Archive for the ‘Healthcare Benchmarks’ Category

Top 2017 Chronic Care Management Modes and 13 More CCM Trends

May 2nd, 2017 by Patricia Donovan

Availability of chronic care management rose 14 percent from 2015 to 2017, according to new metrics from the Healthcare Intelligence Network.

The majority of chronic care management (CCM) outreach is conducted telephonically, say 88 percent of respondents to a 2017 Chronic Care Management survey by the Healthcare Intelligence Network (HIN), followed by face-to-face visits (65 percent) and home visits (44 percent).

This preference for telephonic CCM has remained unchanged since 2015, when HIN first canvassed healthcare executives on chronic care management practices. More than one hundred healthcare companies completed the 2017 CCM survey.

In addition, the April 2017 CCM survey captured a 14 percent increase in chronic care management programs over the two-year-span: from 55 percent in 2015 to 69 percent in 2017. Three-fourths of 2017 responding CCM programs target either Medicare beneficiaries or individuals with chronic comorbid conditions, with management of care transitions the top CCM component for 86 percent of programs.

In terms of reimbursement, payment levels for CCM services remained steady at 35 percent from 2015 to 2017. However, HIN's second comprehensive CCM survey determined that 32 percent of respondents currently bill Medicare using CMS Chronic Care Management codes introduced in 2015.

Forty percent of these Medicare CCM participants believe CMS’s 2017 program changes will reduce administrative burden associated with CCM, the survey documented.

Other metrics from HIN's 2017 CCM survey include the following:

  • A diagnosis of diabetes remains the leading criterion for CCM admission, said 92 percent;
  • Use of healthcare claims as the top tool for identifying or risk-stratifying individuals for CCM continues at 2015’s 70-percent levels;
  • Seventy percent of respondents target individuals with behavioral health diagnoses for CCM interventions;
  • Patient engagement remains the top challenge of chronic care management, with just under one-third of 2017 respondents reporting this obstacle
  • Responsibilities of RN care managers for CCM rose over two years, with 43 percent of 2017 respondents assigning primary CCM responsibility to these professionals (up from 29 percent in 2015); and
  • Two-thirds of respondents observed a drop in hospitalizations that they attribute to chronic care management.

Download an executive summary of 2017 Chronic Care Management survey results.

2016 Population Health Management Snapshot: Most Interventions Telephonic and 9 More PHM Trends

May 19th, 2016 by Patricia Donovan

Most population health management interventions are conducted telephonically, according to HIN's latest PHM metrics.

The majority of outreach in the burgeoning field of population health management is delivered telephonically, according to 84 percent of respondents to an April 2016 Population Health Management (PHM) survey by the Healthcare Intelligence Network.

This third comprehensive PHM assessment also determined that data analytics use in population health management continues to rise, though more slowly than it did from 2012 to 2014, when EHR and registry use tripled.

Additionally, the survey found that 70 percent of respondents have committed to population health management, up from 56 percent in 2012. At the same time, many lament payor reluctance to cover essential PHM services like health coaching and group visits they see as critical to PHM success.

To accrue clinical and financial gains from PHM’s data-driven, risk-stratified care coordination approach, 90 percent provide chronic care management (CCM) services, a strategy that results in PHM ROI between 2:1 and 3:1 for 12 percent of these CCM adopters.

In condition-specific PHM metrics new for 2016, diabetes tops the list of health targets for PHM interventions, say 88 percent.

A health risk assessment (HRA) remains the primary instrument for identifying individuals for PHM interventions, say 70 percent, up from 64 percent in 2014.

Also paramount to PHM success under value-based healthcare reimbursement is strategic oversight of the ‘rising risk’— individuals with two or more unmanaged health conditions. One quarter of 2016 respondents focus PHM attention on their ‘rising risk’ populations, the April 2016 survey determined.

In recent years, population health management (PHM) has ranked as the healthcare space richest with opportunity, according to HIN’s annual industry trends snapshots.

Download an executive summary of 2016 Population Health Management survey results.

