Archive for the ‘Physician Practices’ Category

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

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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Longitudinal Care Plans, Risk Scores Raise Patient Engagement for MSSP ACO’s Complex Population

October 6th, 2015 by Patricia Donovan

A top-performing MSSP in 2014, the Memorial Hermann ACO has successfully engaged its Complex Care population via a collaborative care coordination approach.

The Memorial Hermann ACO may have been one of 2014's top-performing Medicare Shared Savings Programs (MSSPs), but the health system's commitment to achieving quality outcomes was solidified more than eight years ago, when its own physicians asked for a clinically integrated physician network.

Memorial Hermann complied, developing a set of tools, training and care models to not only support the physicians but also reflect payors' needs: chief among them, initiatives that could boost patient engagement.

Today, the Memorial Hermann ACO has a patient-centered care delivery strategy built on teamwork and collaboration. The Texas ACO is proud to point to a patient engagement rate of 74 percent for individuals enrolled in Complex Care, an initiative for individuals with long-term, multiple chronic conditions that has significantly reduced cost and hospital lengths of stay for participants.

This patient engagement measure represents members who consent to participate in the program and remain engaged for 30 days, explained Mary Folladori, RN, MSN, FACM, CMAC, system director of care management at Memorial Hermann Physician Network and ACO, during Care Coordination in an ACO: Managing the Population Health Continuum from Wellness to End-of-Life, a September 2015 webinar from the Healthcare Intelligence Network now available for replay.

Ms. Folladori provided an overview of the ACO's care coordination strategy that in 2014 generated savings of nearly $53 million in the MSSP program, resulting in a health system payout of almost $23 million. The ACO's performance earned Memorial Hermann a MSSP quality score of 88 percent.

Some high points from Memorial Hermann's ACO strategy include the following:

  • Embedding of care coordinators into the 'micro culture' of a physician practice, its community and the members served by the practice;
  • Strategic use of a data warehouse to identify vulnerable members early and link them with needed health services;
  • Development of comprehensive risk scores derived from multiple sources for Complex Care patients; and
  • Creation of longitudinal care plans that follow Complex Care patients for up to 18 months and help to transition them back to a baseline level of functioning.

In wrapping up observations on Memorial Hermann's quality-driven approach, Ms. Folladori quoted its CEO, Chris Lloyd: "The success that has been found within our ACO is deeply based on a collaborative approach to care. It has been cultivated over eight years with our commitment to clinical integration. We all strongly believe that without that strong clinically integrated physician network, without our physicians driving those quality outcomes, we would not have been as successful as we have."

With so much emphasis on quality and outcomes, it's no wonder participation today in the Memorial Hermann ACO is by invitation only—and only after a practice has passed an assessment.

Infographic: 4 Key Steps to Increasing Physician Practice Revenue

September 25th, 2015 by Melanie Matthews

There are several key steps physician practices can take to help grow their practice revenue, according to a new infographic by MedLanding News.

4 Key Steps to Increasing Physician Practice Revenue

Lessons from a Leading Pioneer ACO: Value-Based Gains from Physician Engagement, Performance Improvement and Care ManagementFollowing Pioneer ACO Year 3 results released by CMS in August 2015, Steward Health Care Network continues to make good on its Promise to provide coordinated, high-quality and cost-efficient care to its 80,000 Pioneer-aligned Medicare beneficiaries. Promise, Steward's top-performing Pioneer ACO, has generated $30 million of savings in its first three years of participation, according to recently published data.

Lessons from a Leading Pioneer ACO: Value-Based Gains from Physician Engagement, Performance Improvement and Care Management provides veteran advice from Kelly Clements, Pioneer Program Director, Steward Health Care Network. Steward is one of 20 accountable care organizations remaining in the Pioneer program and one of 15 reporting savings for year 3 (2014).

