Archive for the ‘Care Coordination’ Category

Infographic: State Team-Based Care Strategies for Medicaid-Eligible Women

December 20th, 2019 by Melanie Matthews

State Medicaid agencies provide a variety of health services to promote women’s overall health and improve birth outcomes, such as reducing infant mortality, according to a new infographic by the National Academy for State Health Policy.

The infographic highlights three programs aimed at improving maternal outcomes.

Proactive Care Management in a Top-Performing ACO: Closing Quality and Care Gaps in High-Risk, High-Utilization PopulationsAs one of 2016’s top 10 performing MSSP accountable care organizations, UT Southwestern Accountable Care Network (UTSACN) generated nearly $17.5 million in shared savings.

Proactive Care Management in a Top-Performing ACO: Closing Quality and Care Gaps in High-Risk, High-Utilization Populations divulges some of the secrets behind UTSACN’s success in the Medicare Shared Savings Program (MSSP) for ACOs. Winning strategies of the UTSACN ACO include a commitment to data analytics to inform programming and improve utilization and quality as well as holding its healthcare providers accountable for clinical and fiscal decisions. Click here for more information.

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Infographic: The Broken Healthcare Referral System

November 13th, 2019 by Melanie Matthews

Across the healthcare industry, it is generally agreed that in-network care coordination is important. However, with 19.7 million clinically inappropriate network referrals occurring each year, contradictions in referral behavior remain a concern, according to a new infographic by Evariant.

The infographic pinpoints shortcomings of the current healthcare referral system and highlights opportunities to solve these obstacles.

The release of the Centers for Medicare and Medicaid Services’ care coordination toolkit provides further evidence that care coordination is an integral part of the current healthcare delivery landscape. Whether part of the primary care office, emergency department or health plan, care coordinators are having a positive impact on both the clinical and financial outcomes for healthcare organizations.

2019 Healthcare Benchmarks: Care Coordination is a comprehensive analysis by the Healthcare Intelligence Network of care coordination settings, strategies, targeted populations, supporting technologies, results and ROI, based on responses from over 75 healthcare organizations to the May 2019 Care Coordination survey.

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Infographic: Care Transitions and Partnerships in Value-Based Care

September 9th, 2019 by Melanie Matthews

Strong payer-provider partnerships and a focus on care transitions creates a positive impact on patient experience and outcomes, according to a new infographic by naviHealth, Inc.

The infographic examines why healthcare organizations should focus on care transitions and how organizations are partnering to improve post-acute outcomes.

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®.

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Infographic: Your Pre-Admissions Path: Old & Rocky or New & Smooth?

August 21st, 2019 by Melanie Matthews

As the healthcare world grows increasingly interconnected, new regulations like Patient Driven Payment Model mandate patient-centered care, and data replaces rapport as the foundation of referral relationships—facilities’ care coordination processes are becoming more pivotal than ever. From beating out the competition for acute referrals to paving the way for better clinical outcomes, a modern method of managing care coordination unlocks benefits that extend far beyond the pre-admissions episode, according to a new infographic by Cantata Health.

The infographic looks at a traditional versus a modern care coordination process and highlights the potential results of each option.

The release of the Centers for Medicare and Medicaid Services’ care coordination toolkit provides further evidence that care coordination is an integral part of the current healthcare delivery landscape. Whether part of the primary care office, emergency department or health plan, care coordinators are having a positive impact on both the clinical and financial outcomes for healthcare organizations.

2019 Healthcare Benchmarks: Care Coordination is a comprehensive analysis by the Healthcare Intelligence Network of care coordination settings, strategies, targeted populations, supporting technologies, results and ROI, based on responses from over 75 healthcare organizations to the May 2019 Care Coordination survey.

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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.

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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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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.

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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®.

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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.

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