Archive for the ‘Physician Practices’ Category

Social Determinants of Health: Does Technology Connect or Isolate?

January 12th, 2017 by Patricia Donovan
social isolation

Only half of Americans with two or more chronic conditions actually go online.

Social determinants are areas of health that involve an individual’s social and environmental condition as well as experiences that directly impact health and health status. Here, Dr. Randall Williams, chief executive officer, Pharos Innovations, examines why, contrary to popular thought, technology advances may actually increase the gap between social connectedness and social isolation for certain populations.

In the age of the Internet, technology itself may become a barrier to being connected with others through social interactions. The Pew Research Center has done some nice work on health and the Internet. It turns out that three quarters of adults in the United States go online. That's probably not all that surprising, but what's more nuanced in this data is that the Internet access of individuals in the United States actually differs, depending on whether or not those individuals suffer from chronic health conditions.

It turns out that of Americans who have two or more chronic conditions, which by the way represents the vast majority of the Medicare population, only half go online. As it turns out, the very same groups that suffer most from social determinants of health, and not just from social isolation, also have the highest rates of chronic disease. And according to this research, they are the ones most likely to NOT have access to the Internet. This is called the Internet Divide.

We might be encouraged by the prevalence and penetration of mobile technologies, and maybe those would be the great bridge over the Internet Divide. Unfortunately, that may not be the case yet. According to this same Pew research, 90 percent of Americans who don't have a chronic condition actually own a cellphone. However, if you do have two or more chronic conditions, that number drops down pretty dramatically to 70 percent. That finding is a bit better than Internet access, but certainly not ubiquitous. If you look at those who have a cellphone, only 23 percent of them actually access text-messaging technologies on their cellphones, and smartphone apps fall well below that.

Source: Social Determinants and Population Health: Redesigning Care Management to Bridge Clinical and Non-Medical Services

social determinants of health

In Social Determinants and Population Health: Redesigning Care Management to Bridge Clinical and Non-Medical Services, care teams will learn that by asking patients the right questions and listening carefully to their responses, they can begin to identify and address social determinants, dramatically impacting patient outcomes as well as their own financial success under value-based care.

Infographic: Patient Communication Compliance

January 11th, 2017 by Melanie Matthews

Communication with current and potential patients is pivotal to maintaining and growing your practice, but your practice must ensure that you are compliant in all of your communication points with HIPAA, FDA and FTC rules, according to a new infographic by Response Mine.

The infographic touches on all points of patient communication—from digital advertising and marketing to scheduling appointments and patient reminders—to help practices protect patient information and stay compliant.

Patient Communication Compliance

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

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

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At MACRA Launch, Think Like a MIPS Top Performer

January 9th, 2017 by Patricia Donovan
Change this caption to something else.

A focus on quality activities like influenza vaccines is a good starting point for MIPS performance improvement.

With the opening of the first Quality Payment Program performance period on January 1, 2017, many eligible healthcare providers have picked their MACRA participation pace and begun to collect performance data. In certain cases, Merit-based Incentive Payment System (MIPS) top performers and MIPS exceptional performers potentially could fare better than Advanced Alternative Payment Model (APM) practices. Here, Barry Allison, chief information officer, the Center for Primary Care, describes some ways clinicians can aspire toward MIPS top performer or exceptional performer status.

According to the Centers for Medicare and Medicaid Services (CMS), a MIPS top performer must be one standard deviation point above the mean, as far as the total cost of care for the patient as well as for the quality metrics reported to CMS. This illustrates why it is critical to look at your organization's Quality and Resource Use Report (QRUR) data. From looking at our own QRUR data internally, we want to be in the 90th percentile or higher for things like annual flu shots, influenza vaccines, Pneumovax® vaccinations, or Prevnar® vaccinations in conjunction with the Pneumovax 23.

