Archive for the ‘Healthcare Costs’ Category

Overcoming ‘Clinical Inertia’ and 7 Other Barriers to Remote Patient Monitoring

February 26th, 2015 by Cheryl Miller

It's important to identify potential barriers from both patients and providers before implementing a telehealth program, says Susan Lehrer, RN, CDE, associate executive director of the telehealth office for the New York City Health and Hospitals Corporation (NYCHHC), because both groups need to change behaviors. Resistance to change is universal, and if you’re changing any kind of work flow or communication, there will be initial resistance.

  • Slow buy-in and some resistance by clinicians (referrals).
  • Clinicians concerned with appearance of decreased productivity.
  • Resistance to change in clinic work flow.
  • Inability to “integrate” Web site data and electronic medical records (EMRs).
  • Language and literacy.
  • Complexity of chronic disease management.
  • Lack of protocols for use of email in coordination of care.
  • Not all clinicians utilize secure email system.
  • Source: Remote Monitoring of High-Risk Patients: Telehealth Protocols for Chronic Care Management

    http://hin.3dcartstores.com/Remote-Monitoring-of-High-Risk-Patients-Telehealth-Protocols-for-Chronic-Care-Management_p_5008.html

    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. Susan Lehrer, RN, BSN, CDE, associate executive director of the telehealth office for NYCHHC, shares key aspects of the real-time monitoring program, including how the program blends telehealth, electronic medical records, electronic communication with providers and direct communication with patients by nurse case managers, and much more.

    12 Things to Know About Chronic Care Management

    February 24th, 2015 by Cheryl Miller

    Despite new CPT codes that reimburse physician practices for select chronic care management (CCM) services, almost half of healthcare organizations lack a formal CCM program, leaving critical reimbursement dollars on the table, according to 125 respondents to the Healthcare Intelligence Network’s (HIN) 2015 Chronic Care Management survey, conducted in January 2015.

    However, 92 percent of respondents believe the Medicare CCM reimbursement codes that became effective January 1, 2015 will prompt equivalent quality overtures from private payors, underscoring care coordination’s importance in a value-based healthcare system.

    We also asked respondents how they structured their CCM programs, and who had primary responsibility for CCM services. Following are their responses.

    • Almost 45 percent of respondents to HIN’s 2015 CCM survey have yet to launch a CCM initiative, the survey determined.
    • A diagnosis of diabetes is the leading criterion for admission to a CCM initiative, said 89 percent of respondents with existing CCM programs.
    • A primary care physician or healthcare case manager most often bears primary responsibility for CCM, say 29 percent of survey respondents.
    • Just over one-third of respondents — 35 percent — are currently reimbursed for CCM-related activities.
    • Patient engagement is the most difficult challenge of CCM, according to one-third of survey respondents.
    • The majority of CCM tasks are conducted telephonically, say 88 percent of respondents.
    • Almost three-quarters of respondents — 72 percent — admit patients with hypertension to CCM programs, respondents said.
    • Healthcare claims are the most frequently mined source of risk-stratification data for CCM, say 72 percent of respondents.
    • More than half of respondents — 51 percent — include palliative care or management of advanced illness in CCM programs.
    • On average, each CCM patient is seen monthly, say 29 percent of respondents.

    Source: 2015 Healthcare Benchmarks: Chronic Care Management

    http://hin.3dcartstores.com/2015-Healthcare-Benchmarks-Chronic-Care-Management_p_5003.html

    2015 Healthcare Benchmarks: Chronic Care Management captures tools, practices and lessons learned by the healthcare industry related to the management of chronic disease. This 40-page report, based on responses from 119 healthcare companies to HIN's industry survey on chronic care management, assembles a wealth of metrics on eligibility requirements, reimbursement trends, promising protocols, challenges and ROI.

    BCBSM Physician Incentives Target 5 Root Causes of High-Cost Healthcare

    February 17th, 2015 by Cheryl Miller

    Designed to target underlying reasons for high-cost healthcare, Blue Cross Blue Shield of Michigan's (BCBSM) Physician Group Incentive Program (PGIP) rewards and incentivizes providers to enhance the delivery of care. To address poorly aligned incentives, for example, they developed tiered fees based on performance measured at the population level, not just at the individual physician level or patient’s level, says Donna Saxton, BCBSM's field team manager of BCBSM's value partnerships program.

