Archive for the ‘Reducing Readmissions’ Category

5 Practitioner Tactics for Tackling the Opioid Epidemic

August 15th, 2017 by Susan Butterworth, PhD, and Amanda Sharp, MPH, Q-Consult LLC
opioids

There is promising evidence that motivational interviewing can successfully reduce both the use of non-medical opioid use and overdose risk behaviors for prescription opioids.

Despite evidence and guidelines to the contrary, including significant risk of addiction, there remains a widespread belief among many clinicians and patients alike that opioid medication is a viable and effective first option for multiple chronic pain conditions. Practitioners feel pressure to provide opioids upon patient request, yet many have neither the resources nor the skill set to manage the physiological and psychological complications that can arise when treating a patient with opioids long-term.

As one qualitative study found, it can be awkward at best, and confrontational at worst, when refusing a patient’s request for opioids. Thus, clinicians are faced with the challenging balancing act of providing pain relief for their patients while simultaneously managing the potential for addiction and misuse – with most clinicians ill-equipped for the herculean task.

“Not providing the [opioid] prescription is very hard. It takes time to do the research on the patient. Confronting the patient with a problem is emotionally draining. Doing it 5-10 times in one shift is not only a reality, it is downright crippling. It sucks out [sic] last bit of energy out of your soul. Rather than confronting patients and arguing, it’s far easier to write a prescription for narcotics and move on to the next patient. This is the mindset of thousands of physicians.”
Anonymous Physician, April 25, 2013

Along with knowledge about alternative treatments, a valuable skill set for clinicians in this situation is an effective communication approach to address the possible scenarios that emerge:

  • Engaging patients in discussions about the risks of opioids;
  • Validating the frustration of chronic pain;
  • Evoking commitment to try alternative modalities;
  • Eliciting honesty about unhealthy/drug-seeking behaviors; and

Sharing concerns and resources for opioid addiction.

Motivational Interviewing (MI) is an evidence-based communication approach that has been adapted for the brief healthcare setting to address many lifestyle management issues, including chronic pain. There is one promising clinical trial that used a single MI session in an emergency department to successfully reduce both the use of non-medical opioid use and overdose risk behaviors for prescription opioids as compared to a control group. Even beginning proficiency in MI equips practitioners with the confidence and skills needed to engage patients in conversations that generally lead to outcomes of being able to maintain rapport and successfully incorporate best practice guidelines for chronic pain treatment.

Consider the following two scenarios:

Scenario 1: Your patient has recently hurt their back and has requested strong pain medication.

Scenario 2: You suspect your patient may have an addiction to opioids.

In both cases, a practitioner, competent in the MI approach, would be able to use the following strategies to successfully navigate these challenging waters. These principles and strategies are based on Miller and Rollnick’s description of MI practice.

Engage and Partner

Taking a minute or two to build rapport with the patient may be counter-intuitive to a busy clinician. However, consider the time that is spent in unproductive arguments and power struggles. Research has shown that taking a more patient-centered approach is more time-efficient in the long run. Although the clinician is an expert in clinical aspects, the patient is the expert of their life, and the only one with the ability to commit to the suggested treatment plan. By stepping out of the authoritarian role, ideally, the clinician can partner with the patient in a collaborative way to problem-solve together. When a person helps to identify the best treatment course for themselves, they feel more ownership and are more committed; thus, are more likely to follow through.

Express Empathy

A core component of engaging is being able to express empathy, or the ability to convey accurate understanding through the eyes of the patient. This takes compassion, effort, genuine interest, and reflective listening. The clinician does not need to become a counselor to provide a meaningful statement that lets the patient know that the practitioner “gets it”. When the patient feels understood and accepted, they are more receptive to the clinician’s advice and guidance.

Share Concerns while Supporting Autonomy

In MI, the clinician is not simply following the patient but is a full partner. After establishing rapport and trust, it is not amiss to share any concerns that the provider has, if patient autonomy is concretely verbalized. The patient can always go to another doctor to get what they want; by acknowledging that it is the patient’s choice to pursue what they feel is best for them, the patient relaxes. This allows the clinician to share their concern in a way that does not elicit defensiveness.

