Archive for the ‘Physician Practices’ Category

6 Ways to Overcome Pushback to Embedded Case Management

September 11th, 2014 by Cheryl Miller

Change always incites pushback, and when Sentara Medical Group went from an embedded case management program to a hybrid approach, patient and provider pushback prevailed, recalls Mary M. Morin, RN, NEA-BC, RN-BC, nurse executive with Sentara Medical Group. Among the six ways Sentara overcame resistance was to establish and maintain patient-centered relationships, by conducting comprehensive initial and ongoing assessments with patients, and developing plans of care and coaching education for both patients and their caregivers.

  • We maintained patient lists by populations within our electronic platforms. We came up with a standardized screen or view for all care managers. There was a lot of pushback against standardization but the key is standardizing the workflows. Should someone go out on family and medical leave, you can transfer your patient list. It all looks the same.
  • They were given and are still given assignments. We set expectations, which is critical. We send patient letters from the primary care physician (PCP) on behalf of your primary care provider that state we have this resource to help you should you be admitted to the hospital. We’re very focused on engaging patients. We have a brochure, and each care manager has a bio form that talks about their background.
  • We built workflow within the practices, within care management and within our electronic platform. We had issues: Optima, our health plan, is on a different EMR, as are the practices within our clinically integrated network. Unfortunately, the ambulatory-based care managers, the medical group care managers have to move between these two other platforms as well as our platform.
  • We held many meetings with home health and in-patient care coordination. Putting a face to a name is very helpful, as is lots of education and training. We had to do the electronic medical record (EMR) training. We discussed how to engage and motivate patients. What’s motivational interviewing? We have a requirement that within two years case managers are required to have their specialty certification.
  • We defined the care manager's role. The main piece is to establish and maintain patient-centered relationships. They conduct comprehensive initial assessments and ongoing assessments, identify ongoing needs of the patients and possibly their caregiver, developing care plans and then providing coaching support to the patient, caregivers, and family members.
  • We managed resources such as transportation. We contract with the taxi service for our few patients that don’t drive but need to get to their appointments or to keep them out of the EDs in the hospitals. They manage transitions of care. They conduct advanced care planning.

value-based reimbursement
Mary M. Morin, RN, NEA-BC, RN-BC, is a nurse executive with Sentara Medical Group, where she is responsible and accountable for non-physician clinical practice within the Sentara Medical Group (160 clinics/practices) to ensure integration and alignment with Sentara Healthcare, regulatory compliance, standardization of nursing practice/care, and patient safety.

Source: Hybrid Embedded Case Management: New Model for Cross-Continuum Care Coordination

4 Goals for Furthering Care Coordination in the Medical Neighborhood

August 28th, 2014 by Cheryl Miller

With the advent of the medical neighborhood, care coordination is no longer the sole domain of the primary care practice (PCP), but a responsibility shared among all providers that touch the patient. But how to formalize co-management of patients by PCPs and specialists — in a way that both assures efficient delivery of high-quality healthcare and addresses the ‘pain points’ of each provider group? Here, Robert Krebbs, director of payment innovation at WellPoint, Inc., discusses the four goals for furthering care coordination in the medical neighborhood.

The care compact isn’t intended to solve all the world’s problems. We know it’s not going to make care coordination perfect, but it’s a starting point. Just like the PCMH provides a foundation for the medical neighborhood, the care compacts provide a foundation for care coordination between practices. It’s an essential starting point to further care coordination expectations across the medical neighborhood.

First, with the care compact, we’re helping the pilot practices by identifying the PCPs they can collaborate with to put care compacts in place. We’re playing connector for these two practices.

Second, we’re assessing the current care coordination capabilities of the specialist practices in the pilot and looking at where they’re starting from in terms of care coordination.

Third, we’re watching them customize the care compact and monitoring how they adapt it to their practice needs so we can come up with a stronger template at the end of this pilot than we started with that guides this last point.