11 Value-Based Healthcare Reimbursement Trends to Know

November 24th, 2015 by Patricia Donovan

value-based reimbursement

One-fifth of healthcare companies experience annual savings of $100,000 to $500,000 from value-based payment models, finds a new Healthcare Intelligence Network Savings survey.

A survey by the Healthcare Intelligence Network on the growing trend of fee-for-value payments has documented healthy adoption rates, measured savings and steady gains in the area of preventive services related to fee-for-value formulas.

Seventy-one percent of survey respondents employ a value-based reimbursement or alternative payment model, according to the October 2015 survey. The study also determined that of those respondents not yet exploring a fee-for-value approach, 26 percent plan to do so in the coming year.

In assessing value-based payment formulas, 56 percent of respondents favor a pay-for-performance model, with 71 percent employing these models in contracts for commercial populations.

Despite healthy adoption of alternative payment approaches, one quarter of respondents say the infrastructure required to sustain value-based payment models is the reimbursement trend's most significant hurdle—greater even than the challenge of data integration or patient engagement, the survey determined.

In evaluating healthcare providers for value-based rewards, respondents most often review markers tied to quality (82 percent), hospital readmissions (56 percent) and patient satisfaction (56 percent) to determine payment, the survey found. The use of physician report cards to track provider performance was reported by 63 percent of respondents.

The shift toward fee-for-value has had the greatest impact on the area of prevention, respondents said, with 69 percent attributing a rise in preventive care to value-based reimbursement models.

Other survey findings included the following:

  • Twenty-one percent of respondents reported savings from value-based payment models as ranging from $100,000 to $500,000 annually.
  • Value-based payment contracts most often were executed for populations having more than 100,000 beneficiaries.
  • Fifty-six percent said the market lacks sufficient technological support for value-based payment models.

Download an executive summary of results from the Value-Based Reimbursement survey.

ACO Evolution from 2011-2015: 8 Year-Over-Year Trends

July 21st, 2015 by Patricia Donovan

ACO Trends 2011-2015

Today's ACOs are larger, busier and better staffed than they were four years ago, according to a HIN year-over-year analysis.

Adoption of accountable care organizations (ACO) has more than tripled in four years and clinical integration continues to challenge non-adopters, according to a Healthcare Intelligence Network analysis of accountable care organization benchmarks from 2011 to 2015.

According to year-over-year ACO metrics published in 2015 Healthcare Benchmarks: Accountable Care Organizations, the percentage of healthcare organizations in ACOs has climbed from 14 to 50 percent in the last four years.

Leadership of ACOs by payor-provider co-ops or health plans has slowed to a trickle during this period, while the percentage of physician-hospital organization (PHOs) firmly grasping administration reins has nearly doubled—from 15 percent in 2011 to 28 percent among 2015 respondents.

ACO Staffs Support Healthcare Integration

The ACO staff has become more diverse, boasting more specialists, health coaches and clinical psychologists to support integration of behavioral health and primary care, the ‘sweet spot’ of patient-centered medicine. Watchwords are care coordination and care management, according to 2015 respondents who shared ACO success stories.

Staffing within ACOs has swelled as well: 29 percent of 2015 survey respondents support 500-1,000 physicians within its ACO, nearly double the 17 percent reporting this staffing ratio in 2011.

The average ACO is also busier than ever, with 61 percent encompassing 10,000 covered lives or more, up from 42 percent in 2011, perhaps reflecting consolidation occurring across the healthcare landscape.

Today, healthcare organizations are more conservative about time required to adequately frame an ACO, with 20 percent of 2015 respondents reporting that two years or more was needed, up from 4 percent in 2011, while the percentage requiring 12 to 18 months for ACO creation dropped from 50 percent in 2011 to 37 percent this year.

Reimbursement Shifts from Volume- to Value-Based

The retrospective data supports the industry's transition from the traditional fee for service payment environment to the value-based reimbursement structure favored today, with 45 percent of 2015 respondents favoring a FFS + care coordination + shared savings payment model, up from 15 percent in 2012. (Note: 2011 respondents were not surveyed on reimbursement models).