Manage Expectations

It is important to manage the expectations of the patient. By clearly and transparently stating up front what the clinician feels is best practice and ethically viable, the patient is not disappointed later. Openly share that alternative treatment options may not address the pain as completely as opioids might initially, or, in the case of addiction, that there may be withdrawal symptoms when discontinuing the medication. Honesty preserves trust and conveys the clinician’s desire to support the patient as fully as possible, while still maintaining his integrity of practice.

Provide Decision Support with Menu of Options

Now the patient is ready for a menu of options with the pros and cons succinctly laid out. These include therapies such as non-opioid meds, stretching, and alternative treatments. Some of these options may be those that the clinician is not prepared to provide; e.g., if the patient is still favoring the option of more opioids. The clinician has been transparent about which options he feels are best and is willing to provide; however, the patient is in the driver’s seat to choose the best treatment course for himself. In most cases, the clinician can positively influence the patient’s decision. If not, the discussion remains professional, rapport is not lost, and the patient will feel comfortable returning to this provider. This keeps the door open to further dialogue about the situation.

There are many resources available for those who are interested in getting trained in MI, and the approach can be used for any lifestyle management or treatment adherent situation. However, a fair warning that MI is a complex skill set and cannot be learned in a one-and-done workshop. Just like learning to speak a foreign language or play a musical instrument, it takes practice and feedback from an expert over time to develop a meaningful proficiency. As many clinicians can attest though, this is one hard-earned competency that is more than worth it — for the practitioner, the patient and society!

Susan Butterworth, PhD

Amanda Sharp, MPH

About the Authors: Susan Butterworth, PhD, is principal and Amanda Sharp, MPH is program manager for Q-Consult LLC. Both are both members of the Motivational Interviewing Network of Trainers. Please visit Q-Consult, LLC their blog and find out more about patient-centered initiatives that increase patient engagement and improve clinical outcomes.

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.

Guest Post: Analytics-Backed Wearables Provide Value Through Actionable Health Insights

July 18th, 2017 by John Valiton, CEO of Reemo Health

wearables for seniors

Analytics-enabled wearables offer opportunities for chronic disease management and delivery of value-based care.

The wearable market has experienced a growth rate of more than 20 percent and is estimated to reach over 213 million units shipped worldwide by 2020, according to IDC. These numbers likely don’t come as a surprise, as wearables have become an everyday tech accessory for nearly every generation — children, Millennials, Gen X, and even seniors. In fact, research by Accenture found that 17 percent of Americans over the age of 65 use wearables to track fitness — a percentage right on track with the 20 percent of those under the age of 65 that use wearables similarly.

But, while the value of utilizing wearables to track health has been tapped for the everyday consumer, it has yet to reach its full potential. Wearables can go far beyond heart rate monitoring and counting steps — especially for seniors. These devices, when connected with a data analytics platform, can provide the valuable insights needed to not only track health in real time, but predict potential threats and optimize care according to need. And the analytic insights, integrated with previous health records, not only benefit the senior, but give professional and family caregivers a deeper look into the behavior that can improve long-term health, streamlining delivery of care by mitigating the need for trial-and-error treatment planning.

With over 50 million seniors in the U.S., this offers a huge opportunity for care facilities to provide real value to the patients they serve, whether in a senior care facility where residents are monitored on an hourly basis, or still living independently where facilities provide data insights at scheduled check-ins. But, as more facilities adopt wearable and analytic solutions, they must acknowledge the importance of using the wearable-enabled analytics platform to keep users engaged by providing value through actionable insights, rather than simply mining data and pushing it out. If there are not real benefits for both the senior and care provider, that wearable device is likely to end up in a drawer in a matter of months.

As caregivers dive into these valuable insights, they can be applied to assist with everything from chronic disease management and health event recovery to reduce the chance of post-acute readmission, to predicting potential threats based on irregularities in activity levels and vitals — allowing providers to truly delivery value-based care. For example, through the analysis of activity data, caregivers can follow the pathway to a potential fall for a senior, and proactively take steps to avoid this often traumatic event. Additionally, urinary tract infections (UTIs) are a large risk for seniors, and often occur after a 72-hour period where light activity such as walking becomes increasingly painful and trips to the restroom increase. By tracking a senior’s activity levels through a wearable device, caregivers can strategically treat those with potential UTI issues.

