Archive for the ‘Healthcare Administration’ Category

5-Part Framework for MIPS Success Under MACRA

March 2nd, 2017 by Patricia Donovan

Before picking MACRA pace, physician practices should construct a framework for MIPS success.

Along with picking a MACRA pace, physician practices should construct a framework for MIPS success.

Regardless of the pace a healthcare organization sets for Quality Payment Program participation, there are some key tactics that should form the framework of any MACRA initiative. Here, William Holding, consultant with PDA Inc., outlines the critical elements organizations need to achieve “MACRA-readiness.”

  • The first component for success is perhaps the most important, and that’s having a culture of provider support. A willingness to explore new options. This component is free, so if you don’t have that culture in place today, before going and investing in analytics products, performance improvement or new staffing, you’ve got to put this culture in place. We have seen organizations do this successfully, and make the journey into accountable care organizations (ACOs) or value-based programs by working on this piece first.
  • Second is strategic planning. Set measurable goals. That’s important. Look ahead one year, two years, three years. Set goals that have timelines, and goals that are reasonably achievable.
  • The next piece is strong leadership. If you don’t have a quality committee or a Merit-Based Incentive Payment System (MIPS) committee, consider establishing one, and establishing a position lead in that program. It should be a multidisciplinary effort. Pull physicians, mid-levels, nursing leadership, IT and program management into that program. You should have tailored reporting strategies that align with your planning efforts.

    I’ve experienced teams that didn’t work well. In working with large systems, even with the support of clinical leadership and with the right analytical skills, efforts, I have witnessed efforts that were slower than they should have been until they brought in the right team member. This team member possessed in-depth knowledge of clinical workflows, had clout within the organization, knew personnel across IT, could talk to providers, and was a good communicator. When that person was on the team, the efforts began to move forward much faster. You’ve got to find the right people to be involved.

  • Next, data analytics is key. This starts with an individual with the right skills. It doesn’t mean you have to buy the most expensive solution for this. Sometimes ad hoc solutions work just fine for certain organizations. However, you need the right individual who knows the data, who knows how to respond to requests from leadership, and who can really own it.
  • Lastly, clinical documentation is essential. Doing that well will improve your position in this program.

Source: Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance

social determinants of health

Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance describes the wealth of data analytics available from the CMS Enterprise Portal—Quality Resource Use Reports (QRURs) and other analyses providing a window into practice performance under the Merit-Based Incentive Payment System (MIPS). MIPS is one of two MACRA reimbursement paths and the one where most physician practices are expected to align.

2016 Healthcare Headlines: MACRA Monopolizes News Until Election Shake-Up

December 26th, 2016 by Patricia Donovan
top 2016 news stories

The unexpected election of Donald J. Trump to the U.S. presidency threatened some healthcare initiatives from the Obama administration, including the Affordable Care Act.

There was only one thing capable of distracting the healthcare industry in 2016 from MACRA’s imminent rollout: the election of Donald J. Trump to the presidency of the United States.

Nevertheless, the majority of the last twelve months was spent on healthcare business as usual—the business of transitioning to value-based models of care delivery and reimbursement.

Here are the headlines that dominated the news feeds of healthcare executives in 2016:

New CMS ‘Accountable Health Communities’ Model Aims to Improve Patients’ Health by Addressing Social Needs

January 2016: In a first-ever CMS Innovation Center pilot project to test improving patients’ health by addressing their social needs, the HHS appropriated $157 million in funding to bridge clinical care with social services.

The new pilot will test whether screening beneficiaries for health-related social needs and associated referrals to and navigation of community-based services will improve quality and affordability in Medicare and Medicaid. Many of these social issues, such as housing instability, hunger, and interpersonal violence, affect individuals’ health, yet they may not be detected or addressed during typical healthcare-related visits.

Medicare Shares 6 Core Principles for 21 New ‘Next Generation ACOs’

January 2016: The Centers for Medicare & Medicaid Services (CMS) made waves when it launched a new accountable care organization (ACO) model called the Next Generation ACO Model (NGACO Model). The twenty-one ACOs participating in the NGACO Model in 2016 have significant experience coordinating care for populations of patients through initiatives, including, but not limited to, the Medicare Shared Savings Program and the Pioneer ACO Model.