    How has the program evolved? The several root causes of high-cost healthcare within our system were readily apparent: poorly aligned incentives, a lack of population focus, very fragmented healthcare delivery, a lack of focus on process excellence or process improvement and a weak primary care foundation. As we’ve developed our Physician Group Incentive Program (PGIP) initiative, we were strategic and deliberate in how we were going to address the root causes of our high-cost system, keeping in mind the tenets and the philosophy of the PGIP program.

    To address poorly aligned incentives, we developed tiered fees based on performance measured at the population level, not just at the individual physician level or patient’s level.

    Tiered performance fees also addresses the lack of population focus and places emphasis on all patients and payor registries.

    The one thing that really makes our PGIP program unique is that we are payor-agnostic. The incentive dollars we have distributed through the life of the program readily help and incentivize other payors in the state, because if these capabilities are implemented, they ultimately serve all the patients in our state. We’re very proud of that because we feel that that is part of the servant leadership we need to do for patients and members in our state.

    To attack the fragmented healthcare delivery, we've organized our systems of care, aligning our incentives for primary care physicians, hospitals and specialists.

    We also have collaborative quality initiatives, which help sharpen our physicians, specialists and care delivery people on the science of process improvement.

    Our PCMH initiative is our pinnacle initiative, which we believe has strengthened our primary care foundation across the state.

    generating medical home savings
    Donna Saxton, field team manager of Blue Cross Blue Shield of Michigan’s (BCBSM) value partnerships program, currently oversees the team of representatives that support the statewide collaborative relationships with 44 physician organizations (PO) and 39 organized systems of care (OSCs) that participate in the BCBSM Physician Group Incentive Program (PGIP).

    Source: Generating Medical Home Savings and Quality Improvements Through Outcome-Based Measures

    Guest Post: Building the Right Health Management Program

    February 10th, 2015 by Ann Wyatt, Regional Vice President, HealthFitness

     Ann Wyatt

    Ann Wyatt, Regional Vice President, HealthFitness

    While Sibson's Healthy Enterprise Study found that 40 percent of all health management programs are not effective, research shows that organizations adopting the most effective programs—those in the top 25 percent-- experienced 16 percent lower healthcare costs and a 35 percent lower rate of increase in costs than the rest.1,2

    Well-designed programs lead to improved retention, better employee morale and increased productivity. Reams of data support that.3,4,5

    It would seem the answer is simply to build a good program. However, it's not that simple; what works varies by workplace, income, age and a host of other factors. The task is to develop the right program for your target group. Research6 published in September found comprehensive workplace programs do work, but their success depends on program goals, design and implementation. The program must fit into the organization's culture.

    For instance, a focus group conducted for a client of HealthFitness – a large manufacturing plant population, found that some of wellness program names sounded too "feminine" to attract the rural, blue-collar, mostly male workers. Messages about the importance of good health weren't effective, but "Get fit for hunting season" was.

    Another example: A technology company with employees making six figures launched a health management program. The incentive to complete a health assessment and attend a biometric screening? A $25 gift card. The participation rates were dismal.

    Employees want meaningful and relevant programs.7,8

    It needn't be costly, and success isn't reserved for the mega-firms. Kramer Beverage, a small company in New Jersey, earned American Heart Association recognition for its efforts to keep employees healthy. The company provides gym membership discounts, offers healthful food options at meetings and in vending machines, and has created a walking track outside the building.

    Another small company with a limited budget wanted to test the wellness program waters but was concerned it didn't have the funds to make a big splash. The company started by putting a bowl of fruit in every break room once per week. The buzz it created revealed that employees were hungry for health.

    It comes down to finding out what employees are "hungry" for and "feeding" them the means to reach their goals. That can vary widely, from shaving 10 seconds off a 5K time to being readier to hunt. You don't have to build the perfect health management program--just the right one.

    1Healthy Enterprise Study, Sibson Consulting, (Winter 2011)

    2Steven F. Cyboran and Sadhna Paralkar, MD. "Wellness Program ROI Depends on Design and Implementation" Society for Human Resource Management, July 26, 2013

    3Parks, K., et al. "Organizational Wellness Programs: A Meta-Analysis." Journal of Occupational Health Psychology, 2008

    4Goetzel RZ, et al. "Do workplace health promotion (wellness) programs work?" J Occup Environ Med. 2014 Sep;56(9):927-34

    52013 Aflac WorkForces Report conducted by Research Now

    6J Occup Environ Med. 2014 Sept. op. cit.

