Archive for January, 2019

Infographic: Blockchain Applications in Healthcare

January 30th, 2019 by Melanie Matthews

Healthcare industry leaders believe in the potential of blockchain and are more than willing to execute this technology to transform healthcare, according to a new infographic by TechJini.

The infographic provides a business case for blockchain in healthcare through a series of use applications.

2018 Healthcare Benchmarks: Telehealth & Remote Patient MonitoringArtificial intelligence. Automation. Blockchain. Robotics.

Once the domain of science fiction, these telehealth technologies have begun to transform the fabric of healthcare delivery systems. As further proof of telehealth’s explosive growth, the use of wearable health-tracking devices and remote patient monitoring has proliferated, and the Centers for Medicare and Medicaid Services (CMS) has added several new provider telehealth billing codes for calendar year 2018.

2018 Healthcare Benchmarks: Telehealth & Remote Patient Monitoring delivers the latest actionable telehealth and remote patient monitoring metrics on tools, applications, challenges, successes and ROI from healthcare organizations across the care spectrum. This 60-page report, now in its fifth edition, documents benchmarks on current and planned telehealth and remote patient monitoring initiatives as well as the use of emerging technologies in the healthcare space.

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Infographic: Conquer Small Physician Practice Billing Challenges

January 28th, 2019 by Melanie Matthews

Ninety-six percent of physician practice leaders report inefficient billing processes in their practices, according to a new infographic by Greenway Health.

The infographic examines how Mesa OB/GYN, a private practice with one biller, tackled substantial billing challenges.

Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM RevenueSince the January 2015 rollout by CMS of new chronic care management (CCM) codes, many physician practices have been slow to engage in CCM.

Arcturus Healthcare, however, rapidly grasped the potential of CCM to improve patient outcomes while generating care coordination revenue, estimating it could earn up to $100,000 monthly for qualified patients treated in its four physician practices—or $1 million a year.

Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM Revenue traces the incorporation of CCM into Arcturus Healthcare’s existing care management efforts for high-risk patients, as well as the bonus that resulted from CCM code adoption: increased engagement and improved relationships with CCM patients.

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Infographic: Five Dimensions of Healthcare’s New Front Door

January 25th, 2019 by Melanie Matthews

Healthcare investments in gyms and fitness centers may extend healthcare stakeholders’ reach beyond the pharmacy, clinic, or doctor’s office, into a setting where consumers are far more likely to independently manage and improve their physical fitness and well-being, according to a new infographic by Oliver Wyman.

The infographic examines the market segment of gym users and the benefit to providers who leverage this consumer access point.


Care Coordination in an ACO: Population Health Management from Wellness to End-of-LifeWhen acknowledging its position as a top-ranking Medicare Shared Savings Program (MSSP), Memorial Hermann is quick to credit its own physicians—who in 2007 lobbied for a clinically integrated network that formed the foundation of the current Memorial Hermann accountable care organization (ACO). Now, collaboration and integration continue to be the engines driving the ACO’s cost savings, reduced utilization and healthy patient engagement rates associated with Memorial Hermann ACO’s highest-risk population.

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.

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Infographic: 2019 Global Healthcare Outlook

January 23rd, 2019 by Melanie Matthews

With financial sustainability, care delivery, patient centricity, digital transformation, and regulatory compliance at the top of the agenda, healthcare sector leaders need to collaborate with all stakeholders—both within the healthcare ecosystem and those in converging industries—as they look to shape the future of healthcare and establish a sustainable smart health community, according to a new infographic by Deloitte.

The infographic reviews the current state of the global healthcare sector and explores trends and issues impacting healthcare providers, governments, payers, patients, and other stakeholders. It also outlines suggestions for these stakeholders as they seek to redefine the healthcare ecosystem and looks at examples from the market.

2018 Healthcare Benchmarks: Population Health ManagementAs the healthcare industry’s pace from volume-based to value-based healthcare payment models accelerates so does the demand for more effective management of population health. With the growth of these payment models, healthcare organizations are taking on more risk in terms of shared savings and shared risk arrangements and are investing heavily in programs to support population health. These programs are expanding in both scope of services and health conditions and disease states managed. With the help of advanced technologies in healthcare, this growth will only continue.

2018 Healthcare Benchmarks: Population Health Management is the fourth comprehensive analysis of population health management by the Healthcare Intelligence Network, capturing key metrics such as populations, health conditions and health risk levels targeted by population health management programs; risk stratification criteria; prevalence of value-based payment models supporting population health management programs; population health management processes, tools, workflows and forms; and program outcomes and ROI from responding healthcare organizations. Click here for more information.

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Infographic: Improving Care Quality with Patient Engagement

January 21st, 2019 by Melanie Matthews

Healthcare leaders should strategically distribute work among different care team members to enrich the end-to-end care experience of patients, according to a new infographic by Innovaccer.

The infographic examines patient engagement trends and the impact of patient engagement on care quality.