Providers Slow to Adopt Population Health, Value-Based Models of Care: Study

February 2016: Most healthcare providers continue to lag in implementing population health management despite broad agreement it will be important for future market success, according to a national study by healthcare strategy consultancy Numerof & Associates. The study synthesized survey responses from more than 300 executives and in-depth interviews with over 100 key decision-makers across U.S. healthcare delivery organizations. It provided the first in-depth, national look at the pace of transition from fee-for-service to models based on fixed payments linked to outcomes.

Horizon BCBSNJ ‘Episodes of Care’ Program Pays $3 Million in Shared Savings to Specialty Medical Practice

February 2016: Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) announced that it paid out approximately $3 million to 51 specialty medical practices as part of shared savings generated through the company’s innovative Episodes of Care (EOC) Program. The doctors, in five different specialty areas, earned the payments by achieving quality, cost efficiency and patient satisfaction goals in 2014 while treating more than 8,000 Horizon BCBSNJ members. The EOC model, also known as bundled payments, is one in which specialists manage the full spectrum of care related to a specific procedure, disease diagnosis or health event—such as a joint replacement or pregnancy.

Bundled Payments Improve Care for Medicare Joint Replacement Patients: NYU Langone Study

March 2016: Implementing bundled payments for total joint replacements resulted in year-over-year improvements in quality of care and patient outcomes while reducing overall costs, according to a new three-year study from NYU Langone Medical Center. The three-year pilot at the medical center reported reductions in patient length-of-stay and readmission rates.

CMS to Test New SNF Payment Model to Curb Readmissions, Foster Multidisciplinary Care

March 2016: The Centers for Medicare & Medicaid Services (CMS) today announced it would test whether a new payment model for nursing facilities and practitioners will further reduce avoidable hospitalizations, lower combined Medicare and Medicaid spending, and improve the quality of care received by nursing facility residents. This next phase of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents seeks to reduce avoidable hospitalizations among beneficiaries eligible for Medicare and/or Medicaid by providing new payments to practitioners for engagement in multidisciplinary care planning activities.

Proposed MACRA Rule Would Streamline Medicare Value-Based Payment Models

May 2016: In issuing a proposal to align and modernize how Medicare payments are tied to the cost and quality of patient care for hundreds of thousands of doctors and other clinicians, the Department of Health & Human Services took the first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Are You MACRA-Ready? Physician Groups Prep Members for Medicare Payment Modernization

May 2016: As they digested the HHS’s momentous proposal to modernize how Medicare provider payments are tied to the cost and quality of patient care, physician organizations began assembling arsenals of educational tools to de-mystify MACRA. The federal government’s first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was detailed in an April 2016 announcement.

CMS Releases MACRA Final Rule; Creates Two Pathways for Clinician Value-Based Payments

October 2016: The Department of Health & Human Services (HHS) finalized a landmark new payment system for Medicare clinicians that will continue the administration’s progress in reforming how the healthcare system pays for care. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program, which replaces the flawed Sustainable Growth Rate (SGR), will equip clinicians with the tools and flexibility to provide high-quality, patient-centered care.

ACA Afterlife: Unwinding Obamacare Under the Trump Administration

November 2016: If U.S. President-elect Donald J. Trump delivers on his campaign promises, the ‘repeal and replacement’ of the Affordable Care Act (ACA) should be an early priority for the nation’s chief executive-in-waiting. That prospect sent shock waves through the healthcare industry, as evidenced by a snapshot of post-election responses to the Healthcare Trends in 2017 survey sponsored by the Healthcare Intelligence Network.

Trump Taps Orthopedic Surgeon, Medicaid Architect to Helm U.S. Healthcare Posts, Determine ACA Fate

November 2016: Calling his nominees “the dream team that will transform our healthcare system for the benefit of all Americans,” President-elect Donald J. Trump announced his plan to nominate Chairman of the House Budget Committee Congressman Tom Price, M.D. (GA-06) as secretary of the U.S. Department of Health and Human Services (HHS) and Seema Verma as administrator of the Centers for Medicare and Medicaid Services (CMS).

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Infographic: Using Healthcare Staffing Evidence To Improve Patient Outcomes

December 7th, 2016 by Melanie Matthews

While the healthcare industry’s goal to improve patient outcomes while simultaneously driving down costs, the impact of each health system’s workforce management strategy will be magnified, according to new infographic by API Healthcare.

