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The Case Management Monitor is Here!

June 17th, 2011 by Cheryl Miller

Yes, it’s here – our inaugural Case Management Monitor. It’s HIN’s newest bi-weekly e-newsletter, dedicated to providing the latest news, tools and trends in the healthcare case management arena.

And it’s arrived not a moment too soon. The role of today’s healthcare case manager is constantly evolving, moving beyond the health plan office to co-location with primary care physicians, hospital discharge planners and long-term providers.

Not only are more healthcare organizations using case managers, but the practice of embedding them at the point of care is becoming the norm, as we saw in our second annual Healthcare Case Management survey, conducted in January 2011. In just the last year alone, the number of case managers working in hospital admissions offices nearly doubled. And embedding case managers in emergency departments is becoming a critical part of many hospitals’ case management programs, proving beneficial both clinically and financially. The embedded case manager can act as the first line of defense, determining medical necessity, and also helping to reduce patient visits and the number of claims denials for a hospital stay, says Toni Cesta, senior vice president of operational efficiency and capacity management at Lutheran Medical Center, whom we profiled in a recent podcast that is featured in our newsletter.

And the contemporary case manager’s job description has evolved: it is much more likely to include home visits, crisis management and quality improvement responsibilities in 2011 than it did in 2010. Today’s case manager often helps patients to understand what their treatment is and what their goals of care are. The case manager acts as a liaison between the patient, family, healthcare delivery team and community, enabling their clients to achieve their goals more effectively and efficiently. This includes everything from helping with insurance to medication adherence to home care follow ups, subjects we cover in our newsletter.

And the role of today’s patient is changing as well. With round the clock access to the web, on-line medical records, mobile applications and connected devices, there is a new kind of health delivery system in place — a system that gives patients far more information, and control than they’ve had in the past. What are the implications, risks and opportunities for case managers and case management organizations?

So, please take a moment to read the first Case Management Monitor, and don’t forget to subscribe to the second one, set to arrive in email boxes on June 21st. In the meantime, please provide us with feedback on our newsletter, and share with us any subjects you’d like us to address.

We also have a wealth of information on our Case Management Monitor web site: interviews, podcasts, white papers, videos, blogs, and much more. Again, any feedback on this site is also welcome.

Because interaction is key, isn’t it, to successful case management?

Posted in Accountable Care Organizations, Avoidable ER Use, Behavioral Health, Case Management, Consumer-Driven Healthcare, HIN Blog, Healthcare Costs, Uncategorized | No Comments »

Sensei mHealth App Coaches Diabetics Virtually

June 10th, 2011 by Cheryl Miller

Forget Angry Birds. There’s a new app on the market, and it’s promising to be a lot better for your health.

Sensei, Inc., a technology company that designs mobile health, or mHealth solutions, has been awarded a National Institute of Health (NIH) grant for diabetes and prediabetes research in association with the University of Miami, the Miami VA healthcare System, and the Health Foundation of South Florida. Together, they will trial Sensei’s new mobile application for diabetes and prediabetes users.

The application encourages simple lifestyle changes through personalized expert guidance. Users’ mobile devices are transformed into virtual health coaches that personally guide them to better health through healthier nutrition, fitness, weight loss and tips on self management.

Research shows that modest lifestyle changes, including losing weight and increasing activity, can improve or delay the onset of diabetes in almost 50 percent of cases, according to the Diabetes Prevention Program. Participants in this trial will be prompted to measure key biometric data, eat healthier, and learn and practice appropriate self management of diabetes, hypertension and hyperlipidemia. There will be daily health coach alerts that teach and create calls to action supplemented by a daily agenda and reference information around the different conditions and wellness.

