Reframing the Care Transition Conversation to Increase Home Visit Acceptance

May 9th, 2017 by Patricia Donovan

Sun Health Care Transitions

Patient scripting using the "feel, felt, found" approach increased patients' acceptance of home visits.

In conducting hospital bedside visits to introduce its Care Transitions Program, Sun Health learned that the way its LPNs or social workers described the program to patients influenced their acceptance. Here, Jennifer Drago, executive vice president of population health for Sun Health, provides more detail on scripting developed with the help of a behavioral psychologist that refined the care transition approach, overcame patient objections and increased program acceptance rates.

How did we develop scripting that helped increase patient retention rates? Two things come to mind. First, we changed how we described the home visit. When we were in the hospital or on the phone, we refined our discussion to talk about a brief home visit by a registered nurse. We explained some of the things the nurse would do during the visit and what the patients would gain from them. We reframed the description to highlight what was in it for the patient. And we always describe it as a brief home visit.

Secondly, we worked hard on overcoming objections. We conducted a short survey, and tracked our results over time to determine our top objections. We then framed scripting around each one of those top objections using the “feel, felt, found” approach recommended by our behavioral psychologist.

For example, we taught our nurses to say: “I understand you feel that way. Others in our program have felt that way in the past, but what they’ve found is after they’ve gone through the Care Transitions program ...”

The nurses were able to overcome that objection using that framework. We created scripting for the top three or four objections we normally received, and found that to be very helpful.

Source: The Science of Successful Care Transition Management: Leveraging Home Visits to Improve Readmissions and ROI

advanced care coordination

The Science of Successful Care Transition Management: Leveraging Home Visits to Improve Readmissions and ROI The Science of Successful Care Transition Management: Leveraging Home Visits to Improve Readmissions and ROI explores the critical five pillars of the Arizona non-profit's leading care transitions management initiative, adapted from the Coleman Care Transitions Intervention®.

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: Physician Appointment Wait Times; Medicare and Medicaid Acceptance Rates

May 5th, 2017 by Melanie Matthews

The average wait time for a physician appointment in 15 mid-sized metropolitan areas was nearly 8 days longer than in l5 major metropolitan areas, according to a new infographic by Merritt Hawkins.

The infographic also examined rates of Medicare and Medicaid acceptance by physicians in these markets.

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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CMS Quality Payment Program: Clinicians Should Expect MIPS Participation Status Letter This Month

May 4th, 2017 by Melanie Matthews

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CMS has specified two key criteria for MIPS participation.

The Center for Medicare and Medicaid Services (CMS) is reviewing claims and letting practices know which clinicians need to take part in the Merit-based Incentive Payment System (MIPS), according to information on MLNConnects, the CMS Medical Learning Network.

MIPS is an important part of the new Quality Payment Program (QPP). In late April through May, clinicians will get a letter from their Medicare administrative contractor that processes Medicare Part B claims, providing the participation status of each MIPS clinician associated with their Taxpayer Identification Number (TIN).

Clinicians should participate in MIPS in the 2017 transition year if they meet the following conditions:

  • Bill more than $30,000 in Medicare Part B allowed charges a year; and
  • Provide care for more than 100 Part B-enrolled Medicare beneficiaries a year.

The QPP intends to shift reimbursement from the volume of services provided toward a payment system that rewards clinicians for their overall work in delivering the best care for patients. It replaces the Sustainable Growth Rate (SGR) formula and streamlines the “Legacy Programs:” Physician Quality Reporting System, the Value-based Payment Modifier, and the Medicare Electronic Health Records Incentive Program.

During this first year of the QPP program, CMS said it is committed to working with clinicians to streamline the process as much as possible. The federal payor stated that its goal is to further reduce burdensome requirements so that providers can deliver the best possible care to patients.

Infographic: Payer-Provider Partnership Trends

May 3rd, 2017 by Melanie Matthews

Partnered-products are gaining favor with payers and providers, and the value-based environment is pushing players to explore new ways to control total cost of care, according to a new infographic by Oliver Wyman.

The infographic provides an up-to-date look at market-wide and nationwide trends in payer-provider partnerships.

Positioning for Value-Based Reimbursement: Leveraging Care Management for Clinical and Financial OutcomesWhile others wait for the healthcare industry to complete its transition to value-based reimbursement, Bon Secours Medical Group has already aligned itself with payment reform, leveraging its care team and providers and automating workflows to enjoy immediate rewards from its patient-centered approach.

Positioning for Value-Based Reimbursement: Leveraging Care Management for Clinical and Financial Outcomes describes how this 600-provider medical group has primed its providers to employ a broad mix of team-based care, technology and retooled care delivery systems to maximize quality and clinical outcomes and reduce spend associated with its managed patients.

Click here for more information.

