Archive for the ‘Medication Management’ Category

Essentia Health Virtual Telemedicine Services Support Rural Hospitals and Clinics

March 13th, 2018 by Patricia Donovan

Essentia Health conducts 5,000 virtual visits annually.

There may be some challenges associated with Essentia Health’s comprehensive telemedicine program, but provider engagement isn’t one of them.

“In the seven years I have been with Essentia Health, I have not gone to any provider to ask them to do telehealth,” notes Maureen Ideker, RN, BSN, MBA, the organization’s senior advisor for telehealth. Instead, physicians seek out Ms. Ideker, asking to be connected to any of Essentia Health’s six hospital-based and more than 20 clinic-based telehealth services.

Such robust telemedicine adoption among Essentia Health’s more than 800 physicians may be one reason why the organization averages 5,000 virtual visits annually, and why it has another 10 to 20 new telehealth offerings in development, according to Ms. Ideker’s presentation during Telemedicine Across the Care Continuum: Boosting Health Clinic Revenue and Closing Care Gaps.

The largely rural footprint of Essentia Health, which touches the three states of Minnesota, Wisconsin and North Dakota, is ideally suited to telehealth implementation. During this March 2018 webinar, which is now available for rebroadcast, Ms. Ideker outlined her organization’s telehealth program models, history of program development, and equipment and staffing requirements. She also shared key program outcomes, such as the impact of remote patient monitoring on hospital readmissions and clinic ROI from telehealth.

For example, the 30-day readmission rate for Essentia Health patients with heart failure remotely monitored at home is 2 percent, versus its non-monitored heart failure patients (9 percent) and the national 30-day readmissions average of 24 percent.

Essentia Health’s hospital-based telemedicine began with an emergency room platform, which includes pediatric ER and pharmacy and toxicology and a soon-to-be-added behavioral health component. Today, hospitalist and stroke care are the largest of Essentia Health’s hospital-based telemedicine programs, explained Ms. Ideker. These virtual services support Essentia Health’s rural hospitals in five key ways, including the avoidance of unnecessary patient transfers.

On the outpatient side, the 20-something tele-clinic based services developed by Essentia Health over the last seven years run the gamut from allergy and infant audiology to urology and vascular conditions, she explained. Her organization’s telemedicine approach to opioid tapering is catching on across Minnesota, she added.

And while it is appreciative of its providers’ enthusiasm, Essentia Health approaches telehealth development with precision, consulting data analytics such as metrics on annual health screenings to create target groups for new services. The launching of a new telemedicine service can take up to twelve weeks, using a 75-item checklist and an implementation retreat and walk-through, Ms. Ideker explained.

In closing, Ms. Ideker shared several innovation stories from its portfolio of telehealth offerings, including Code Weather, employed during hazardous weather for patient safety reasons and to reduce cancellations of appointments, and a gastroenterology initiative designed to reduce no-show rates.

Listen to Maureen Ideker explain how Essentia Health pairs remote patients with hospital- and clinic-based telehealth services.

Guest Post: Patient Engagement Technology Tool for Preventing Hospital Readmissions in Chronic Patients

January 23rd, 2018 by Allison Hart, Vice President of Marketing, TeleVox Solutions at West

While almost all chronic care patients say they need help managing their disease, less than one-third receive regular check-ins from healthcare providers.

During the past decade, the Centers for Medicare and Medicaid Services have increased the pressure on hospitals to prevent readmissions. In response to that pressure, many hospitals made changes that have led to declines in readmission rates. However, even with more measures in place to prevent readmissions than ever before, the risk of being readmitted to the hospital is still high for patients with chronic illnesses.

Studies have shown that the risk of adverse health effects increases with each hospitalization. Unfortunately, it can be difficult to keep chronic patients from readmitting once they have been hospitalized. Because of this, it is important that healthcare teams prioritize chronic disease management, and work to engage and support chronic patients. One tool that can help with this is the patient engagement technology many healthcare teams already have in place.

Survey responses indicate that chronic patients welcome efforts from their healthcare team that are aimed at managing disease and preventing hospital admissions and readmissions. A West survey found that 91 percent of chronic patients say they need help managing their disease, and at least 70 percent would like more resources or clarity on how to manage their condition. Additionally, 75 percent of chronic patients want their healthcare provider to touch base with them regularly so they can be alerted of potential issues.

