Archive for the ‘Palliative Care’ Category

Infographic: Medicare and End-of-Life Care

November 23rd, 2016 by Melanie Matthews

Although Medicare spent significantly more on care for people at the end of life who died in 2014 ($34,529 per person) than for other beneficiaries that year ($9,121 per person), the share of total Medicare spending for people at the end of life decreased from 18.6% to 13.5% between 2000 and 2014, according to a new Visualizing Health Policy infographic by the Kaiser Family Foundation.

The infographic also examines Medicare spending for end of life care by age, Medicare spending on hospice and the impact of Medicare reimbursement to discuss end of life care, which began in January 2016.

Medicare and End-of-Life Care

Care Coordination in an ACO: Population Health Management from Wellness to End-of-LifeWhen acknowledging its position as a top-ranking Medicare Shared Savings Program (MSSP), Memorial Hermann is quick to credit its own physicians—who in 2007 lobbied for a clinically integrated network that formed the foundation of the current Memorial Hermann accountable care organization (ACO). Now, eight years later, collaboration and integration continue to be the engines driving the ACO’s cost savings, reduced utilization and healthy patient engagement rates associated with Memorial Hermann ACO’s highest-risk population.

Care Coordination in an ACO: Population Health Management from Wellness to End-of-Life details Memorial Hermann’s carefully executed journey to quality and the culmination of the ACO’s community-based care management program.

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.

6 Population Health Strategies to Set Stage for Physician Reimbursement

May 12th, 2016 by Patricia Donovan

Robert Fortini, PNP

A team-based, top-of-license approach is key to population health success, says Robert Fortini, PNP, Bon Secours Medical Group chief clinical officer.

In the last six years, Bon Secours Medical Group (BSMG) has deployed a half-dozen population health strategies as groundwork for its Next Generation Healthcare offering. Here, Robert Fortini, PNP, BSMG chief clinical officer, identifies the tactics his organization leverages to effect health behavior change.

The specific population health strategies Bon Secours has deployed over the last six years start with the patient-centered medical home (PCMH) concept. I’m an avid believer in the concept of a team of professionals working together, along with that ‘top of license’ aspect, where it’s not just the sole domain of the independent ‘cowboy’ physician taking care of the patients. It’s pharmacists, nurses, social workers, and registered dietitians. It’s the entire team, with everyone having a vested responsibility for practicing to the top of his or her license.

Next, access is huge. It is ridiculous to think we can manage chronic disease in four 15-minute visits a year scheduled between 8 a.m. and 5 p.m. Monday through Friday, while closing at lunchtime. It’s absolutely ludicrous. We are blowing that up by opening weekends and evenings and using technology to expand access, which is critical to affecting that behavioral change.

Third, know your population. Identifying effectively those who are most at risk with advanced analytics to make your efforts more efficient is very important.

Next is managed care contracting—aggressively coming to the table with our payors to help guide the conversations and craft the contracts and benefit designs that are attainable and achievable. That has been a new experience for Bon Secours in the last five years in particular. We have a CMS-based Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) covering about 30,000 attributed lives. We also have a number of commercial ACO-type contractual relationships with our commercial payors.

Fifth on the list: aggressive growth for palliative and hospice. We have invested very significantly in management of advanced illness that occurs at the end of life. The Medicare numbers around that are staggering: 40 percent of Medicare spend occurs in the last two years of life, and the pain, suffering, and emotional angst that occurs for patients and their families is incredible. Investing in the resources necessary to manage that effectively has been our strategic initiative at Bon Secours. We have a very large, well-versed palliative program that provides inpatient, outpatient and even home-based palliative services. And our hospice agency, which I am responsible for in addition to our medical group, has quadrupled in size in the last two years alone.

Then, finally, we manage the white space with powered care coordination, which includes health promotion, chronic disease management, care transition management, and more.

