Archive for the ‘Medication Management’ Category

ROI and 12 More Rewards from Stratifying High-Risk, High-Cost Patients

May 21st, 2015 by Patricia Donovan

Health risk stratification—for example, grouping diabetics in a single physician practice or drilling down to an ACO's subset of medication non-adherent diabetics with elevated HbA1cs—followed by risk-appropriate interventions can significantly enhance a healthcare organization's clinical and financial outlook.

For 9.4 percent of respondents to HIN's 2014 Health Risk Stratification Survey, risk stratification resulted in program ROI of between 3:1 and 4:1, while 6.3 said return on investment was greater than 5:1.

Stratification and targeted interventions also generated a healthy drop in healthcare cost, nursing home stays, ER utilization and time off work while boosting quality ratings, patient engagement levels and care plan adherence.

Survey respondents further quantified successes achieved from health risk stratification in their own words:

  • "„„Decreased readmissions and decreased skilled nursing facility (SNF) utilization."
  • "Improved treat-to-target for diabetes, blood pressure, and depression care."
  • "Reduction in readmissions by 20+ percent."
  • "Reducing heart failure, pneumonia, acute myocardial infarction (AMI) and chronic obstructive pulmonary disorder (COPD) Medicare readmissions."
  • "Patient compliance to care plan."
  • "Patient health outcomes, quality of life, and satisfaction with services."
  • "Member satisfaction."
  • "More referrals to patient-centered medical homes and fair retention with limited resources."
  • "Decreased primary care-sensitive ED visits and increased quality metrics."
  • "One-on-one interaction w/members to promote behavior change."
  • "A reduction of costs in the range of 6 to 8 percent of target spend."
  • "Lower readmission rates for those patients on AIM 2.0 program with home health and more compliance with meds. We meet with FQHCs every other month and discuss issues and case management."

Source: 2014 Healthcare Benchmarks: Stratifying High-Risk Patients

2014 Healthcare Benchmarks: Stratifying High-Risk Patients captures the tools and practices employed by dozens of organizations in this prerequisite for care management and jumping-off point for population health improvement — data analytics that will ultimately enhance quality ratings and improve reimbursement in the industry's value-focused climate.

Home Health on Care Transitions Management: Focus on Post-Acute to Home Handoff

April 7th, 2015 by Patricia Donovan

With the hospital-to-home care transition deemed the most critical by half of healthcare organizations, home health sits on the front lines of care transitions management.

An overwhelming majority of home health organizations, which comprised approximately 10 percent of respondents to HIN's 2015 survey on Care Transitions Management, have a care transition management program in place: 80 percent versus 67 percent overall, and of those that don’t, 100 percent intend to implement one in the next 12 months, versus 56 percent overall.

Contrary to overall respondents, this sector considers the hospital to post-acute care transition key (50 percent versus 24 percent overall) as well as the post-acute care to home handoff (50 percent versus 9 percent overall).

Heart failure is the top health condition targeted by home health organizations (87 percent of respondents, versus 81 percent overall). This sector also targets acute myocardial infarction, or AMI (62 percent versus 51 percent overall), and the frail elderly, a top concern for 75 percent of this sector versus 44 percent overall.

Half of home health organizations surveyed self-developed care transitions programs (50 percent versus 34 percent overall). Similarly to most respondents, programs include medication reconciliation (87 percent versus 75 percent overall) and transition/handoff training (87 percent versus 39 percent overall). This sector also relied on telephonic follow-up (87 percent 79 percent overall) in their care transition programs.

Transition coaches were primarily responsible for coordinating care transitions, according to 37 percent of home health respondents, versus 25 percent overall.

Some ways home health organizations improved transitions of care included creation of community partnerships with acute care facilities, development of post-acute networks, and collaborations with all clinical and hospice providers.

Successful strategies for this sector included separating data input from hands-on patient discharge paperwork so clinicians doing the transition could focus more on the patient, and not typing. Also, maintaining open communication with all staff and following up on communication with the patient and/or caregiver to ensure they transitioned appropriately into the new setting helped them to identify any concerns in the hopes of avoiding an unnecessary hospitalization.

Provider engagement remains the biggest challenge to this sector’s transition management efforts, say 37 percent of home health organizations, versus 13 percent overall.