Although patients with chronic conditions have expressed that they desire more assistance from their healthcare providers, they are not necessarily receiving it. For example, more than half (54 percent) of patients feel a weekly or twice-weekly check-in from their provider would be valuable, yet only 30 percent of patients report receiving regular check-ins. This shows that, in some cases, providers could be doing much more to offer ongoing chronic disease management support.

Providers seem to be underestimating patients’ interest in chronic care and their desire to receive support. Patients have suggested that they not only want assistance with managing chronic conditions, they would also be willing to pay for that extra support. Many providers are unaware that their patients feel this way. When asked if their patients would agree to pay 10 dollars per month for additional chronic care support, just over half (53 percent) of providers answered “yes.” However, two-thirds of patients say they would be willing to pay a nominal amount for chronic care support. The eye-opening response from patients confirms that chronic disease management is in demand—more so than providers realize. It also suggests that some providers may need to do more to offer ongoing chronic disease management support.

Chronic Care Management Enrollment

One way healthcare teams can better serve chronic patients and potentially prevent readmissions is by enrolling patients in chronic disease management programs. Chronic care programs, like Medicare’s Chronic Care Management program, require a lot of communication on the part of the healthcare team. Automating some of the communication and outreach makes it easier for providers to offer ongoing chronic care support. Healthcare teams can use their patient engagement technology to:

  • Send patients messages to invite them to enroll in a chronic care program. Using information from electronic health records, healthcare teams can identify patients that are eligible for chronic care management programs. (Patients must have two or more chronic conditions to enroll in Medicare’s Chronic Care Management program.) Then, they can use their patient engagement technology to send patients automated messages with information about the benefits of participating in a chronic care program, and instructions or links for patients to enroll or get further information.
  • Schedule disease-specific preventive screenings and tests. The Chronic Care Management program mandates that patients receive recommended preventive services. Care managers can schedule and send patients automated text messages, emails or voice messages to notify them when they are due for preventive screenings and tests. Patients with diabetes, for example, would automatically receive messages when they are due for an A1C test, foot exam or eye exam.
  • Send medication reminders and messages. Providers are required to manage and reconcile medications for patients enrolled in the Chronic Care Management program. Providers can assign medication reminders and send automated messages to ensure patients know how and when to take their medication, and that they don’t forget to take it.

Communication that engages chronic patients and aids them in disease management can result in better health outcomes and fewer readmissions. Engagement communications can be easily automated, meaning outreach does not require excessive time or resources. Hospitals and healthcare providers have incentives to reduce readmissions, and in many cases, they have the technology in place to make chronic disease management efficient and effective.

About the Author: Allison Hart is a regularly published advocate for utilizing technology-enabled communications to engage and activate patients beyond the clinical setting. She leads thought leadership efforts for West’s TeleVox Solutions, promoting the idea that engaging with patients between healthcare appointments in meaningful ways will encourage and inspire them to follow and embrace treatment plans – and that activating these positive behaviors ultimately leads to better outcomes for both healthcare organizations and patients. Hart currently serves as Vice President of Marketing for TeleVox Solutions at West, where the healthcare mission is to help organizations harness communications to expand the boundaries of where, when, and how healthcare is delivered.

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.

Improve Medication Adherence, and Payors Pay Attention

June 20th, 2017 by Patricia Donovan
medication adherence

Training in motivational interviewing helps Novant health set medication adherence goals that are meaningful to patients.

Seeking additional dollars from managed care contracts? Work harder at getting patients to adhere to medication therapies, advises Rebecca Bean, director of population health pharmacy for Novant Health. Here, Ms. Bean describes ways her organization is improving medication adherence, including pharmacist referrals, while enhancing Novant Health’s bottom line.

Medication adherence is a huge focus for our organization. There are some quality measures related to adherence, including CMS Star measures. They are triple-weighted, which indicates they mean a lot to payors. Often, medication adherence is a way to get additional dollars through managed care contracts. Our pharmacists work hard at helping patients adhere to medication therapies.