These are very key points. For most EHRs and registries, if you look at quality, that 60 percent that CMS will review in MACRA’s first year, those are the activities where you should aim to report at the high end. I would recommend anywhere from 88 percent and upwards, but my minimum would be reporting on 90 percent of areas where you can use technology to deploy a short message service (SMS) outreach campaign for influenza vaccines or similar tasks.

You want to make sure that in the areas considered low hanging fruit, that you’re either rendering those services, or if you don’t render those types of services, you direct the patient toward a Medicare provider or provider that does render those services and from whom Medicare receives that information.

Let’s take flu shots, for example. Even though your particular practice may not render that service, you should refer your patients somewhere that does administer the shots. You want to refer that patient somewhere where you know that claim will be filed to Medicare, because through their attribution methodology, you’re still that patient’s primary care provider. You still get credit right now for that quality element, even though you may not have administered the shot.

Source: Physician Chronic Care Management Reimbursement: Roadmap to MIPS Success Under MACRA

http://hin.3dcartstores.com/Home-Visits-for-Clinically-Complex-Patients-Targeting-Transitional-Care-for-Maximum-Outcomes-and-ROI_p_5180.html

Physician Chronic Care Management Reimbursement: Roadmap to MIPS Success Under MACRA describes how early adoption of Medicare's CCM Reimbursement program enhanced the Center's MACRA-readiness, laying the foundation for success under the Merit-based Incentive Payment System (MIPS) path.

Infographic: Obstacles to Value-Based Healthcare

December 19th, 2016 by Melanie Matthews

Obstacles to Value-Based Healthcare
Multispecialty medical groups and integrated systems of care that deliver care to one in three Americans—reported that the transition away from fee-for-service medicine continues, but at a slower pace than anticipated, according to new infographic by AMGA.

The infographic examines the barriers to value-based care for these organizations.

A 2015 adopter of Medicare's Chronic Care Management (CCM) reimbursement program, The Center for Primary Care (CPC) quickly expanded its CCM initiative to qualifying Medicare beneficiaries at its nine locations. Today, with a detailed profile of its CCM population and the health improvements and revenue that resulted, the CPC is leveraging this Chronic Care Management experience for participation in MACRA.

Physician Chronic Care Management Reimbursement: Roadmap to MIPS Success Under MACRA describes how early adoption of Medicare's CCM Reimbursement program enhanced the Center's MACRA-readiness, laying the foundation for success under the Merit-based Incentive Payment System (MIPS) path.

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2017 Healthcare Success Formula: Care Management Sophistication and ‘Patient Stickiness’

November 29th, 2016 by Patricia Donovan

HIN's 13th annual planning session provided a roadmap to key healthcare issues, challenges and opportunities in 2017.

Whether concerned with healthcare delivery or reimbursement for services rendered, providers and payors alike will need to be nimble in the coming year to survive and thrive in a sharply shifting, value-based marketplace, advises Steven Valentine, vice president, Advisory Consulting Services, Premier Inc.

"Be aware: the competitors you've had in the past are changing, and you're seeing more competition with various Internet providers, CVS, Apple, Watson. It's all going to change," said Valentine during Trends Shaping the Healthcare Industry in 2017: A Strategic Planning Session, a November 2016 webinar now available for replay.

But what healthcare shouldn't panic about, at least for the immediate future, is the demise of the Affordable Care Act (ACA).

"[The ACA] is not going to be canceled any time soon," Valentine emphasized during the thirteenth annual planning session sponsored by the Healthcare Intelligence Network. "We would expect it would take two years, at least, to begin to put in some kind of a replacement program."

Assuring participants that within all this industry flux are opportunities, Valentine suggested they follow the lead of retail pharmacy CVS. "CVS envisions itself as a full service healthcare organization with a goal of 'patient stickiness.' In other words, CVS is saying, 'I need patients to rely on me as their source of getting started for healthcare.'"

Later in the program, he offered participants a four-point plan for improving patient stickiness.

As for care management sophistication, Valentine pointed to the pairing of hospitals with a case manager, with incentives for care managers and hospitalists to manage down length of stay, or manage resource consumption.