The infographic details the increasing availability of reliable workforce analytics to empower healthcare organizations to achieve workforce optimization, propelling them to a successful synergy between patient outcomes and cost containment.

Using Healthcare Staffing Evidence To Improve Patient Outcomes

Since the January 2015 rollout by CMS of new chronic care management (CCM) codes, many physician practices have been slow to engage in CCM. Arcturus Healthcare, however, rapidly grasped the potential of CCM to improve patient outcomes while generating care coordination revenue, estimating it could earn up to $100,000 monthly for qualified patients treated in its four physician practices—or $1 million a year.

Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM Revenue traces the incorporation of CCM into Arcturus Healthcare’s existing care management efforts for high-risk patients, as well as the bonus that resulted from CCM code adoption: increased engagement and improved relationships with CCM patients.

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Trump Taps Orthopedic Surgeon, Medicaid Architect to Helm U.S. Healthcare Posts; Industry Reacts

December 5th, 2016 by Patricia Donovan

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Healthcare industry reaction to President-elect Donald J. Trump’s choices to head the HHS and CMS was largely positive.

Calling his nominees “the dream team that will transform our healthcare system for the benefit of all Americans,” President-elect Donald J. Trump last week announced his plan to nominate Chairman of the House Budget Committee Congressman Tom Price, M.D. (GA-06) as secretary of the U.S. Department of Health and Human Services (HHS) and Seema Verma as administrator of the Centers for Medicare and Medicaid Services (CMS).

“Chairman Price, a renowned physician, has earned a reputation for being a tireless problem solver and the go-to expert on healthcare policy,” said President-elect Trump in a news release. “He is exceptionally qualified to shepherd our commitment to repeal and replace Obamacare and bring affordable and accessible healthcare to every American.”

Prior to serving in Washington, Rep. Price worked in private practice as an orthopedic surgeon for nearly 20 years.

In the same announcement, the President-elect called Seema Verma, his nominee for CMS administrator, one of the leading experts in the country on Medicare and Medicaid. “She has decades of experience advising on Medicare and Medicaid policy and helping states navigate our complicated systems,” he said.

Seema Verma is the president, CEO and founder of SVC, Inc., a national health policy consulting company. For more than 20 years, Ms. Verma has worked extensively on a variety of policy and strategic projects involving Medicaid, insurance, and public health, working with governors’ offices, state Medicaid agencies, state health departments, state insurance departments, as well as the federal government, private companies and foundations.

Ms. Verma has extensive experience redesigning Medicaid programs in several states. Ms. Verma is the architect of the Healthy Indiana Plan (HIP), the nation’s first consumer-directed Medicaid program, and served as the State of Indiana’s health reform lead following the ACA’s passage in 2010.

Responding to the announcement, the American Medical Association (AMA) said it supports the nomination of Dr. Tom Price, who would be the first physician to serve as HHS secretary since President George H.W. Bush appointed Louis W. Sullivan, MD, in 1989, and only the third doctor in the HHS’s 63-year history.

In a statement, Patrice A. Harris, MD, MA, AMA Board Chair, cited decades of interactions with Dr. Price as a member of the AMA House of Delegates, Georgia state senator and House of Representatives. “Over these years, there have been important policy issues on which we agreed (medical liability reform) and others on which we disagreed (passage of the Affordable Care Act). Two things that have been consistent are [Dr. Price’s] understanding of the many challenges facing patients and physicians today, and his willingness to listen directly to concerns expressed by the AMA and other physician organizations.”

On the payor side, America’s Health Insurance Plans (AHIP), the national trade association representing the health insurance community, said in a statement that it anticipates cooperative, collaborative relationships with the new leaders of HHS and CMS.

“For many years, Dr. Price has been committed to ensuring that patients and consumers are well-served,” said Marilyn Tavenner, AHIP president and CEO. “He will bring a balanced and thoughtful perspective to his role as Secretary of HHS. We look forward to working with him to promote competition, increase choice, and lower costs for every consumer.

“Likewise, we look forward to working with Seema Verma to strengthen our nation’s healthcare system and empower Americans to improve their health and financial well-being, particularly those who depend on the valuable support and services provided through Medicare and Medicaid.”