Through these kind of applications, truly actionable wearable data can provide immense value for both seniors and the caregivers tasked with keeping them on the pathway to a positive aging experience. And for those still living independently, the integration of response systems — such as push-of-a-button 911 dialing — within the wearable devices can provide additional value in their daily life by providing peace of mind to the senior and their loved ones, and functionality in the case of an emergency.

The use of wearables in everyday life doesn’t have to be limited to tracking a morning walk or getting reminders to stand up when you’ve been sitting for too long. If used alongside a powerful analytics platform, these devices can truly improve seniors’ quality of life, while strengthening connections with caregivers through increased visibility into seniors’ daily activities and peace of mind for loved ones. And while the wearable revolution is sweeping the nation, it truly should be about more than wearables for seniors. Wearables, backed by powerful data analytics, can become invaluable for our aging generation while providing unmatched insights for both personal and professional caregivers.

John Valiton, CEO, Reemo Health

John Valiton, CEO, Reemo Health

About the Author: John Valiton is CEO of Reemo Health, a senior health technology solution designed to empower caregivers with actionable insights to improve the aging experience. As a 20-year business development veteran and entrepreneur, Valiton has developed partnerships with many national and international companies. He has been an avid technology enthusiast since an early age, and applied his interest in all things tech at the intersection of IoT, wearable technology, healthcare and data science through his position as a strategic advisor, chief revenue officer and now chief executive officer for Reemo.

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.

2017 ACO Snapshot: As Adoption Swells, Social Determinants of Health High on Accountable Care Agenda

June 29th, 2017 by Patricia Donovan

Nearly two-thirds of 2017 ACO Survey respondents attribute a reduction in hospital readmissions to accountable care activity.

Healthcare organizations may have been wary back in 2011, when the Department of Health and Human Services (HHS) first introduced the accountable care organization (ACO) model. The HHS viewed the ACO framework as a tool to contain skyrocketing healthcare costs.

Fast-forward six years, and most resistance to ACOs appears to have dissipated. According to 2017 ACO metrics from the Healthcare Intelligence Network (HIN), ACO adoption more than doubled from 2013 to 2017, with the number of healthcare organizations participating in ACOs rising from 34 to 71 percent.

During that same period, the percentage of ACOs using shared savings models to reimburse its providers increased from 22 to 33 percent, HIN’s fourth comprehensive ACO snapshot found.

And in the spirit of delivering patient-centered, value-based care, ACOs have embraced a whole-person approach. In new ACO benchmarks identified this year, 37 percent of ACOs assess members for social determinants of health (SDOH). In support of that trend, the 2017 survey also found that one-third of responding ACOs include behavioral health providers.

Since that first accountable care foray by HHS, the number of ACO models has proliferated. The May 2017 HIN survey found that, of current ACO initiatives, the Medicare Shared Savings Program (MSSP) from the Centers for Medicare and Medicaid Services (CMS) remains the front runner, with MSSP participation hovering near the same 66 percent level attained in HIN’s 2013 ACO snapshot.

Looking ahead to ACO models launching in 2018, 24 percent of respondents will embrace the Medicare ACO Track 1+ Model, a payment design that incorporates more limited downside risk.

This 2017 accountable care snapshot, which reflects feedback from 104 hospitals, health systems, payors, physician practices and others, also captured the following trends:

  • More than half—57 percent—participate in the Medicare Chronic Care Management program;
  • Cost and provider reimbursement are the top ACO challenges for 18 percent of 2017 respondents;
  • Clinical outcomes are the most telling measure of ACO success, say 83 percent of responding ACOs;
  • Twenty-nine percent of respondents not currently administering an ACO expect to launch an accountable care organization in the coming year;
  • 75 percent expect CMS to try and proactively assign Medicare beneficiaries to physician ACO panels to boost patient and provider participation.

Download HIN’s latest white paper, “Accountable Care Organizations in 2017: ACO Adoption Doubles in 4 Years As Shared Savings Gain Favor,” for a summary of May 2017 feedback from 104 hospitals and health systems, multi-specialty physician practices, health plans, and others on ACO activity.

Shared SNF Patients, Common Readmissions Goals Unify Three Competing Health Systems

June 15th, 2017 by Patricia Donovan

A common desire to reduce SNF readmissions resulted in the formation of Michigan's Tri-County SNF Collaborative.

A common desire to reduce SNF readmissions resulted in the formation of Michigan’s Tri-County SNF Collaborative.

