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Appropriate ER Use May Be Only a Phone Call Away

March 8th, 2012 by Patricia Donovan

Want to reduce avoidable emergency room visits? Pick up the phone, say respondents to our latest Reducing Avoidable ER Visits e-survey — either to respond to callers to your health advice line or to contact patients following an ER visit or hospital stay.

Healthcare organizations who responded to the September 2011 survey report that nurses and doctors are staffing telephonic health advice lines in greater frequency to assess patients before they come to the ER unnecessarily and to educate them about appropriate venues of care. Consider these 2011 survey data:

41 percent of respondents offer nurse-only health advice lines;
The use of nurse-only advice lines has jumped 11 percent from 2010 to 2011;
8 percent of respondents offer nurse-physician health advice lines;
For 12 percent of respondents, physicians are called in to triage high-acuity calls;
Almost 39 percent take time during calls to nurse-only health lines to promote proxy and alternative health services such as an urgent care center, an opportunity second only to contacting patients within 48 hours of the emergency room visit.

The 134 respondents included hospitals, health plans, physicians and other healthcare organizations. A detailed analysis of the 2011 survey provides critical benchmarks that show how the industry is working to reduce avoidable hospital emergency department visits, including data on program components, challenges and benefits and ROI.

Patricia Curtis, RN, BSN, MBA, is director of operations for clinical care services for Optima Health, whose nurse advice line has evolved from a call center supporting a staff model HMO to a critical tool for improving the efficiency of healthcare use. Nurses on the phone work from clinical protocols developed in-house and reviewed by Optima’s physicians.

“We have nurses completing all the assessments. They may or may not ask all of these questions, but [the protocol] gives them a good guide and types of questions they should be asking — for example, things they should be looking for in the triage,” Ms. Curtis explains. “Based on responses to those questions, the [electronic] protocols will lead the nurse to decide what level of care the person needs.

“[Patients] can call any time day or night to ask questions, and there’s always a nurse here to answer those questions,” she continues. All protocols are reviewed at least annually and are available to physicians should they want to see them.

Optima Health was not a survey respondent, but Curtis presented an overview of its nurse advice line during a recent Healthcare Intelligence Network webinar, Maximizing the Nurse Advice Line To Ensure Appropriate Healthcare Utilization.

The second annual survey also found that phone calls out to patients — particularly those recently discharged from the ER or hospital — are making a difference. Key is making these calls within two days of discharge — to confirm that the patient has made a follow-up appointment, that he or she has seen the primary care provider and that there are no questions regarding the care plan provided at discharge.

And finally, more than two-thirds of respondents notify primary care providers when their patients visit the ER, part of an overall trend of engaging physicians in efforts to promote appropriate ER use. (A quarter of respondents say this is the most significant challenge of reducing avoidable ED utilization.)

Physicians successful in these efforts should be rewarded with incentives, said 80 percent of survey respondents, although one respondent feared that if incentives were offered, “providers may keep patients out of the ER even when to admit them would be medically prudent.”

Conversely, two-thirds of survey respondents did not want to see hospitals suffer financial penalties for avoidable visits to their emergency rooms.

Posted in Avoidable ER Use, Case Management, Healthcare Administration, Patient-Centered Medical Home, Transitions in Care | No Comments »

Meet Case Manager Stacey B. Hodgman: Patient Advocacy, Resource Utilization, Discharge Planning Keys to Success

February 29th, 2012 by Cheryl Miller

This month we provide an inside look at a healthcare case manager, the choices she made on the road to success, and the challenges ahead.

Stacey B. Hodgman, MS, RN-BC, CCDS, CPUM, District Director of Case Management for Kindred Healthcare, Board of Directors for the Case Management Society of New England

HIN: What was your first job out of college and how did you get into case management?

