Archive for the ‘Physician Practices’ Category

Horizon Episodes of Care Program Prototype for Value-Based Specialty Care and Reimbursement

April 21st, 2016 by Patricia Donovan

Horizon BCBS-NJ's Episodes of Care program engages specialists across a suite of nine episodes.

Imagine a value-based healthcare payment model in which the sole financial hazard to specialist providers is the risk of amassing additional revenue.

Further, envision a scenario in which these specialists are invited to design their payment program, from the model's intent to key quality metrics.

Those are some highlights of Horizon Blue Cross Blue Shield of New Jersey's Episodes of Care (EOC) program, a value-based model designed to focus specialists on the provision of quality- and value-based care across nine separate episodes, from joint replacement to hysterectomy to oncology.

Hailed as a national leader in advancing the episodes model as a prototype for value-based specialty care, Horizon is careful to distinguish its EOC program from a bundled payment initiative, for two key reasons.

"First, our EOC program is a quality-based program; it's not only about the payment or payment structure," explained Lili Brillstein, director of the Horizon Episodes of Care program during a recent webinar, Episodes of Care: Improving Clinical Outcomes and Reducing Total Cost of Care Through a Collaborative Payor-Provider Relationship.

Secondly, bundled payments typically refer to a prospective model in which a bundled amount of money is paid to a provider or group of providers in advance of services being delivered, while Horizon's retrospective model pays providers after services have been provided.

The upside-only nature of Horizon's retrospective model contributes to the program's collaborative nature, Ms. Brillstein added. "If the metrics are met, savings are shared. If the metrics are not met, we’re not punishing our partners."

There is other evidence of collaboration and of Horizon's desire to see the providers succeed in the EOC program. One example is the payor's use of case mix-adjusted budgets at the practice level rather than the prevalent member-specific risk-adjusted budgets. "This budgeting allows Horizon to create an opportunity for providers to move the needle [on a metric], and benefit from that. The opportunity for cost savings and shared savings also is dramatically improved."

Another case in point is Horizon's invitation to prospective providers to talk through the episode's construct, intent and design prior to its launch.

Horizon's engagement of providers in the EOC program has "changed the spirit of the relationships between the payor and the provider," Ms. Brillstein noted. "It’s like nothing I’ve ever seen before. Our provider partners have become our ambassadors for the program."

Select EOC results presented during the webinar indicated that outcomes are better for EOC partners—in the area of reduced readmissions, for example—than they are for physicians not in the EOC program.

Horizon expects to launch at least three more episodes in 2016, including a Crohn’s Disease episode that will take into account behavioral health services for those members. While the payor fully expects to move to a prospective model, it believes its current EOC model is preparing them for that eventuality, softening the transition from fee for service to prospective payments.

"[That transition] doesn’t just happen. You don’t sign the paper, and suddenly know what to do. It is an evolutionary transformative process," concluded Ms. Brillstein.

Click here to listen to an interview with Lili Brillstein: Horizon BCBSNJ Episodes of Care: No-Risk Retrospective Model Paves Way for Value-Based Migration

CHS on Data Analytics in Accountable Care: “No Matter What Happens, This Change is Coming”

February 11th, 2016 by Patricia Donovan

Collaborative Health Systems, the largest sponsor of Medicare ACOs in the United States, recently rolled out an analytics and dashboard portal for its 3,200 providers.

Attention, please. Two aggressive milestones to migrate Medicare providers to value-based healthcare are on the horizon:

  • In 2016, CMS expects 30 percent of Medicare fee-for-service (FFS) reimbursement to be tied to alternative payment models such as accountable care and bundled payments.
  • Also this year, the federal payor wants 85 percent of Medicare FFS payments to be based upon quality metrics.

"If you are a provider, or working with providers who accept Medicare beneficiaries, it's really important to know these changes are coming," advises Elena Tkachev, director of ACO analytics for Collaborative Health Systems (CHS). "It will be the responsibility of physicians to participate in these payments because no matter what happens, this change is coming."

Ms. Tkachev detailed the power of data analytics to drive CHS's success in accountable care during Data Analytics in Accountable Care: Strategies and Case Studies, a January 2016 webinar from the Healthcare Intelligence Network now available for replay.

As the largest sponsor of Medicare Shared Savings Program (MSSP) ACOs in the United States, CHS has a firm handle on HHS's value-based agenda. The organization manages 24 MSSP ACOs, nine of which generated savings of nearly $27 million in 2014, and one that has been accepted as a Next Generation ACO, the newest Medicare accountable care model.