Concerned about escalating hospital readmissions from skilled nursing facilities (SNFs) and the accompanying pinch of Medicare readmissions penalties, three Michigan healthcare organizations decided to set competition aside to collaborate and reduce rehospitalizations from SNFs. Here, Susan Craft, director of care coordination, family caregiver program, Office of Clinical Quality & Safety at Henry Ford Health System, describes the origins of Michigan’s Tri-County SNF Collaborative, of which her organization is a founding member.

I want to talk about the formation of the Tri-County SNF Collaborative between Henry Ford Health System, Detroit Medical Center, and St. John Providence Health System. As quality and care transition leaders from each of the health systems, we see each other frequently at various meetings. After some good conversation, we learned that each of us was partnering with our SNFs to improve quality and reduce readmissions.

We all required that they submit data to us that was very similar in nature but not exactly the same, which created a lot of burden for our SNFs to conform to multiple reporting requirements. We knew we were working with the same facilities because geographically, we are all very close to each other. We recognized that this was really a community problem, and not an individual hospital problem. Although we are all competing healthcare systems, those of us with very similar roles in the organization had very little risk from working together. And because we had so much in common, it just made sense that we create this collaborative.

We also worked with our MPRO (Michigan Quality Improvement Organization) and reviewed data that showed that about 30 percent of our patient population was shared between our three health systems. We decided it made sense to move forward. We created a partnership that was based on collaboration and transparency, even within our health systems. We identified common metrics to be used by all of our organizations and agreed upon operational definitions for each of those. We all reached out to our SNF partners to tell them about the collaborative and invite them to join, and then engaged MPRO as our objective third party. We created a charter to solidify that cooperation and collaboration.

Source: A Collaborative Blueprint for Reducing SNF Readmissions: Driving Results with Quality Reporting and Performance Metrics

reducing SNF readmissions

A Collaborative Blueprint for Reducing SNF Readmissions: Driving Results with Quality Reporting and Performance Metrics examines the evolution of the Tri-County SNF Collaborative, as well as the set of clinical and quality targets and metrics with which it operates.

Infographic: The Post-Acute Care Landscape

May 8th, 2017 by Melanie Matthews

Hospitals can’t just leave patient care to chance after patients leave the hospital. They must be more actively involved in managing their patients to ensure that they will receive the most appropriate post-acute care and avoid readmissions, according to a new infographic by eviCore healthcare.

The infographic examines the components of the post-acute healthcare market, guidelines for avoiding unnecessary readmissions and strategies for modernizing post-acute care.

Reducing SNF Readmissions: Quality Reporting Metrics Drive ImprovementsA tri-county, skilled nursing facility (SNF) collaborative in Michigan is holding the line on hospital readmission rates for the three competitive health systems participating in the program.

Henry Ford Health System, Detroit Medical Center and St. John’s Providence, along with the state’s Quality Improvement Organization (QIO), MPRO, developed standardized quality reporting metrics for 130 SNFs in its market. The SNFs, in turn, enter the quality metrics into a data portal created by MPRO.

During Reducing SNF Readmissions: Quality Reporting Metrics Drive Improvements, a 45-minute webinar on May 11th at 1:30 p.m. Eastern, Susan Craft, director, care coordination, family caregiver program, Office of Clinical Quality & Safety at Henry Ford Health System, will share the key details behind this collaborative, the impact the program has had on her organization’s readmission rates along with the inside details on new readmission reduction target areas born from the program’s data analysis.

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Infographic: Stopping the Revolving Door of Short-Term Readmissions

April 10th, 2017 by Melanie Matthews

Transitioning eligible patients to hospice can help hospitals avoid Medicare’s 30-day readmission penalty, according to a new infographic by VITAS.

The infographic examines how hospice can reduce readmission rates and increase patient satisfaction.

Reducing SNF Readmissions: Quality Reporting Metrics Drive ImprovementsA tri-county, skilled nursing facility (SNF) collaborative in Michigan is holding the line on hospital readmission rates for the three competitive health systems participating in the program.

Henry Ford Health System, Detroit Medical Center and St. John’s Providence, along with the state’s Quality Improvement Organization (QIO), MPRO, developed standardized quality reporting metrics for 130 SNFs in its market. The SNFs, in turn, enter the quality metrics into a data portal created by MPRO.