Stacey Hodgman: My first career out of nursing school was working for the VA Hospital in New Hampshire. I only worked there for a short time before transferring to a local acute care hospital where I worked the night shift to avoid having to place my three children in day care. About eight years out of nursing school, and in addition to working at the acute care hospital, I accepted a part-time job as a work site wellness nurse for a steel manufacturing plant. Although the job title was not ‘case manager,’ I found that my daily interactions with the employees were in fact all about case management. I was listening, evaluating, educating, promoting lifestyle changes and optimal health and found sincere satisfaction in this role. Building trusting relationships that helped the employees make healthy changes to their lifestyle was truly rewarding.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road.

About two years later, a new managed care organization (MCO) came to town. They were hiring case managers. My children were all in school and I loved the idea of working a ‘normal’ schedule and being home together as a family at night. So I accepted a position with the MCO and learned so much about case management, utilization review and the business side of healthcare, which I found fascinating. I couldn’t learn enough, fast enough.

In brief, describe your organization.

I am currently district director of case management for Kindred Healthcare, a national post acute for-profit healthcare company; I work in the Long-Term Acute Care Hospital (LTACH) division. Our company has over 120 LTACHs, 224 skilled nursing facilities (SNF), five inpatient rehabilitation facilities and 47 home care and hospice locations. We consider ourselves to be the provider of choice for patients, post acute care needs.

What are two or three important concepts or rules that you follow in case management?

First and foremost; patient advocacy. I tell new case managers that if they have a need to be popular, case management may not be the career choice for them. Case managers have an obligation to the patient first, then to the organization. Oftentimes, this can cause conflict between administration and case management.

Secondly, ensuring stewardship for both the patient and for the organization one works for. Simply said, this means ensuring that the patient receives the right care, in the right setting, at the right time. Continuing inpatient care in the hospital longer than a patient needs to be there not only places them at risk for hospital-acquired conditions, but also continues to utilize their hospital benefit and in the Medicare population, this is limited. Hospitals are often paid as a prospective payment system, meaning they receive one amount regardless of length of stay or resource consumption. The case manager helps ensure appropriate utilization of resources and timely discharge planning.

Lastly, that discharge planning is probably the case manager’s most important responsibility. Ensuring resources are in place, that patient/caregiver teaching has been completed, and that they are able to verbalize an understanding of the discharge plan are critical steps in facilitating a safe appropriate discharge plan. The role of the case manager is to facilitate this through the entire interdisciplinary team; ensuring pharmacy has reconciled medications, diabetic teaching has been completed by the nurse, equipment needs and use have been reviewed by physical or occupational therapy, care for a percutaneous endoscopic gastrostomy (PEG) tube or wound has thoroughly been reviewed with the patient and/or their caregivers. The case manager also ensures that there is a solid understanding of who the post discharge caregivers are, what appointments need to be made or kept and a phone number to call if there are any issues that arise post discharge from the hospital. Not only is thorough discharge planning critical to patient safety, but also to preventing rehospitalizations.

What is the single most successful thing that your organization is doing now?

We continue to improve our efforts with care coordination and care management as we strategize to become the post acute care provider of choice for our market areas in the country. We are working with the Pioneer ACOs to identify ways we can help ensure progression of care through the continuum and reduce readmissions. This is an exciting time for us, as it is for our nation, as we embark upon a new healthcare delivery system.

Do you see a trend or path that you have to lock onto for 2012?

It is critical that we do not lose sight of what is happening with healthcare reform, and continually plan for the effects it will have on balancing patient outcomes through care transitions along with pay for performance and changes to provider reimbursement methods.

What is the most satisfying thing about being a case manager?

There are so many potential answers to this question! But personally, I would say that as a case manager, I learn something new every day of my practice, that it is continually both challenging and rewarding and there is never a day where I look at the clock and say ‘It’s only 3:00?’ On the contrary, I look at the clock and say ‘It’s already 3:00?!’

Where did you grow up?

I was born and raised in Boston, Massachusetts on the North shore. Being near the sea is something I would never sacrifice!

What college did you attend? Is there a moment from that time that stands out?