Source: Physician Reimbursement in 2016: 4 Billable Medicare Events to Maximize Care Management Revenue and Results

http://hin.3dcartstores.com/Physician-Reimbursement-in-2016-4-Billable-Medicare-Events-to-Maximize-Care-Management-Revenue-and-Results_p_5143.html

Physician Reimbursement in 2016: 4 Billable Medicare Events to Maximize Care Management Revenue and Results details the ways in which Bon Secours Medical Group (BSMG) leverages a team-based care approach, expanded care access and technology to capitalize on four Medicare billing events: transitional care management, chronic care management, Medicare annual wellness visits and advance care planning.

End-of-Life Care: Infographic

June 3rd, 2015 by Melanie Matthews

Only 27% of Americans report having talked with their families about end-of-life care, according to a new infographic by Vitas Healthcare.

The infographic examines the need for a living will and a medical power of attorney and the communication needs about these documents.

Case Management for Advanced Illness: Best Practices in End-of-Life CarePoor prognoses, the loss of functional capabilities, and the need for advanced care planning are just some of the emotionally charged challenges of caring for individuals with advanced illness.

Case Management for Advanced Illness: Best Practices in End-of-Life Care examines Aetna’s Compassionate Care program, a case management approach for this population. The payor’s initiative breaks down barriers commonly encountered in this highly sensitive stage of the health continuum while positively impacting both healthcare utilization and spend.

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: Decision-Making in Cancer Care

March 6th, 2015 by Melanie Matthews

Cancer patients should be involved with decisions about their care and should understand the goals of treatment and prognosis of their disease, according to a new infographic by the National Coalition for Cancer Survivorship.

The infographic examines the current state of prognosis and end-of-life care discussions.

2014 Healthcare Benchmarks: Palliative CareWhile the word ‘palliative’ literally means to cloak or conceal, healthcare is taking the wraps off this critical service — in spite of provider resistance. Recent data increasingly supports the thesis that a well-timed palliative care consult can enhance the patient experience and foster appropriate use of healthcare resources.

2014 Healthcare Benchmarks: Palliative Care documents emerging trends in palliative care at 223 healthcare organizations, from the timing for initial palliative care consults to individuals on the palliative care team to the impact this specialized care is having on healthcare utilization and the patient experience — two critical markers of healthcare performance.

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.

10 Healthcare Trends Measured in 2014: Medical Neighborhoods, Data Analytics Flourish

January 13th, 2015 by Patricia Donovan

2014's HINtelligence Reports captured trends in healthcare delivery, technology and utilization management.


Each year, the Healthcare Intelligence Network’s series of HINtelligence Reports pinpoint trends shaping the industry, from cutting-edge care collaborations to remote patient management connections to tactics to reduce avoidable utilization.

HINtelligence Report benchmarks are derived from data provided by more than one thousand healthcare companies.

Here are 10 highlights from 2014 HINtelligence Reports that support Triple Aim goals of improving population health and the patient experience while reducing the per capita cost of healthcare.

Share your reactions with us on Twitter @H_I_N.

