Archive for the ‘Healthcare Costs’ Category

AltaMed Constructs Business Case for Care Coordination Team

May 19th, 2015 by Patricia Donovan

The AltaMed multidisciplinary care team targets dual eligibles with multiple chronic conditions and functional and cognitive impairments.

When the largest FQHC in the country set out to quantify the contributions of its multidisciplinary care team, it found the concept didn't fit neatly into return on investment models.

So at budget time this year, leaders of AltaMed Health Services Corporation's care coordination model for its highest risk patients identified seven performance metrics to present to its CFO, explained Shameka Coles, AltaMed's associate vice president of medical management, during A Comprehensive Care Management Model: Care Coordination for Complex Patients, a May 2015 webinar now available for replay.

The evidence that ultimately secured funding for the care coordination project's next phase included the model's impact on specialty costs, emergency room visits, and HEDIS® measures, among other factors.

These were all areas examined early on, back in phase one, when the care coordination team set a number of strategic goals that aligned with the corporation's five pillars: service, quality, people, community and finance.

Rolled out in four phases beginning in July 2014, the model is aimed at AltaMed's dually eligible population— Medicare-Medicaid beneficiaries with high utilization, multiple chronic conditions, and multiple functional and cognitive impairments, Ms. Coles explained.

Phase one of the project was devoted to understanding and engaging the duals population via telephonic and print outreach, then developing a care management model reflecting both Triple Aim and patient-centered medical home goals. (The 23-site multi-specialty physician organization in Southern California has earned Joint Commission primary care medical home designation.)

At the heart of the model is a multidisciplinary care team, which counts a care coordinator, clinic patient navigator and care transitions coach among its eleven roles. Patients are stratified as high, moderate or low risk and matched to risk-appropriate interventions.

"Each member is activated based on where the patient is at in the continuum of care," noted Ms. Coles, who also reviewed team member roles and responsibilities and a host of complementary programs supporting care coordination during the May 2015 program sponsored by the Healthcare Intelligence Network.

In phase two, focused on development of end-to-end workflows, staff assessments and ratios, and team training, AltaMed hired an educator, fleshed out the patient navigator role, and examined integration of behavioral health and long-term services and supports (LTSS).

Phase three triggered a deeper dive into case manager caseloads and utilization patterns as well as several quality improvement activities.

Now in phase four, the goal of AltaMed's care coordination model is to ensure it can reflect a financial impact. "We'll look very closely at our per member per month cost and our inpatient metrics," Ms. Coles concluded.

13 Metrics on Care Transition Management

May 7th, 2015 by Cheryl Miller

Care transitions mandate: Sharpen communication between care sites.


Call it Care Transitions Management 2.0 — enterprising approaches that range from recording patient discharge instructions to enlisting fire departments and pharmacists to conduct home visits and reconcile medications.

To improve 30-day readmissions and avoid costly Medicare penalties, more than one-third of 116 respondents to the 2015 Care Transitions Management survey—34 percent—have designed programs in this area, drawing inspiration from the Coleman Care Transitions Program®, Project BOOST®, Project RED, Guided Care®, and other models.

Whether self-styled or off the shelf, well-managed care transitions enhance both quality of care and utilization metrics, according to this fourth annual Care Transitions survey conducted in February 2015 by the Healthcare Intelligence Network. Seventy-four percent of respondents reported a drop in readmissions; 44 percent saw decreases in lengths of stay; 38 percent saw readmissions penalties drop; and 65 percent said patient compliance improved.

Following are eight more care transition management metrics derived from the survey:

  • The hospital-to-home transition is the most critical transition to manage, say 50 percent of respondents.
  • Heart failure is the top targeted health condition of care transition efforts for 81 percent of respondents.
  • A history of recent hospitalizations is the most glaring indicator of a need for care transitions management, say 81 percent of respondents.
  • Beyond the self-developed approach, the most-modeled program is CMS’ Community-Based Care Transitions Program, say 13 percent of respondents.
  • Eighty percent of respondents engage patients post-discharge via telephonic follow-up.
  • Discharge summary templates are used by 45 percent of respondents.
  • Home visits for recently discharged patients are offered by 49 percent of respondents.
  • Beyond the EHR, information about discharged or transitioning patients is most often transmitted via phone or fax, say 38 percent of respondents.