I attended Rivier College in Nashua, NH for my undergraduate degrees and George Washington University for my Master’s degree. The most important thing I took away from my master’s program was gaining an understanding of the value of other’s perspectives — perception is reality — and the extremely positive impact that has had on my world view.

Are you married? Do you have children?

My husband and I will be celebrating our 30th wedding anniversary this year. We have three children in their 20’s whom we are very proud of; one is an attorney, one is a teacher, and one is a nursing student.

What is your favorite hobby and how did it develop in your life?

My absolute favorite hobby is travel. I have created a ‘bucket list’ of things I would like to do, places I would like to visit. Hopefully, Italy and Hawaii will be next on our itinerary! I also enjoy research, writing and have an interest in historical fashion trends.

Is there a book you recently read or movie you saw that you would recommend?

I am currently reading ‘Transforming Ourselves and the Relationships that Matter Most’ by Lisa Oz, wife of Dr. Mehmet Oz. I enjoy ‘self-help’ books and always look for ways to better understand human behavior and relationships. As a case manager, it is imperative that we understand human behavior and how we can help influence patients to make lifestyle changes that they want to make while promoting optimal health. Relationships define us both personally and professionally and understanding how to make the best of each one can only lead to a happier, more fulfilling life.

Any additional comments?

I would be remiss to let this opportunity to ‘add a comment’ go by without espousing that I believe case management is one of the top professions for nurses and social workers. Patients need case managers to help them navigate the ever-changing world of access to healthcare and other resources. It is a very rewarding career that is always challenging, never boring and always manages to bring a tear of joy along with those of sadness as we continually advocate and empathize with our patients and families.

Posted in Avoidable ER Use, Behavioral Health, Case Management, Case Manager Profile, Disease Management, HIN Blog, Healthcare Costs, Hospital Readmissions, Reducing Readmissions, Uncategorized | No Comments »

CMS to Release Stage 2 Meaningful Use proposals

February 27th, 2012 by Cheryl Miller

CMS and the Office of the National Coordinator for Health IT have just announced proposed regulations for Stage 2 Meaningful Use and Medicare and Medicaid EHR Incentive Programs.

Incorporating recommendations from the Health IT Policy Committee, they stress the need for hospitals and physicians to improve quality and efficiency through HIT. The rules focus on increasing the electronic capturing of health information in a structured format, and increasing the exchange of clinically relevant information between providers of care at so-called “care transitions.”

At this time of writing, some of the new Stage 2 recommendations will include the following: the percentage of orders entered via computerized physician order entry (CPOE) will rise from 30 percent to 60 percent and include medications, labs and radiology; E-prescribing in the emergency department will increase from 40 percent to 60 percent; and recording objectives, such as problem lists, vitals and smoking status will increase from 50 percent to 80 percent.

The proposed Stage 2 regulations will keep some Stage 1 criteria unchanged, revise others, and include new requirements. Once published in the Federal Register, there will be a 60 day comment period; these regulations are expected to be released this summer.

In related news, the use of HIT by hospitals and physicians has more than doubled in the last two years and CMS reports that nearly 2,000 hospitals and more than 41,000 doctors have received $3.1 billion in incentive payments for ensuring meaningful use of health IT, particularly certified EHRs. EHR incentive payments can total as much as $44,000 under the Medicare EHR Incentive Program and $63,750 under the Medicaid EHR Incentive Program.

Want to know the secrets to launching a successful ACO pilot program? Thomson Reuters has published a report showing four key metrics that can predict success; the first metric is the number of attributed members. The others are detailed in this issue.

And unfortunately, there is no secret formula to reducing avoidable hospitalizations; according to a new study from Delta Health Technologies, which was based on data from more than 1,000 homecare agencies across the U.S., while most agencies are taking steps to reduce avoidable hospitalizations, with patient care a strong concern, there was no one magic formula for success in this area. But there were a number of findings on successful hospitalization reduction strategies.