Source: 2015 Healthcare Benchmarks: Care Transitions 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 delivery of value-based care.

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

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.

Guest Post: 10 Medication Adherence Facts to Know in 2015

January 22nd, 2015 by Troy Hilsenroth

medication adherence

$105 billion of avoidable U.S. healthcare costs is due to medication non-adherence.

With 50 percent of Americans suffering from at least one chronic condition in their lifetime, medication management affects nearly everyone at some point. Whether an individual takes multiple medications or cares for a family member who is, the importance of taking medications as prescribed is highly undervalued. While missing a pill one day may seem insignificant, the effects of these habits can be highly detrimental and far-reaching, as guest blogger Troy Hilsenroth explains.

Not taking medication as prescribed, or medication non-adherence, can result in costly hospital bills, declines in patient wellness, and medical complications among other outcomes. Due to these very real risks, additional awareness about this serious public health issue is crucial moving into 2015.

Pharmacists already possess the patient care tools necessary to help with this problem. Patients need to access available tools to improve their medication adherence and educate themselves about their meds. The first step in reversing these trends is to promote education around the severity of medication non-adherence.

The following are ten medication adherence statistics to know in 2015:

  • In the United States, avoidable healthcare costs add up to $213 billion, of which $105 billion is due to medication non-adherence, according to the Express Scripts 2013 Drug Trend Report.
  • Non-adherence causes 30-50 percent of treatment failures and 125,000 deaths annually. 1
  • 64 percent of readmissions within 30 days are due to medication issues, according to HIN's 2010 Benchmarks in Improving Medication Adherence.
  • Medications are not continued as prescribed in about 50 percent of cases, according to a 2013 Centers for Disease Control and Prevention (CDC) presentation.
  • Nearly 50 percent of Americans have one or more chronic conditions that require prescription medications, according to the CDC.
  • Medication adherence is higher among patients who see the same healthcare provider each time they have a medical appointment. In this group, the average adherence is 81 percent, according to "Medication Adherence in America: A National Report Card," a recent report from the National Community Pharmacists Association.
  • Non-adherent patients are 17 percent more likely to be hospitalized than adherent patients, with a cost that exceeds that of an adherent patient by $3,575. 2
  • Generic medications have higher rates of adherence than name brand prescriptions, with 77 percent of patients adhering to generics as opposed to 71 percent with the name brand. 3
  • For some classes of medication, up to 30 percent of prescriptions are never filled by the patient, according to the Network for Excellence in Health Innovation (NEHI).
  • Patients receive 3.4 more refills per prescription in a 12-month period when their refills are synchronized, according to the National Community Pharmacists Association.

Medication non-adherence poses a very real risk for patients and their providers. A collaborative care team including physicians, pharmacists, and the patient is crucial to continuing education on this issue and establishing a medication management strategy to stay healthy and out of the hospital.

About the Author: Troy Hilsenroth has been with Omnicell for over six years, and currently serves as its vice president of the non-acute care division. In this role, he develops and delivers solutions to help organizations develop new and better ways of doing business and cultivates programs that change healthcare dynamics. Throughout his 22-year career in healthcare, his mission has been to deliver higher clinical quality at a lower cost. Prior to working at Omnicell, Troy served as a licensed clinical pharmacist for 14 years in a broad range of pharmacy environments, while also working as a firefighter and paramedic.

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

1. Smith D, Compliance Packaging; a patient education tool, American Pharmacy, Vol. NS29, No 2, February 1989.
2. A. Dragomir et al. (May 2010.). Impact of Adherence to Antihypertensive Agents on Clinical Outcomes and Hospitalization Costs. Medical Care, 48 (418-425). doi: 10.1097/MLR.0b013e3181d567bd
3. O’Riordan, Michael. (2014, September 15). Generics Beat Brand-Name Statins for Patient Adherence and Improving Outcomes. Medscape. Retrieved from

Infographic: Medication Non-Adherence’s Impact

November 12th, 2014 by Melanie Matthews

Medication Adherence

Medication Adherence

Medication non-adherence negatively impacts patient health and drives increases in healthcare costs, according to an infographic by NextIT.

The infographic examines one of the top reasons for medication non-adherence, eliminating health risk factors, and the role of virtual health assistants in helping patient manage chronic conditions.