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Guest Post: 7 Ideas to Improve Communication and Coordination between Care Sites

September 22nd, 2015 by Richard A. Royer, CEO, Primaris

With access to some of the most highly educated and trained medical professionals in the world, providing Americans with the best patient care possible should be simple. Unfortunately, that’s not often the case. Poor communication between specialists, duplicate tests and unnecessary procedures are frequently the norm rather than the exception, leading to costly, dangerous and sometimes deadly consequences. With so many specialists and resources readily on hand, how is this happening?

The problem is a lack of care coordination. Simply put, care coordination is the idea that all specialists treating a patient should communicate and share information to ensure that everyone acts as a team to meet patient needs. This includes reporting all results back to a primary care practice or to someone coordinating patient care, and ensuring that labs, specialists, hospitals, and long-term care facilities work together to communicate information quickly and appropriately. It’s about primary care physicians, nurses, technicians, specialists, and caregivers collaborating on patient care rather than working as separate entities.

The average Medicare beneficiary interacts with seven physicians in four different practices during a single year, according to the New England Journal of Medicine. For those with chronic conditions, the numbers can be even higher. And, nearly one-fifth of Medicare patients who are hospitalized are readmitted within 30 days of discharge, and 75 percent of these readmissions could have been prevented by improved care coordination.

Too often, patients discharged from hospitals don’t get the support and encouragement they need to take their medicine, follow their diets, and adhere to the regimens doctors have prescribed during their stay. Many of these problems can be solved by improving care coordination, and that starts with communication between care sites.

Here are seven suggestions for improving communication between care sites—as well as across the care continuum:

  • Start the dialog: As a rule of thumb, improving communication between care sites begins with healthcare providers asking themselves what they know that others need to know, and sharing that information with the patient’s care team. What do patients need to know when they’re referred to a specialist? What do the specialists that patients are being referred to need to be aware of, e.g. what tests have already been completed? Has the primary care physician been informed?
  • Create a team and make it accountable: Organizations should start by assigning a team of people to be accountable for managing patient care. Define the extent of their responsibilities for key activities such as following up on test results and communicating information to other physicians. Establish when specific responsibilities should be transferred to other care providers—whether that means specialty physicians, long-term care facilities, or home care providers.
  • Designate care coordinators: Designate staff that will act specifically as care coordinators can help to reduce hospital readmissions. Before patients leave the hospital, care coordinators should meet with them to make sure they understand the treatment plans they need to follow at home as well as any changes to their medication regimens. The hospital care coordinators also must follow up on any pending labs and imaging studies and contact primary care physicians to communicate updated medications, treatment plans, and test results for their patients. The likelihood of readmission drops significantly when patients leave with a clear understanding of their treatment plans and when their primary care physicians know what is necessary during follow-up care.

    This same communication protocol should also apply to patients who leave the hospital for long-term care facilities. In this instance, the hospital care coordinator should communicate discharge instructions to the long-term care staff. As soon as residents return to the long-term care facility, staff there should meet with residents to review their discharge instructions, answer their questions, and communicate with the hospital if any further clarification is needed. Long-term care staff should also follow up regularly with these residents to ensure they continue to comply with instructions the doctor has recommended and intervene if any problems arise.

  • Standardize communication processes: Create a protocol for filling out patient charts in a standard way so they are easy to interpret and key elements aren’t overlooked. You also should standardize communication by using structured forms to ensure primary care providers, specialists, and long-term care providers all have the same and necessary information.
  • Develop a referral tracking system: Creating a system to internally track and manage referrals and transitions— including consultations with specialists, hospitalizations and ER visits, and referrals to community agencies—can go a long way towards improving communication between care sites. It will help to ensure patients are well prepared for their referral visit and know what to expect afterwards. And, it simplifies follow-up with referral providers about findings, next steps and treatment plans.
  • Follow up on referrals: When a primary care physician refers a patient to a specialist, for example, office staff should follow up to make sure the appointment was made and completed. In addition, office staff needs to ensure the specialist shares his findings with the primary care physician so he can be well versed on the patient's progress and any additional steps to be taken.
  • Notify providers in the patient's medical neighborhood: Similarly, when patients visit the emergency room or are admitted to the hospital, communication should be a priority. In this instance, hospital staff should notify the primary care practice so the primary care doctor can follow the patient’s progress through discharge and institute a care plan to prevent future admissions. In addition, the practice can reach out to patients when they leave the hospital to make sure they understand discharge instructions and schedule follow-up appointments. When the patient comes in for follow-up care, the primary care physician should have a complete history of specialists seen during the hospital admission, their recommendations, and tests performed, along with the results.

