks: Value-Based Reimbursement captures the healthcare industry's reaction to payment formulas for value-added care, and how this shift away from fee-for-service is transforming care delivery and quality.

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11 Value-Based Healthcare Reimbursement Trends to Know

November 24th, 2015 by Patricia Donovan

value-based reimbursement

One-fifth of healthcare companies experience annual savings of $100,000 to $500,000 from value-based payment models, finds a new Healthcare Intelligence Network Savings survey.

A survey by the Healthcare Intelligence Network on the growing trend of fee-for-value payments has documented healthy adoption rates, measured savings and steady gains in the area of preventive services related to fee-for-value formulas.

Seventy-one percent of survey respondents employ a value-based reimbursement or alternative payment model, according to the October 2015 survey. The study also determined that of those respondents not yet exploring a fee-for-value approach, 26 percent plan to do so in the coming year.

In assessing value-based payment formulas, 56 percent of respondents favor a pay-for-performance model, with 71 percent employing these models in contracts for commercial populations.

Despite healthy adoption of alternative payment approaches, one quarter of respondents say the infrastructure required to sustain value-based payment models is the reimbursement trend's most significant hurdle—greater even than the challenge of data integration or patient engagement, the survey determined.

In evaluating healthcare providers for value-based rewards, respondents most often review markers tied to quality (82 percent), hospital readmissions (56 percent) and patient satisfaction (56 percent) to determine payment, the survey found. The use of physician report cards to track provider performance was reported by 63 percent of respondents.

The shift toward fee-for-value has had the greatest impact on the area of prevention, respondents said, with 69 percent attributing a rise in preventive care to value-based reimbursement models.

Other survey findings included the following:

  • Twenty-one percent of respondents reported savings from value-based payment models as ranging from $100,000 to $500,000 annually.
  • Value-based payment contracts most often were executed for populations having more than 100,000 beneficiaries.
  • Fifty-six percent said the market lacks sufficient technological support for value-based payment models.

Download an executive summary of results from the Value-Based Reimbursement survey.

Infographic: Connecting the Dots of Care Engagement

November 23rd, 2015 by Melanie Matthews

Patient engagement opportunities exist at the point of care with unique, viable ways to drive audience engagement and conversation between patients, prescribers, and pharmacists, according to a new infographic by CMI/Compas.

This infographic discusses the multiple opportunities for delivering brand messages at the point of care.

Transformational patient-centered models emerging post-ACA are designed to succeed with a core of engaged, activated patients, yet enlistment of individuals in chronic care management, telehealth and other health enhancement interventions continues to challenge the healthcare industry.

2015 Healthcare Benchmarks: Patient Engagement documents strategies, program components, successes and challenges of engaging patients and health plan members in self-care from 133 organizations responding to the 2015 Patient Engagement survey by the Healthcare Intelligence Network.

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Infographic: Community Health Centers Transform to Medical Homes

November 20th, 2015 by Melanie Matthews

Community health centers provide essential health services to all patients, even those uninsured or unable to pay. When these centers operate as patient-centered medical homes, they can care for patients more efficiently and effectively.

A new infographic by the Commonwealth Fund looks at some of the key characteristics of a patient-centered medical home and the growth of community health centers now operating as medical homes from 2009 to 2013.

Having established a firm foundation over two decades of patient-centered care, the medical home model is poised for a makeover, expanding to medical neighborhoods and opening the door to specialists' enhanced role in care coordination—while embracing value-based compensation models that reward quality over quantity.

Those are just two of the trends explored in 2014 Healthcare Benchmarks: The Patient-Centered Medical Home, the Healthcare Intelligence Network's in-depth analysis of medical home adoption, tools, technologies, challenges, benefits and outcomes.

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Healthcare Drivers for 2016: Cost Management, Consolidation, Consumerism

November 19th, 2015 by Patricia Donovan
Healthcare Trends 2016

Healthcare data, both system-generated and consumer-reported, will continue to transform the industry in the year ahead, according to HIN's twelfth annual strategic planning session.

As healthcare heads into a presidential election year, cost management remains a key focus, with infomediation—the growing practice of mining healthcare data about cost, quality, and services—a major tactic against price pressure.

These were just a few predictions by thought leaders during an annual industry strategic planning session sponsored by the Healthcare Intelligence Network.

"The North Star now for healthcare, for all players in the system, is sustainable cost," said Paul Keckley, managing director of Navigant, during Trends Shaping the Healthcare Industry in 2016: A Strategic Planning Session, now available for replay. Multiple forecasts indicate U.S. health costs will increase between 5.6 and 6 percent a year over the next decade, he noted, with the nation's economy only recovering to about a 3 percent growth rate.

"Not to be missed is the pressure on price and therefore, the pressure on reducing operating costs and reducing the cost per episode of care," agreed Laura Jacobs, executive vice president of GE Healthcare Camden Group. "Where you're going to be in that cost value equation is a key strategic question and should be part of your board discussions about where you want to be on that spectrum."

To become leaner and more efficient, healthcare organizations are closing ranks in increasing numbers. Ms. Jacobs predicted that this "dance of consolidation" would continue among all stakeholders in healthcare, with intense scrutiny by the FTC of those collaborations.

Some payors already are well ahead of hospitals, doctors and service providers in the degree of consolidation, added Mr. Keckley. "These super regional systems of care are evolving as a result of this transition of volume to value."

At the moment, health plans are better positioned to profit from healthcare's pay for value formulas and the proliferation of shared risk arrangements, he continued, largely because of the huge data repositories they have constructed. "A very strong meta-analysis of [health plan] data becomes the anchor for shared risk arrangements," Keckley said, referring to the phenomenon known as infomediation. "The strongest asset health plans have is their data." Manipulation of this data to influence population health trends is fast becoming central to health plan operations, he said.