Finally, we’re going to disseminate best practices throughout the process to all participants in the pilot. Everyone will benefit from the hard work of each participating practice.

Excerpted from Care Compacts in the Medical Neighborhood: Transforming PCP-Specialist Care Coordination.

Infographic: Physician Practice Patterns

August 27th, 2014 by Melanie Matthews

Physicians are key to improving hospital quality and lowering costs, according to a new infographic by Dimensional Insight.

The infographic looks at how physicians influence healthcare spending, the growing trend toward physician data transparency and the potential impact if all states improved to best-performing state levels.

Physician Practice Patterns

Guide to Value-Based Reimbursement: Profiting from Payment Bundling, PHO Shared Savings, and Pay for PerformanceIn healthcare's post-reform volume-to-value world, payor reimbursement strategies are tipping in favor of providers who can deliver the clinical and financial goods. In the mix are bundled payments, shared savings, pay for performance and bonuses — with some going so far as to restructure organizations for maximum gain. The Guide to Value-Based Reimbursement: Profiting from Payment Bundling, PHO Shared Savings, and Pay for Performance goes beyond theory explores emerging models of episode-based payments, physician-hospital organizations and physician bonus structures.

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Infographic: High-Performing Medical Groups

August 22nd, 2014 by Melanie Matthews

For physician practices to succeed in emerging healthcare delivery and financing models they have to forgo traditional practice management models, according to a new infographic by The Advisory Group.

The Advisory Group identifies the 16 steps to becoming a "high-performance medical group."

16 Steps to a<br />
High-Performance Medical Group

Improving Healthcare Team Performance: The 7 Requirements for Excellence in Patient CareTeams and collaboration have become an expectation in most healthcare facilities and environments. It is accepted that high performance, patient-focused teams are critical to quality patient care. However, there is often a wide gap between traditional practices and the new behaviors and practices required for teamwork and collaboration. Improving Healthcare Team Performance: The 7 Requirements for Excellence in Patient Care goes beyond theory to provide the knowledge, tools, and techniques required to develop a single team, or to develop an organization-wide team-based culture, from which exceptional patient care emerges.

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8 Challenges to Medical Home Success

August 21st, 2014 by Cheryl Miller

"The reality of today is that the healthcare world as we know it is changing more than any time since the advent of Medicare," says Dr. Terry McGeeney, director of BDC Advisors. System coordination, patient-centeredness and patient engagement are some of the new industry goals, he says, which bring new challenges, chief among them being physician reluctance to change.

  • First, there are some real challenges to making the changes to patient-centered medical homes (PCMHs). A lot of physicians are reluctant to change. Physicians have been trained to be change-averse and variable-averse to avoid making mistakes at two o’clock in the morning, etc.
  • Second, physician leadership and physician champions are critical, and again, sometimes this has to be trained and taught.
  • Third, there’s a culture that is very traditional in healthcare; we need to think and talk about that. There is also a culture within individual practices and health systems that creates barriers to successful transformation.
  • Fourth, some providers are not able to function effectively in a team environment and this needs to be supported and transformed with the appropriate training provided.
  • Fifth, communication is critical at multiple levels. Successful medical neighborhoods and clinically integrated neighborhoods (CINs) are built around communication, care plans, care that’s delivered, data, quality metrics, lab data, etc.
  • Sixth, there has to be trust between all of the entities as systems are transforming and payor data becomes more critical. Partnerships with payors around shared savings or shared risk are becoming more common. Trust is critical, and again, that hasn’t always existed.
  • Seventh, we need to make sure there are aligned incentives; you can’t ask people to do more work for the same compensation. You can’t ask them to assume more risk for the same compensation. Incentives need to be aligned around what is now called ‘value-proposition’ or ‘pay-for-value,’ or to where there is an expectation to improve quality and lower cost.
  • And finally, there needs to be full recognition that PCMH transformation is not easy. It’s very difficult, it’s time consuming, but at the end it’s highly rewarding.

value-based reimbursement
Terry McGeeney, MD, MBA, is a director at BDC Advisors. He was recently appointed a visiting scholar in Economic Studies for the Brookings Institute in Washington, D.C.