"We're probably gravitating more toward care management models that are outside the four walls of the hospitals...which will give us better economies, better outcomes, people more specialized in the areas they're in that could really help provide better quality at a lower cost."

And while the healthcare thought leader believes Medicare will remain essentially untouched by the incoming presidential administration, he did identify nearly a dozen areas where President-Elect Donald Trump's 'Better Way' might eventually make its mark on healthcare, including more price transparency and the sale of insurance across state lines.

Moving on to sector-specific forecasts, Valentine outlined four expectations for health plans, including a push for more access points like telehealth and urgent care centers and added pressure to reduce chronic care costs.

Healthcare providers should focus on population health and immerse themselves in data analytics to better prepare for MACRA and the narrow, quality-based provider networks that will result.

Both sectors should expect more consumer demand for accountability, Valentine said, since patients and health plan members are fed up with rising costs and armed with more transparency information and health awareness.

Valentine concluded his presentation with eight guiding principles for 2017 success, including collaboration between health plans and physicians.

And in the Q&A that followed, Valentine offered guidance on a number of issues, including how providers can grow their population bases; identifying and addressing social health determinants; succeeding in value-based healthcare, and offering efficient, integrated behavioral healthcare services.

Click here to listen to advice from Steven Valentine on employing technology for patient engagement.

Infographic: MACRA Pathways

November 16th, 2016 by Melanie Matthews

Under MACRA, 2017 will be the first performance year physicians will be scored to determine payment adjustments in 2019. Physicians will choose between two payment tracks: the Merit-based Incentive Payment System (MIPS) or the Alternative Payment Model (APM), according to a new infographic by the American Academy of Family Physicians (AAFP).

The infographic highlights the path options physicians can choose.

Infographic: MACRA Pathways

No matter which level of participation physician practices choose for the first Quality Payment Program performance period beginning January 1, 2017, CMS's "Pick Your Pace" announcement means practices should proactively prepare for the impact of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) on physician quality reporting and reimbursement.

MACRA Physician Quality Reporting: Positioning Your Practice for the MIPS Merit-Based Incentive Payment System delivers a veritable MACRA toolkit for physician practices, with dozens of tips and strategies that lay the groundwork for reimbursement under Medicare's Merit-based Incentive Payment System (MIPS), expected to begin in 2017 and one of two payment paths Medicare will offer to practices.

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Infographic: Overcoming 5 Data Challenges Preventing Effective Physician Alignment

November 14th, 2016 by Melanie Matthews

Achieving physician alignment, critical to the success of health systems, requires a view into physician activity and referrals, according to a new infographic by Evariant.

Claims data is the best source of information to help analyze and identify referral patterns to move toward achieving physician alignment, but analyzing this information does not come without its own unique set of challenges. The infographic examines five data challenges preventing effective physician alignment and how to overcome them.

Overcoming 5 Data Challenges Preventing Effective Physician Alignment

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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Breaking Down UTSACN Advanced Care Coordination: “Data Analyst Is Your Best Friend”

October 6th, 2016 by Patricia Donovan

advanced care coordination

Data is useless unless transformed into actionable information, notes Cathy Bryan, UTSACN director of care coordination.

Although the care coordination director for UT Southwestern's Accountable Care Network (UTSACN) insists there's no secret sauce that ensures ACO success, Cathy O'Brien readily proposes eight ingredients to season care management initiatives.

It's a recipe heavy on data analytics, and one destined to fail unless extracted data is transformed into actionable information, emphasized Ms. Bryan during Advanced Care Coordination: Bridging the Gap Between Appropriate Levels of Care and Care Plan Adherence for ACO Attributed Lives, a September 2016 webinar now available for replay.

For that transformation, the Year Three Medicare Shared Savings Program (MSSP) ACO relies heavily on its data analyst. "Your analyst is your best friend. You need someone who is skilled and knows how to analyze large, complex data sources like you get with ACO claims data and other sources," Ms. Bryan said.