And with CMS expectations for value-based reimbursement slated to rise over the next two years, expectations for data analytics to improve care and costs related to Medicare beneficiaries have never been higher.

"Today, physicians are being measured through claims and the clinical metrics on the population they serve. We see the main responsibility of analytics as providing simple access to actionable, timely and relevant information to help clinicians make better decisions, improve quality of care and enhance the patient experience."

Despite the magnitude of its enterprise, CHS believes its future in accountable care rests upon its primary care physicians (PCPs), which it views as "quarterbacks of care" for its more than 280,000 Medicare beneficiaries.

To foster quality improvement, CHS equips PCPs with an arsenal of analytics capabilities. So that its 3,200 providers can tap into CHS's massive storehouse of CMS, claims, lab, risk stratification and care coordination data collected on its 24 Medicare Shared Savings Program (MSSP) ACOs, the health system recently rolled out an analytics and dashboard portal.

These tools enable providers to monitor the aggregate health of their populations as well as their own performance, even giving providers the ability to track their own performance over time and contrast it with other clinicians'—a capability that pleases CHS's more competitive physicians, Ms. Tkachev notes.

Frequent webinar training keeps provider analytics' use sharp, and dashboard-generated reports and scorecards help physicians to monitor and enhance quality performance and improve patient outreach, Ms. Tkachev explained.

Despite its significant success, CHS still encounters the perennial challenges of access to timely and accurate data, aggregation abilities, and the display of meaningful results. Ms. Tkachev shared some CHS tactics to resolve these issues, including soliciting feedback on the tools from providers who use them.

Listen to an interview with Elena Tkachev on data analytic's potential to drive annual wellness visits and boost beneficiary attribution.

Bon Secours Next Generation Healthcare: Smart Tools Tell Care Transitions, Chronic Care Management Stories

February 4th, 2016 by Patricia Donovan

Next Generation Healthcare smart tools facilitate Bon Secours care plans for care transitions, chronic care management and Medicare wellness visits.


A key component of chronic care management is a comprehensive plan of care—the "refrigerator copy" patients can refer to, explains Robert Fortini, PNP, chief clinical officer for Bon Secours medical Group (BSMG).

Today, using smart tools built into its electronic medical record, Bon Secours nurse navigators document twelve-point care plans for the 50 patients they have enrolled via Medicare's year-old Chronic Care Management (CCM) codes—a number Fortini expects will double this month.

The CCM assessment tool also captures frequently forgotten issues such as depression, pain and sleep problems that can derail care, Fortini said in a recent webinar on Physician Reimbursement in 2016: Workflow Optimization for Chronic Care Management and Advance Care Planning.

Bon Secours' seventy nurse navigators, embedded in physician practices, also tap these point-and-click smart tools to document transitions of care for patients recently discharged from the hospital. This Transition of Care smart note tracks 17 different aspects of patient care, including risk of readmission and medication reconciliation, and includes a placeholder for an advance medical directive.

Similar tools are in use for Medicare's three types of wellness visits, he added.

"I have been in this business a long time, and the documentation that navigators produce using these workflows is extraordinary," Fortini noted. "This is purposeful design. It tells a story and you have something actionable at the conclusion of reading it."

The smart tools are but one aspect of Bon Secours' Next Generation Healthcare initiative, which Fortini defined as "population health meets total access." Next Generation Healthcare fortifies the team-based medical home foundation Bon Secours introduced six years ago with expanded care access and technology, among other components the organization leverages to improve clinical outcomes and value-based reimbursement.

In the Next Generation Healthcare model, the primary care physician is the quarterback of care, with embedded nurse navigators doing the "heavy lifting" of enrolling at-risk patients into care management, building comprehensive care plans, and scheduling Medicare beneficiaries for annual wellness visits, Fortini explained.

Additionally, Bon Secours has broadened its care access menu to include employee clinics, fast care and urgent care sites, self-scheduling, and virtual visits for primary care. The organization expects to expand virtual visits to specialist consultations and behavioral health in the near future, and also envisions virtual case management visits, allowing nurse navigators to conduct real-time medication reconciliations with at-home patients.

To round out its Next Generation Healthcare continuum, Bon Secours is training a portion of nurse navigators as facilitators in a Virginia advance care planning initiative called "Honoring Choices," with the goal of formalizing the placement of advance directives in patients' records.

Investing in resources necessary to manage end-of-life effectively is a critical aspect of Bon Secours' strategic initiative, Fortini concluded. "Forty 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."

Listen to an interview with Robert Fortini in which he describes how Bon Secours nurse navigators have won over solo practitioners.