We have found some benefit to using adherence estimators. Adherence estimators give you a better feel for what is causing the patient to have difficulty with taking their medication. The other finding is that oftentimes providers are unaware; they have no idea patients aren’t taking medications. This becomes a safety issue; providers may keep adding blood pressure medications because they are not getting that blood pressure to goal. If for whatever reason the patient suddenly decides to take a medication they weren’t taking before, there could be a serious issue with taking all of those blood pressure medicines at one time.

The other benefit to estimating adherence and identifying root causes is that it frames the discussion with the patient. I don’t want to spend an hour talking to a patient about why it’s important to take this blood pressure medicine when it’s actually a financial issue. If I know it’s a financial issue, then I can make recommendations on cost-saving alternatives. It helps you to be more efficient in your conversation with the patient.

The other challenge of adherence is that patients are reluctant to be honest about this issue. You have to be creative to get the answers you need or get to the truth about adherence. If you flat out ask a patient if they’re taking their medications, most of the time they will say yes.

One other helpful strategy when working with patients to set adherence goals is to have them set goals that mean something to them. It’s not helpful for me to set a goal for a patient. If I ask them to tell me what they’re going to do, then they’re accountable for that. It is very helpful to get your staff trained in motivational interviewing. This trains them to meet the patients where they are and to understand what is important to that patient, which helps you frame the medication therapy discussion.

Source: Leveraging Pharmacists to Reduce Cost and Improve Medication Adherence in High-Risk Populations

pharmacists and medication adherence

Leveraging Pharmacists to Reduce Cost and Improve Medication Adherence in High-Risk Populations examines Novant Health’s deployment of pharmacists as part of its five-pronged strategy to deliver healthcare value through medication management services.

Infographic: The Battle for Medication Adherence

May 24th, 2017 by Melanie Matthews

Patient adherence to a prescription regimen can reduce costs and improve the quality of life, according to a new infographic by Medical Marketing & Media.

However, healthcare providers and pharmaceutical companies struggle to find the best tools, words and technologies that will improve adherence rates among patients with chronic conditions.

The infographic examines the impact of non-adherence and how text messaging and “polypills” can impact adherence.

Leveraging Pharmacists to Reduce Cost and Improve Medication Adherence in High-Risk PopulationsWhen it comes to medication management for Medicare beneficiaries, there are more than 25 different factors that can complicate proper use of prescribed medicines—from affordability issues, even among the insured, to fear of a drug’s side effects to potential dangers from high-risk medications or health conditions.

Leveraging Pharmacists to Reduce Cost and Improve Medication Adherence in High-Risk Populations examines Novant Health’s deployment of pharmacists as part of its five-pronged strategy to deliver healthcare value through medication management services.

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Reducing SNF Readmissions: Clinical Targets, Quality Scorecards Elevate Performance

May 23rd, 2017 by Patricia Donovan

reducing SNF readmissions

Michigan’s Tri-County Collaborative holds the line on hospital readmissions from 130 participating SNFs.

Three geographically close Michigan health systems shared more than a concern over escalating readmissions from skilled nursing facilities (SNFs).

As Henry Ford Health System (HFHS), the Detroit Medical Center and St. John’s Providence Health System ultimately discovered from Michigan Quality Improvement Organization (MPRO) data in 2013, they also shared about 30 percent of their patient population.

This revelation, combined with the pinch of new hospital readmission penalties from the Centers for Medicare and Medicaid Services (CMS), prompted the three to set aside competition and siloed strategies and forge a coordinated approach to reducing readmissions from SNFs.

Today, the resulting Tri-County SNF Collaborative operates with a set of clinical and quality targets and metrics created in tandem with more than 130 member SNFs. Tri-County’s dozen participation requirements for SNFs range from regular reporting through a dedicated SNF portal to achievement of specified performance metrics.

“We developed collaborative relationships,” explained Susan Craft, director of care coordination for the family caregiver program in HFHS’s Office of Clinical Quality & Safety. “We wanted to have very open, honest conversations to review issues that were identified and find ways to resolve those.”

Ms. Craft shared the roots, framework and results of the SNF collaborative, which launched in the first quarter of 2015, during Reducing SNF Readmissions: Quality Reporting Metrics Drive Improvements, a May 2017 webcast now available for replay.