And don’t forget to participate in our latest e-survey: our third annual Healthcare Case Management survey. Participants receive a free, downloadable executive summary of the results once compiled.

Posted in Accountable Care Organizations, Avoidable ER Use, Case Management, Health IT, Healthcare Costs, Uncategorized, e-Health | No Comments »

Health Insurers Must Provide “Plain English” Summaries of Benefits, Coverage

February 13th, 2012 by Cheryl Miller

Transparency and clarity are the objectives in HHS’s “Plain English” ruling on health plan benefits and coverage. Under the rule, health insurers must provide consumers with simple, understandable summaries about their plans. Roughly 150 million Americans have private health insurance today, and should benefit from the ruling. More on this in our feature story.

Transparency is also a key objective in CMS’s new data for its Hospital Compare Web site consumers can now access hospital infection rates at the more than 4700 hospitals listed. According to the CMS, hospital-acquired infections result in thousands of deaths each year and nearly $700 million in added costs to the U.S. healthcare system.

Healthcare costs are key to a recent study from Virginia Commonwealth University, which finds that the managed care medical home for the uninsured will help curb costs and reduce ER visits for the uninsured. The study, which focused on nearly 27,000 uninsured adults over a seven-year period, found that when they had access to regular healthcare their ED visits and inpatient admissions declined, while their primary care visits increased. Researchers concluded that savings in healthcare costs were cut by nearly half.

And lastly, costs are also key to a recent Rand Corporation study on declining prescription drug costs. While costs on brand name drugs have decreased because of increased purchases of generic drugs, drug costs in general remain a hardship for many American families.

Posted in Accountable Care Organizations, Avoidable ER Use, Behavioral Health, Patient-Centered Medical Home, Prescription Drugs, Reducing Readmissions | No Comments »

Snowboarder Video As Much About Miracles as Helmet Safety

January 24th, 2012 by Patricia Donovan

Spoiler: This video has a happy ending. But not all athletes participating in extreme sports are so lucky. Last week’s tragic death of Canadian freestyle skier Sarah Burke underscores the physical risks these athletes face each time they “strap in.”

The fact remains that in 2009, hospital emergency rooms, doctors’ offices, and clinics treated 353,346 injuries related to these winter sports activities, according to a position paper by the American Academy of Orthopedic Surgeons (AAOS). The medical, legal, work loss and pain and suffering costs were more than $9.28 billion.

Know any “shredders” who think helmets aren’t cool? You might want to share this video with them.

The newly released film Moving Forward chronicles the recovery to date of Danny Toumarkine, a professional snowboarder from New Hampshire who suffered a traumatic brain injury (TBI) while snowboarding in Montana on a film trip in January 2011. (Full disclosure: My nephew Tom is the human greeting card in the video.) After a grueling year of multiple brain surgeries, physical rehabilitation and sheer determination, Danny was able to return to the slopes to “ride” this month.

Danny wasn’t wearing a helmet at the time he was injured, but this video is a convincing argument for the use of “brain buckets” in any type of riding. Sarah Burke was, and there is no indication at this time that equipment played any part in her injury and subsequent death. According to the AAOS position paper, the National Ski Patrol recommends wearing a helmet while skiing or snowboarding:

Studies show that helmets offer considerably less protection for serious head injury to snow riders traveling more than 12-14 mph. Safety and conscientious skiing and riding should be considered the most important factors to prevent injury, while helmets provide a second line of defense against head injuries.

Snowboarders face greater risks, the paper continues:

The 1999 CPSC evaluation of snow skiing and snowboarding-related head injuries found that snow boarders are 30 percent more likely to have a significant head injury than skiers. One of the most common causes of injury is collision with fixed objects, such as trees. More than 40 percent of the annually reported snow skiing and snowboarding-related head injuries could have been prevented or minimized with helmet use.