Chronic Care Management Revenue Relies on Physician Momentum

January 28th, 2016 by Patricia Donovan

Embedded in CMS's year-old Chronic Care Management codes is a dramatic potential for revenue—in both reduced costs and enhanced health outcomes for Medicare beneficiaries. But before primary care practices can tap into these opportunities, physician leadership must create momentum for CCM with staff and patients, advises Debra Burbary, RN, clinical quality assurance manager with Arcturus Health.

CMS recognizes that care management is a critical component of the primary care setting and that it can help contribute to the better health of our patients and also reduce spending as well. Our group has looked at this as an opportunity to capture more revenue as well as improve our patients’ health conditions.

However, when we first began to study the Chronic Care Management (CCM) regulations, we found out that it wasn’t going to be quite that easy. CMS has put into place many requirements and guidelines that need to be followed to qualify for this service. We think that one of the biggest messages that came through was the fact that 75 percent of healthcare spending is directly related to chronic conditions. The prevalence of co-morbid conditions also presents a challenge for disease management. Mostly, these patients fall into that category.

The CCM program was going to require a comprehensive effort to reconfigure our clinical workflows and processes to adjust to the needs of these chronically ill patients within a primary care setting. One of the main things we determined we needed was physician leadership. Involvement by our physicians to support this program was going to be a major key to success.

I was very fortunate to work with my physician medical director, who does provide that support for our department, and we were able to move forward. One thing to look at if you’re just starting with this process is the creation within your group of physician buy-in for disease management activities in order to create that culture. Without this supportive culture, you will have a difficult time sustaining a chronic disease management effort.

The cost of disease management continues to drive many of our decisions related to encouraging our patients in self-management activities complementary to the patient-physician relationship—decisions that drive our strategies for supporting patients in becoming informed. Active participants must be extensively developed.

The potential revenue for the CCM code cannot be overlooked. It’s remarkably very, very high, but at the same time very difficult to accomplish.

Source: Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM Revenue

http://hin.3dcartstores.com/Framework-for-Patient-Engagement-6-Stages-to-Success-in-a-Value-Based-Health-System_p_5102.html

Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM Revenue traces the incorporation of CCM into Arcturus Healthcare's existing care management efforts for high-risk patients, as well as the unexpected bonus that resulted from CCM code adoption.

Infographic: Improving Patient Satisfaction

January 25th, 2016 by Melanie Matthews

Provider-led changes can have a significant impact on patient satisfaction rates, according to a new infographic by PatientSafe Solutions.

The infographic outlines how communication is key to unlocking patient satisfaction via face-to-face visits, online touchpoints and provider office interactions.

Intermountain 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: 12 Physician Practice Models

January 18th, 2016 by Melanie Matthews

Healthcare industry challenges and government mandates are changing the way some physician practices operate, according to a new infographic by BillingParadise.

The infographic outlines how 12 different physician practice models work to help physicians understand and choose a model best suited for them.

One year after the Centers for Medicare and Medicaid Services began reimbursing physician practices for chronic care management services, Bon Secours Medical Group is now comfortable with the CCM reimbursement requirements and is reporting that it's unique approach to this revenue opportunity is ramping up nicely. And, the organization's approach to chronic care management reimbursement is helping to position itself for advance care planning as a new billable CMS event in the upcoming year.

During Physician Reimbursement in 2016: Workflow Optimization for Chronic Care Management and Advance Care Planning, a January 26th webinar at 1:30 p.m. Eastern, Robert Fortini, PNP, chief clinical officer for Bon Secours Medical Group, will provide an inside look at his organization's experience with CMS' chronic care management reimbursement this year and how they are leveraging this experience for CMS' newest billable event in 2016—advance care planning.

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Infographic: Systemized Care by Physicians

January 6th, 2016 by Melanie Matthews

As patient care becomes increasingly systemized, more doctors say they feel less engaged and less motivated, according to a recent infographic by Bain & Company.

The infographic looks at the growth in the number of physicians using electronic medical records and treatment protocols, along with the growth in the number of doctors who work in large, management-led organizations.

Healthcare Trends & Forecasts in 2016: Performance Expectations for the Healthcare IndustryFrom cost pressures, consumerism and consolidation to a proliferation of patient-centered, value-based delivery and payment models, the state of healthcare continues to challenge organizations in the industry.

Healthcare Trends & Forecasts in 2016: Performance Expectations for the Healthcare Industry, HIN's 12th annual business forecast, pins down the trends destined to impact the industry in the year to come and proposes tactics C-suite executives can employ to distinguish their operations in a dynamic marketplace.