  • Readmissions: More than half of survey respondents participate in post-acute partnerships, with home health collaborations the most common (79 percent). These partnerships serve to streamline processes and care transitions, educate and align staff, and implement changes of value to patients, said respondents to the fourth annual Reducing Hospital Readmissions Survey.
  • Palliative Care: While the majority of respondents (68 percent) administer palliative care on an inpatient basis, more than half (54 percent) say care is conducted on home visits and just under a third offer palliative care at extended care facilities.
  • Patient-Centered Medical Home: Prepared to take their medical homes to the next level of care in the year to come, almost half—48 percent—have joined or expect to join a medical home neighborhood, defined by TransformMed℠ as “a strong foundation of transformed primary care practices aligned with health systems and specialists to insure that care is maximally coordinated and managed.
  • Remote Patient Monitoring: More than half of 2014 respondents—54 percent—have instituted remote monitoring programs, the survey found, which was most often employed for patients or health plan members with multiple chronic conditions (83 percent). Other targets of a remote monitoring strategy included frequent utilizers of hospitals and ERs (62 percent) and the recently discharged (52 percent).
  • Telephonic Case Management: More than 84 percent of respondents utilize telephonic case managers. „One-fifth of telephonic case managers work within the office of a primary care practice.
  • Population Health Management: The last two years reflects a dramatic surge in the use of data analytics tools barely on population health management’s radar in 2012: the use of health risk assessments (HRAs), registries and biometric screenings more than tripled in the last 24 months, while electronic health record (EHR) applications for population health increased five-fold for the same period.
  • Emergency Room Utilization: Among populations generating the majority of avoidable ED visits, dual eligibles jumped nearly 10 percent in the last four years, from 2 to 11 percent, while other populations—high utilizers, Medicare and Medicaid—remained roughly the same. „„Chronic disease replaced pain management as the most frequently presented problem in the ER, at 54 percent.
  • Stratification of High-Risk, High-Cost Patients: The „LACE readmission risk tool (Length of stay, Acute admission, Charleston Comorbidity score, ED visits) is considered the primary indice and screen to assess health risk, according to 33 percent of respondents.
  • Embedded Case Management: Fifty-seven percent of respondents embed or co-locate case managers in primary care practices, where their chief duties are care and transition management, reducing hospital readmissions and patient education and coaching.
  • 2015 Healthcare Forecast: Almost 92 percent of 2015 respondents said the impact of value-based healthcare on their business has been positive, with more than one quarter identifying healthcare’s value-based shift as the trend most likely to impact them in the year to come.

Make your healthcare voice count in 2015 by answering 10 Questions on Chronic Care Management by January 31, 2015. You’ll receive a complimentary HINtelligence Report summarizing survey results.

Caldwell UNC Healthcare Embedded Case Managers Count Outreach, Not Cases

October 2nd, 2014 by Patricia Donovan

embedded case management

Visibility is the embedded case manager's greatest asset.

A frequently sought metric in case management is the optimal case load. However, embedded case managers at Caldwell UNC Healthcare don’t count cases, they count outreach, explains Melanie Fox, director of Caldwell Physician Network’s Embedded Case Management program.

For Ms. Fox’s team of case managers embedded in seven primary care practices and two work sites, outreach is mostly telephonic, but may also include visits to patients’ homes if they see the need.

“We will do anything to make sure patients get to where they need to be. A lot of our home visits occur because of confusion with medications,” she explained during Embedded Case Management in Primary Care and Work Sites: Referral, Stratification and Protocols, a September 2014 webinar now available on-demand.

Typically, the embedded case management team averages about a thousand outreaches per month, Ms. Fox estimates. Telephonically, they reach almost all patients within 48 hours of discharge, and most ED discharges, running down a multi-item checklist, from medication and home health needs to scheduled follow-up appointments and advanced illness management (AIM), formerly referred to as palliative care, which was frequently misunderstood as strictly hospice, she noted.

Caldwell is working to establish that reporting linkage with skilled nursing facilities as well.

Medication is a large part of that telephonic conversation, Ms. Fox adds, as is a focus on new Transition Care Management Codes, where practices can be reimbursed for non-face-to-face care provided when patients transition from an acute care setting back into the community.

The visibility of embedded case managers in a practice is a great asset to both providers and patients, she says. “We seem to be more accepted by providers, staff and patients because they see us as part of the team.”

At the two work sites, the case manager works alongside a nurse practitioner, where the goals are preventive care and chronic disease management.

With extensive RN experience in home health and schooled in the Geisinger Healthcare System model of embedded case management known as ProvenHealth Navigator℠, Ms. Fox joined Caldwell three years ago to develop and launch the program. Referrals to embedded case managers come from hospital discharge and ED reports, as well as provider and even self-referrals.

Although relatively new, Caldwell’s embedded case management approach has helped to halve 30-day hospital readmissions in its Medicare population— from 19.16 percent in second quarter 2012 to 9.09 percent in fourth quarter 2013, she said. Buoyed by this success, Ms. Fox’s team is targeting ED visits as its next metric.

During the program, Ms. Fox also shared six qualities of an effective embedded case manager, advantages of embedding case managers in care sites, and tactics for engaging physicians and staff in the embedded model.

Click here for an interview with Melanie Fox.