And even for helmet-wearing athletes, speed is a considerable factor in the severity of a head injury:

The purpose of the helmet is to partially absorb the force and dissipate the energy of blunt trauma in an effort to protect the head. While helmets do not decrease the risk of injury, they can decrease the severity. A study found 15 skull fractures among 27 fatal head injuries. Six of these fractures were depressed, suggesting that protective gear may be of benefit. Several studies in Sweden show that the use of helmets has reduced head injuries by approximately 50 percent.

More detail on Danny’s yearlong struggle is chronicled in the Danny is the Bomb blog created by his brother Conor to keep friends and family abreast of Danny’s condition, to accept donations for Danny’s medical expenses and to raise helmet and TBI awareness in action sports.

Posted in Avoidable ER Use, Healthcare Costs, Wellness/Prevention | No Comments »

Two Medical Home Approaches Behind $1 Billion in N.C. Medicaid Savings

January 9th, 2012 by Patricia Donovan

Aggressive care management and preventive care saved North Carolina Medicaid nearly $1 billion over four years, according to a new analysis by Milliman Inc., a national healthcare consulting firm.

This latest report of savings in the Tar Heel State from patient-centered medical homes (PCMH) links the cost reductions to reduced hospital admissions, readmissions and emergency room visits, many of which are avoided when patient care is managed more efficiently.

The savings update was announced in a press release this week by the office of the state’s office governor, Bev. Perdue.

To provide medical homes, the state continues to partner with the Community Care of North Carolina (CCNC), a nonprofit group of local healthcare provider networks that provide and coordinate care for Medicaid recipients. The 14 regional CCNC networks since 1998 have pooled their resources for technological and administrative purposes, which not only saves operational costs but also provides opportunities for cooperation and collaboration throughout the networks.

With financial support from The Commonwealth Fund, CCNC has created a 16-module toolkit on constructing a medical home approach for vulnerable and high-cost populations.

The modules span everything from program development and rollout to IT support and informatics to establishing a network pharmacist program. There are also modules dedicated to a pregnancy medical home, integration of behavioral health and other populations.

CCNC has also created a workbook and resources for organizations pursuing recognition as a patient-centered medical home.

The Milliman report found that the key to the success of medical homes approach is a strong emphasis on preventative care, and aggressive care management. Although the cost of frequent office visits and treatment of newly diagnosed conditions adds to program costs initially, the reduction of emergency room visits and hospital admissions, as well as capturing of efficiencies and improving quality of care, results in significant savings and better health for the recipient.

The report by the San Diego-based accounting firm examined the impact of the state’s support for primary care medical homes – a system to coordinate healthcare for Medicaid recipients. Milliman’s report, which was required by the General Assembly, found that recipients with a medical home get better care and consumed fewer Medicaid resources than those who lack a medical home. From fiscal year 2007-2010, N.C. Medicaid avoided spending $984 million by having 1.1 million of its members enrolled into medical homes. In just the last two fiscal years of the study – 2009 and 2010 – $677 million was saved.

As N.C. Medicaid enrolled higher numbers of its members into a CCNC medical home, Milliman found annual savings increased—$103 million in fiscal year 2007 (July 1, 2006-June 30, 2007); $204 million in FY 2008; $295 million in FY 2009; and $382 million in FY 2010.

Milliman also reported that N.C. Medicaid is on a successful path to decrease cost by enrolling aged, blind or disabled (ABD) members into a medical home. Those Medicaid populations are generally the least healthy overall and costliest to treat. Enrollment into medical homes initially would add to the cost of caring for them but pays off in the long term. Indeed, Milliman found that in FY 2006, medical home enrollment of ABD populations cost the state an additional $82 million. But by FY 2010, enrollment of ABD Medicaid recipients into medical homes had paid off with the state avoiding $53 million in costs.