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.

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Infographic: Physician Practice Profitability

December 14th, 2015 by Melanie Matthews

The Practice Profitability Index, a survey of more than 5,000 physicians that provides an annual window into the issues affecting the financial and operational health of physician practices across the United States, revealed room for cautious optimism in 2016, with the share of physicians forecasting a negative profitability trend declining year over year. The Practice Profitability Index is sponsored by CareCloud and QuantiaMD.

A new infographic highlights some of the results from the Practice Profitability Index, including challenges to practice profitability, physician practice ownership trends and key targets for physician practice operational improvement.

One year after the Centers for Medicare and Medicaid Services began reimbursing physician practices for chronic care management services, Bon Secours Medical Group is now comfortable with the CCM reimbursement requirements and is reporting that it's unique approach to this revenue opportunity is ramping up nicely. And, the organization's approach to chronic care management reimbursement is helping to position itself for advance care planning as a new billable CMS event in the upcoming year.

During Physician Reimbursement in 2016: Workflow Optimization for Chronic Care Management and Advance Care Planning, a January 26th webinar at 1:30 p.m. Eastern, Robert Fortini, PNP, chief clinical officer for Bon Secours Medical Group, will provide an inside look at his organization's experience with CMS' chronic care management reimbursement this year and how they are leveraging this experience for CMS' newest billable event in 2016—advance care planning.

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.

4 Patient Engagement Strategies from a Top-Performing Medicare ACO

November 17th, 2015 by Patricia Donovan

The Memorial Hermann accountable care organization, a top Medicare Shared Savings Programs (MSSP) in terms of quality metrics and cost savings, is proud of the 74 percent patient engagement rate associated with its Complex Care program for individuals with complex health conditions. Here, Mary Folladori, RN, MSN, FACM, CMAC, system director of care management at the Memorial Hermann Physician Network and ACO, outlines four tactics that help to engage high-risk patients in self-management.

First, when we outreach to members during our telephone calls, we identify our team member as calling from Memorial Hermann. We have designed scripts; our team members introduce themselves as members of that particular person’s physician office. We have access to the physician clinic’s electronic medical record (EMR) as well as to the hospital EMR if that member has been hospitalized, so we’re able to represent and present knowledge of that member as part of that physician’s team. All of those combined elements help to build trust and to enhance those engagement rates.

Second, we also have learned over time that we need to offer multiple ways to work with members. Depending on the individual member and family situation, and depending on the risk and complexity of the member, we may have a team member go into one of our facilities to introduce themselves and set up a time for that initial outreach when a transition is being planned. We may meet members in their physician clinics if we have had difficulty outreaching to them. This allows us again to build that trust and rapport with a member, or build a face-to-face relationship base with the family. That has led to that higher telephonic outreach engagement rate of 74 percent.

Third, we also have been able to enhance our engagement rates because we have built very close relationships with care managers on the payor side in the past. Sometimes there might be a different type of relationship between the care or case managers on the insurance side, but in the world of our ACO, we have specifically and deliberately built very close relationships where we have worked out workflows. We get concurrent data reports for most payors so that we’re able to reach out to members in real time—within 24 hours after a discharge, for example. We also get real-time reports on gaps in care, and on frequent or high-cost utilizers.

In the past, we started out using claims that we received. That presented a challenge, because there still is a claims lag in the world we all work within. Now for the most part, we get information directly from our payor partners, which has enabled us to outreach and engage members in a real-time manner rather than three or six months after an acute episode has ended.

And finally, because we are embedded within our physician practices and so much a part of their culture, our physicians talk to their members at that point of care and let them know that a care manager by this name will reach out to them. They explain the reason for the program and encourage that member or family to participate.

Source: Care Coordination in an ACO: Population Health Management from Wellness to End-of-Life

http://hin.3dcartstores.com/Care-Coordination-in-an-ACO-Population-Health-Management-from-Wellness-to-End-of-Life_p_5092.html

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.

Infographic: An Average Physician Day

November 4th, 2015 by Melanie Matthews

The average patient caseload of a primary care physician is about 2,300 patients, with about 94 patient encounters per week, according to a new infographic by eVisit.

The infographic breaks down the typical day of a physician, including the percentage of a physician's day that is spent outside the exam room doing documentation and follow-up due to insurance and new regulatory requirements. It also examines the impact of this workload and how it could be better managed.

An Average Physician Day

Starting this past January, Medicare is reimbursing physician practices for select Chronic Care Management (CCM) services not previously eligible for reimbursement, underscoring the vital role of care management in primary care.

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

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