Archive for the ‘Disease Management’ Category

Guest Post: Value-Based Care is Dying—But Longitudinal Patient Data Can Revive It

November 16th, 2017 by William D. Kirsh, DO, MPH, CMO at Sentry Data Systems

In 2013, Harvard Business Review (HBR) called value-based care “the strategy that will fix healthcare.” And the concept goes back even further than that—Michael Porter and Elizabeth Teisberg introduced the value agenda in their book, Redefining Health Care, in 2006, accord to HBR. Yet years later, value-based care is still struggling to survive, still in limbo, not quite breathing on its own. At this point, you might say it’s in critical condition.

More than a decade after Porter and Teisberg’s book, the industry is still talking about the “transition” to value-based care. In January of this year, CMS and HHS’ Office of the National Coordinator for Health IT (ONC) issued a vision for the continued shift to value-based care. In April, CEOs from Kaiser Permanente, Medtronic, Novartis and others, along with the Netherlands’ health minister, the head of England’s National Health Service, and Harvard economics professor Michael Porter (author of the 2006 book mentioned above) called for a new approach that would embrace patient-centered care and focus on outcomes.

Also in April, the World Economic Forum, in collaboration with The Boston Consulting Group, released a report, Value in Healthcare: Laying the Foundation for Health-System Transformation. Why are we still seeing words like “a new approach” and “laying the foundation” after all the time we’ve had, as an industry, to embrace value-based care?

After much wandering, it’s apparently a destination we still haven’t found on the map.

Resisting Change

According to a report from professional services organization EY (Ernst & Young) in July, about a fourth of 700 respondents (chief medical officers, clinical quality executives and chief financial officers at U.S.-based healthcare providers with annual revenue of $100 million and higher) polled said they had no value-based reimbursement initiatives planned for 2017. And that’s despite figures stating that healthcare spending in the United States “has now risen to 17.8 percent of GDP,” as the EY report says. So, what’s stopping physicians and hospitals from acting on value-based care?

As Modern Healthcare notes, the EY report points to “the escalating cost of care, a lack of standardization in how quality is defined, a disengaged workforce that leads to more medical errors, and a lack of trust and transparency between providers, payers and regulators,“ as some of the barriers. A 2016 article from Deloitte Insights adds that physician compensation may be part of the problem, stating, “Currently, there is little focus on value in physician compensation, and physicians are generally reluctant to bear financial risk for care delivery…86 percent of physicians reported being compensated under fee-for-service (FFS) or salary arrangements.” Deloitte recommends, “At least 20 percent of a physician’s compensation should be tied to performance goals. Current financial incentive levels for physicians are not adequate.”

But financial incentives alone are not enough. “Regardless of financial incentives to reduce costs and improve care quality, physicians would have a difficult time meeting these goals if they lack data-driven tools,” Deloitte says. “These tools can give them insight on cost and quality metrics, and can help them make care decisions that are consistent with effective clinical practice.”

Achieving Quality Outcomes

The EY report seems to come to the same conclusion as Deloitte about the lack of metrics and data. “Clinical outcomes and healthcare quality are often measured inconsistently by healthcare providers — if they are measured at all,” EY says. One way for hospitals to change that—a vital step in the value-based payment model—is through access to and analysis of longitudinal patient data, which is data that tracks the same patients over multiple episodes of care over the course of many years.

The problem is that hospitals and physicians often do not see the outcomes of particular treatment protocols (prescriptions, diagnostic tests, surgeries, etc.) for a long time, and capturing clinical data with this level of accuracy has historically been the industry’s blind spot. Without having a comparison population, each institution can only compare its data to real-world experience within their own data depository. A critical need is to use a de-identified real-world census population to compare protocols, best practices or specific utilization by National Drug Codes to help identify patterns of interventions that create value consistently across multiple systems, physicians, and patients. To truly answer these challenging questions about value in a meaningful way, hospitals need a comparison longitudinal patient data set.