9 Protocols to Promote Patient Engagement in High-Risk, High-Cost PopulationsPatient-centric interventions like population health management, health coaching, home visits and telephonic outreach are designed to engage individuals in health self-management—contributing to healthier clinical and financial results in healthcare’s value-based reimbursement climate. But when organizations consistently rank patient engagement as their most critical care challenge, as hundreds have in response to HIN benchmark surveys, which strategies will help to bring about the desired health behavior change in high-risk populations?

9 Protocols to Promote Patient Engagement in High-Risk, High-Cost Populations presents a collection of tactics that are successfully activating the most resistant, hard-to-engage patients and health plan members in chronic condition management. Whether an organization refers to this population segment as high-risk, high-cost, clinically complex, high-utilizer or simply top-of-the-pyramid ‘VIPs,’ the touch points and technologies in this resource will recharge their care coordination approach.

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Infographic: Improve Physician Practice Efficiency in 4 Easy Steps

January 18th, 2019 by Melanie Matthews

Trying to manage a physician practice while keeping patients, staff, and physicians happy is challenging, according to a new infographic by Change Healthcare.

The infographic examines how practices can improve efficiency both pre- and post-visit.

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS SuccessA laser focus on population health interventions and processes can generate immediate revenue streams for fledgling accountable care organizations that support the hard work of creating a sustainable ACO business model. This population health priority has proven a lucrative strategy for Caravan Health, whose 23 ACO clients saved more than $26 million across approximately 250,000 covered lives in 2016 under the Medicare Shared Savings Program (MSSP).

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success examines Caravan Health’s population health-focused approach for ACOs and its potential for positioning ACOs for success under MSSP and MACRA’s Merit-based Incentive Payment System (MIPS).

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Guest Post: Medicare Advantage Environment Sparks Effective Risk, Quality and Care Strategies to Battle New Challenges

January 17th, 2019 by Jay Baker

Commercial insurers remain interested in competing for MA beneficiaries.

Projections show that national health expenditure growth is expected to average 5.5 percent annually to reach $5.7 trillion by 2026—higher than the projected increase in Gross Domestic Product (GDP). Fortunately, trends of insurers entering and exiting the program show that the Medicare Advantage (MA) market is stable yet dynamic—roughly the same numbers of plans enter/exit the program each year. Data shows that commercial insurers remain interested in competing for MA beneficiaries.

Given the benefits and challenges of value-based healthcare, stakeholders should gain a full understanding of Medicare Advantage (MA) plans, as well as strategies for optimizing this approach. What’s more, research indicates that the successes of MA are already having a positive impact on the broader healthcare delivery and payment landscape. In fact, fee-for-service Medicare spending has trended down in markets with high MA plan participation, indicating that doctors and other medical professionals operating in markets with high MA penetration adapt their practice patterns in alignment with MA plans’ strategies that control spending and use. This, in turn, helps to reduce use and costs for all their patients—including those enrolled in traditional Medicare and commercial/employer-sponsored plans.

MA plan coverage offered by private companies approved by Medicare provide all Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) coverage.

Optimizing the MA Plan Opportunity

An effective MA plan that significantly improves outcomes takes a whole patient approach and applies an end-to-end solution designed to enhance care coordination using analytics, in-home care, retrospective solutions and care management.

Value-based contracting generates cost efficiencies and improves clinical outcomes in MA. The challenge is to design MA plans and risk-bearing entities to remain sustainable. This requires innovative quality and risk adjustment programs to meet the growing demand for effective care strategies. For instance, MA plans can gain clinical insight into risk-adjusting conditions to enhance their traditional analytical platforms.

Understanding a Risk Adjustment Model

Risk adjustment is an actuarial tool used to calibrate payments to health plans based on the relative health of the at-risk populations. If insurers are limited in the extent to which premiums can vary by health status or other factors that are associated with health spending, risk adjustment ensures that health plans are appropriately compensated for the risks they enroll.

Keep in mind that most claims in fee-for-service Medicare are paid using procedure codes, which offer little incentive for providers to record more diagnosis codes than necessary to justify ordering a procedure. In contrast, MA plans have a built-in financial incentive since the current risk adjustment model was introduced that prompts providers to record all possible diagnoses. This is important because higher enrollee risk scores result in higher payments to the plan.

Consider MA plans that rely upon Physician Record Review (PRR), a two-stage retrospective chart review process from a 1) certified coder and 2) board-certified physician. These same plans also use Prospective Health Assessments (PHA) to gain a robust view of members and their care needs. Providers also rely on PHAs to lay the groundwork for developing more accurate reporting documentation, improving patient engagement and compliance, enhancing disease management, and reducing utilization.

This kind of full-spectrum, end-to-end approach to care helps providers identify gaps in care and manage plan members more productively. It also helps health plans that are serving as intermediaries, executing solutions and assuming risk. Fortunately, plan members gain the most form this approach because they are guided toward more preventive care and self-management early in the care process.