Aetna Compassionate Care: “Advanced Illness Care Coordination Can’t Be Measured by Numbers Alone”

September 30th, 2014 by Patricia Donovan

In its new report, “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life,” the Institute of Medicine recommends the development of measurable, actionable, and evidence-based quality standards for clinician-patient communication and advance care planning to reflect the evolving population and health system needs.

Aetna’s Compassionate Care program, a case management approach for individuals in advanced stages of illness, breaks down barriers commonly encountered in this highly sensitive stage of the health continuum while positively impacting both healthcare utilization and spend. Here, Dr. Joseph Agostini, senior medical director, Aetna Medicare, shares some best practices from Aetna’s Compassionate Care Program.

There are several best practices. First, there is training, which is integral to the success of the Aetna Compassionate Care program.

Second, there is the proper selection, mentoring and ongoing learning opportunities for nurse case managers. These include such things as ongoing online tutorials, in-person training, where everyone gets training in change management and motivational interviewing techniques, regular ‘lunch and learns,’ medical director sessions including case-based rounds of cases that are in progress right now and feedback sessions. We bring in external entities to provide specialized expertise as necessary so that nurses get continuing education throughout the process.

Another best practice for us is having Aetna case managers manage all types of members. We don’t have a specialized unit that just specializes in advanced illness care needs. We think all of the nurse case managers should have developed this critical skill of being able to manage those with advanced illness, but also be able to identify support and be advocates for patients in all phases of their lives.

We also use a variety of functional status and prognosis tools. Many of these rating scales are scores focused on functional status. That’s important to follow over time, and can be predictive of outcomes. In our program we don’t necessarily use all of these scales, but we always capture some basic functional status over time and it’s useful and necessary to view that longitudinally.

A real-life example captures the heart of what we do. A case manager writes:

‘Wife stated member passed away with hospice. Much emotional support given to spouse, she talked about what a wonderful life they had together, their children, all of the people’s lives that he touched. They were married 49 years last Thursday and each year he would give her a piece of jewelry. On Tuesday when she walked into his room he had a gift and card lying on his chest, a beautiful ring that he had their daughters purchase. She was happy he gave it to her on Tuesday; on Thursday he was not alert. She stated through his business that he touched many people’s lives and they all somehow knew he was sick and he has received many flowers, meals, fruits, cakes. She stated her lawn had become overgrown and the landscaper came and cleaned up the entire property, planted over 50 mums, placed cornstalks and pumpkins all around. She said she is so grateful for the outpouring of love. Also stated that hospice is wonderful, as well as everyone at the doctor’s office and everyone here at Aetna. She tells all of her friends that when you are part of Aetna, you have a lifeline.”

And the case manager concludes, “Encouraged her to call with ongoing issues or concerns and closed to case management.”

You can really feel the depth of connection that develops between the Aetna member, or the family caregiver and the case manager. You can’t really make this happen; it occurs over time and I would suggest to everyone that advanced illness care coordination can’t be measured by numbers alone or on hospital admissions or the length of time in hospice. We need to develop quality measures that capture the degree of family, caregiver and patient support that a program like this engenders.

advanc care planning
Dr. Joseph Agostini is the senior medical director for the Aetna Medicare team. He is responsible for medical management strategy, clinical initiatives, and provider collaboration oversight for Aetna Medicare members.

Source: Case Management for Advanced Illness: Best Practices in End-of-Life Care

9 Things to Know About Palliative Care

June 12th, 2014 by Cheryl Miller

With an aging population that is living longer—an estimated 10,000 baby boomers become eligible for Medicare each day — and a shortage of specialists trained for the field, palliative care is no longer taking a back seat to more traditional healthcare. The majority of respondents to the Healthcare Intelligence Network’s first annual Palliative Care survey in February 2014 said they have a palliative care program in place, and of those that don’t, more than half said they planned to launch a program within 12 months.

