Archive for the ‘Care Coordination’ Category

Infographic: Managing Hemophilia Costs

May 17th, 2019 by Melanie Matthews

Hemophilia treatment costs can vary greatly depending on the severity of disease. Total annual costs up to or more than $1 million per year for individual patients are not uncommon, according to a new infographic by Optum, Inc.

The infographic examines how Optum Inc. is applying consistent management and holistic care coordination for patients with hemophilia.

2019 Healthcare Benchmarks: Reducing Avoidable Healthcare UtilizationMedicaid expansion programs, newly covered individuals under healthcare insurance exchanges, the rise of big data, and shifts in healthcare delivery models have influenced emergency department and hospital utilization.

2019 Healthcare Benchmarks: Reducing Avoidable Healthcare Utilization is a comprehensive analysis by the Healthcare Intelligence Network of how healthcare organizations define and address avoidable healthcare utilization. The report captures key actionable metrics on reducing avoidable healthcare utilization initiatives, challenges, case studies and innovative programming.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

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.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Infographic: Improving Patient Care through Clinical Integration

November 28th, 2018 by Melanie Matthews

Clinical integration plays a key role in the creation of meaningful connections and collaboration within the healthcare sector, according to a new infographic by Regis College.

The infographic examines the benefits of clinical integration and conditions that benefit from integrated care.


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.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Infographic: 6 Recommended Practices for Strengthening Care Transitions

November 21st, 2018 by Melanie Matthews

Poorly coordinated care transitions from hospitals to other care settings contributes to avoidable healthcare costs, according to a new infographic by Cureatr.

The infographic examines six best practices for improving care transitions.

The Science of Successful Care Transition Management: Leveraging Home Visits to Improve Readmissions and ROI A care transitions management program operated by Sun Health since 2011 has significantly reduced hospital readmissions for nearly 12,000 Medicare patients, resulting in $14.8 million in savings to the Medicare program. Using home visits as a core strategy, the Sun Health Care Transitions program was a top performer in CMS’s recently concluded Community-Based Care Transitions (CBCT) demonstration project, which was launched in 2012 to explore new solutions for reducing hospital readmissions, improving quality and achieving measurable savings for Medicare.

The Science of Successful Care Transition Management: Leveraging Home Visits to Improve Readmissions and ROI explores the critical five pillars of the Arizona non-profit’s leading care transitions management initiative, adapted from the Coleman Care Transitions Intervention®.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Guest Post: The Provider’s Responsibility for Building Patient Relationships

July 31st, 2018 by Dr. Delanor Doyle

A foundational element of healthcare is the relationship between a patient and their PCP.

One of the foundational elements of healthcare is, or at least should be, the relationship between a patient and their primary care physician (PCP). And yet, it seems many Americans are not fully utilizing their PCP and instead are turning to emergency rooms or urgent care clinics for non-urgent conditions and illnesses. In fact, only 9 percent of emergency department visits result in a hospital admission. This means it is likely that many of these cases could have been avoided by seeking the care of a PCP.

Emergency department visits not only result in hefty costs to the patient and their employer, but also create wastes of time and resources in the healthcare system. The impact in terms of costs, for the patients can have many down-stream consequences. In fact, a recent report by the U.S. Federal Reserve found that four out of 10 adults in the United States could not cover an unexpected $400 expense. In some cases, this amount can easily be reached for a single emergency room visit between out-of-pocket costs for the visit, medications and laboratory services —especially when dealing with out-of-network issues. Providers should work to keep patients out of emergency rooms and urgent care facilities and to emphasize the importance and purpose of the PCP in the patient’s healthcare journey.

Until the 1940s, about 40 percent of all physician visits were house calls and while today patients don’t have this same expectation, providers should treat patients with that same level of personalized, individual care that builds a strong relationship. Providers can consider implementing the following best practices with their patients:

Every Discharge Deserves a Follow-Up

In many cases the PCP is not the provider who admitted or cared for the patient while in the hospital. However, it is imperative that the PCP insist on receiving information about the patient’s admission, so that he or she can be a part of the discharge plan. The patient should be seen back in the practice within three to five days after discharge —even if they were seen just prior to going into the hospital. In fact, this should be scheduled for the patient prior to hospital discharge. Timely follow-up appointments have been associated with a decreased risk of readmission. A converse association also exists. A study published in Clinical Interventions of Aging found only half of patients discharged following heart failure had a follow-up appointment scheduled and the readmission rate was significantly higher in those that had no follow-up scheduled.