Related Resource: MACRA Physician Quality Reporting: Positioning Your Practice for the MIPS Merit-Based Incentive Payment System

MACRA MIPS

MACRA Physician Quality Reporting: Positioning Your Practice for the MIPS Merit-Based Incentive Payment System delivers a veritable MACRA toolkit for physician practices, with dozens of tips and strategies that lay the groundwork for reimbursement under Medicare’s Merit-based Incentive Payment System (MIPS), one of two payment paths Medicare will offer to practices beginning January 1, 2017.

2017 Healthcare Success Formula: Care Management Sophistication and ‘Patient Stickiness’

November 29th, 2016 by Patricia Donovan

HIN’s 13th annual planning session provided a roadmap to key healthcare issues, challenges and opportunities in 2017.

Whether concerned with healthcare delivery or reimbursement for services rendered, providers and payors alike will need to be nimble in the coming year to survive and thrive in a sharply shifting, value-based marketplace, advises Steven Valentine, vice president, Advisory Consulting Services, Premier Inc.

“Be aware: the competitors you’ve had in the past are changing, and you’re seeing more competition with various Internet providers, CVS, Apple, Watson. It’s all going to change,” said Valentine during Trends Shaping the Healthcare Industry in 2017: A Strategic Planning Session, a November 2016 webinar now available for replay.

But what healthcare shouldn’t panic about, at least for the immediate future, is the demise of the Affordable Care Act (ACA).

“[The ACA] is not going to be canceled any time soon,” Valentine emphasized during the thirteenth annual planning session sponsored by the Healthcare Intelligence Network. “We would expect it would take two years, at least, to begin to put in some kind of a replacement program.”

Assuring participants that within all this industry flux are opportunities, Valentine suggested they follow the lead of retail pharmacy CVS. “CVS envisions itself as a full service healthcare organization with a goal of ‘patient stickiness.’ In other words, CVS is saying, ‘I need patients to rely on me as their source of getting started for healthcare.'”

Later in the program, he offered participants a four-point plan for improving patient stickiness.

As for care management sophistication, Valentine pointed to the pairing of hospitals with a case manager, with incentives for care managers and hospitalists to manage down length of stay, or manage resource consumption.

“We’re probably gravitating more toward care management models that are outside the four walls of the hospitals…which will give us better economies, better outcomes, people more specialized in the areas they’re in that could really help provide better quality at a lower cost.”

And while the healthcare thought leader believes Medicare will remain essentially untouched by the incoming presidential administration, he did identify nearly a dozen areas where President-Elect Donald Trump’s ‘Better Way’ might eventually make its mark on healthcare, including more price transparency and the sale of insurance across state lines.

Moving on to sector-specific forecasts, Valentine outlined four expectations for health plans, including a push for more access points like telehealth and urgent care centers and added pressure to reduce chronic care costs.

Healthcare providers should focus on population health and immerse themselves in data analytics to better prepare for MACRA and the narrow, quality-based provider networks that will result.

Both sectors should expect more consumer demand for accountability, Valentine said, since patients and health plan members are fed up with rising costs and armed with more transparency information and health awareness.

Valentine concluded his presentation with eight guiding principles for 2017 success, including collaboration between health plans and physicians.

And in the Q&A that followed, Valentine offered guidance on a number of issues, including how providers can grow their population bases; identifying and addressing social health determinants; succeeding in value-based healthcare, and offering efficient, integrated behavioral healthcare services.

Click here to listen to advice from Steven Valentine on employing technology for patient engagement.

Infographic: The Reality of Healthcare Claims Denials

August 12th, 2016 by Melanie Matthews

Some 90 percent of healthcare claims denials are avoidable and two out of three denials are recoverable, according to a new infographic by ZirMed.

The infographic looks at the rates of claims denials, the cost of appealing denials and provides a timeline for working a denial.



Innovative Plan-Provider Ventures: Case Studies From Anthem and AetnaInnovative Plan-Provider Ventures: Case Studies From Anthem and Aetna provides the details of two case studies of plans and providers that are collaborating on value-based care models:

* Vivity, a collaboration between seven prestigious California health systems and Anthem Blue Cross of California, promises to improve quality and share cost savings among the participating entities.

* Innovation Health, the northern Virginia health plan owned 50-50 by Aetna Inc. and Inova Health System, represents a great example of an “alignment” structure, with the new health plan allowing the provider and carrier to tap into each other’s expertise to lower costs, grow market share and move to value-based payment.