There are countless questions about patient cohorts that physicians might want answered as they seek to make the best treatment decisions: What treatment protocol will result in the highest quality outcomes for a 50-year-old female diabetic patient with kidney failure? Which medications most effectively keep children with asthma from repeat visits to the ER? What comorbidities and symptoms are seen among patients with acute myelocytic leukemia (AML) in their earliest visits to the ER, and how can that information result in earlier diagnosis or different treatment options down the line? Quality historical longitudinal patient data may answer all these questions.

“Market forces are moving the industry toward a new paradigm; one in which delivering the highest value is an organization’s defining goal,” notes the EY report. “Optimizing patient experiences across the continuum of care while industrializing quality requires more than episodic effort.” This is the crux of value-based care. The only way to bring all stakeholders together and keep value-based care alive is by leveraging real-world, longitudinal patient data and using that information to make actionable treatment and prescribing decisions that lead to overall wellness and financial value, instead of focusing on just acute-care treatment.

William D. Kirsh, DO, MPH, CMO at Sentry Data Systems

About the Author: William D. Kirsh, DO, MPH, is chief medical officer at Sentry Data Systems and a practicing physician, clinically certified in family practice, geriatrics, hospice and palliative medicine. Sentry Data Systems, a pioneer in automated pharmacy procurement, utilization management and 340B compliance, is leading the healthcare industry in turning real-time data into real-world evidence through Comparative Rapid Cycle Analytics™ to reduce total cost of care, improve quality, and provide better results for all.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

Guest Post: Combining Big Data, EHRs and IoT for Chronic Disease Management

November 7th, 2017 by Brian Geary, Senior Account Manager, AndPlus

Providers and developers can work together to create solutions that leverage big data, EHRs and the IoT.

Have you ever used a Fitbit® or an Apple Watch®, or downloaded a mHealth app? If so, are you using these tools as an integrated way to improve your health?

The more we use technology, the more we want it to do for us. With millions of people living with complex diseases such as diabetes, cancer and heart disease, the development of intuitive and secure chronic disease management tools has become indispensable.

Yet, these tools may not support successful, sustained disease management—at least, not without the help of providers themselves.

More than 40 percent of patients who had downloaded an mHealth app had stopped using it when the app failed to provide accurate, personalized and actionable strategies for achieving their health goals. High data entry burden, hidden fees, and poor usability were other sticking points for these patients.

Another study carried out by an international team of researchers tracked 800 people for a year to see what impact Fitbit had on their health. The experts concluded that such devices are unlikely to be a magic bullet for the early detection and monitoring of chronic diseases.

So how can providers and developers work together to create engaging and supportive solutions that leverage big data, electronic health records and the Internet of Things (IoT) to utmost effect?

Using Big Data to Make Wiser Medical Decisions

Big data analytics allow providers to discover certain patterns that assist them in making better predictions about certain diseases.

With the help of big data and IoT, including patient records, clinical trials, insurance claims, and wearables, providers can discern the extent to which each intervention, as well as its associated expenditures, contribute to the improvement of their patients’ health.

However, in order to achieve measurable cost savings and long-lasting chronic disease control for patients, software models are required to help clinicians organize the data, recognize patterns, interpret results, and set thresholds for actions.

For example, to avoid the failure of an EHR to keep up with one’s sudden healthcare changes, hospitals should look at its software as being only the foundation of their health information, risking a negative impact on patient care.

Through department-appropriate software customization, hospitals can cut down wasted time spent scrolling through irrelevant screens and unnecessary fields, tracking down patient histories and reviewing duplicate data.

Having an intuitive, user-friendly EHR software also helps patients be more informed about their own health and prevents potential issues. They can access test results to see when follow-up appointments are due or communicate with their doctors to bring up any issues that may show significant health problems.