This handwriting is on CMS’s wall, in the form of its pledge to move half of Medicare payments into value-based payment models by 2018. More than half of 2015 respondents—54 percent—expressed faith in the federal payor's ability to meet this financial goal.

Despite the latest benchmarks, operational ACOs insist no two accountable care organizations are alike. In the experience of Steward Health Care Network, a top-performing Medicare Pioneer ACO, “When you’ve seen one ACO, you ‘ve really seen...one ACO.” Having ended Pioneer performance year two with gross savings of $19.2 million, Steward still must scale the perennial hurdles of physician engagement, performance improvement and care management, explained Kelly Clements, Steward’s Pioneer program director.

This year’s ACO survey benchmarks bear this out. Clinical integration, which can only succeed with the support of an engaged physician population, is still the biggest barrier to ACO formation, say 17 percent of 2015 survey respondents with no plans for accountable care.

Source: 2015 Healthcare Benchmarks: Accountable Care Organizations

Infographic: The Growing Industry, Effects of mHealth

April 11th, 2014 by Jackie Lyons

mHealth is currently a $1.3 billion industry that is expected to reach $20 billion by 2018, according to a new infographic from Mobile Future and Infield Health.

This infographic shows savings attributed to remote patient monitoring and medication adherence resulting from mHealth. It also assesses how mobile tools are transforming healthcare as more Americans, including healthcare providers, adopt mobile devices and wireless connectivity, and more.

Learn more about mHealth in 2013 Healthcare Benchmarks: Mobile Health, which delivers a snapshot of mHealth trends, including current and planned mHealth initiatives, types and purpose of mHealth interventions, targeted populations and health conditions, and challenges, impact and results from mHealth efforts. This 50-page resource provides selected metrics on the use of mHealth for medication adherence, health coaching and population health management programs.

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Hospitals More Likely to Offer Nutrition Health Coaching, Group Sessions

February 26th, 2014 by Jessica Fornarotto

Health coaching is a critical tool in population health management, helping to boost self-management of disease and reduce risk and associated cost across the health continuum. In its fourth Health Coaching e-survey, conducted in 2013, the Healthcare Intelligence Network captured the ways in which healthcare organizations implement health coaching as well as the financial and clinical outcomes that result from this health improvement strategy.

Drilling down to the hospital/health system perspective, this survey analyzed this sector's health coaching program components, delivery methods, and more.

Health coaching programs by hospitals and health systems are more inclined to address weight management, tobacco cessation and nutrition than coaching programs overall, survey results reveal. For example, 87 percent of responding hospitals offer nutrition-related coaching, versus 70 percent overall.

Conversely, this sector, which comprised 27 percent of survey respondents, is only a third as likely to address falls prevention (7 percent versus 19 percent overall) and much less likely to address medication adherence (33 percent versus 51 percent overall).

When Coaching is Provided

Coaching delivery methods differed for this sector as well. While no respondent in this sector reported the use of a smartphone app, responding hospitals/health systems were three times as likely as health coaching or disease management respondents to conduct group coaching sessions (53 percent of hospitals versus 14 percent of health coaching or disease management organizations), and significantly more likely to conduct face-to-face coaching (73 percent versus 59 percent overall).

Hospitals/health systems are only half as likely to mandate participation in coaching (7 percent versus 12 percent overall), yet are more likely to incent program participation (60 percent of hospitals/health systems versus 50 percent overall).

Excerpted from: 2013 Healthcare Benchmarks: Health Coaching

Infographic: The State of Healthcare Innovation

February 17th, 2014 by Jackie Lyons

With the changing healthcare landscape, healthcare providers are looking toward innovation to reduce costs, improve patient care and increase patient safety and satisfaction.

Sixty-five percent of healthcare providers rely on internal staff networks as their main innovation resource, according to a new infographic from HIMSS and AVIA. The infographic also includes the top priorities of healthcare providers, top barriers to innovation, organizational return expectations and impacts, average innovation budgets and more.