Risk-Based Contracting on the Rise

Medicare beneficiaries in fee-for-service Medicare are normally required to pay multiple premiums and deductibles and face a confusing array of cost-sharing arrangements for benefits and services from physicians, pharmacies, and hospitals.

In contrast, when a Medicare beneficiary enrolls in a MA plan it is usually a comprehensive, integrated health plan that includes richer benefits and solid catastrophic coverage. Unburdened of siloed benefits and payments, MA beneficiaries’ plan structure is simpler, and they are able to receive more coordinated care.

The value-based world is enlarging to the benefit of MA patients. In a recent move, CMS expanded its definition of “primarily health-related” benefits that private insurers are allowed to include in their MA policies. These extras include, for instance, air conditioners for people with asthma, healthy food, rides to medical appointments and home-delivered meals. This means MA beneficiaries will have more supplemental benefits and be better able to lead healthier, more independent lives.

Jay Baker

Jay Baker is the senior vice president of quality and risk adjustment solutions at Advantmed, LLC. He was most recently responsible for the ACA risk adjustment strategy and execution for UnitedHealth Group’s Optum division. His accomplishments included standing up an end-to-end service offering and exceeding revenue goals for the first two years of the program. As one of the founders of Dynamic Healthcare Systems, he was responsible for the original design for each of their 10 Medicare Advantage software modules. He is an ACA and Medicare Advantage industry leader and expert in policy, compliance, systems and plans operations.

Advantmed recently developed a white paper that discusses federal policy and the economics of Medicare. Advantmed, LLC is a healthcare solutions company dedicated to partnering with health plans, provider groups and risk-bearing entities to optimize risk adjustment and quality improvement programs. Our integrated and technology-enabled solutions improve health plan financial results and offer insights on health plan members. For more information on Advantmed’s solutions visit www.advantmed.com.

Infographic: Consumer Expectations Define Today’s Patient Journey

January 16th, 2019 by Melanie Matthews

The modern patient’s healthcare journey is made up of seven distinct phases, according to a new infographic by Stericycle Communication Solutions.

The infographic dives into how to capitalize on opportunities to enhance engagement throughout each phase—and to avoid the very real risks that could damage the patient experience.

Improving the Patient Experience: Engaging Front-line Staff for a System-Wide Action PlanUnityPoint Health has moved from a siloed approach to improving the patient experience at each of its locations to a system-wide approach that encompasses a consistent, baseline experience while still allowing for each institution to address its specific needs. Armed with data from its Press Ganey and CAHPS ® Hospital Survey scores, UnityPoint’s patient experience team developed a front-line staff-driven improvement action plan.

During Improving the Patient Experience: Engaging Front-line Staff for a System-Wide Action Plan a 45-minute webinar, now available for replay, Paige Moore, director, patient experience at UnityPoint Health—Des Moines, shares how the organization switched from a top-down, leadership-driven patient experience improvement approach to one that engages front-line staff to own the process.

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Infographic: Telehealth’s Big Impact on the Patient Experience

January 14th, 2019 by Melanie Matthews

The growth of telehealth is being driven by younger consumers who bring heightened expectations for technology solutions to the patient experience, according to a new infographic by Spectrum Enterprise.

The infographic looks at what’s driving telehealth expectations, challenges in deploying telehealth and how changing policies on telehealth reimbursement may help remove barriers to its growth.

Real-time remote management of high-risk populations curbed hospitalizations, hospital readmissions and ER visits for more than 80 percent of respondents and boosted self-management levels for nearly all remotely monitored patients, according to 2014 market data from the Healthcare Intelligence Network (HIN).

Remote Monitoring of High-Risk Patients: Telehealth Protocols for Chronic Care Management profiles a successful eight-year initiative by New York City Health and Hospitals Corporation’s (NYCHHC) House Calls Telehealth Program that significantly lowered patients’ A1C blood glucose levels.

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Infographic: Blueprint for Complex Care

January 11th, 2019 by Melanie Matthews

The United States spends more on healthcare than any other industrialized nation, and much of that spending is concentrated on a small percentage of individuals with complex medical, behavioral, and social needs, according to a new infographic by the Center for Health Care Strategies.

The infographic highlights recommendations for advancing the field, based on input from stakeholders across the country.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations Asked by its C-suite to quantify contributions of its multidisciplinary care team for its highest-risk patients, AltaMed Health Services Corporation readily identified seven key performance metrics associated with the team. Having demonstrated the team’s bottom line impact on specialty costs, emergency room visits, and HEDIS® measures, among other areas, the largest independent federally qualified community health center (FQHC) was granted additional staff to expand care management for its safety net population.

The Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations chronicles AltaMed’s four-phase rollout of care coordination for dual eligibles—a population with higher hospitalization and utilization and care costs twice those of any other population served by AltaMed.

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