5 Things to Look for When Choosing an EHR System

    • Firstly, your EHR system should integrate easily with other systems within the hospital, such as clinical discussion support systems, laboratory information systems and other tools.
    • Further to considering the individual and specific departmental needs in a hospital, the other important feature of EHR software is customization (e.g. streamlining manual data entry). This is also advantageous for patients, as a customizable EHR system can be tailored to suit specific needs for data access, education and portability.
    • To make the most out of technological advancements and the benefits of customization, constant performance reviews of the chosen EHR systems in real-life scenarios are highly important. For example, when Medica conducted a research study to identify how they could improve their blood gas analyzer product line, it found out that its user interface needed a refresh. The outdated push button control system caused a lengthy training process for new users, so it required a radically improved user interface.
       
    • Make EHR software accessible with smartphones and tablets and provide easy access from connected devices, freeing clinicians from their workstations and creating access to patient data remotely. With accessibility, productivity soars and doctors can provide better care and reduce the lag between diagnosis and treatment, while lowering healthcare costs and improving patient’s compliance with treatment through consistent two-way communication.
    • Last but not least, a customized solution for your EHR can align workflows with the current processes a staff is already following, which can save time and prevent confusion when training users on the new EHR.

    By ensuring all your staff members receive thorough training and have access to ongoing support when questions or problems arise, the risk of the EHR becoming outdated is also minimized. Situations such as missing patient history or test results, which can lead to delayed diagnosis, unnecessary tests or even a misdiagnosis, are avoided.

    IoT Benefits for Healthcare Providers and Patients

    Doctors, nurses, and caregivers are not the only benefactors of IoT and healthcare apps. These devices can alert medical staff to wandering patients, monitor ICU patients or potentially dangerous procedures and treatments.

    Moreover, if a patient with a chronic illness needs immediate attention, the IoT can alert medical experts, and even connect the two to talk them through an emergency.

    In terms of direct patient benefits, IoT devices can remind patients when to take their medications, alert them about pending prescription refills or train them about upcoming medical procedures, while transferring relevant medical information back to the patient’s healthcare provider.

    To sum up, big data, electronic health records, and IoT devices have the potential to save money and often, even people’s lives. Together they contribute to increased efficiency, improved patient satisfaction and more time to focus on patient care.

    About the Author: Brian Geary is a senior account manager for AndPlus, LLC. Brian is a true believer in the Agile process. He often assists the development process by performing the product owner role. In addition to his technical background, he is an experienced account manager with a background in sales and customer service, as well as graphic design and marketing. Brian’s role at AndPlus ranges from marketing to sales and everything in between. Brian brings 10+ years of graphic design, marketing and account management experience to AndPlus.

    HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

  • SNF Visits to High-Risk Patients Break Down Barriers to Care Transitions

    September 21st, 2017 by Patricia Donovan

    For patients recently discharged from the hospital, a SNF visit covers the same ground as a home visit: medications, health status, preparing for physician conversations and care planning.

    The care transitions intervention developed by the Council on Aging (COA) of Southwestern Ohio for high-risk patients starts off in the hospital with a visit by an embedded coach, and includes a home visit.

    Additionally, to reduce the likelihood of a readmission, patients discharged to a skilled nursing facility (SNF) also can expect a COA field coach to stop by within 10 days of SNF admission. Here, Danielle Amrine, transitional care business manager for the COA of Southwestern Ohio, describes the typical SNF visit and her organization’s innovative solution for staffing these visits.

    We conduct the home visit within 24 to 72 hours. We go over medication management, the personal health record (PHR), and follow-up with specialists and red flags. At the SNF, we do the same things with those patients, but in regards to the nursing facility: specifically, do you know what medications you’re taking? Do you know how to find out that information, especially for family members and caregivers? Do you know the status of your loved one’s care at this point? Do you know the right person to speak to about any concerns or issues?

    We also ask the patients to define their goals for their SNF stay. What are your therapy goals? What discharge planning do you need? We set our SNF visit within 10 calendar days, because normally within three days, they’ve just gotten there. They’re not settled. There haven’t been any care conferences yet. We set the visit at 10 calendar days to make sure that everything is on track, to see if this person is going to stay at the SNF long-term. Our goal is to have them transition out. We provide them with all of the support, resources and program information to help them transition from the nursing facility back to independent living.