During Reducing SNF Readmissions: Quality Reporting Metrics Drive Improvements, a 45-minute webinar on May 11th at 1:30 p.m. Eastern, Susan Craft, director, care coordination, family caregiver program, Office of Clinical Quality & Safety at Henry Ford Health System, will share the key details behind this collaborative, the impact the program has had on her organization’s readmission rates along with the inside details on new readmission reduction target areas born from the program’s data analysis.

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Touting ‘Magic’ of Home Visits, Sun Health Dispels 5 Care Transition Management Myths

April 4th, 2017 by Patricia Donovan


With an average of 299 warm, sunny days a year, Phoenix is a mecca for senior transplants. However, as Phoenix-based Sun Health knows well, when an aging population relocates far from their adult children, there’s a danger that if some of them experience cognitive decline or other health issues, no one will notice.

That’s one reason home visits are the cornerstone of Sun Health’s Care Transitions Management program. Visiting recently discharged patients at home not only tracks the individual’s progress with the hospitalization-related condition, but also pinpoints any social determinants of health (SDOH) that inhibit optimum health.

“There are a number of social determinants of health that, if not addressed, could adversely impact the medical issue,” explains Jennifer Drago, FACHE, executive vice president of population health for the Arizona non-profit organization. Ms. Drago outlined the program during A Leading Care Transitions Model: Addressing Social Health Determinants Through Targeted Home Visits, a March 2017 webinar now available for replay.

Identifying social determinants of health (SDOH) such as medication affordability, transportation, health literacy and social isolation are so important to Sun Health that SDOHs form the critical fifth pillar of its Care Transitions Program. Modeled on the Coleman Care Transitions Intervention®, SDOH identification and support balance Coleman’s four pillars of education, medication reconciliation, physician follow-up visits, and personalized plan of care.

The belief that organizations can effectively execute transitions of care programs pre-discharge or by phone only is one of five care transition myths Ms. Drago dispelled during the webinar. “You will have an impact [with phone calls], but it won’t be as great as a program incorporating dedicated staff and that home visit. I can’t tell you the magic that happens in a home visit.”

That “magic” contributed to Sun Health’s stellar performance in CMS’s recently concluded Community-Based Care Transitions Program demonstration. Sun Health was the national demo’s top performer, achieving a 56 percent reduction in Medicare 30-day readmissions—from 17.8 percent to 7.81 percent—as compared to the 14.5 percent readmission rate of other demonstration participants.

Sun Health’s multi-stepped intervention begins with a visit to the patient’s hospital bedside. “Patients are a captive audience while in the hospital,” explained Ms. Drago. That scripted bedside encounter, which boosted patients’ receptivity to the program, addresses not only the reason for the hospitalization (hip replacement, for example) but also co-occuring chronic conditions, she continued.

“The thing that will have the greatest chance of going out of whack or out of sync in their recovery period is their chronic disease, because they’re probably not eating the same, they’re more sedentary, and their medications likely have been disrupted.”

Ms. Drago went on to present some of the intervention’s tools, including care plans, daily patient check-ins, and the science behind her organization’s care transitions scripts.

After sharing six key lessons learned from care transitions management, Ms. Drago noted that while her organization participated as a mission-based endeavor, others could model Sun Health’s intervention and benefit from those readmissions savings. She also shared a video on the Sun Health Care Transitions Program:

Listen to an interview with Jennifer Drago on the science behind care transition management.

Infographic: Transitional Care Management

March 13th, 2017 by Melanie Matthews

Transitional Care ManagementMedicare’s billing codes for Transitional Care Management (TCM) highlight the importance of timely post-discharge contact with patients by provider offices, and timely face-to-face follow up and evaluation by TCM providers. Incorporating automated patient communications can facilitate efficient and effective handoffs, and support a consistent track of care to help providers earn TCM reimbursements and avoid hospital readmission penalties, according to a new infographic by West Healthcare.

The infographic looks at the financial impact of reducing readmission penalties and examines how automated patient communications can improve care transitions.

A Leading Care Transitions Model: Addressing Social Health Determinants Through Targeted Home VisitsSun Health, an Arizona non-profit organization, launched its Sun Health Care Transitions program in November 2011. Modeled after the Coleman Care Transitions Intervention® and adapted to meet the needs of its community, the program has been credited with keeping readmission rates well below the national average.