Here are nine benchmarks gleaned from the 2014 Palliative Care survey:

  • Timely referrals of patients to palliative care are one of the biggest challenges to implementing a program, according to 89 percent of respondents.
  • Frailty is a key characteristic of their palliative patient/member population, say 48 percent of respondents; other traits include impaired cognitive capacity (34 percent) and disabilities (15 percent).
  • „„Candidates for palliative care are primarily identified by physician referrals (78 percent).
  • More than half (60 percent) of respondents said that case management assessments were important tools for identifying palliative care candidates.
  • While the majority of respondents (68 percent) administer palliative care on an inpatient basis, more than half (54 percent) say care is conducted on home visits and just under a third offer palliative care at extended care facilities.
  • About 88 percent of respondents with palliative care programs reported an increase in patient satisfaction levels among Medicare participants, while 89 percent saw more satisfaction among caregivers.
  • Overall, the presence of palliative care helped to curb healthcare utilization costs for 70 percent of respondents.
  • Seventy-one percent of respondents with palliative care programs in place reported an uptick in hospice election by Medicare patients.
  • Nearly 20 percent of respondents said it was too early to tell what ROI their palliative care program generated.

„
Excerpted from 2014 Healthcare Benchmarks: Palliative Care

2014 Market Data: The Hospital Perspective on Palliative Care

March 11th, 2014 by Patricia Donovan


The majority of palliative care consults take place in hospitals, according to 62 percent of respondents to HIN’s 2014 survey on Palliative Care, although many responding healthcare organizations are working to separate these consults from the hospital bedside. In the meantime, there were several key areas where hospitals and health systems, which comprised almost half of survey respondents, stood out in terms of how they conducted palliative care programs.

For example, when asked to identify candidates for palliative care, this sector was least likely to rely on a diagnosis set (27 percent within this sector, versus a high of 78 percent and a mean of 45 percent) and direct member/patient referrals (33 percent for this sector, versus a high of 78 percent within the health plan and an overall mean of 55 percent). When listing components of their palliative care programs, this sector was also least likely to include a patient/provider liaison (44 percent versus a high of 78 percent and a mean of 68 percent) and clinical assessment (71 percent versus a high of 89 percent and a mean of 82 percent).

The composition of this sector’s palliative care team also varied, starting with the presence of primary care physicians, or PCPs: (52 percent of hospital palliative care teams versus a high of 77 percent and a mean of 63 percent); oncologists (19 percent versus a high of 67 percent and mean of 31 percent); geriatricians (19 percent versus a high of 56 percent for case managers and a mean of 33 percent); and physical therapists (13 percent of hospitals versus a high of 67 percent and mean of 34 percent). However, this sector was most likely to have a nurse practitioner on board (62 percent versus a low of 11 percent for health plans and an overall mean of 43 percent).

The timing of palliative care consults has shifted over the years. This sector is most likely to conduct them during a hospital stay (85 percent, versus a low of 44 percent and mean of 60 percent) and the least likely to conduct them during a home visit (21 percent versus a high of 79 percent for home health agencies, not surprisingly, and a mean of 47 percent).

Where to administer palliative care has also shifted, and this sector was twice as likely to conduct it on an inpatient basis (94 percent) as home health agencies, at a low of 50 percent, and typically least likely to conduct it via telephonic visits (10 percent), one fourth as likely as health plans, at 44 percent.

Excerpted from: 2014 Healthcare Benchmarks: Palliative Care

Infographic: Few States Meet Palliative Care Benchmark

March 3rd, 2014 by Jackie Lyons

Only four states have effective strategies in place to improve access to and knowledge of palliative care services, according to the American Cancer Society Cancer Action Network.

State palliative care services are scored on a 0-6 scale, according to a new infographic from IMNG Medical Media. This infographic shows how each state scores on the scale, which combines grades from the Center to Advance Palliative Care’s national palliative care report card with actions on model legislation.

You may also be interested in this related resource: 2014 Healthcare Benchmarks: Palliative Care. Healthcare organizations need to be informed of new technologies and information sources. This 40-page report documents emerging trends in palliative care at more than 200 healthcare organizations, from the timing for initial palliative care consults to individuals on the palliative care team to the impact this specialized care is having on healthcare utilization and the patient experience.


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.