    For our nursing facility visits, we also utilize the LACE readmissions tool (an index based on Length of stay, Acute admission through the emergency department (ED), Comorbidities and Emergency department visits in the past six months) to see if that person would need a visit post-discharge.

    For our CMS contract, we are paid for only one visit. Generally we’re only paid for the visit we complete in the nursing home, but through our intern pilot, our interns do that second visit to the home once the patient is discharged from the nursing home. We don’t pay for our interns, and we don’t get paid for the visit. We thought that was a perfect match to impact these patients who may have a hard time transitioning from the nursing facility to home.

    Source: Post-Discharge Home Visits: 5 Pillars to Reduce Readmissions and Engage High-Risk Patients

    home visits

    In Post-Discharge Home Visits: 5 Pillars to Reduce Readmissions and Engage High-Risk Patients, Danielle Amrine, transitional care business manager at the Council on Aging (COA) of Southwestern Ohio, describes her organization’s home visit intervention, which is designed to encourage and empower patients of any age and their caregivers to assert a more active role during their care transition and avoid breakdowns in post-discharge care.

    18 Success Strategies from Seasoned Healthcare Case Managers for New Hires

    September 14th, 2017 by Patricia Donovan

    Advice from case management trenches: “Don’t do more work for your patient than they are willing to do for themselves.”

    What does it take to succeed as a healthcare case manager? For starters, patience, flexibility and mastery of motivational interviewing, say veterans from case management trenches.

    As part of its 2017 Healthcare Benchmarks Survey on Case Management, the Healthcare Intelligence Network asked experienced case managers what guidance they would offer to new hires in the field. Respondents were thoughtful and generous with their advice, highlights of which are shared here.

    It’s important to note that in total, a half dozen veterans identified motivational interviewing as an essential case management skill.

    We hope you find these tips useful. We invite all experienced case managers to add your tips in the Comments below.

    • “It’s hard work but satisfying. It takes a good year to get all resources and process, so don’t give up.”
    • “Learn the integrated case management model and get ongoing coaching in motivational interviewing.”
    • “Listen, think, develop, coordinate, adhere to plan benefits, and be honest.”
    • “Communicating and developing a relationship with members are key.”
    • “Be aware of and utilize telemedicine.”
    • “Be prepared to help patients with non-medical matters. Develop a trust bond, almost as a family member, and your medical-focused concerns will be that much easier to handle.”
    • “Always remain flexible. Listen and meet the patient where they are at in their disease and life process.”
    • “Understand both the clinical and financial impacts of healthcare on the patient.”
    • “Establish a good working relationship with your manager. Ensure you understand job expectations and identify a mentor.”
    • “Time management is crucial.”
    • “Stay visible within the practice; interact regularly with the care team; share examples of success stories.”
    • “Compassion and empathy are a must.”
    • “Don’t become overwhelmed by all that needs to be learned. Strive for sure and steady progress in gaining the knowledge needed.”
    • “Don’t let a fear of the unknown hold you back. Learn all that you can.”
    • “Get a good understanding of the population of patients you are working with. Study motivational interviewing and harm reduction.”
    • “This is a wide body of knowledge. Each case is different. It takes six months to a year to be fully comfortable in the practice.”
    • “Establish boundaries with your patients, and don’t do more work for your patient than they are willing to do for themselves.”
    • “Earn the trust of your patients and providers. LISTEN to your patients.”

    One respondent geared her advice to case management hiring managers:

    • “Hire for coaching mentality and chronic disease experience.”

    Excerpted From: 2017 Healthcare Benchmarks: Case Management

    2017 case management benchmarks

    2017 Healthcare Benchmarks: Case Management provides actionable information from 78 healthcare organizations on the role of case management in the healthcare continuum, from targeted populations and conditions to the advantages and challenges of embedded case management to CM hiring and evaluation standards. Assessment of case management ROI and impact on key care components are also provided.

    Guest Post: Analytics-Backed Wearables Provide Value Through Actionable Health Insights

    July 18th, 2017 by John Valiton, CEO of Reemo Health

    wearables for seniors

    Analytics-enabled wearables offer opportunities for chronic disease management and delivery of value-based care.