Source: Driving Value-Based Reimbursement with Integrated Care Models

Guest Post: With Rise of Remote Healthcare, Are Physicians Equipped for Engaged Patients?

August 13th, 2014 by Scott Zimmerman

More engaged patients will expect more responsive healthcare professionals.

Thanks to a proliferation of wireless health monitoring tools, healthcare providers must prepare for a new breed of patient who is more tech-savvy and engaged in the management of their own health, advises guest blogger Scott Zimmerman, president of TeleVox Software.

Is your healthcare organization ready for a new breed of patient? Individuals who want or need to play a more active part in their health, and who expect their physicians to do the same?

If it’s not, it may be time to start prepping. Think about consumers’ growing interest in smart devices, sensors and mobile apps for tracking fitness levels. IHS Technology has predicted that global market revenue for sports, fitness and activity monitors will rise by 46 percent, to $2.8 billion, from 2013 through 2019.

That trend is accompanied by employers’ trying to lower their own healthcare costs, by having employees take on higher deductibles or paying only fixed amounts for certain tests or procedures. That’s creating a consumer class more conscious of securing the best health services at the best prices. Increasing personal responsibility in this area may well have a spillover effect, motivating people to become better overall managers of their own health. We may see the same result, too, as more businesses offer wellness incentives that give employees rebates for engaging in better health practices.

Also taking on greater healthcare accountability are individuals with chronic conditions, especially those using wireless home health monitoring tools to track and even transmit EKG, sugar levels and other health statistics to their providers’ systems. IHS Technology has studied this area, too, finding that worldwide revenue for telehealth devices and services used for monitoring diseases and conditions will grow to $4.5 billion in 2018, up from $440.6 million in 2013.

What Have You Done For Me Lately?

As consumers become more savvy and more engaged participants in their healthcare, they may have increased expectations about how providers will respond to their efforts. As they become better equipped to remotely transmit healthcare data to their doctors, for example, they may naturally assume providers are equally well-equipped to provide feedback on that information in real-time—or at least something close to it.

After all, while it’s nice to have direct feedback from a wireless activity wristband on daily calorie intake, that data may be even more useful if a physician can analyze it in context with other patient data—such as information in the EMR that the individual has Type 2 diabetes and blood glucose levels recorded by a home health monitoring device. The healthcare practitioner may conclude from all these measurements that calorie intake should actually be reduced now that blood glucose control has improved, in order to avoid weight gain. It’s understandable if the patient would like to be informed of that as soon as the conclusion is reached, rather than waiting for the next scheduled appointment.

Just-in-time patient engagement, then, is the direction in which healthcare providers must move. Consider that three in ten U.S. consumers responding to TeleVox’s Healthy World Research Survey said that receiving text messages, voicemails or e-mails that provide patient care between visits would increase feelings of trust in their provider. Of those who have received such communications, 51 percent reported feeling more valued as a patient, and 34 percent reported feeling more certain about visiting that healthcare provider again.

An Eye Toward the Future

Today, tens of thousands of healthcare providers already have started down that road of between-visit engagement, with automated appointment, prescription and treatment notification and reminder systems that use the patient’s medium of choice—e-mail, text or voice. In fact, TeleVox’s survey showed that more than 35 percent of patients who don’t follow exact treatment plans said they would be more likely to adhere to directions if they received reminders from their doctors via these methods. Though the outreach is automated and one-to-many, the systems feel one-to-one, as they are personalized with the patient’s name and other details drawn from providers’ practice management systems.

Ochsner Health System in Louisiana is among healthcare providers who have successfully leveraged this technology. It deployed an automated phone campaign to 3,000-plus patients who had been ordered to have colonoscopies and upper endoscopies, but had not scheduled the exams. The phone messages even offered patients the option to book the appointment by pressing a key while on the line. Of the patients reached, close to 20 percent made the appointment.