Posted in Accountable Care Organizations, Avoidable ER Use, Case Management, Disease Management, Healthcare Costs, Patient-Centered Medical Home | No Comments »

Hospital Initiative, GE-Microsoft Collaboration Target Healthcare-Acquired Conditions

December 19th, 2011 by Cheryl Miller

Hospitals are the targets of two of our stories this week: an initiative and collaboration both aimed at reducing the millions of preventable injuries and complications arising from hospital-acquired infections (HAI.) Ironically, this refuge for the sick is making people sicker; in the United States alone, an estimated 1.7 million HAIs occur annually, resulting in $35 billion in additional healthcare costs, and the loss of nearly 100,000 lives. As we reported in an earlier story this year, a University of Maryland report found that nearly half of the hospital rooms of patients who tested positive for a multi-drug resistant bacteria were contaminated with the bacteria.

In response to this, hospitals across the country will now have the resources and support to reduce HAIs: the HHS has launched a new initiative called the Hospital Engagement Network. Part of the Partnership for Patients initiative, a nationwide public-private collaboration to improve healthcare, $218 million will be awarded to 26 state, regional, national, and hospital system organizations to help develop learning collaboratives for hospitals and provide a wide array of initiatives and activities to improve patient safety.

And a new collaboration between GE Healthcare and Microsoft is tackling this problem by pulling together data from disparate IT systems and identifying those patients most at risk for a given HAI. Hopefully their solutions will enable healthcare organizations to more effectively deploy their resources and deliver better care at lower costs.

And on a local level, a new ER unit designed solely for seniors is in place in HIN’s backyard, at New Jersey’s Monmouth Medical Center. To ease the increasingly complex needs of those 65 and up, the unit has special age-related features like wall sconces with dimmers and floor lighting to prevent falls. More in this issue.

In other news, a new study shows that disease registries can improve health outcomes and save the United States billions of dollars. Research on 13 registries in five countries, including the United States and Sweden, shows that these tools are becoming even more important under healthcare reform as payments for care are linked to effective treatments. According to our 2011 Survey on patient registries, 68 percent of respondents are using registries to improve care quality.

And lastly, a new report from Deloitte reveals that the majority of physicians do not think that PPACA will reduce costs by increasing efficiency, and they are predicting a continued shortage in primary care physicians as they seek administrative roles in health plans, hospitals and other settings.

These stories and more, in this week’s issue of Healthcare Business Weekly Update.

Posted in Accountable Care Organizations, Affordable Care Act, Avoidable ER Use, Disease Management, Health IT, Healthcare Administration, Healthcare Costs, Healthcare Trends, Hospital Readmissions, Transitions in Care, Uncategorized | No Comments »

5 Key Trends for Physicians in 2012

December 12th, 2011 by Cheryl Miller

More than half of today’s physicians believe that healthcare reform will not improve patient care, according to a new trends report from the Physicians Foundation. The changing healthcare landscape is also pushing the majority of physicians to leave primary care practices for hospitals and group practices. These and other trends detailed in this issue.

Children with special healthcare needs are less likely to receive care that meets the criteria for having a medical home, according to a new national report from the Health Resources and Services Administration (HRSA), the first such report on this segment of the population and its counterparts: children without special needs. These children are also being exposed to less than ideal conditions at home; secondhand smoke and poor nutrition are just two situations cited in the report, which based their data on a national survey of more than 90,000 children in the United States.

Depression and diabetes can trigger dementia within three to five years of diagnosis, say researchers from the University of Washington and Kaiser Permanente. Contributors to the study, among the first and largest to date to examine dementia in diabetes patients with and without depression, hope these findings will ultimately slow the advent of dementia.

The CMS has issued a final rule that will give qualified organizations access to health claims data that can help them identify high quality healthcare providers, or create online tools to help consumers make educated healthcare choices. The final rule makes a number of important changes from the original proposed rule, one of them being that data is less costly than previously thought for qualified entities.

And we wanted to make you aware of our new complimentary e-book on the use of embedded case managers in healthcare, a trend embraced by Geisinger, Aetna, CDPHP, Advocate Physician Partners, Marshfield Clinic, Bon Secours and others. This downloadable e-book provides some early metrics on the emerging trend of placing case managers alongside care teams in physician practices and describes some of the benefits that can result.