    The wearable market has experienced a growth rate of more than 20 percent and is estimated to reach over 213 million units shipped worldwide by 2020, according to IDC. These numbers likely don’t come as a surprise, as wearables have become an everyday tech accessory for nearly every generation — children, Millennials, Gen X, and even seniors. In fact, research by Accenture found that 17 percent of Americans over the age of 65 use wearables to track fitness — a percentage right on track with the 20 percent of those under the age of 65 that use wearables similarly.

    But, while the value of utilizing wearables to track health has been tapped for the everyday consumer, it has yet to reach its full potential. Wearables can go far beyond heart rate monitoring and counting steps — especially for seniors. These devices, when connected with a data analytics platform, can provide the valuable insights needed to not only track health in real time, but predict potential threats and optimize care according to need. And the analytic insights, integrated with previous health records, not only benefit the senior, but give professional and family caregivers a deeper look into the behavior that can improve long-term health, streamlining delivery of care by mitigating the need for trial-and-error treatment planning.

    With over 50 million seniors in the U.S., this offers a huge opportunity for care facilities to provide real value to the patients they serve, whether in a senior care facility where residents are monitored on an hourly basis, or still living independently where facilities provide data insights at scheduled check-ins. But, as more facilities adopt wearable and analytic solutions, they must acknowledge the importance of using the wearable-enabled analytics platform to keep users engaged by providing value through actionable insights, rather than simply mining data and pushing it out. If there are not real benefits for both the senior and care provider, that wearable device is likely to end up in a drawer in a matter of months.

    As caregivers dive into these valuable insights, they can be applied to assist with everything from chronic disease management and health event recovery to reduce the chance of post-acute readmission, to predicting potential threats based on irregularities in activity levels and vitals — allowing providers to truly delivery value-based care. For example, through the analysis of activity data, caregivers can follow the pathway to a potential fall for a senior, and proactively take steps to avoid this often traumatic event. Additionally, urinary tract infections (UTIs) are a large risk for seniors, and often occur after a 72-hour period where light activity such as walking becomes increasingly painful and trips to the restroom increase. By tracking a senior’s activity levels through a wearable device, caregivers can strategically treat those with potential UTI issues.

    Through these kind of applications, truly actionable wearable data can provide immense value for both seniors and the caregivers tasked with keeping them on the pathway to a positive aging experience. And for those still living independently, the integration of response systems — such as push-of-a-button 911 dialing — within the wearable devices can provide additional value in their daily life by providing peace of mind to the senior and their loved ones, and functionality in the case of an emergency.

    The use of wearables in everyday life doesn’t have to be limited to tracking a morning walk or getting reminders to stand up when you’ve been sitting for too long. If used alongside a powerful analytics platform, these devices can truly improve seniors’ quality of life, while strengthening connections with caregivers through increased visibility into seniors’ daily activities and peace of mind for loved ones. And while the wearable revolution is sweeping the nation, it truly should be about more than wearables for seniors. Wearables, backed by powerful data analytics, can become invaluable for our aging generation while providing unmatched insights for both personal and professional caregivers.

    John Valiton, CEO, Reemo Health

    John Valiton, CEO, Reemo Health

    About the Author: John Valiton is CEO of Reemo Health, a senior health technology solution designed to empower caregivers with actionable insights to improve the aging experience. As a 20-year business development veteran and entrepreneur, Valiton has developed partnerships with many national and international companies. He has been an avid technology enthusiast since an early age, and applied his interest in all things tech at the intersection of IoT, wearable technology, healthcare and data science through his position as a strategic advisor, chief revenue officer and now chief executive officer for Reemo.

    HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

    Infographic: Chronic Migraine Patients

    March 1st, 2017 by Melanie Matthews

    Chronic migraine patients have impaired socioeconomic status, reduced quality of life and reduced workplace productivity, according to a new study released by the Headache & Migraine Policy Forum. Moreover, chronic migraine patients commonly have other comorbid conditions that complicate their medical treatment.