    7Aon Consumer Health Mindset,

    8"Five voluntary trends to watch in 2014." BenefitsPro , Dec. 13, 2013

    Healthcare Payor Strategies for Co-Located Case Management

    January 29th, 2015 by Cheryl Miller

    How to best strategize the co-location of case managers at points of care? The key is to understand the population you’re serving, be very targeted, and direct your services appropriately, says Dorothy Moller, managing director in the government healthcare solutions business unit of Navigant Healthcare.

    Question: New market data on embedded case management found that two-thirds of respondents have co-located case managers at points of care, including primary care practices, hospital ERs and patients’ homes. What are some payor strategies for matching case managers with providers, and how do health plans benefit from co-location?

    Response: (Dorothy Moller) I must acknowledge the safety net payors, who have been co-locating case managers for a number of years — in particular in hospital ERs. Very often the case managers you co-locate are not healthcare case managers, but behavioral health or social services case managers.

    In terms of strategies for co-location, it depends on the population you’re serving and what you’re trying to accomplish with that population. There are a number of places where you can co-locate case managers — not so much case managers as case or care coordination services. Very often in large multi-specialty or primary care practice settings such as federally qualified health centers (FQHCs), community clinics, or multi-specialty clinics, case managers are sometimes nurses, sometimes social workers, sometimes physician assistants performing various functions. They may link members with specific services that are non-health related or coordinate care.

    The key is to understand the population you’re serving and to make sure you include case management and care coordination services appropriate for that population. If you have a very acute population with high risks or readmission or other health complications, clearly you’re going to have a different kind of co-located service and you’re going to place them in a different location than you would otherwise. If you’re trying to encourage more effective access of services, use of preventive services, use of nurse call lines, and so on, you might place those services in a primary care practice. Those are going to be very different.

    Embedded case managers could even be community health workers. In fact, I’ve worked with payors in the Southwest using community health workers in that role. They are sometimes co-located within the practice but then go into the community and deliver education services there as well, sometimes in collaboration with medical and education specialists.

    It depends on the population you’re serving, the types of services you want to encourage or direct members to, and the most efficient staffing model for those services. Ultimately, you must remember you’re trying to develop a better staffing pyramid within the practice so that physicians do the most complex work — where a physician’s skills and capabilities are most needed. Nurses and other staff deliver care and services appropriate for their skills, education and capabilities. Be very targeted, understand your population, and direct the services appropriately.

    healthcare trends
    Dorothy Moller, MBA, is a managing director in the Government Healthcare Solutions business unit of Navigant Healthcare. She has nearly 30 years of experience specializing on a wide range of strategic issues from business intelligence and competitive analysis, to market, business and product strategy and design, business and product innovation, and business and operations turnaround and repositioning.

    Source: Healthcare Trends & Forecasts in 2015: Performance Expectations for the Healthcare Industry

    Majority Back Medicare Timeline for Value-Based Reimbursement

    January 29th, 2015 by Patricia Donovan

    For the first time in Medicare history, HHS has set explicit goals for alternative payment models and value-based payments.

    The healthcare industry took notice earlier this week of Medicare's ambitious timeline for moving Medicare payments from volume- to value-based models—an agenda validated by the majority of respondents to HIN's eleventh annual Healthcare Trends and Forecasts survey.

    Ninety-two percent of respondents to the December 2014 survey endorsed healthcare’s transition to rewarding healthcare value and quality over volume of services, noting the trend has boosted accountability and revenues.

    In a related data point, 26 percent view the adoption of value-based reimbursement and rewards as the most promising area of healthcare.

    The HHS timeline will tie 30 percent of traditional or fee-for-service (FFS) Medicare payments to quality or value through alternative payment models by the end of 2016. Alternative payment formulas include accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and bundled payment arrangements for episodes of care, which CMS has tested in a range of pilots in recent years.

    The HHS said it will tie 50 percent of payments to these models by the end of 2018. In 2011, Medicare made almost no payments to providers through alternative payment models, but today such payments represent approximately 20 percent of Medicare payments.

    With views toward value-based reimbursement mostly favorable, 2015 Trends survey respondents shared some spoils of a value-over-volume approach:

    • „„“Higher levels of accountability in order to be well positioned to execute in a value environment.”
    • „„“As a high quality provider, shift to rewarding this behavior has increased revenue.”
    • „„“Not as much direct impact as implied and perceived focus on quality and reporting.”
    • „„“We built a provider network upon this principle.”