This was a win-win for patients and providers. Colon cancer detected and treated early has a nearly 100 percent success rate. These patients told Ochsner that without the automated notification, they never would have completed the test. As for the health system, Ochsner generated more than $600,000 in revenue from conducting the exams.

Today, the industry is just scratching the surface of how it can use communications technology to help healthcare providers better engage with patients between visits. The future holds the promise for more providers to obtain more data from EMRs, sensors, wearable medical devices, and home health monitoring tools; feed this data into patient engagement systems, and use business rules to trigger just-in-time customized patient engagement communications. A worrisome remote ECG reading transmitted from a heart disease patient’s home monitoring device, for example, can drive a follow-up action such as a time-sensitive outbound call to the first available specialist.

While getting to this level might sound a little daunting, it doesn’t have to be. Providers can take on the project in stages, moving from general reminders about preventive tests to follow-up messages aimed at those with chronic conditions, before they tackle real-time or near real-time responses to data submissions generated via remote healthcare devices. For instance, daily text messages could be scheduled to go out to obese patients querying them about whether they have met their daily walking goal. Or, treatment protocol compliance reminders, such as retinal and foot exams for diabetic patients, could be scheduled at regular intervals.

All that said, I suspect most providers are looking to this future less with trepidation than with excitement. They’re in the healthcare business, after all, because they want to help people. Now, the doors are open for them to have more regular and proactive contact with their patients, as well as respond more quickly to potentially dangerous situations.

About the Author: Scott Zimmerman is a regularly published authority on utilizing technology to engage and activate patients. He also spearheads TeleVox’s Healthy World initiative, which leverages ethnographic research to uncover, understand and interpret both patient and provider points of view with the end goal of creating a healthy world, one person at a time. Healthier World promotes the idea that touching the hearts and minds of patients by engaging with them between healthcare appointments will encourage and inspire them to follow and embrace treatment plans, and that activating these positive behaviors leads to healthier lives. Zimmerman possesses 20 years of proven performance in the healthcare industry, and currently serves as the president of TeleVox Software, Inc, a high-tech engagement communications company that provides automated voice, e-mail, SMS and web solutions that activate positive patient behaviors by applying technology to deliver a human touch. www.televox.com

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.

5 Market Trends Impacting Value-Based Reimbursement: “It’s Not Just About Volume”

July 31st, 2014 by Cheryl Miller

Accompanying the move to value-based care and reimbursement is the need to align economic and practice incentives to create accountability, says Cynthia Kilroy, senior vice president of provider strategy and business development, Optum. It is not just about volume, but about managing populations, and investing in capabilities and tools to manage populations.

We are seeing five trends in the industry, with implications for each of them.

First, there is a consolidation of the provider community that physicians are organizing, and then hospital systems or large integrated delivery networks (IDNs) are purchasing physicians. We are seeing both an affiliated and an employed model in the market right now.

Another trend is system affordability. Premiums have been increasing significantly — more than 30 percent over the last five years. The challenge that CMS and some payors are focusing on is how to make healthcare more affordable to the community at large.

A third trending area is value-based care, and aligning the economic and the practice incentives to create accountability. It is not just about volume, but about managing populations. This leads into the fourth trend, which is that provider organizations are investing in capabilities and tools to manage populations. Then the incentive models are moving more around that population care, which is more challenging to measure.

Finally, there is a significant amount of interest in finding performance metrics. There is HCAHPS®. Every other payor is asking for different performance metrics from organizations; how do we focus that into the right incentive, especially from an incentive program for physicians? Each organization will be trying to achieve something different; each market is very different. I may see one provider organization focus in particular areas and disease states around quality. In other markets there might be something completely different. It is based on what is going on in that particular market and practice.

Excerpted from 6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability.