    The Headache & Migraine Policy Forum has released a new infographic based on the study’s findings. The infographic examines the prevalence of chronic migraine patients, healthcare spending on migraine patients and the leading comorbidities associated with migraine patients.

    EHR and Clinical Documentation Effectiveness

    Centralized Care Management to Reduce Readmissions and Avoidable ED Visits in High-Risk PopulationsWhen AMITA Health set out to devise a more efficient method of moving its highest-risk Medicare beneficiaries across its care continuum, the newly minted Medicare Shared Savings Program (MSSP) accountable care organization (ACO) abandoned its siloed approach in favor of an enterprise-wide human-centric model of care.

    Centralized Care Management to Reduce Readmissions and Avoidable ED Visits in High-Risk Populations describes how the nine-hospital system inventoried, reexamined and revamped its care management resources, ultimately implementing a centralized care management model that would support the Institute for Healthcare Improvement’s Triple Aim goals.

    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: The Data Behind Diabetes

    July 22nd, 2016 by Melanie Matthews

    The number of people living with diabetes has quadrupled since 1980, growing to more than 400 million. And with this rise in disease, sales of diabetes-related products have also climbed. In fact, in 2015, American consumers spent $592 million on such products, according to the World Health Organization.

    Managing diabetes requires a proper balance of professional medical management, blood sugar control, and maintaining a healthy diet. So there is great value in understanding the diabetic patient and consumer journey through each step of the management process, all the way from the doctor’s office to the grocery aisles. And today, thanks to the power of data insights, healthcare providers and physicians, product manufacturers, and retailers can better tailor their offerings and experiences to aid diabetic patients and consumers in their path to healthy living.

    A new infographic by Nielsen reflects key insights around the diabetic consumer.

    Remote Monitoring of High-Risk Patients: Telehealth Protocols for Chronic Care ManagementReal-time remote management of high-risk populations curbed hospitalizations, hospital readmissions and ER visits for more than 80 percent of respondents and boosted self-management levels for nearly all remotely monitored patients, according to 2014 market data from the Healthcare Intelligence Network (HIN).

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

    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.

    Health Coaching Success Metrics and 8 More Behavior Change Benchmarks

    July 7th, 2016 by Patricia Donovan

    Satisfied clients and participants on track for goal attainment are two hallmarks of a can't-lose coaching initiative.

    Satisfied clients and participants on track for goal attainment are two hallmarks of a can’t-lose coaching initiative.

    What are the hallmarks of a winning health coaching strategy? The answer depends on what’s being measured: the effectiveness of the individual coach, the participant’s progress, or overall program success.

    That’s the feedback from 111 healthcare organizations responding to the 2016 Health Coaching Survey by the Healthcare Intelligence Network.

    If you’re looking to measure the health coach’s success, then client satisfaction is the best indicator, say 27 percent of these respondents.

    On the other hand, for a gauge of an individual’s progress, look to the participant’s goal attainment, report 78 percent.

    This same metric—goal achievement—is also the best indicator of program success as a whole, agree 64 percent.

    The May 2016 survey documented a number of other health coaching benchmarks, including the following:

    • Motivational interviewing is a coach’s top tactic to effect behavior change, say 83 percent.
    • All-important ‘face time’ with coaches is plentiful: 47 percent embed or co-locate health coaches at points of care, with most onsite coaching occurring in primary care offices (50 percent) or at employer work sites (50 percent).
    • Nine percent even embed health coaches in hospital emergency rooms.
    • While a majority focuses on coaching high-risk individuals with multiple chronic illnesses, 51 percent now extend eligibility for health coaching to individuals stratified as ‘rising risk.’
    • Nearly half of respondents—48 percent—offer health coaching to patients and health plan members with behavioral health diagnoses.
    • Reflecting the surge in telehealth, 12 percent of respondents offer video health coaching sessions to clients.

    Download an executive summary of the 2016 Health Coaching survey.