These stories and more in this week’s issue of Healthcare Business Weekly Update.

Posted in Accountable Care Organizations, Affordable Care Act, Avoidable ER Use, Behavioral Health, Healthcare Trends, Patient-Centered Medical Home | No Comments »

Got an Idea? CMS Offers $1 Billion in Health Care Innovation Challenge

November 28th, 2011 by Cheryl Miller

The CMS continues to reward innovation in healthcare; the latest initiative, the New Health Care Innovation Challenge, plans to award up to $1 billion in grant money to organizations that come up with creative ways to deliver healthcare, improve care and lower costs. The agency will take notice of projects that can be up and running within six months and that can hire, train and deploy workers rapidly. Funded by the PPACA, it’s a push for both creative healthcare solutions and increased healthcare job opportunities in as short amount of time as possible, contrary to the Innovation Advisors initiative launched in October, which seeks healthcare solutions over a year long, labor intensive period. All segments of the healthcare industry are encouraged to apply for the Innovation Challenge; December 19th is the cut off date for LOIs.

A quick, innovative, effective solution is also needed to alter the latest statistics on diabetes furnished by the IDF on World Diabetes Day (November 14th): studies show that one adult in 10 will have diabetes by 2030. Far too many are already afflicted with the preventable disease, including 78,000 children suffering with type 1; this despite the fact that the greatest number of diabetics fall within 40 to 59 years of age. The IDF is hoping that continued international awareness of this problem will help; and the agency is in the midst of a five-year campaign to promote diabetes education and prevention programs. Ironically, the CMS cited one health system that worked with community partners to decrease the risk of diabetes with nutrition programs as inspiration for its Healthcare Challenge initiative. Food for thought.

Another area of concern is the number of seniors receiving the wrong medication during their home healthcare visits. The Journal of General Medicine recently published a study stating that nearly 40 percent of patients 65 and over are prescribed potentially inappropriate medications (PIMs) at rates three times higher that patients who visit a medical office. Some of the blame can be placed on our fragmented healthcare system, researchers said: home health-based patients see multiple physicians who don’t communicate with each other, resulting in the wrong medication. Perhaps most troubling about this study is that the majority of these patients are taking 11 medications on average, and nearly half of them are taking at least one PIM, researchers say.

And lastly, one quick fix that should boost care access for patients: a new clinical affiliation between CVS Minute Clinics and Emory Healthcare. The stand alone clinics are open seven days a week in select areas throughout metropolitan Atlanta and have nurse practitioners on hand to administer wellness and preventive services and tend to common family illnesses. Patients who need care not provided at the clinics will be referred to Emory Healthcare. Both CVS and Emory hope to streamline the process with the use of EMR systems. These stories and more in this week’s issue of Healthcare Business Weekly Update.

Posted in Accountable Care Organizations, Avoidable ER Use, Bundled Payments, Disease Management, Health IT, Healthcare Costs, Healthcare Trends, Hospital Readmissions, Uncategorized, Wellness/Prevention | No Comments »

Mini Medical Homes Open Door to Disease-Based Patient-Centered Care

November 22nd, 2011 by Patricia Donovan

Call it Medical Homes 2.0: disease-specific ‘mini’ medical homes for high-risk, high cost patients with chronic diseases.

“We do see a trend right now with the medical home; especially in the Medicare area where the patient is assessed up front,” noted Steve T. Valentine during HIN’s eighth annual healthcare industry forecast. This approach generally focuses on but is not limited to the ‘big five’ chronic diseases: ischemic heart disease, diabetes, COPD, asthma and heart failure, Valentine said.

“For example, let’s just pick diabetics and move them into their own mini medical home. They would have a multidisciplinary team focused around those complex patients,” said the president of The Camden Group. “We see that as a bigger change that’s beginning to come. This model does help with throughput in terms of primary care in the medical home.