Follow-up appointments allow for the provider to engage or re-engage the patient and ensures the patient is aware of any care transition recommendations. Concerns regarding disease process, expectations and convalescence should be addressed at this time. Working to schedule all patients for timely follow-up post discharge eliminates the risk of the patient forgetting to schedule the appointments themselves. Many patients report a higher sense of satisfaction with the communication between themselves and their provider and with their overall care.

Encourage Virtual Care Options

For after-hours needs, do your patients know there are virtual care options they can use in lieu of going to the emergency room or urgent care clinics for non-urgent concerns? Many patients are simply unaware of these services or aren’t sure how to use them so they don’t consider it as an option. According to the National Business Group on Health, only 8 percent of employees utilize telemedicine services, yet the cost of healthcare benefits is expected to increase an average of 5 percent due in part to pharmaceutical costs but also to site of service issues as well. Spend a few minutes during the visit to educate patients on the services available as well as when to use them.

Promote Health Plan Resources

Unfortunately, many patients are also not familiar with the services or programs offered by their health plans. These materials are good resources for preventative care measures and offer proactive suggestions for patients. For example, their insurance provider might offer diabetes educational materials and resources. Most health plans have programs for diabetes and other chronic conditions. If members are encouraged to access the materials available online, telephonically and in print they might be more likely to seek out that information and if contacted by the health plan they will be much more likely to engage. It is important that patients begin to get a sense that the health plan and the providers are collaborating for the patient’s benefit.

We are still in a fee-for-service world but moving toward fee-for-value. This is being driven by the Centers for Medicare and Medicaid Services (CMS) and all the major health plans. To be successful in this new world, improved patient outcomes should be a major focus for providers. Strategies that engage the patient and simplify the healthcare experience when and where it is needed most are going to be produce the winners in this new era. The literature is replete with strategies that can produce population health success, but few are shown to be consistently correlated to economic success combined with improved patient satisfaction and outcomes. The exceptions have been those that employ heavy care coordination in a face-to-face venue and that address the social determinants of disease.

Fully leveraging these strategies is going to require the development of trust between the patient and provider so that patients know we are not just treating a disease but caring for the whole person. When that level of trust is reached it becomes easier to influence utilization of the PCP practice and other more appropriate levels of care instead of the ED. Similarly, it becomes easier to impact the readmission rate in one’s own panel of patients.

About the Author:

Dr. Delanor Doyle

Dr. Delanor Doyle

Dr. Delanor Doyle is the chief medical officer of Texas Health Aetna. Leveraging the strengths of two leading organizations, Texas Health Aetna is blurring the lines of traditional health care plans and health systems to create a truly integrated solution that’s simple to navigate and puts the member’s experience first. The local health plan is committed to providing affordable, high-quality health care services and delivering customized care to members throughout the Dallas-Fort Worth metroplex. For more information about Texas Health Aetna, visit www.texashealthaetna.com.

Infographic: Skilled Nursing Facilities Focus on Quality and Partnerships

July 13th, 2018 by Melanie Matthews

Focus on performing well in the CMS Five-Star Quality program has become a business imperative for skilled nursing facilities—it’s essential to keeping occupancy rates up, according to a new infographic by the Health Industry Distributors Association.

The infographic examines how skilled nursing facilities are working with the hospitals in their communities to reduce readmission rates and gain referral volume.

2018 Healthcare Benchmarks: Post-Acute CareValue-based healthcare payment models, such as clinical integration, shared savings, bundled payments, shared risk and full capitation, as well as the need to coordinate care across the acute and post-acute care (PAC) continuum, are reshaping the PAC landscape. And, with the start of Medicare readmission penalties for skilled nursing facilities starting in October of this year, PAC providers will continue to examine strategies for improving care quality and reducing costs.