Mobile Health, or mHealth, the utilization of mobile devices to improve health outcomes, is emerging as an important technology not only for developed countries but for developing countries as well. According to a survey conducted by the World Health Organization (WHO), more than 80 percent of countries across the globe are using mobile phone technology in different ways to improve their health services. In fact, only 19 of the 114 studied countries have no mobile health initiative, although many of the initiatives in place are at the pilot stage. The most popular mHealth programs globally are mobile technology call centers, emergency services management, including toll-free telephone services, telemedicine services like text messaging with pill reminders and health information and transmission of tests and lab results, and managing emergencies and disasters. The survey goes on to state that many of these countries’ citizens have no other means of access to health care.

If this technology can be so beneficial for some of the poorest countries in the world, it isn’t hard to see how beneficial it can be for some of the richest countries in the world. And if users, like the diabetes and prediabetes patients being trialed with Sensei’s app, devote only a fraction of the time, passion and commitment to these kinds of health apps that others do to apps like Angry Birds, then they are sure to be an important resource for healthcare.

Posted in Avoidable ER Use, Behavioral Health, Case Management, Consumer-Driven Healthcare, Disease Management, Health Coaching, Health IT, Healthcare Trends, Telehealth & Telemedicine, Uncategorized, Wellness/Prevention, e-Health | No Comments »

Patient Satisfaction: What’s It Worth to Your Organization?

May 23rd, 2011 by Patricia Donovan

There’s a lot of heated debate about whether patient satisfaction ratings should figure into healthcare quality and reimbursement models. The fact is, CMS already posts patient satisfaction ratings in 10 key areas on its Hospital Compare site. It’s only a matter of time before the Physician Compare site follows suit.

We’ve just launched a new survey on Improving Patient Experience and Satisfaction. Please tell us how your organization is working to improve patients’ and members’ experience and satisfaction with their care by June 20. We’ll e-mail you a free summary of survey results once it is compiled in mid-July. We’ll be sharing some of the most impressive strategies in future blog posts and publications.

In the meantime, we’ve heard about a hospital that claims to be the first in the nation to solicit and publish patient reviews. Hill Country Memorial in central Texas integrates online rating and review tools into its Web site. Patients can rate the Patient Experience, Quality of Care, or any of a number of hospital departments. The published reviews capture the good, the bad and the ugly…and Mark Peterson, the hospital’s director of customer experience, responds to many of them.

In an April 2011 post on patient satisfaction, a blogger for Better In Emergency Medicine describes how he has come to view that there is value in pursuing a goal of more satisfied patients:

Needless to say, as I mature in my practice, I have come to realize that there is a lot of truth to the statement, “They don’t care how much you know until they know how much you care.” With that in mind, I want to share some key points from a nice review of customer satisfaction that I stumbled upon from the Emergency Medicine Clinics of North America.

So why pursue a goal of having more satisfied patients?

There are multiple demonstrating benefits from hospitals which perform better:

Staff morale improves (Turnover decreases, work is more enjoyable)

Malpractice risk decreases (Happy patients sue less frequently)
Patients respond better to treatment (Patients follow instructions when they believe that they received good care)
Hospital finances improve (Patients recommend the facility and will come back)

We came across this brief video from HcPro on improving patient satisfaction. While geared to hospitals, the six tips contained herein can be adapted for physician practices as well as health plans.

Posted in Accountable Care Organizations, Affordable Care Act, Consumer-Driven Healthcare, Health IT, Healthcare Quality Ratings, Healthcare Trends | No Comments »

How Diabetes Patients Can See a Decrease in Medical Costs

April 1st, 2011 by Jessica Papay

Could diabetes patients decrease their medical costs if they are more medication adherent? Read this week’s issue of the DM Update to find out, and also learn if patients with high-deductible health plans use fewer preventive care services.

Posted in Consumer-Driven Healthcare, Disease Management, Healthcare Administration, Healthcare Costs, Medication Management, Prescription Drugs, Wellness/Prevention | No Comments »

Survey Identifies Top 3 Uses for HRA Data

August 30th, 2010 by Jessica Papay

Aggregate data from health risk assessments (HRAs) provide a roadmap for healthcare organizations to deliver health promotion and disease management interventions to targeted individuals — with the goal of improving clinical and financial outcomes.