Sun Health’s program was part of the Center for Medicare and Medicaid Services’ National Demonstration Program, Community-Based Care Transitions Program, which ended in January. Not only did Sun Health lead the CMS demonstration project with the lowest readmission rates, Sun Health also widened the gap between their expected 30-day readmission rate (56 percent lower than expected) and their expected 90-day readmission rate (60 percent less than expected).

During A Leading Care Transitions Model: Addressing Social Health Determinants Through Targeted Home Visits, a March 23, 2017 webinar at 1:30 p.m. Eastern, Jennifer Drago, FACHE, executive vice president, population health, Sun Health, will share the key features of the care transitions program, along with the critical, unique elements that lead to its success.

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.

3 Priority Populations for Home Visits and 10 More House Calls Benchmarks

February 14th, 2017 by Patricia Donovan

More than half of home visits include screening for social determinants of health.

More than half of home visits include screening for social determinants of health.

Which patients should healthcare providers visit at home? A new survey on home visits identified three key populations that should receive home-based care management: the frail elderly and homebound (69 percent); the medically complex (69 percent); and individuals recently discharged from the hospital (68 percent).

In stratifying patients for these home visits, 62 percent rely on care manager referrals.

These were just two findings from the 2017 Home Visits survey conducted by the Healthcare Intelligence Network. Nearly three quarters of the survey’s 107 respondents visit targeted patients at home, an intervention that can illuminate health-related, socioeconomic or safety determinants that might go undetected during an office visit.

Who’s conducting these home visits? In more than half of responding programs, a registered nurse handles the visit, although on rare occasions, patients may open their door to a primary care physician (4 percent), pharmacist (4 percent) or community paramedic (3 percent).

Once inside the home, the visit is first and foremost about patient and caregiver education, say 81 percent of respondents, with an emphasis on medication reconciliation (80 percent). Fifty-nine percent also screen at-home patients for social and economic determinants of health, factors that can have a huge impact on an individual’s health status.

Patient engagement, including obtaining consent for home visits, tied with funding and reimbursement issues tied as the top challenges associated with in-home patient visits.

How to know if home visits are working? The most telling success indicator is a reduction in 30-day hospital readmission rates, say 83 percent of survey respondents, followed by a drop in hospital and ER utilization (64 percent). Seventy percent of survey respondents reported either a drop in readmissions or in ER visits.

Here are a few more metrics derived from HIN’s 2017 Home Visits survey:

  • Eighty-five percent of respondents believe that the use of in-home technology enhances home visit outcomes.
  • Fifteen percent report home visits ROI of between 2:1 and 3:1.
  • Eighty percent have seen clients’ self-management skills improve as a result of home visits.

Download an executive summary of results from HIN’s 2017 Home Visits Survey.

2016 Healthcare Headlines: MACRA Monopolizes News Until Election Shake-Up

December 26th, 2016 by Patricia Donovan
top 2016 news stories

The unexpected election of Donald J. Trump to the U.S. presidency threatened some healthcare initiatives from the Obama administration, including the Affordable Care Act.

There was only one thing capable of distracting the healthcare industry in 2016 from MACRA’s imminent rollout: the election of Donald J. Trump to the presidency of the United States.

Nevertheless, the majority of the last twelve months was spent on healthcare business as usual—the business of transitioning to value-based models of care delivery and reimbursement.

Here are the headlines that dominated the news feeds of healthcare executives in 2016:

New CMS ‘Accountable Health Communities’ Model Aims to Improve Patients’ Health by Addressing Social Needs

January 2016: In a first-ever CMS Innovation Center pilot project to test improving patients’ health by addressing their social needs, the HHS appropriated $157 million in funding to bridge clinical care with social services.

The new pilot will test whether screening beneficiaries for health-related social needs and associated referrals to and navigation of community-based services will improve quality and affordability in Medicare and Medicaid. Many of these social issues, such as housing instability, hunger, and interpersonal violence, affect individuals’ health, yet they may not be detected or addressed during typical healthcare-related visits.

Medicare Shares 6 Core Principles for 21 New ‘Next Generation ACOs’

January 2016: The Centers for Medicare & Medicaid Services (CMS) made waves when it launched a new accountable care organization (ACO) model called the Next Generation ACO Model (NGACO Model). The twenty-one ACOs participating in the NGACO Model in 2016 have significant experience coordinating care for populations of patients through initiatives, including, but not limited to, the Medicare Shared Savings Program and the Pioneer ACO Model.