2018 Healthcare Benchmarks: Post-Acute Care is the second comprehensive analysis of the PAC market by the Healthcare Intelligence Network, capturing such key metrics as PAC initiatives, strategies, challenges, tools used to manage PAC, results and ROI.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

10 Critical Care Coordination Model Elements for Medicaid Managed Care Members

May 17th, 2018 by Melanie Matthews

There are 10 critical elements of the care coordination model for Independent Health Care Plan (iCare) Medicaid managed care members, according to Lisa Holden, vice president of accountable care, iCare.

The first element and touchpoint for Medicaid managed care members is their care coordinator. “Every single one of our incoming SSI Medicaid members is assigned to a care coordinator,” Holden told participants in the May 2018 webinar, Medicaid Member Engagement: A Telephonic Care Coordination Relationship-Building Strategy, now available for replay. “That person is responsible for everything to do with that member’s coordination of care.”

Care coordinators are assigned to every Medicaid member and are responsible for engaging and coordinating member’s care needs.

“We want our care coordinators to make an initial phone call as early as a couple of days after the member is enrolled in our plan,” she said. “If the member is interested in having a conversation, we offer to conduct a health risk assessment. But if the timing isn’t right, then we offer to schedule another appointment. There’s no pressure except that we want them to feel engaged by us.”

Once completed, the health risk assessment forms the basis of an interdisciplinary individualized care plan created by the care coordinator with the member.

The care coordinator, who is a social worker by background, has access to a nurse, who is available for medically complex members, said Holden.

iCare also relies on health coaches. Health coaches are now teaming up with a care coordinator as much as, if not more than, the nurses are historically, Holden said.

“Our health coaches are literally assigned to work in the community to become very familiar with the resources that are available,” she added. “They are becoming steeped in the communities in which they serve. Each one is assigned to a neighborhood, and we’ve asked them, ‘Get to know the police. Get to know the fire. Get to know the food organizations and food pantries. Get to know the housing specialists in your area.'”

The health coaches also help the care coordinators locate difficult-to-contact members by being in the community as a boots on the ground force. They’re also focused on assessing and addressing social determinants of health.

“We really believe that health coaches are going to be the key to our success in this year and in years to come,” Holden explained.

In addition to the care coordinators, health coaches and nurses, the care coordination team includes two specialized positions…a trauma-informed intervention specialist and a mental health and substance abuse intervention specialist. “We brought those two specialties into this program for our Medicaid members because we know that there’s a high instance of behavioral health conditions, which usually has another diagnosis of alcohol and drug use, not always, but quite often. We wanted to have the team ready to engage the member,” said Holden.

Once the member is engaged, iCare’s care coordination team begins to identify unmet needs, she explained. “We want to know, ‘Is their life going well? Do they have appropriate medical care? Are they in a relationship with a primary care provider that they feel is co-respectful? Are they getting their answers to their questions?'”

To begin talking about medical needs, the care coordination team has to establish trust, said Holden. “We have to talk with the member in an honest way that reflects our respect for them and also engages them in order for them to tell us how they really feel.”

iCare uses the Patient Activation Measure tool to help identify where the member is in a spectrum of four different levels of activation. iCare then tailors its member engagement approach to build a trusting relationship and provide member education by recognizing where they are in their activation level.

Following up on preventive measures are key for the iCare care coordination model. Care coordinators reach out to members for care plan updates. The care plan has to be alive and very member-centric, said Holden. The health risk assessment is repeated each year and the care plan is updated based on those results.

iCare is also focusing on social determinants of health with the recognition that they impact a members’ health more than clinical care. Clinical care attributes to only about 20 percent of somebody’s health outcomes; the rest of that 80 percent is made up of by health behaviors, social and economic factors, and physical environment. “If we don’t get underneath those issues, we can ask for things to improve, but we’re going to see minimal success,” Holden added.

During the webinar, Holden also shared: how the care coordinators helps Medicaid members overcome barriers to care; seven rising risk/acuity identification tools; readmission prevention initiatives for high-risk patients; three programs aimed at reducing high emergency department utilization; and details on a Follow-to-Home program for members who are homeless. Holden also shared: details on language to use…and not to use…when engaging members; advice on the best time to connect with members by phone, such as time of day, specific days of the months; the role of the specialist interventionist compared to the care coordinator; and the background of iCare’s care coordinators and health coaches.