Source: 2015 Healthcare Benchmarks: Care Transitions Management

Care Transition Management

2015 Healthcare Benchmarks: Care Transitions Management HIN's fourth annual analysis of these cross-continuum initiatives, examines programs, models, protocols and results associated with movement of patients from one care site to another, including the impact of care transitions management on quality metrics and the delivery of value-based care.

Infographic: Health Literacy

May 6th, 2015 by Melanie Matthews


One in two adults can't use a BMI chart to find a healthy weight, understand a vaccination chart and/or read a prescription label, according to an infographic by GSW on health literacy.

The infographic details examples of low health literacy and the impact it has on patients and the healthcare system.

Advancing Health Literacy: A Framework for Understanding and ActionAdvancing Health Literacy: A Framework for Understanding and Action addresses the crisis in health literacy in the United States and around the world. This book thoroughly examines the critical role of literacy in public health and outlines a practical, effective model that bridges the gap between health education, health promotion, and health communication.

Step by step, Advancing Health Literacy: A Framework for Understanding and Action outlines the theory and practice of health literacy from a public health perspective. This comprehensive resource includes the history of health literacy, theoretical foundations of health and language literacy, the role of the media, a series of case studies on important topics including prenatal care, anthrax, HIV/AIDS, genomics, and diabetes.

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Have an infographic you'd like featured on our site? Click here for submission guidelines.

PHOs Let Quality, Cost Guide Them Toward Value-Based Reimbursement

April 16th, 2015 by Cheryl Miller

Instead of focusing on volume, physician-hospital organizations (PHOs) are concentrating on value-based care, says Travis Ansel, senior manager with the Healthcare Strategy Group. The once revenue-based organizations are now focused on quality and cost, realizing that if they can’t manage those two things, their reimbursement will go down.

Why is the PHO model going to work now? We always get this question. This comes more from doctors than it does from administrators: why are PHOs going to work now, when they didn’t work before? The simple answer is that before, PHOs were revenue-focused. They were about getting the biggest number of physicians into the model regardless of their quality. It was run by the hospital as a methodology for increasing rates. Then fee-for-service (FFS) didn’t really give anybody the incentive to work together.

They gave everybody the incentive to sign their name on the contract and hope for better rates. What we’re seeing PHOs focus on now is quality and cost, with the idea that if they can’t manage those two things, their reimbursement is going to go down. We have clinical integration guidance from the Federal Trade Commission (FTC), which gives everybody the framework for developing joint contracting capabilities and defines legally how we can work together. What we’re seeing now, since there’s more of a clinical than a revenue focus for PHOs, is that they are more dominated by physician leadership. The hospital keeps control over the purse strings, but gives the governance of the group to physicians. They are letting them take the leadership on the cost and quality protocols that they need to develop to be successful.

There is also the way that payment reform is transitioning the incentives. They’re focused on getting quality and cost across populations or across episodes of care. They’re giving the right incentives for collaboration, which the PHO model provides the forum for.

Source: Physician-Hospital Organizations: Framework for Clinical Integration and Value-Based Reimbursement

Home Visits

Physician-Hospital Organizations: Framework for Clinical Integration and Value-Based Reimbursement describes the relevance of the PHO model to today's healthcare market, offering strategies to leverage the physician-hospital organization for maximum clinical outcomes, competencies and value-based reimbursement.

Countering 5 Remote Monitoring Cautions in Face of mHealth Uncertainty

March 24th, 2015 by Cheryl Miller

remote_patient_monitoring

Physician champions and legislative advocates can spur remote patient monitoring success.

Physician skepticism about mHealth is a frequently cited barrier to implementing remote monitoring. But once physicians understand they can allot in-person visits for those who truly need them, then use their other time remotely monitoring other patients to wellness, they might be more willing to buy in to mHealth.