Home Visits for the High-Risk: Targets, Timelines and Training

July 29th, 2014 by Patricia Donovan

Many patient-centered medical home (PCMH) initiatives have added home visits to care transition management to reduce avoidable hospital readmissions and ER utilization. Jessica Simo, program manager with Durham Community Health Network for the Duke Division of Community Health, describes likely candidates for home visits, the structure of a typical home visit and recommended staff training.

HIN: Which diagnosis or patient profile benefits most from a home visit?

(Jessica Simo) As a general rule for the patient population we serve, the people who get the most home visits are middle-aged individuals with at least two chronic health conditions. These are not generally healthy individuals who had one adverse event that brought them to our attention. These are people living day in and day out with chronic health problems they struggle with managing. Those people benefit the most from the amount of time it takes to do a home visit.

HIN: What is the average length and typical format of a home visit?

(Jessica Simo) The average home visit lasts 45-60 minutes. It would be longer for the initial home visit when an assessment is being done—where the Care Partner (a partnering stakeholder from across the Duke University health system and the Durham community) collects information for the first time about medications the patient takes, their sources of support, ADL deficits, etc. Those visits tend to be a bit longer, certainly an hour at a minimum, but once that rapport has been established, the weekly visits are often less than an hour. They become briefer as a patient transitions from phase one to phase two of the Care Partners Pathway because there is less to talk about at that point. This is a good thing; it means they are improving.

The home visits are structured around assessments and protocols, but as the home visits progress and the care partner becomes more familiar with the patient, there is less reliance on assessments and more on follow-up from the previous week.

HIN: How do you prepare and train staff to conduct home visits?

(Jessica Simo) The best way to prepare somebody to do home visits is to have them shadow a more experienced staff person. There are too many independent variables at play when you go into somebody’s home and you just don’t have control over that environment. Nor should you. It’s impossible to anticipate every possible scenario. Therefore, we do a lot of shadowing for at least a month before someone does a home visit on their own.

Excerpted from: Home Visit Handbook: Structure, Assessments and Protocols for Medically Complex Patients

Infographic: Physician Social Media Use

July 25th, 2014 by Melanie Matthews

Physicians have mixed opinions about leveraging social media use in their practices, according to a new infographic by MedData Group.

The infographic looks at the top two social media channels that physicians use, the top five physician specialties that engage in online physician communities and the top concerns preventing physicians from using social media for professional reasons.

Physician Use of Social Media

The growth of social networking has been dramatic, and the applications are quickly finding their way into healthcare organizations. This expanded best-seller provides an overview of the social media tools healthcare organizations are using to connect, communicate, and collaborate with their patients, physicians, staff, vendors, media, and the community at large.

Social Media in Healthcare: Connect, Communicate, Collaborate, 2nd edition describes the major social media applications and reviews their benefits, uses, limitations, risks, and costs. It also provides tips for creating a social media strategy based on your organization’s specific needs and resources. Through real-world examples and up-to-date statistics on social media and healthcare, this book illustrates how social media can improve the efficiency, effectiveness, and marketing of your healthcare organization.

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Infographic: Physicians’ Salaries 2014

July 21st, 2014 by Melanie Matthews

Physicians are becoming more proactive in managing their incomes by being more selective about insurers and patients and providing ancillary services. In addition, a small but growing number of physicians are moving toward cash-only practices.

A new infographic from Medscape looks at these trends, along with details on how the Affordable Care Act is impacting physician practices, the income gender disparity among physicians and physician career satisfaction.

Physicians' Salaries 2014

In today's value-based healthcare sphere, providers must not only shoulder more responsibility for healthcare outcomes, cost and quality but also align with emerging compensation models rewarding these efforts — models that often seem confusing or contradictory. The challenges for payors and partners in creating a common value-based vision are sizing the reimbursement model to the provider organization and engaging physicians' skills, knowledge and behaviors to foster program success.

6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability examines a set of provider compensation models across the collaboration continuum, advising adopters on potential pitfalls and suggesting strategies to survive implementation bumps.

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