The State of Healthcare Innovation

You may also be interested in this related resource: Healthcare Innovation in Action: 19 Transformative Trends. Want to know more about healthcare innovations? This 40-page resource examines a set of pioneering efforts supporting the industry's seismic shift from a volume-based culture to one rewarding value and patient-centeredness.


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HINfographic: Telehealth in Population Health Management

August 12th, 2013 by Jackie Lyons

Healthcare is hanging up land lines — a decrease in use from 80 percent in 2010 to 53 percent in 2013 — and plugging into videoconferencing, virtual visits and smartphones to fortify care management and expand reach to remote and vulnerable populations, according to a recent HIN survey.

The top targets of telehealth include CHF, diabetes, hypertension, COPD and mental health populations, according to a new infographic from the Healthcare Intelligence Network. This HINfographic also details future programs, the top five telehealth targets, the technology and devices most utilized by telehealth, how organizations plan to take advantage of telehealth provisions in the ACA, and more.


Telehealth Powers Population Health Management

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.

Information presented in this infographic was excerpted from: 2013 Healthcare Benchmarks: Telehealth & Telemedicine. If you would like to learn more about telehealth and telemedicine, this resource offers an expanded analysis punctuated with more than 40 easy-to-follow graphs and tables and a year-over-year comparison of telehealth trends from 2009 to present.

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Video: Population Health Management Earns Spot on Industry Radar for 2013

January 14th, 2013 by Patricia Donovan

Population health management is one of the top 10 industry issues to watch in 2013, according to PwC's Health Research Institute.

Our newest video brings to life data on the latest population health management activities at more than 100 companies, including metrics on PHM team members, program modalities, challenges and outcomes. The data is drawn from our 2012 e-survey on population health management.

The video is narrated by HIN COO and Executive Vice President Melanie Matthews, with important advice on building an effective PHM program from healthcare consultant Patricia Curran, principal in Buck Consultants' National Clinical Practice.

Population health management is a cog in the well-documented shift in healthcare from rewarding quantity over quality toward a more value-based approach, managing health across the risk continuum.

If this topic interests you and you haven't already signed up for our new e-newsletter, Population Health Monitor, you can subscribe free here.

37 Population Health Management Benchmarks

December 26th, 2012 by Patricia Donovan

Contemplating a comprehensive population health management (PHM) program in the new year? The following data from 2012 Healthcare Benchmarks: Population Health Management may help to shape your initiative. The report analyzes PHM trends for 102 companies, including program prevalence and components, professionals on the PHM team, incentives, challenges and ROI.

Of those 102 respondents, 62 identified their organization type. Of those, 23 percent were disease management/health coaches, 14 percent were health plans and hospital/ health systems, and 8 percent were employers.

Organizations were surveyed in September 2012.

• Organizations that have a PHM program in place: 58 percent

• Organizations that don't have a PHM program in place but plan to launch one in the next 12 months: 36.4 percent

Areas covered by PHM program:
Health promotion and wellness 83.3 percent
Health risk assessment 68.8 percent
Care coordination/advocacy 60.4 percent
Disease management 75 percent
Case management 66.7 percent
Other 16.7 percent

Populations served by PHM program:
Commercial 85.4 percent
Medicare 47.9 percent
Medicaid 41.7 percent
Uninsured 22.9 percent
Other 14.6 percent

Health risk levels served by PHM program:
All 71.7 percent
Healthy 6.5 percent
Moderate risk 26.1 percent
Complex (5 or more conditions) 19.6 percent
Other 0 percent

Health professionals on the PHM team:
Primary care physician 59.6 percent
Specialist/other provider 36.2 percent
Nurse practitioner 40.4 percent
Case manager 63.8 percent
Registered dietician 34 percent
Health coach 55.3 percent
Pharmacist 31.9 percent
Social worker 34 percent
Other 23.4 percent

Primary method of determining intervention level:
Claims data 33.3 percent
Chart review 8.9 percent
Pharma data 0 percent
Health risk assessment 15.6 percent
Biometric screening 6.7 percent
Electronic health record 8.9 percent
Registry 6.7 percent
Self-report 8.9 percent
Physician referral 2.2 percent
Other 8.9 percent