To better manage its nearly 250,000 ACO-attributed lives (up from 19,000 in 2014), UTSACN leverages data from a number of sources, including paid claims data from CMS and commercial payors; more than 100 disparate electronic medical record (EMR) systems; and ADT feeds. This data mining has helped UTSACN to identify and bridge care and quality gaps, manage transitions in care, and risk-stratify its population for care management, including 'risking risk' patients exhibiting signs of struggle with adherence to care plans.

It's also provided a starker picture of utilization, especially on the home health front. When data indicated UTSACN home health use had risen to levels more than twice the national average, UTSACN's analyst created an internal efficiency index to categorize the more than 1,200 home health agencies in use. The use of this claims-based, risk-adjusted score ultimately pared the home health network to a manageable twenty agencies and saved approximately $6 million in home health utilization costs in the first quarter of 2016 alone.

To engage physicians, UTSACN supported the rollout of this narrow network with a large-scale reeducation effort. Presented with the rationale for this change, providers now better understand Medicare's home health utilization rules and their accountability to the ACO for their share of costs, utilization and outcomes, notes Bryan.

"You’ve got to create buy-in. You don't just take providers a list and say, here's your problem. You've got to take a solution to them."

Another solution designed to support providers is UTSACN's primary-care-centric model, in which care coordination teams are paired geographically with eight to fifteen physician practices. Composed of embedded care coordinators (as well as field staff that do in-home work), the care coordination teams reach out to the practices' patients on their behalf.

"We really see our team as an extension of the primary care practice, and we function as such. As we introduce ourselves to patients, we say we're with the UT Southwestern Accountable Care Network calling on behalf of Dr. Smith, your primary care physician."

As that extension, embedded care coordinators help physician practices to address barriers to patients' medical plans of care, from lack of transportation to medication costs to the presence of falls risks in the home.

Click here to listen to an interview with Ms. Bryan.

Infographic: 10 Things To Know About MACRA

October 3rd, 2016 by Melanie Matthews

The Medicare Access and CHIP Reauthorization Act provides a new framework for the drive toward value-based reimbursement for physicians, according to a new infographic by athenahealth Inc.

The infographic provides physicians with 10 critical steps to prepare for MACRA.

No matter which level of participation physician practices choose for the first Quality Payment Program performance period beginning January 1, 2017, CMS's "Pick Your Pace" announcement means practices should proactively prepare for the impact of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) on physician quality reporting and reimbursement.

MACRA Physician Quality Reporting: Positioning Your Practice for the MIPS Merit-Based Incentive Payment System delivers a veritable MACRA toolkit for physician practices, with dozens of tips and strategies that lay the groundwork for reimbursement under Medicare's Merit-based Incentive Payment System (MIPS), expected to begin in 2017 and one of two payment paths Medicare will offer to practices.

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Infographic: Which Physician Quality Payment Program Is Right for You?

September 19th, 2016 by Melanie Matthews

For Medicare physicians and groups that will be impacted by the new Merit-Based Incentive Payment Program (MIPS) and the Advanced Alternative Payment Model (APM) requirements, it is important to remember that planning for the Quality Payment Program is more nuanced than simply 'selecting a track,' according to a new infographic by Able Health.

To help make understanding the two Quality Payment Program tracks a bit easier, Able Health's infographic helps physicians and medical groups determine which track may be the most appropriate to prepare for in 2017.

No matter which level of participation physician practices choose for the first Quality Payment Program performance period beginning January 1, 2017, CMS's "Pick Your Pace" announcement means practices should proactively prepare for the impact of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) on physician quality reporting and reimbursement.

MACRA Physician Quality Reporting: Positioning Your Practice for the MIPS Merit-Based Incentive Payment System delivers a veritable MACRA toolkit for physician practices, with dozens of tips and strategies that lay the groundwork for reimbursement under Medicare's Merit-based Incentive Payment System (MIPS), expected to begin in 2017 and one of two payment paths Medicare will offer to practices.

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Have an infographic you'd like featured on our site? Click here for submission guidelines.