Another type of data the healthcare industry should be cognizant of is consumer-generated healthcare data, in the form of provider reviews on social media or within apps. "Consumer reporting on their experience with providers is not something that providers love," Ms. Jacobs said. "But just as we've experienced with other parts of consumerism, the impact of these kinds of venues will continue."

The panelists also shared thoughts on opportunities in the Medicare Advantage market, the blurring of lines between payor and provider, early returns from provider-sponsored health plans, and the anticipated evolution of primary care as the "epicenter" of healthcare.

Click here to listen to more predictions from Laura Jacobs.

HINfographic: Next Generation ACO Model

November 18th, 2015 by Melanie Matthews

One fifth of healthcare organizations are gearing up to participate in CMS' new 'Next Generation' ACO Model in the year ahead, according to 2015 metrics from the Healthcare Intelligence Network (HIN). In the Next Generation ACO model, participants can take on greater financial risk than those in current Medicare ACO initiatives, while also potentially sharing in a greater portion of savings.

A new infographic by HIN examines ACO participation by model type, the top challenges to ACO creation, current and planned ACO participation levels and success criteria.

2015 Healthcare Benchmarks: Accountable Care Organizations Even before CMS published its agenda for moving Medicare into value-based payment models like the accountable care organization (ACO), the number of public and private ACOs had exceeded 700, by a Leavitt Partners estimate. Already, more than 20 percent of healthcare organizations plan to participate in Medicare's latest accountable care model, the Next Generation ACO, in the coming year.

Support for CMS's latest alternative payment offering is just one of the ACO metrics contained in 2015 Healthcare Benchmarks: Accountable Care Organizations. HIN's fourth annual compendium of metrics on ACOs captures how ACOs are faring in an industry rapidly shifting away from fee for service to one that rewards quality, the patient and population experiences, and cost efficiencies. Click here for more information.

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4 Patient Engagement Strategies from a Top-Performing Medicare ACO

November 17th, 2015 by Patricia Donovan

The Memorial Hermann accountable care organization, a top Medicare Shared Savings Programs (MSSP) in terms of quality metrics and cost savings, is proud of the 74 percent patient engagement rate associated with its Complex Care program for individuals with complex health conditions. Here, Mary Folladori, RN, MSN, FACM, CMAC, system director of care management at the Memorial Hermann Physician Network and ACO, outlines four tactics that help to engage high-risk patients in self-management.

First, when we outreach to members during our telephone calls, we identify our team member as calling from Memorial Hermann. We have designed scripts; our team members introduce themselves as members of that particular person’s physician office. We have access to the physician clinic’s electronic medical record (EMR) as well as to the hospital EMR if that member has been hospitalized, so we’re able to represent and present knowledge of that member as part of that physician’s team. All of those combined elements help to build trust and to enhance those engagement rates.

Second, we also have learned over time that we need to offer multiple ways to work with members. Depending on the individual member and family situation, and depending on the risk and complexity of the member, we may have a team member go into one of our facilities to introduce themselves and set up a time for that initial outreach when a transition is being planned. We may meet members in their physician clinics if we have had difficulty outreaching to them. This allows us again to build that trust and rapport with a member, or build a face-to-face relationship base with the family. That has led to that higher telephonic outreach engagement rate of 74 percent.

Third, we also have been able to enhance our engagement rates because we have built very close relationships with care managers on the payor side in the past. Sometimes there might be a different type of relationship between the care or case managers on the insurance side, but in the world of our ACO, we have specifically and deliberately built very close relationships where we have worked out workflows. We get concurrent data reports for most payors so that we’re able to reach out to members in real time—within 24 hours after a discharge, for example. We also get real-time reports on gaps in care, and on frequent or high-cost utilizers.

In the past, we started out using claims that we received. That presented a challenge, because there still is a claims lag in the world we all work within. Now for the most part, we get information directly from our payor partners, which has enabled us to outreach and engage members in a real-time manner rather than three or six months after an acute episode has ended.

And finally, because we are embedded within our physician practices and so much a part of their culture, our physicians talk to their members at that point of care and let them know that a care manager by this name will reach out to them. They explain the reason for the program and encourage that member or family to participate.

Source: Care Coordination in an ACO: Population Health Management from Wellness to End-of-Life

http://hin.3dcartstores.com/Care-Coordination-in-an-ACO-Population-Health-Management-from-Wellness-to-End-of-Life_p_5092.html

Care Coordination in an ACO: Population Health Management from Wellness to End-of-Life details Memorial Hermann's carefully executed journey to quality and the culmination of the ACO's community-based care management program.

Infographic: mHealth Improves Medication Adherence, Lowers Costs

November 16th, 2015 by Melanie Matthews

Fifty percent of medications are not taken as prescribed, according to a new infographic by MediSafe.

The infographic also looks at the impact of three chronic conditions on the U.S. healthcare system and results from an IMS study on how MediSafe's medication management platform increased medication adherence.

mHealth Improves Medication Adherence, Lowers Costs

What's the cost of medication non-adherence? As high as $290 billion annually, according to one frequently cited estimate. An equally bitter pill to swallow is the dismal C+ grade in medication adherence earned in 2013 by Americans with chronic medical conditions, according to the first National Report Card on Adherence from the National Community Pharmacists Association (NCPA).

Fortunately, the healthcare industry is striving to improve performance in this area. 42 Metrics for Improving Medication Adherence: Interventions, Impacts and Technologies provides convincing evidence of the impact of nine key interventions on medication non-adherence—from the presence of pharmacists in patient-centered medical homes to medication reconciliation conducted during home visits.

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