Click here to view the webinar today or order a DVD or CD of the conference proceedings.

Infographic: Seven Essentials Steps to Effective Care Coordination

April 30th, 2018 by Melanie Matthews

Understanding and removing barriers to health and coordination is the key to successful care coordination, according to a new infographic by Optum.

The infographic examines seven essentials steps to removing these barriers.

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, eight years later, 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.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Integrated Case Management Scripts Keep MSKCC Patient Care Team on Same Page

February 1st, 2018 by Patricia Donovan
Healthcare Scripting

MSKCC scripting improved the consistency of patient communication and staff efficiency.

To help ensure its patients receive consistent messages, Memorial Sloan-Kettering Cancer Center (MSKCC) has developed a series of scripts for use by its integrated case management team. Here, Laura Ostrowsky, RN, CCM, MUP, MSKCC director of case management, describes some scripting scenarios employed by the state-of-the-art specialty hospital.

There are a variety of ways we’ve done scripting. For example, there was a time when a case manager would meet with a doctor and the doctor would say, “I think we need to set up hospice for this patient.” The case manager then would go into the patient’s room and say, “I’m here to help you to set up your discharge plan. I know you’ll be going to hospice.”

And then the patient would say, “What are you talking about?”

One thing all case managers know is that when you go into a patient’s room, especially if someone told you they said something to the patient, you first must confirm what the patient understands about that previous conversation. If it turns out that they didn’t understand what you were told to talk about, then you don’t have that conversation. You go back to the staff member that sent you in there and discuss it. Perhaps you schedule a family meeting to discuss that issue.

We also developed scripts not only for preadmission staff, but for all staff trying to get approvals from insurers for high-cost medications and for procedures. We work with them to identify how to answer questions from the insurance company or insurance case manager so that those tasks can be handled by the doctor’s office or admitting department rather than by case management.

The approach of our length of stay reduction teams, while not exactly scripted, is concerned about consistency of message. The teams came up with the steps and planned the patient education material with the imperative that we never overestimate a length of stay, but rather err on the short side.

The imperative is that everybody speaks to the patient the same way. The case managers make a point to tell the team, “Don’t make promises we can’t keep.” That’s not exactly scripting, but it keeps everybody on the same page. For example, don’t tell a patient they are going to have plenty of help at home. Or that they will get home care and someone will be there every day, because you don’t know if that is going to happen.

Instead, you can say to the patient, “We are going to see if you are eligible for home care. I am going to send the case manager in to see you. They will check your benefits and go over eligibility. We will do our best to get you the services you need.”

Source: Integrated Case Management: Elevating Quality and Clinical Metrics with Multidisciplinary Team-Based Care

integrated case management

Integrated Case Management: Elevating Quality and Clinical Metrics with Multidisciplinary Team-Based Care details the framework and implementation of the service-based multidisciplinary program MSKCC adopted to ensure that the care it provides to more than 25,000 admitted patients each year is both cost-effective and cost-efficient.

Infographic: Medicare Home Health Beneficiaries

January 29th, 2018 by Melanie Matthews

Home healthcare patients are among the poorest, sickest and most vulnerable beneficiaries in the Medicare program, according to a new infographic by the Partnership for Quality Home Healthcare.

The infographic compares a traditional Medicare beneficiary with a Medicare home health beneficiary and factors that demonstrate why Medicare home health beneficiaries are financially vulnerable.

The Science of Successful Care Transition Management: Leveraging Home Visits to Improve Readmissions and ROI A care transitions management program operated by Sun Health since 2011 has significantly reduced hospital readmissions for nearly 12,000 Medicare patients, resulting in $14.8 million in savings to the Medicare program. Using home visits as a core strategy, the Sun Health Care Transitions program was a top performer in CMS’s recently concluded Community-Based Care Transitions (CBCT) demonstration project, which was launched in 2012 to explore new solutions for reducing hospital readmissions, improving quality and achieving measurable savings for Medicare.

The Science of Successful Care Transition Management: Leveraging Home Visits to Improve Readmissions and ROI explores the critical five pillars of the Arizona non-profit’s leading care transitions management initiative, adapted from the Coleman Care Transitions Intervention®.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.