In its HRA e-survey administered in June 2010, the Healthcare Intelligence Network captured trends in the use of HRAs, from format and target audiences to incentive use and impact. Through responses provided by 116 healthcare organizations, the survey results reveal that the top three ways companies use HRA data are to identify health risks, develop programs aimed at high-risk indicators and deliver follow-up interventions for those at risk.

Figure 1: Top Uses for Aggregate HRA Data

Survey Highlights

More than 67 percent of responding organizations use HRAs to assess health risk factors in their populations.
HRA completion is voluntary, according to 84.8 percent of respondents.
The biggest barriers to launching an HRA program are staffing and cost, according to 66.7 percent of responding organizations.
Many organizations said HRAs work best when integrated with wellness and disease management programs.
Several responding organizations said self-reporting data for HRAs is not often accurate. However, approximately 94 percent of respondents use self-reported data inputs for HRAs.

Posted in Consumer-Driven Healthcare, Healthcare Costs | No Comments »

More Companies Offer Carrots for HRA Completion

August 30th, 2010 by Patricia Donovan

As open enrollment season nears, many companies are still planning major changes to employee coverage — from eliminating insurance for retirees to reducing premiums for employees who take a health risk assessment (HRA). Our own research on HRA use found that 56 percent of organizations offer incentives for HRA completion, with cash incentives of up to $100 offered by 63 percent and reduced premiums by 44 percent.

We share more employer insurance trends and more of our research on the top uses of HRA aggregate data by 116 healthcare organizations in this week’s Healthcare Business Weekly Update. You can also download a free e-summary of the June 2010 HRA Survey results.

Posted in Consumer-Driven Healthcare, Disease Management, Health Coaching, Wellness/Prevention | No Comments »

Remote Monitoring + Case Management = Better Care

June 14th, 2010 by Patricia Donovan

Remote monitoring of some Aetna Medicare members with CHF combined with enhanced case management has meant more timely attention to health alerts, resolution of medication errors and increased engagement of the member, physician and nurse case manager, according to early results of a study featured in this week’s issue of Healthcare Business Weekly Update.

We’ve already seen how the application of telemononitoring or case management alone can impact this population, so we imagine the combined intervention is hard to beat. According to a HIN benchmark study on the use of telehealth, more than half of survey respondents are using remote monitoring, with more than four-fifths focusing this effort on patients with CHF. In a 2010 study of healthcare case management trends, more than 80 percent of respondents employ case managers, of which more than half are primarily focused on CHF patients.

Download these complimentary study results.

Posted in Case Management, Consumer-Driven Healthcare, Healthcare Trends | No Comments »

Digesting the Healthcare Overhaul

March 30th, 2010 by Melanie Matthews

Healthcare’s historical week continued with last Tuesday’s signing by President Barack Obama of the Patient Protection and Affordable Care Act, followed by Thursday’s passage by the House of Representatives of the budget reconciliation bill that tweaked the sweeping healthcare overhaul.

It’s a lot to digest. There is certainly confusion over the one-two punch of the bills; many seek a simpler, streamlined version of the changes. We took some time last week to gauge industry reaction, and found that just over half of 125 respondents to our online survey see the landmark legislation as positive. Respondents also predicted the impact of healthcare reform on care access, delivery and cost and described the steps they’ll take immediately to prepare for immediate and long-term changes spelled out in the bill.

Watch this space next week for an e-summary of the survey results, or e-mail me at pdonovan@hin.com to request your copy.

What is clear is that healthcare reform will reward payors, purchasers and providers for innovations that streamline care delivery and reduce costs. In this week’s Healthcare Business Weekly Update, we launch a new feature — Chart of the Week — to track trends and innovations in healthcare, starting with a look at populations targeted by telehealth.