    In other trends documented by the survey, declining reimbursement and cost constraints posed considerable challenges for respondents in the last 12 months, while interventions to tighten transitions in care, reduce hospital readmissions and integrate care via the patient-centered medical home (PCMH) model—all value-based initiatives—were among business successes recounted by this year’s participants.

    Infographic: Medicare Spending Trends

    January 26th, 2015 by Melanie Matthews

    In the short term, Medicare spending per person is expected to be lower relative to previous projections and to grow more slowly than private health insurance, according to a "Visualizing Health Policy" infographic by the Henry J. Kaiser Family Foundation.

    The infographic also examines long-term predictions for Medicare spending and projections on a Medicare shortfall.

    Physician Reimbursement for Chronic Care Management: Identifying New Practice Revenue OpportunitiesStarting this month, Medicare is reimbursing physician practices for select Chronic Care Management (CCM) services not previously eligible for reimbursement, underscoring the vital role of care management in primary care.

    Physician Reimbursement for Chronic Care Management: Identifying New Practice Revenue Opportunities offers practical guidance to prepare physician practices to maximize CCM reimbursement in the year ahead.

    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: Six Health Plan Design Changes To Maximize ROI

    January 2nd, 2015 by Melanie Matthews

    Employers are using a number of strategies to maximize health plan return on investment in light of increasing healthcare costs.

    A new infographic by Towers Watson explores the strategies and approaches companies are adopting, such as new coverage or utilization restrictions on specialty pharmacy, employee accountability, technology and more.

    Narrow Network Strategies and Trends for Health Plans and PBMsNarrow networks — for both medical and pharmacy providers — are gradually becoming more accepted by carriers, plan sponsors and patients. Smaller provider networks allow payers to manage overall healthcare costs while still maintaining access to benefits — an important consideration as plan designs become more commoditized in the age of public and private health insurance exchanges.

    Narrow Network Strategies and Trends for Health Plans and PBMs outlines the tactics health plans are using to restrict medical and pharmacy networks while still maintaining adequate access to care and positive relationships with providers. It also summarizes case studies of health plans and PBMs that have formed narrow networks and the results they've seen.

    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.

    The Year in Healthcare Intelligence: Reimbursement, Value-Based Results Resonate with Readers

    December 29th, 2014 by Patricia Donovan

    Newswise, fee-for-value healthcare initiatives eclipsed fee-for-service models.

    When survival of healthcare providers hinges on payment for services rendered, it's not surprising our 2014 readers closely tracked news of emerging payment models and results from patient-centered, quality-based initiatives.

    Here is a retrospective of stories that dominated our readers' news feeds over the last 12 months:

    • We reported on results from many accountable care organizations (ACO) over the last year, but few generated interest like the Anthem Blue Cross-Healthcare Partners accountable care collaboration that saved more than $4 million. The program succeeded by sharpening its focus to those with two or more chronic diseases—the population that research shows can most effectively be helped by coordinated care, officials state. A dedicated staff of care managers and care coordinators identify hospitalized ACO patients, coordinate transitions of care, and ensure patient care and healthcare resources are accessible.

    • Heads also turned when the Centers for Medicare and Medicaid Services (CMS) proposed updated penalties and incentives for its Medicare Shared Savings Program (MSSP), an accountable care initiative for Medicare beneficiaries. The proposed rules are designed to strengthen MSSP by placing greater emphasis on primary care services and promoting transitions to performance-based risk arrangements. CMS is also suggesting a third ACO model," track 3," which integrates some elements from the Pioneer ACO model.

    • The patient-centered medical home (PCMH) model, a stepping stone to an ACO, garnered its share of readership, especially when the National Committee for Quality Assurance (NCQA) added five measures to its medical home criteria, the gold standard for patient-centered measurement.

      In its third iteration of PCMH standards since 2008, the NCQA added behavioral health integration and care management for high-need populations, among other new criteria.

    • The patient-centered model suffered a setback, however, when one of the first, largest, and longest-running multipayor trials of PCMHs in the United States was associated with limited improvements in quality and was not associated with reductions in use of hospital, emergency department (ED), or ambulatory care services or total costs of care over three years. Research by Rand Corporation and colleagues centered on patient-centered activities in the Southeastern Pennsylvania Chronic Care Initiative.