“A focus on population management and delivering superior value become critical strategies as we begin to move forward,” Valentine predicted during the healthcare publisher’s annual industry forecast.

The disease-specific approach is gaining followers as the industry navigates away from a fee-for-service environment toward a more evidence-based, protocol-driven approach that rewards not only clinical outcomes but an organization’s ability to deliver value-based healthcare.

HealthCare Partners Medical Group of California, which is experiencing its lowest hospital readmission rates in its history, uses a predictive modeling tool, a dollar tool predictor, and a hierarchical condition categories (HCC) or HCC-like modeling tool to risk-stratify their patients before placing them in the medical home that best suits their needs, explains Dr. Stuart Levine, corporate medical director.

This could be hospice and palliative care, or a home care program where teams of physicians, nurse practitioners, case managers and social workers take care of chronically frail patients at home, meeting all of their needs, Dr. Levine said.

HealthCarePartners also has a medical home program for patients with end-stage renal disease (ESRD). “All patients are seen at the dialysis center, and that’s where their medical home is. They no longer come into offices. They are seen by nurse practitioners with backup nephrologists.

“They’re not only getting their renal disease managed, but way more importantly, they’re getting all their primary care needs met.”

Some diabetes-focused medical homes are being constructed with a little help from corporate sponsors. The GE Foundation recently awarded a $3M grant to establish a Care Management Medical Home Center for 10,000 Miami Dade patients suffering from chronic diabetes and its costly and debilitating side effects. The grant is part of the GE Foundation’s Developing Health initiative.

The grant will enable Health Choice Network of Florida and its seven participating health centers to provide a centralized model staffed with medical professionals who will assist the health center teams in providing high quality, effective and efficient care management services that will decrease costly hospitalizations and emergency room visits.

In addition to the new jobs the funding will add, the center will leverage existing data warehouse infrastructure and electronic medical records to deploy real-time disease-specific patient panels, identify health trends and expects to improve diabetic patient outcomes by 10 to 20 percent in the first year.

The Camden (N.J.) Coalition of Healthcare Providers and the Cooper Foundation will receive $3.45 million over five years from the Bristol-Meyers Squibb Foundation to strengthen community-based components of its Camden Citywide Diabetes Collaborative care model by focusing on patient self-management, education and support, care coordination, food access and physical activity programs, and behavioral health and community engagement activities in order to bend the curve of the diabetes burden and healthcare costs in the city.

One of the goals of the diabetes collaborative is to Increase the capacity of community-based, primary care practices to provide comprehensive, proactive care to their patients with diabetes.

The Camden collaborative was one of eight organizations to receive grants from the Bristol-Meyers Squibb Foundation grants.

The mini medical home approach is not limited to the big five chronic diseases. Last week, Priority Health and Cancer and Hematology Centers of West Michigan (CHCWM) announced their intention to jointly explore an innovative oncology patient-centered medical home. The goal of the oncology medical home is to integrate and coordinate the many office visits, medical professionals, high-tech services and care decisions encountered by cancer patients to help streamline their care while ensuring better outcomes, Priority Health said in a press release.

“This project is a natural evolution of our extensive experience with medical homes,” said John Fox, M.D., Priority Health’s associate vice president of medical affairs. “Cancer patients experience complex medical needs and rely on an extensive network of interdisciplinary healthcare specialists. Having a medical home can ensure cancer patients receive optimal care.”

Both organizations have agreed to payment reforms and care enhancements. Under this new model, oncologists will be paid a care management fee and will share in savings resulting from reductions in emergency room visits, imaging and hospitalizations. Current fee structures pay physicians based on the costs of drugs administered, which results in higher payments for more costly drugs, not necessarily the physician’s time, expertise or resource utilization.

The care management fee will go directly for patient support services, such as end-of-life and financial counseling, case management, medication therapy management, survivorship programs and social work services.

Posted in Avoidable ER Use, Bundled Payments, Disease Management, Patient-Centered Medical Home, Physician Practices, Reducing Readmissions | No Comments »

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