Once admitted to the collaborative, member SNFs must report on 14 metrics in four key areas: acuity, care transitions, quality and readmissions. In return, SNFs receive a 13-point unblinded quarterly scorecard with metrics on readmissions and patient acceptance response times, among many others.

A multidisciplinary team within Tri-County Collaborative reviews all SNF metrics bi-annually to determine each facility’s continued participation.

As for the collaborative’s impact since its launch, Henry Ford Health System achieved a nearly 20 percent drop in Medicare SNF readmissions as well as a 28 percent reduction in SNF lengths of stay. The initiative also identified opportunities for improvement, resulting in enhanced outpatient scheduling and nurse-to-nurse handoffs and interventions focused on SNF-specific issues like sepsis, Ms. Craft explained.

Despite these advancements, the collaborative still faces the inherent challenges of competition and transparency, as well as SNFs’ hesitancy to adopt value-based practices. “Our SNFs are still entirely dependent on fee for service [payment models],” said Craft. “They haven’t been impacted by penalties and value-based purchasing, although that is coming for them next year.”

Although not yet referring to participating SNFs as “preferred providers,” the collaboratives hopes to one day equip patients with complete data pictures to guide them in SNF selection. Also on Tri-County Collaborative’s radar are home care agencies, concluded Ms. Craft.

“We know there needs to be a lot of coordination across all post-acute care settings.”

Listen to Susan Craft describe how Michigan’s SNF Collaborative set aside competition to improve quality and readmission rates.

Infographic: Improve Patient Engagement To Increase Medication Adherence

March 3rd, 2017 by Melanie Matthews

Chronic illnesses treated with long-term use of medications could be more successful with improved medication adherence rates, according to a new infographic by Fleming. Some 50% of patients do not take their medications as prescribed.

The infographic drills down on the factors related to non-adherence, the cost of non-adherence and the impact of technology on patient engagement.

Improve Patient Engagement To Increase Medication Adherence

Framework for Patient Engagement: 6 Stages to Success in a Value-Based Health SystemIntermountain Healthcare’s strategic six-point patient engagement framework not only has transformed patient care delivered by the Salt Lake City-based organization but also has fostered an attitude of shared accountability throughout the not-for-profit health system.

Framework for Patient Engagement: 6 Stages to Success in a Value-Based Health System details Intermountain’s multilayered approach and how it supports its corporate mission: Helping people live the healthiest lives possible.

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Infographic: A Digital Prescription for Medication Adherence

December 26th, 2016 by Melanie Matthews

A Digital Prescription for Medication AdherenceMedication adherence is a $337 billion problem in the U.S. healthcare industry. Patients failing to take their prescriptions or follow treatment plans result in more than $100 billion every year in hospitalizations alone, and healthcare spending on noncompliant patients is nearly double the cost of abiding patients, according to a new infographic by epam.

The infographic examines how telehealth can be used to improve medication adherence.

2016 Healthcare Benchmarks: Medication ManagementMedication management is the standard of care that ensures each patient’s medications (whether prescription, nonprescription, alternative, etc.) are individually assessed for appropriateness, effectiveness, safety given the individual’s comorbidities, other medications and ability to be taken as intended, according to a 2012 Patient-Centered Primary Care Collaborative definition. And while medications represent only a fraction of overall medical cost, they wield considerable influence over patients’ chronic condition outcomes, utilization, cost and care experiences.

2016 Healthcare Benchmarks: Medication Management compiles actionable data on the infrastructure, challenges and outcomes of medication management initiatives, based on responses from 101 healthcare organizations to the August 2016 Medication Management survey by the Healthcare Intelligence Network. Click here for more information.

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Infographic: Leveraging Data To Improve Medication Compliance

October 26th, 2016 by Melanie Matthews

Some 75 percent of patients admit to not taking prescription medication as directed, according to a new infographic by SCIOInspire, Corp.

The infographic examines the extent of medication non-adherence, the impact on care quality and outcomes and how data can be used to reduce non-adherence.