What's the cost of medication non-adherence? As high as $290 billion annually, according to one frequently cited estimate. An equally bitter pill to swallow is the dismal C+ grade in medication adherence earned in 2013 by Americans with chronic medical conditions, according to the first National Report Card on Adherence from the National Community Pharmacists Association (NCPA). Fortunately, the healthcare industry is striving to improve performance in this area.

42 Metrics for Improving Medication Adherence42 Metrics for Improving Medication Adherence provides convincing evidence of the impact of nine key interventions on medication non-adherence— from the presence of pharmacists in patient-centered medical homes to medication reconciliation conducted during home visits.

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5 Features of the Patient-Centered Medical Home

October 23rd, 2014 by Cheryl Miller

Patient-centered medical homes (PCMHs) are not about pigeon-holing certain diseases or illnesses, says Terry McGeeney, MD, MBA, director at BDC Advisors, but about delivering acute and chronic care prevention and wellness. Dr. McGeeney reiterated the five essential features of the medical home as the groundwork for a medical neighborhood.

Given many of the initiatives of the Centers for Medicare and Medicaid Services (CMS), coupled with the Triple Aim, many have gotten bogged down and probably overly focused on the name: patient-centered medical home (PCMH). What’s important are the features or attributes of the PCMH: first, its patient-centeredness, a partnership among practitioners, patients and their families that ensures and respects the decisions of the patients and ensures patients have the education and support they need.

Secondly, in a PCMH, the care needs to be comprehensive. It’s a team of care providers who are wholly accountable for a patient’s physical and mental healthcare needs, including prevention and wellness, acute care, and chronic care.

Third, you will hear discussions about the PCMH being about a certain disease or illness. Please note that it’s acute and chronic care prevention and wellness. Pigeon-holing conditions, while important, is more of a chronic quality improvement initiative and not PCMH.

Fourth, under the PCMH, care needs to be coordinated. Care is organized across all elements of the broader healthcare system, including specialists, hospital, home healthcare, community service and support. There’s a lot of debate now about what we call ‘post-acute care’ or ‘transitions in care.’ Jonathan Blum, principal deputy administrator of CMS, recently spoke on the importance of post-acute care. This is what coordinated care particularly is all about.

Care has to be accessible. Patients are able to access services with shorter waiting times, after-hours care with access to EHRs, etc., and there has to be a commitment to quality and safety. Clinicians and staff need to enhance quality improvement with the use of health IT and other tools that are available to them.

We also need to be very careful that quality care is not equated with lower cost of care. Sometimes those two have a tendency to get muddled.

Source: Blueprint for a Medical Neighborhood: Building Care Coordination Between Specialists and PCPs

Blueprint for a Medical Neighborhood: Building Care Coordination Between Specialists and PCPs provides a framework in which to evaluate the patient-centered medical neighborhood (PCM-N) model. Pictured here is Terry McGeeney, MD, MBA, director of BDC Advisors, who navigates the landscape of the medical neighborhood, from the value-based payment realities of healthcare today to identifying and engaging specialists in a medical home neighborhood.

Home Visits 101: Empower the Patient, and Don’t Forget the Gloves

September 2nd, 2014 by Patricia Donovan

It's hard to plan a home visit for a recently discharged patient if you don't know they've been in the hospital. Obtaining data on hospitalized patients is one of the challenges of administering a home visits program, notes Samantha Valcourt, MS, RN, CNS, a clinical nurse specialist for Stanford Coordinated Care (SCC), a part of Stanford Hospital and Clinics.

Some of the challenges I’ve experienced with our home visits program is first of all, knowing when our patients are actually in the hospital. It’s easy to know when they’re at SCC; I get an electronic communications or an EMR. However, if patients go outside our system, I may not know. Sometimes that discharge summary is not available when I’m ready to go see the patient the day after. Holidays and weekends always increase that 48- to 72-hour window and I really do try to get in there the following day if possible.

For patients that don’t see primary care doctors within our clinic, it can sometimes be a challenge getting hold of their primary care doctor outside of SCC, and then explaining my role and why I need them.

On the back of our patient ID card, we emphasize to our patients to please contact us if they’re even considering going to the emergency department so that perhaps we can avoid a hospital admission or a readmission. If they are being seen in the hospital, we want them to call us as soon as they’re there, as soon as they’re able to, or to have their family member call so we can make sure that we’re involved in that transition.