    • There was good news on the medical home front, however: A study published in September, 2014 attributed reductions in emergency room visits, principally by patients with chronic illness, to the PCMH approach. Research by Independence Blue Cross (Independence) and CTI Clinical Trial and Consulting Services (CTI), and published by Health Services Research, found that transitions to a medical home were associated with a 5 to 8 percent reduction in ED utilization. This finding is specific to patients with chronic illness(es) having one or more ED visits in any given year. These reductions were most evident among patients with diabetes.

    • Readers also paid attention when Geisinger Health System, an early adoptor of care coordination for chronic illness, announced that its all-or-none or “bundled” approach to primary care for patients with diabetes produced better health outcomes, and the benefits happened quickly for the more than 4,000 patients in the study. The system-wide approach was not easy, warned Geisinger: the model requires constant evaluation, and must be scalable across a variety of practice settings.

    • Also raising the bar for physician practices was Highmark, which shared six requirements for the "best practices" element of its successful pay-for-performance initiative. Physician practices can earn additional rewards for completion of an office-based best practice project, essentially a small pilot, that involves measurement and reporting.

    • On the flip side, reporting of some questionable hospital pricing strategies rated some page views as well. Data released early in 2014 by National Nurses United (NNU) and the Institute for Health and Socio-Economic Policy (IHSP) found that some U.S. hospitals charge more than 10 times their cost, or nearly $1200 for every $100 of their total costs. Public oversight or regulation seems to help constrain excessive pricing, researchers found; Maryland, probably the most regulated state in the United States, has the lowest average charges of all the states among its 10 most expensive hospitals.

    • Cost savings aside, readers seemed especially attuned to new approaches or technologies designed to streamline healthcare delivery and enhance the patient experience, such as an uptick in remote monitoring.

      One hundred percent of respondents to the Telehealth in 2013 Survey by the Healthcare Intelligence Network monitor weight and vital signs, up from a respective 79 and 77 percent in 2010. The health conditions monitored remotely remain the same from 2010, the top three being heart failure, COPD and diabetes.

    • And finally, as all eyes focus on care management interventions that span the healthcare continuum, many readers responded to a story on a CMS pilot that would give hospice patients more options in the type of care they wish to receive at the end of life. Under the Medicare Care Choices Model, individuals who meet Medicare hospice eligibility requirements could receive palliative care services from certain hospice providers while concurrently receiving services provided by their curative care providers.

    Were these stories on your news radar in 2014? Stay up-to-date in 2015 with the latest healthcare news, trends and benchmarks with a free subscription to the Healthcare Business Weekly Update.

    11 Statistics About Remote Patient Monitoring

    December 23rd, 2014 by Cheryl Miller

    Remote monitoring of individuals with multiple chronic conditions reduced hospitalizations, hospital readmissions and ER visits for more than 80 percent of respondents and boosted disease self-management for nearly all of these monitored patients, according to the 119 respondents who participated in the Healthcare Intelligence Network's inaugural survey on Remote Patient Monitoring in March 2014. Other targets of a remote monitoring strategy included frequent utilizers of hospitals and emergency rooms (ERs) (62 percent) and the recently discharged (52 percent).

    Following are seven more statistics from the Remote Patient Monitoring survey:

    • Fifty percent of respondents rely on specific diagnoses sets to identify candidates for remote monitoring.
    • More than a quarter of respondents (27 percent) target the frail and/or home-bound with remote monitoring programs.
    • Reimbursement for remote monitoring, followed by the education of patients in this technology, were identified by respondents as the chief challenges of these remote care management efforts.
    • Two-thirds of respondents said remote monitoring reduced bed days.
    • Telephonic case management is a component of remote monitoring efforts for 71 percent of 2014 respondents.
    • About a third of respondents report the use of either a Web interface or a dedicated mHealth app to supplement remote monitoring.
    • A patient-centered touch, such as a follow-up phone reminder to use a monitoring device or a personal coaching session, was frequently cited as a noteworthy supplement to remote monitoring technology.

    Source: 2014 Healthcare Benchmarks: Remote Patient Monitoring

    http://hin.3dcartstores.com/2014-Healthcare-Benchmarks-Remote-Patient-Monitoring_p_4868.html

    2014 Healthcare Benchmarks: Remote Patient Monitoring delivers a comprehensive set of metrics from more than 100 healthcare organizations on current practices in and ramifications of remote monitoring for care management of chronic illness, the frail elderly and remote populations.