2016 Healthcare Benchmarks: Medication ManagementMedication management is the standard of care that ensures each patient’s medications (whether prescription, nonprescription, alternative, etc.) are individually assessed for appropriateness, effectiveness, safety given the individual’s comorbidities, other medications and ability to be taken as intended, according to a 2012 Patient-Centered Primary Care Collaborative definition. And while medications represent only a fraction of overall medical cost, they wield considerable influence over patients’ chronic condition outcomes, utilization, cost and care experiences.

2016 Healthcare Benchmarks: Medication Management compiles actionable data on the infrastructure, challenges and outcomes of medication management initiatives, based on responses from 101 healthcare organizations to the August 2016 Medication Management survey by the Healthcare Intelligence Network. Click here for more information.

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Engage a Pharmacist and 12 More Prescriptions for Medication Management

October 20th, 2016 by Patricia Donovan

Half of medication management programs engage retail or community pharmacists in 2016.

When should a pharmacist be brought in for a medication management consultation?

When the patient requests a consult, experiences general medication adherence issues, or suffers complications from medications, say respondents to the 2016 Medication Management survey by the Healthcare Intelligence Network.

The 101 respondents to the August 2016 survey also indicated that as a general medication management guideline, and with or without a pharmacist’s involvement, polypharmacy patients, individuals taking high-risk medications, those registering frequent ER or inpatient stays and those transitioning between care sites should receive priority.

Drilling down to clinical red flags for medication management, a diagnosis of diabetes is a key indicator, say 84 percent, followed by congestive heart failure or hypertension, say 81 percent of respondents.

Despite the inclusion of pharmacists in 90 percent of medication management programs, 42 percent of respondents say pharmacists are not currently reimbursed for medication management-related tasks.

Other medication management metrics documented by the survey include the following:

  • The three most common components of medication management programs are education and health coaching (71 percent), a medication needs assessment (69 percent) and pharmacist counseling (68 percent).
  • A pharmacist-driven clinical assessment is the most reliable standard for measuring medication management, say 63 percent of respondents.
  • E-prescribing and aids such as medication event monitoring system (MEMS) caps, pillboxes and calendars are the most common medication management tools, according to 49 percent of participants.
  • Patient-reported medication data is the information most commonly assessed for medication management, say 78 percent, closely followed by medication refill patterns (75 percent) and claims data (53 percent).
  • Half of responding medication management programs engage a retail or community pharmacist.
  • Fifty-eight percent of respondents not currently engaged in medication management plan to launch a program in the coming year.
  • Forty-four percent of respondents share electronic health records for medication management purposes.
  • Beyond a pharmacist-driven assessment, the Medication Possession Ratio (MPR) is the key measure of medication management for 31 percent of respondents.

Click here to download an executive summary of survey results: Medication Management in 2016: Polypharmacy, Diabetes Patients Priorities for Pharmacist-Led Interventions.

Infographic: The Impact of Medication Reconciliation on Readmission Rates

July 18th, 2016 by Melanie Matthews

Medication reconciliation programs, in which pharmacists review patients’ medication regimens and provide adherence counseling during the patient’s transition from hospital to home, reduced ths risk of hospital readmission by 50 percent and helped avoid unnecessary healthcare costs, according to a new study from the CVS Health Research Institute.

A new infographic by CVS highlights the survey findings, including details on the impact of medication non-adherence on readmission rates and how a pharmacist intervention reduced readmission risks.

Medication Management: Using Clinical Pharmacists To Complete Comprehensive Drug Therapy Management Post Discharge in High-Risk PatientsA clinical pharmacist-driven medication management effort at Novant Health identifies patients at high-risk for readmissions or ED visits related to adverse drug events. Using a combination of medication reconciliation, pharmacotherapy review, and patient education, Novant Health’s clinical pharmacists are working to reduce preventable readmissions by optimizing medication regimens and removing barriers to adherence among these high-risk patients.

During Medication Management: Using Clinical Pharmacists To Complete Comprehensive Drug Therapy Management Post Discharge in High-Risk Patients a 45-minute webinar on February 3rd, now available for replay, Rebecca Bean, director, population health pharmacy, Novant Health, shares her organization’s medication management approach and why a clinical pharmacist is key to the program’s success.

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