Posted in Consumer-Driven Healthcare, Healthcare Administration, Healthcare Costs, Healthcare Trends | No Comments »

How Healthcare Blunts Financial Impact of Uninsured

March 22nd, 2010 by Melanie Matthews

According to a 2007 Commonwealth Fund study, nearly 25 million Americans are underinsured and can’t close the gap between their insurance coverage and their medical bills. At the beginning of 2009, the number of uninsured Americans was estimated at 52 million. In response to a 2009 e-survey, 127 healthcare organizations described how they’re softening the financial blow of the un- and underinsured on their organizations.

Conducted online in May 2009, the survey’s goal was to discover the strategies organizations are using to reduce the financial burden of the uninsured, while making healthcare more affordable to these populations. Through responses provided by 127 healthcare organizations to 24 multiple choice and open-ended questions, the survey results reveal a tightening of business processes, new and modified product lines and an emphasis on consumer education.

Survey Highlights

Of 127 responding healthcare organizations including physicians, hospitals and health plans, 58.5 percent have launched products and/or services to reduce the financial impact of the uninsured and underinsured.
Almost one-fourth of the 44 organizations that have not launched products or services for this purpose (22.7 percent) plan to do so in the next 12 months.
Nearly 35 percent of all respondents say 5 to 10 percent of their populations are uninsured while 19 percent say their uninsured totals between 11 and 19 percent of their populations.
More people are underinsured than uninsured, with about a third (32.5 percent) of respondents noting that 20 percent or more of their populations are underinsured.
More than two-fifths of respondents — 42.9 percent — say the programs they have implemented have not helped to blunt the financial impact of the un- and underinsured, but nearly half — 42.9 percent — report a negative financial impact from their efforts.

Key Findings

Physicians:

Improving billing, collections and cash handling functions is the top strategy employed by physicians to reduce the financial impact of the uninsured and underinsured on their business, said 75 percent of responding physicians.
Three-quarters of responding physicians are discounting primary care to make healthcare more affordable for the uninsured and underinsured.

Hospitals:

Nearly all of responding hospitals — 90 percent — are educating the uninsured on policies that provide financial assistance to them in the hopes of reducing the financial impact of care costs for these populations.
Almost three-fourths of respondents — 70 percent — are educating patients on policies that provide financial assistance to uninsured and underinsured to try to make healthcare more affordable to these populations.

Health Plans:

More than half — 58.8 percent — of responding health plans have seen a reduction in number of employers offering employer-sponsored coverage.
Almost half — 43.8 percent — of responding health plans have created a basic coverage health plan to reduce the financial impact of the uninsured and underinsured on their organizations.

Posted in Consumer-Driven Healthcare, Healthcare Administration, Healthcare Costs | No Comments »

Heading Off High-Cost Complications in Elderly

February 1st, 2010 by Melanie Matthews

In spite of President Obama’s plea last week for renewed commitment to healthcare reform, the nation’s priorities appear to be gravitating more toward job creation and budget deficit reduction. Meanwhile, a new Kaiser Family Foundation poll finds that even after a yearlong media blitz, many Americans remain unfamiliar with key elements of the two major healthcare reform bills passed in the House and the Senate. A featured story in this week’s Healthcare Business Weekly Update, the poll also found that while Americans are divided over health reform proposals, many become more supportive after being told about many of the major provisions in the bills.

We also present new data that could help control healthcare costs and utilization among Medicare beneficiaries. Contrary to popular thought, Brown University researchers now believe that increasing co-pays for outpatient visits — at least for senior citizens — may make care far more expensive. They determined that patients faced with higher co-payments did cut back on doctor visits, but ultimately required expensive hospital care because their illnesses worsened. Aetna hopes to avoid this with its user-friendly strategy for heading off high-risk complications among its elderly. Listen to the details in this week’s HealthSounds podcast.

New month, new survey. We’re taking another look this year at the way healthcare uses economic incentives to drive participation and results in health and prevention programs. Complete the survey by February 28 and get a summary of the results.

Posted in Consumer-Driven Healthcare, Disease Management, Healthcare Trends | No Comments »

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