The healthcare industry can no longer simply “discharge” patients. Providers must now work collaboratively with all others across the continuum of care to transition and coordinate the ongoing care of every patient. That’s what care coordination is all about.

Richard Royer

About the Author: Richard A. Royer has served as the chief executive officer of Primaris since 2001. He has extensive administrative healthcare experience and is actively involved in several statewide healthcare initiatives. In 2006 he was appointed by the Missouri governor to the Missouri Healthcare Information Technology Task Force and chaired the resources workgroup. He also serves on the board of directors as treasurer for the Excellence in Missouri Foundation. In his over 35 years of medical business experience he has held positions as chief executive officer at Cuyahoga Falls, Ohio, General Hospital; executive director of Columbia Regional Hospital in Missouri; and founder and president of Avalon Enterprises, a medical financial consulting firm.

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.

Infographic: Primary Care’s View of Changing Healthcare Landscape

August 12th, 2015 by Melanie Matthews

Primary care providers are seeing a host of changes in the delivery and reimbursement of the care they provide.

A new infographic by the Commonwealth Fund looks at the perception of physicians and nurse practitioners and physician assistants of these emerging models.

6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability 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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Infographic: Physicians on the Front Line of Healthcare

July 31st, 2015 by Melanie Matthews

As the healthcare industry moves increasingly toward a value-based system of healthcare delivery and reimbursement, a growing number of physician practices are delivering care in a more systemized way, according to a new infographic by Bain & Company.

The infographic illustrates this change—with 75 percent of physicians using electronic medical records, up from just 29 percent two years ago and 81 percent of practices using treatment protocols, up from 34 percent two years ago.

The infographic also examines the number of practices using metrics, participating in risk-based contracts and the change in management of physician practices.

11 Profitable Value-Based Reimbursement Models: Lessons from Early AdoptersCMS's ambitious agenda for moving Medicare into alternative payment models is driving the U.S. healthcare system toward greater value-based purchasing at a furious rate. Private payors also have pledged to continue to shift payments away from fee for service and into alternative payment models such as accountable care organizations (ACOs). Fortunately, many healthcare organizations are already exploring value-based payments—often a single innovation at a time—testing models that reward providers for meeting Triple Aim goals of improving patient experience and population health while reducing healthcare's per capita cost.

11 Profitable Value-Based Reimbursement Models: Lessons from Early Adopters encapsulates nearly a dozen such approaches, from Bon Secours' building of a business case for its multidisciplinary care team to the John C. Lincoln ACO's deep dive into data analytics to identify and manage the care of high-risk, high-cost 'VIP' patients to 'beat the benchmark' to WellPoint's engagement of specialists in care coordination.

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Integrating Behavioral Health & Primary Care: Colocation Breaks Down Patient Resistance

July 16th, 2015 by Patricia Donovan

Integration of behavioral health and primary care fosters 'warm handoffs' between providers.

Behavioral health conditions affect nearly one of five Americans, leading to healthcare costs of $57 billion yearly, notes a 2009 AHRQ brief. Integration of behavioral and physical health services helps to ensure access by all individuals to preventive, ongoing and appropriate behavioral health services as part of a whole-person healthcare approach.

According to 2015 metrics from the Healthcare Intelligence Network (HIN), 62 percent of healthcare organizations have integrated behavioral health and primary care to some degree, with nearly one third—31 percent—reporting they have achieved “close collaboration onsite in a partly integrated system,” one of six integration levels defined by the Center for Integrative Health Solutions (CIHS).