It's all about educating the physician, advises Dr. Luke Webster, vice president, chief medical information officer, CHRISTUS Health, who shared how CHRISTUS responded to these challenges during its remote patient monitoring pilot.

  • Unclear ROI: There are always questions around ROI. We look at pre-implementation costs and pre-enrollment costs versus post-costs, including all project costs. What does that ROI mean for your organization?
  • Limited Resources: With care transitions, we took remote patient monitoring and put it on top of the care transitions program. That added additional responsibilities to the already busy workflow process. Whether you’re looking at an E-Hub model or expanding these programs into other areas of your organization, it’s important to review that budget up front. What’s expected of your outcome goals? How will you do that from a day-to-day process and biweekly performance outcomes and measures so you meet that targeted overall outcome, whether it’s reducing length of stay, cost of care, or 30-day readmissions?

    You want all of that to match. Your resources have to be identified upfront. We have been very fortunate to have our providers as champions. They buy into it; they understand it. They didn’t buy into it initially because the nurse coach thought it necessary to make that patient home visit. Sometimes it is. But she has found, with these tools, that she can better do that from her office and manage more patients.

  • Physician Skepticism: It is important to understand your champions, your available resources, backup, etc., when issues come up and you need those resources. We’re finding — and statistics state this — that physicians are still more comfortable doing face-to-face visits. Keeping those patients healthier and at home means we’re keeping them out of the facilities. The physicians and primary care providers may have some skepticism regarding that as well. They have less hands-on training with the equipment so perhaps don’t fully understand the opportunity for them to fill clinic days with patients that are truly in need of an appointment that day versus monitoring others who can be coached to wellness at home.

    It’s about educating physicians, finding those champions and engaging them in the overall process and direction of our health system.

  • Reimbursement Regulations: You need an advocate who can speak for you, represent what you’re doing, and prove the value both at a state and federal level. That should be an ongoing process and on your calendar monthly: identifying and calling your state or federal representative.
  • Rising Technology Costs: This is a booming area; vendors can’t get their products out fast enough. When you set up a budget for a program like this and look to initiate a pilot or expansion, you must look at all technology costs—not only for hardware but for software, upgrades and required support. Do you go through a third party vendor, and do you lease or purchase your equipment? When do you purchase the equipment? Just from our original pilot in late 2012 to today, we’ve seen some changes in technology. If your kits are organized to fit that original technology, how will that change 18 months later, and what will be the cost of adjusting the kits (for example, Styrofoam, boxes, etc.)?

    All of that will change. Look at those technology costs and related issues as you move forward and have a plan to how best recycle that kit.

    Remote Monitoring
    Luke Webster, MD, is vice president and chief medical information officer of CHRISTUS Health. Dr. Webster has over 20 years of clinical and health informatics experience. He specializes in health informatics and physician leadership, clinician adoption and change leadership, clinical transformation, evidence-based medicine, clinical analytics and process improvement.

    Source: Remote Patient Monitoring for Chronic Condition Management

Infographic: The Adverse Impact of High-Deductible Health Plans on Providers

March 23rd, 2015 by Melanie Matthews

The increase in high-deductible health plans (HDHP) is having a negative impact on healthcare providers, according to a new infographic by Nobility.

The growth in HDHPs, up from one million in 2005 to 17.4 million in 2014, has led to some patients skipping or delaying procedures and an increase in medical debt for patients who cannot afford their deductible. The infographic examines the impact of HDHPs and how physician practices can respond to this growing trend.

Healthcare Trends & Forecasts in 2015: Performance Expectations for the Healthcare IndustryFrom collaboration and consolidation to the inevitable acceptance of a value-based system, the state of healthcare continues to stimulate health plans, providers and employers.

Healthcare Trends & Forecasts in 2015: Performance Expectations for the Healthcare Industry, HIN's eleventh annual industry forecast, examines the factors challenging healthcare players and suggests strategies for organizations to distinguish themselves in the steadily evolving marketplace.

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Have an infographic you'd like featured on our site? Click here for submission guidelines.

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