Another lesson learned is definitely to empower the patient. Again, as a nurse I try to do as much for the patient as I can. But I have to keep in mind that when I’m in the home, my goal is to make sure will be able to identify the red flags and symptoms that indicate things are not going well, and that they’ll be able to contact the doctor’s office with their needs. I make sure that both handoffs are very clear; I never want to leave a patient wondering, ‘Oh I had this nurse and she came into my home and then she called me every few days and then all of a sudden she was gone.’

I need to make sure that I have good communication with that next transition.

And then last, I always carry a set of gloves, because you never know what you’ll walk into. I was not a home health nurse before I did these types of home visits, so I was ill prepared on one of my first visits to a patient with a dialysis catheter that was oozing blood. My nursing instinct caused me to run in there and try to clean things up.

Now I carry a good stock of gloves and supplies, because you just never know.

value-based reimbursement
Samantha Valcourt, MS, RN, CNS, a clinical nurse specialist for Stanford Coordinated Care (SCC), a part of Stanford Hospital and Clinics.

Source: Home Visits for High-Risk Patients: Tools, Timing and Outcomes

Trained Military Medics Ease Transitions for John C. Lincoln’s Newly Discharged Patients

August 26th, 2014 by Patricia Donovan

A large part of the success of the John C. Lincoln Network accountable care organization (ACO) can be attributed to its Transition Coach Program, which uses trained military medics as care transition coaches, explains Heather Jelonek, the organization's CEO for ACOs.

We applied for a CMS Innovation grant in spring 2012. Our hypothesis was that we could take military healthcare professionals, medics and army corpsmen; these individuals are incredibly well trained. Army medics can do appendectomies in the field; they’re providing basic primary care services. However, when they’re discharged from the military, they have no equivalent licensure.

We decided to begin a program where we hired individuals we referred to as having ‘blood on their boots.’ Tom Jargon was our first transition coach; he started with us about 90 days after his last tour in Afghanistan ended. But what the program really does is bring these young men and women into our health system. They get six weeks of training, they meet with a cardiologist, they are introduced around the hospital staff, and they get to know how to use the EPIC® electronic health record to its most effective benefit.

These transition coaches go into the hospitals and meet with patients when they are admitted. They get to know the patients and develop a rapport, but they also start preparing the patients for discharge. They are doing basic things like making sure the patient has a social support system in place and transportation to their primary care or specialists’ visits. They also try to determine the patients' financial resources.

Once that patient is discharged from the hospital, our transition coaches follow them for a minimum of 30 days. They’re going into the patient’s home looking for fall risks. They’re helping the patient set up their home so that they’re a little bit safer. They’re doing a general review of cabinets: does the patient in fact have food in the refrigerator? Do they have pet food available if they have pets? Sometimes we find patients are feeding their pets rather than feeding themselves. So through our relationship with PetSmart®, we’ve been able to collect donations of animal food; we deliver those to our patients’ homes so they can afford food for themselves.

If on the other hand they’re finding evidence that the patient has pet food in the home but no food for themselves, we connect those patients with our Desert Mission Food Bank.

Transition coaches help patients learn to monitor their blood pressure. They explain their medication. They go through basic nutrition and education services. We bring in a registered dietician to work with patients who have dietary issues.

Source: Beyond the EMR: Mining Population Health Analytics to Elevate Accountable Care

Beyond the EMR Population Health Analytics

Beyond the EMR: Mining Population Health Analytics to Elevate Accountable Care
Reviews the concentrated data dig undertaken by John C. Lincoln to prepare for participation in the CMS Medicare Shared Savings Program (MSSP).

Infographic: Medicated to Death

May 16th, 2014 by Jackie Lyons

Approximately one in five Americans take five or more prescriptions, which can lead to risks such as addiction or drug-resistant infections, according to a new infographic from Top RN to BSN.

This infographic details the statistics behind the use of medication in the United States, as well as the causes and risks of overmedication.

Want to know more about medication and prescription drugs trends? 2013 Healthcare Benchmarks: Improving Medication Adherence provides actionable information from more than 100 healthcare organizations on efforts to improve medication adherence and compliance in their populations.

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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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