The greatest benefit from integrated care is easy access to behavioral health providers, say numerous respondents to HIN’s 2015 survey on Integrating Behavioral Health and Primary Care. Their on-site presence facilitates everything from daily huddles of psychologists and primary care physicians for reviewing candidates for behavioral health interventions to warm hand-offs by doctors who schedule patients with behavioral health at the end of a primary care appointment.

Colocation also helps to break down patient resistance and reduce the stigma associated with seeking behavioral health services. One respondent stated the physical presence of a psychologist in the primary care office increased patients’ willingness to engage with a behavioral health professional.

When colocation isn’t possible, telehealth can help to fill the gaps. Twenty-one percent of respondents conduct behavioral health consults via telehealth.

“Psychiatrists and independently licensed practitioners are hard to find in our rural area,” said a respondent. “Telehealth is consistently used to meet demand, often with staff sitting in ‘live’ with the member.”

Source: 2015 Healthcare Benchmarks: Integrating Behavioral Health and Primary Care

Steward Medicare Pioneer ACO ‘Patient Trackers’ Boost Care Management, Improve Performance

July 14th, 2015 by Patricia Donovan

Steward Medicare Pioneer ACO

Steward's Medicare Pioneer ACO was a top performer in performance year two, with gross savings of $19.2 million.

The ability to track patients across a continuum of care sites is a perennial challenge for healthcare organizations—even a top-performing Medicare Pioneer ACO.

"We can't prevent a readmission back to the hospital or redirect unnecessary emergency department visits if we don't know the patients were in the hospital to begin with," noted Kelly Clements, Pioneer program director at Steward Healthcare Network, during Medicare Pioneer ACO: Care Management, Quality Improvement and Data Integration Yields Substantial Performance Gains, a Healthcare Intelligence Network webinar now available for replay.

But Steward's Medicare Pioneer ACO meets this challenge head-on with two tools: a home-grown patient surveillance tracker, and the "Patient Ping" service that provides real-time patient admissions and discharge notifications to providers. Both tools help Steward to identify and coordinate care for Pioneer ACO beneficiaries who seek services from both Steward and non-Steward providers.

These innovations have helped Steward's Medicare Pioneer ACO, aptly named Promise ("For our promise to do the best we can to coordinate beneficiaries' care and increase quality of care," said Ms. Clements), to emerge as one of the top CMS Medicare Pioneer ACO performers in 2013, with gross savings of $19.2 million.

Three Medicare Pioneer ACO Challenges

Care management, including the tracking of its 80,000 Promise beneficiaries, was one of three categories of Medicare Pioneer ACO challenges Ms. Clements touched on during the webinar, along with physician engagement and performance improvement.

Supporting care management, the internally developed patient surveillance tracker is Steward's in-network solution for real-time tracking of care received from Steward providers and facilities; the contracted Patient Ping service allows the Pioneer ACO to communicate with skilled nursing facilities (SNFs) outside their network that care for Steward Pioneer patients, providing the SNF is registered with Patient Ping.

"Through the Pioneer program, we've learned that a large portion of our opportunity to reduce cost and achieve savings as an ACO is in the post-acute care space, particularly in the SNFs," noted Ms. Clements.

To engage physicians in the delivery of accountable care, Steward has done everything from holding road shows for providers to creating performance improvement teams for each geographic "chapter" in the ACO to work with physician practices to improve efficiency and quality. Physician report cards measure stewardship (including attendance at chapter meetings) and other efficiency and quality indicators.

And finally, to drive performance improvement, Steward has worked aggressively on data integration, with a strong focus on the two most popular electronic health records (EHRs) its physician network, in order to feed its 'quality data warehouse.'

This focus, along with efforts by the physician practices, has generated results. Steward saw its Pioneer ACO raw quality scores rise significantly from performance year one to performance year two: a 39 percent jump in the preventive health domain, and a 42 percent improvement in the at-risk domain (care for chronic conditions such as diabetes and coronary artery disease (CAD).