Innovative Plan-Provider Ventures: Case Studies From Anthem and Aetna provides strategies to reduce coverage costs and improve outcomes.

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Are You MACRA-Ready? Physician Groups Prep Members for Medicare Payment Modernization

May 16th, 2016 by Patricia Donovan

Physician groups digested the 962-page MACRA notice of proposed rule-making in order to distill the notice for their members.

As they digest the HHS’s momentous proposal to modernize how Medicare provider payments are tied to the cost and quality of patient care, physician organizations are assembling arsenals of educational tools to de-mystify MACRA.

The federal government’s first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was detailed in an April 2016 announcement.

Just nine days after that bulletin, the AAFP arranged a town hall meeting for its members with two high-ranking CMS officials to discuss the law that will greatly influence how physicians are paid. Comments provided by CMS Acting Administrator Andy Slavitt via conference call are detailed here.

While the HHS window to receive feedback on the proposal remains open through June 27, 2016, the AMA has created an extensive set of online resources to support physician preparations for a post-MACRA Medicare. The resources include a guide to physician-focused payment models, key points of the Merit-based Incentive Payment System (MIPS), and five things providers can do now to prepare for the legislation, among other resources, according to a May 2016 press release.

“The core policy elements in MACRA are surfacing in other public and private insurance programs, so understanding these policies will be essential for most physician practices,” said AMA President Steven J. Stack, MD.

The AMA’s MACRA support tools were announced in conjunction with the release of its new interactive module on practicing value-based care authored by Grace Terrell, MD, an internal medicine physician and president of Cornerstone Health Care, who shares the proven steps her clinic used to focus on patients at the center of care.

The value-based care module is the latest in the AMA’s STEPS Forward™ collection of physician-developed practice improvement strategies.

Also readying its membership for MACRA is the AAFP, which last week launched a comprehensive member communication and education effort related to the proposed legislation. The AAFP’s MACRA Ready site is a one-stop shop filled with resources family physicians can use right now such as the following:

  • A timeline of important MACRA dates;
  • A list of acronyms to help digest the alphabet soup associated with MACRA’s complicated regulations;
  • A “MACRA in a Minute” 60-second overview video;
  • A deep-dive review of what value-based payment means to family physicians;
  • and much more.

In announcing the MACRA tools, AAFP President Wanda Filer, MD, MB, told family physicians that the academy’s MACRA communication plan “is designed to help simplify the transition and provide the guidance that you will need to realize the benefits of MACRA and value-based payments.”

A recent AAFP survey indicated that some 40 percent of family physicians already were involved in some kind of value-based payment system, she noted.

As she related the history of MACRA, Dr. Filer reminded members that the legislation not only repealed the sustainable growth rate (SGR) but also established an annual positive or flat-fee payment for the next 10 years as well as a two-track program (the MIPS, and Alternative Payment Models, referred to as APMs) for calculating Medicare payments beginning in 2019.

Infographic: 6 Healthcare Performance Management Trends

May 9th, 2016 by Melanie Matthews

The healthcare industry’s transformation to a value-based system has placed even greater importance on performance management, according to a new infographic by Perficient. Healthcare Enterprise Performance Management creates visibility and accountability throughout the organization to identify financial performance gaps continuously and quickly change course when needed.

The infographic identifies 6 strategies and solutions that will help you succeed in a data-driven, cost-management culture.

Healthcare Trends & Forecasts in 2016: Performance Expectations for the Healthcare IndustryFrom cost pressures, consumerism and consolidation to a proliferation of patient-centered, value-based delivery and payment models, the state of healthcare continues to challenge organizations in the industry.

Healthcare Trends & Forecasts in 2016: Performance Expectations for the Healthcare Industry, HIN’s 12th annual business forecast, pins down the trends destined to impact the industry in the year to come and proposes tactics C-suite executives can employ to distinguish their operations in a dynamic marketplace. 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.

MACRA Transition Bolstered by CMS Quality Measure Development Plan

May 9th, 2016 by Patricia Donovan

payment bundling shared savings

Partnerships are key to the final Quality Measure Development Plan by CMS.

The final Quality Measure Development Plan by CMS is an essential aspect of its transition to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), according to last week’s blog post by Kate Goodrich, MD, MHS, director of CMS’s Center for Clinical Standards & Quality.