    Infographic: The Case for Preventive Care

    May 4th, 2016 by Melanie Matthews

    Counseling, screenings, wellness visits. These are a just a few avenues that employers take to help employees improve health, increase productivity and reduce costs, according to a new infographic by osWell Health Management.

    The infographic provides background data on the impact of chronic conditions on healthcare costs and employee productivity and the potential impact of preventive interventions.

    2015 Healthcare Benchmarks: Chronic Care ManagementThe desire to improve health outcomes for individuals with serious illness coupled with opportunities to generate additional revenue have prompted healthcare providers to step up chronic care management initiatives. The Centers for Medicare and Medicaid Services now reimburses physician practices for select chronic care management (CCM) services for Medicare beneficiaries, with more private payors likely to follow suit.

    2015 Healthcare Benchmarks: Chronic Care Management captures tools, practices and lessons learned by the healthcare industry related to the management of chronic disease. Click here for more information.

    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.

    Horizon Episodes of Care Program Prototype for Value-Based Specialty Care and Reimbursement

    April 21st, 2016 by Patricia Donovan

    Horizon BCBS-NJ's Episodes of Care program engages specialists across a suite of nine episodes.

    Imagine a value-based healthcare payment model in which the sole financial hazard to specialist providers is the risk of amassing additional revenue.

    Further, envision a scenario in which these specialists are invited to design their payment program, from the model’s intent to key quality metrics.

    Those are some highlights of Horizon Blue Cross Blue Shield of New Jersey’s Episodes of Care (EOC) program, a value-based model designed to focus specialists on the provision of quality- and value-based care across nine separate episodes, from joint replacement to hysterectomy to oncology.

    Hailed as a national leader in advancing the episodes model as a prototype for value-based specialty care, Horizon is careful to distinguish its EOC program from a bundled payment initiative, for two key reasons.

    “First, our EOC program is a quality-based program; it’s not only about the payment or payment structure,” explained Lili Brillstein, director of the Horizon Episodes of Care program during a recent webinar, Episodes of Care: Improving Clinical Outcomes and Reducing Total Cost of Care Through a Collaborative Payor-Provider Relationship.

    Secondly, bundled payments typically refer to a prospective model in which a bundled amount of money is paid to a provider or group of providers in advance of services being delivered, while Horizon’s retrospective model pays providers after services have been provided.

    The upside-only nature of Horizon’s retrospective model contributes to the program’s collaborative nature, Ms. Brillstein added. “If the metrics are met, savings are shared. If the metrics are not met, we’re not punishing our partners.”

    There is other evidence of collaboration and of Horizon’s desire to see the providers succeed in the EOC program. One example is the payor’s use of case mix-adjusted budgets at the practice level rather than the prevalent member-specific risk-adjusted budgets. “This budgeting allows Horizon to create an opportunity for providers to move the needle [on a metric], and benefit from that. The opportunity for cost savings and shared savings also is dramatically improved.”

    Another case in point is Horizon’s invitation to prospective providers to talk through the episode’s construct, intent and design prior to its launch.

    Horizon’s engagement of providers in the EOC program has “changed the spirit of the relationships between the payor and the provider,” Ms. Brillstein noted. “It’s like nothing I’ve ever seen before. Our provider partners have become our ambassadors for the program.”

    Select EOC results presented during the webinar indicated that outcomes are better for EOC partners—in the area of reduced readmissions, for example—than they are for physicians not in the EOC program.

    Horizon expects to launch at least three more episodes in 2016, including a Crohn’s Disease episode that will take into account behavioral health services for those members. While the payor fully expects to move to a prospective model, it believes its current EOC model is preparing them for that eventuality, softening the transition from fee for service to prospective payments.

    “[That transition] doesn’t just happen. You don’t sign the paper, and suddenly know what to do. It is an evolutionary transformative process,” concluded Ms. Brillstein.

    Click here to listen to an interview with Lili Brillstein: Horizon BCBSNJ Episodes of Care: No-Risk Retrospective Model Paves Way for Value-Based Migration