There is one additional hurdle: Steward must decide which ACO program it will participate in next year: Pioneer ACO, Next Generation ACO or Medicare Shared Savings Program (MSSP), Track 3. "The more efficient we become, the harder it will be to achieve shared savings, because the benchmark will keep getting lower, so this is one of our big concerns," said Ms. Clements.

"Our leadership is fully committed to pursuing risk aggressively and it's been worthwhile being at the table with Medicare and advocating for programmatic changes that will benefit our providers and patients in a sustainable way."

3 Embedded Care Coordination Models Manage Diverse High-Risk, High-Cost Populations

June 30th, 2015 by Patricia Donovan

YNHHS embedded care coordination

YNHHS uses an embedded care coordination approach to manage its high-risk, high-cost medical home patients, geriatric homebound and health system employees.

When it comes to coordinating care for its highest-risk, highest-cost individuals—whether patients in a medical home, the geriatric homebound or its own employees—Yale New Haven Health System (YNHHS) believes an onsite, embedded face-to-face approach will best position it for success in a value-based healthcare industry.

The Connecticut-based health system shared its vision for managing patients across its continuum via three embedded care coordination models during a June 2015 webinar, Embedded Care Coordination for At-Risk Populations: A Case Study from Yale New Haven Health System, now available for replay.

In the first model, livingwellCARES, RN care coordinators at YNHHS's four health system campuses work with its high-risk, high-cost health system employees and their adult dependents with chronic disease.

"We help these employees access the care they need and identify their goals of care. We get under the surface a little bit to determine barriers to their being as healthy as they can be and manage them over time," explained Amanda Skinner, executive director, clinical integration and population health, adding that YNHHS offers employees incentives such as waived insurance co-pays for participation.

Launched three years ago, livingwellCARES was YNHHS's "on-the-job training for learning to manage care across the continuum," she continued. Starting with employees with diabetes, livingwellCARES expanded to care coordination of most chronic diseases. Having significantly impacted clinical metrics like A1Cs as well as hospital utilization and ED visits in the approximately 500 employees it manages, livingwellCARES is now transitioning to a more risk-based approach.

The second embedded care coordination model, a patient-centered medical home (PCMH), also launched three years ago. Focused on complex care management, the PCMH is heavily driven by data derived from its electronic health records and patient registries, Ms. Skinner continued.

Because five of eight PCMH care coordinators are embedded and cover multiple physician practices, YNHHS is exploring the use of televisits by care coordinators to manage patients in the practices served. Also important is schooling PCMH staff in the relatively new practice of "warm handovers" during critical transitions of care.

Nine challenges of the PCMH embedded model shared by Ms. Skinner include engaging patients and obtaining reimbursement for various pay for performance programs.

In the third model, outpatient geriatric care coordination, embedded high touch care coordinators manage frail elderly deemed homebound by Medicare standards—when it’s a severe and taxing effort to leave the home—and those in assisted living facilities, explained Dr. Vivian Argento, executive director of geriatric and palliative services at Bridgeport Hospital.

"There is a challenge not just with frailty but also with access—having these patients go into the physician offices—so that the care tends to get shifted into the hospital because it’s easier for those patients to get there," Dr. Argento explained.

Physicians and nurse practitioners provide care in the patient's home to break that utilization cycle, while embedded care coordinators constantly collaborate with the care team to risk-stratify and prioritize patients, resolve medication concerns, make referrals, manage care transitions, triage telephone calls—all tasks required to coordinate care for what Dr. Argento termed "a very sick Medicare population in in the last two to three years of life."

Well received by the geriatric patients, the program also has positively impacted healthcare utilization metrics: its annual hospital admission rate of 5.4-5.8 percent is significantly below Medicare's overall 28-30 percent hospitalization rate, and the program boasts a readmissions rate of 14 percent, versus Medicare's 20 percent national average, Dr. Argento added.