The Quality Measure Development Plan is a strategic framework for clinician quality measurement development to support the new Merit-based Incentive Payment System (MIPS) and advanced alternative payment models (APMs), stated Dr. Goodrich.

CMS recently rolled out a proposed rule outlining MACRA’s payment incentives for physicians and other clinicians based on quality rather than quantity of care.

The final Quality Measure Development Plan will provide the foundation for building and implementing a measure portfolio to support the quality payment programs under MACRA, Dr. Goodrich said.

After considering comments and suggestions for the plan, CMS finalized the Quality Measure Development Plan to include the following:

  • Identification of known measurement and performance gaps and prioritization of approaches to close those gaps by developing, adopting and refining quality measures, including measures in each of the six quality domains:
    • Clinical care;

    • Safety;

    • Care coordination;

    • Patient and caregiver experience;

    • Population health and prevention;

    • Affordable care.
  • CMS actions to promote and improve alignment of measures, including the Core Quality Measures Collaborative, a work group convened by America’s Health Insurance Plans (AHIP). On February 16, 2016, CMS and the collaborative announced the selection of seven core measure sets that will support multi-payor and cross-setting quality improvement and reporting across our nation’s healthcare systems.
  • Partnering with frontline clinicians and professional societies as a key consideration to reduce the administrative burden of quality measurement and ensure its relevance to clinical practices.
  • Partnering with patients and caregivers as a key consideration for having the voice of the patient, family, and/or caregiver incorporated throughout measure development.
  • Increased focus and coordination with federal agencies and other stakeholders to lessen duplication of effort and promote person-centered healthcare.

Yale New Haven’s High-Risk Care Management Commences with Its Employees

January 14th, 2016 by Patricia Donovan

A care management pilot by YNHHS for employees and their dependents with diabetes was a template for future embedded care management efforts.

Disenchanted with vendors it engaged to provide care management for its workforce, Yale New Haven Health System (YNHHS) launched an initial care management pilot for its high-risk employee populations. The pilot went on to become a very robust program and served as a training ground for two more embedded on-site care management initiatives. Here, Amanda Skinner, YNHHS’s executive director for clinical integration and population health, provides details from on-site face-to-face care management for YNHHS employees and their dependents.

We have an RN care coordinator based on each of the four main hospital campuses of our health system: one in Greenwich, one in Bridgeport and two in New Haven. All of the RN care coordinators in this program are trained in motivational interviewing. The intent is for them to work with our high-risk, high-cost employees who have chronic diseases, and with their adult dependents that also fall into that population.

The care coordinators work with these employees across the entire system to help them access the care they need, identify their goals of care, get under the surface a little to determine barriers to their being as healthy as they can be, and manage them over time. We did create some incentives for employee participation in this program, including waived co-pays on a number of medications (for example, any oral anti-diabetics).

When we initially launched the program, we limited it to employees and dependents that had diabetes, because that was the population for which we had very robust data. We also knew that diabetes was generally a condition that lent itself well to the benefit of care coordination; that there were a lot of gaps in care. When we looked at our data, we saw that ED utilization was very high for this population; that their past trend was rising, that utilization of their primary care provider was actually below what you would expect. This meant that they were under-utilizing primary care, over-utilizing hospital services, and were not particularly compliant with care.

With that population, we saw a lot of opportunity that a care management program could help address. In general, diabetes is a condition that lends itself to accepting a helping hand, to help people understand their condition and address the medical and social issues so they can manage that condition more effectively.

The program has been tremendously successful. We expanded it this year to include wellness coaches based at all of our delivery networks’ main campuses as well. These coaches work with a lower risk population and are available to any health system employee that wants to work with a coach to set care goals and then meet with the coach monthly or quarterly to track improvements against those goals. This expansion is because we’ve seen such positive results from this program.

Source: 3 Embedded Care Coordination Models to Manage Diverse High-Risk, High-Cost Patients across the Continuum examines YNHHS’s three models of embedded care coordination that deliver value while managing care across time, across people, and across the entire continuum of care. In this 30-page resource, Amanda Skinner, executive director for clinical integration and population health at Yale New Haven Health System, and Dr. Vivian Argento, executive director for geriatric and palliative care services at Bridgeport Hospital, present a trio of on-site care models crafted by YNHHS to manage three distinct populations.