Providers Slow to Adopt Population Health, Value-Based Models of Care: Study

February 2016: Most healthcare providers continue to lag in implementing population health management despite broad agreement it will be important for future market success, according to a national study by healthcare strategy consultancy Numerof & Associates. The study synthesized survey responses from more than 300 executives and in-depth interviews with over 100 key decision-makers across U.S. healthcare delivery organizations. It provided the first in-depth, national look at the pace of transition from fee-for-service to models based on fixed payments linked to outcomes.

Horizon BCBSNJ ‘Episodes of Care’ Program Pays $3 Million in Shared Savings to Specialty Medical Practice

February 2016: Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) announced that it paid out approximately $3 million to 51 specialty medical practices as part of shared savings generated through the company’s innovative Episodes of Care (EOC) Program. The doctors, in five different specialty areas, earned the payments by achieving quality, cost efficiency and patient satisfaction goals in 2014 while treating more than 8,000 Horizon BCBSNJ members. The EOC model, also known as bundled payments, is one in which specialists manage the full spectrum of care related to a specific procedure, disease diagnosis or health event—such as a joint replacement or pregnancy.

Bundled Payments Improve Care for Medicare Joint Replacement Patients: NYU Langone Study

March 2016: Implementing bundled payments for total joint replacements resulted in year-over-year improvements in quality of care and patient outcomes while reducing overall costs, according to a new three-year study from NYU Langone Medical Center. The three-year pilot at the medical center reported reductions in patient length-of-stay and readmission rates.

CMS to Test New SNF Payment Model to Curb Readmissions, Foster Multidisciplinary Care

March 2016: The Centers for Medicare & Medicaid Services (CMS) today announced it would test whether a new payment model for nursing facilities and practitioners will further reduce avoidable hospitalizations, lower combined Medicare and Medicaid spending, and improve the quality of care received by nursing facility residents. This next phase of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents seeks to reduce avoidable hospitalizations among beneficiaries eligible for Medicare and/or Medicaid by providing new payments to practitioners for engagement in multidisciplinary care planning activities.

Proposed MACRA Rule Would Streamline Medicare Value-Based Payment Models

May 2016: In issuing a proposal to align and modernize how Medicare payments are tied to the cost and quality of patient care for hundreds of thousands of doctors and other clinicians, the Department of Health & Human Services took the first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Are You MACRA-Ready? Physician Groups Prep Members for Medicare Payment Modernization

May 2016: As they digested the HHS’s momentous proposal to modernize how Medicare provider payments are tied to the cost and quality of patient care, physician organizations began assembling arsenals of educational tools to de-mystify MACRA. The federal government’s first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was detailed in an April 2016 announcement.

CMS Releases MACRA Final Rule; Creates Two Pathways for Clinician Value-Based Payments

October 2016: The Department of Health & Human Services (HHS) finalized a landmark new payment system for Medicare clinicians that will continue the administration’s progress in reforming how the healthcare system pays for care. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program, which replaces the flawed Sustainable Growth Rate (SGR), will equip clinicians with the tools and flexibility to provide high-quality, patient-centered care.

ACA Afterlife: Unwinding Obamacare Under the Trump Administration

November 2016: If U.S. President-elect Donald J. Trump delivers on his campaign promises, the ‘repeal and replacement’ of the Affordable Care Act (ACA) should be an early priority for the nation’s chief executive-in-waiting. That prospect sent shock waves through the healthcare industry, as evidenced by a snapshot of post-election responses to the Healthcare Trends in 2017 survey sponsored by the Healthcare Intelligence Network.

Trump Taps Orthopedic Surgeon, Medicaid Architect to Helm U.S. Healthcare Posts, Determine ACA Fate

November 2016: Calling his nominees “the dream team that will transform our healthcare system for the benefit of all Americans,” President-elect Donald J. Trump announced his plan to nominate Chairman of the House Budget Committee Congressman Tom Price, M.D. (GA-06) as secretary of the U.S. Department of Health and Human Services (HHS) and Seema Verma as administrator of the Centers for Medicare and Medicaid Services (CMS).

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