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Top 2017 Chronic Care Management Modes and 13 More CCM Trends

May 2nd, 2017 by Patricia Donovan

Availability of chronic care management rose 14 percent from 2015 to 2017, according to new metrics from the Healthcare Intelligence Network.

The majority of chronic care management (CCM) outreach is conducted telephonically, say 88 percent of respondents to a 2017 Chronic Care Management survey by the Healthcare Intelligence Network (HIN), followed by face-to-face visits (65 percent) and home visits (44 percent).

This preference for telephonic CCM has remained unchanged since 2015, when HIN first canvassed healthcare executives on chronic care management practices. More than one hundred healthcare companies completed the 2017 CCM survey.

In addition, the April 2017 CCM survey captured a 14 percent increase in chronic care management programs over the two-year-span: from 55 percent in 2015 to 69 percent in 2017. Three-fourths of 2017 responding CCM programs target either Medicare beneficiaries or individuals with chronic comorbid conditions, with management of care transitions the top CCM component for 86 percent of programs.

In terms of reimbursement, payment levels for CCM services remained steady at 35 percent from 2015 to 2017. However, HIN's second comprehensive CCM survey determined that 32 percent of respondents currently bill Medicare using CMS Chronic Care Management codes introduced in 2015.

Forty percent of these Medicare CCM participants believe CMS’s 2017 program changes will reduce administrative burden associated with CCM, the survey documented.

Other metrics from HIN's 2017 CCM survey include the following:

  • A diagnosis of diabetes remains the leading criterion for CCM admission, said 92 percent;
  • Use of healthcare claims as the top tool for identifying or risk-stratifying individuals for CCM continues at 2015’s 70-percent levels;
  • Seventy percent of respondents target individuals with behavioral health diagnoses for CCM interventions;
  • Patient engagement remains the top challenge of chronic care management, with just under one-third of 2017 respondents reporting this obstacle
  • Responsibilities of RN care managers for CCM rose over two years, with 43 percent of 2017 respondents assigning primary CCM responsibility to these professionals (up from 29 percent in 2015); and
  • Two-thirds of respondents observed a drop in hospitalizations that they attribute to chronic care management.

Download an executive summary of 2017 Chronic Care Management survey results.

Infographic: Overcoming Barriers To Improve Care Transitions

May 1st, 2017 by Melanie Matthews

Leveraging the right technology can improve post-acute patient outcomes, according to a new infographic by Ensocare.

The infographic looks at: the impact of streamlining multiple, disparate workflows; and how to strengthen post acute networks, simplify ongoing post-acute follow-up communications and improve patient engagement during care transitions.

The Science of Successful Care Transition Management: Leveraging Home Visits to Improve Readmissions and ROIA care transitions management program operated by Sun Health since 2011 has significantly reduced hospital readmissions for nearly 12,000 Medicare patients, resulting in $14.8 million in savings to the Medicare program.

Using home visits as a core strategy, the Sun Health Care Transitions program was a top performer in CMS's recently concluded Community-Based Care Transitions (CBCT) demonstration project, which was launched in 2012 to explore new solutions for reducing hospital readmissions, improving quality and achieving measurable savings for Medicare.

The Science of Successful Care Transition Management: Leveraging Home Visits to Improve Readmissions and ROI explores the critical five pillars of the Arizona non-profit's leading care transitions management initiative, adapted from the Coleman Care Transitions Intervention®.

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Infographic: Navigating Risk Adjustment Headwinds

April 28th, 2017 by Melanie Matthews

More than half of respondents (60%) to a recent survey by SCIO Health Analytics indicated that their organizations have hit at least the half way point when it comes to implementing the changes needed to support the Encounter Data Processing System (EDPS)/Risk Adjustment Payment System (RAPS), according to a new infographic by SCIO Health Analytics.

The infographic looks at where organizations are on their path for implementing changes needed to support EDPS/RAPS, the discrepancy between RAPS and EDPS scores and some predictions on the future of the Affordable Care Act.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry Not in recent history has the outcome of a U.S. presidential election portended so much for the healthcare industry. Will the Trump administration repeal or replace the Affordable Care Act (ACA)? What will be the fate of MACRA? Will Medicare and Medicaid survive?

These and other uncertainties compound an already daunting landscape that is steering healthcare organizations toward value-based care and alternative payment models and challenging them to up their quality game.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry, HIN's 13th annual business forecast, is designed to support healthcare C-suite planning during this historic transition as leaders prepare for both a new year and new presidential leadership.

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HINfographic: Social Determinants of Health: Screenings Abound, But Support Services Scarce

April 26th, 2017 by Melanie Matthews

Social determinants of health like food insecurity, unsafe neighborhoods and even loneliness can impact quality of life and population health. Although more than two-thirds of healthcare organizations now screen populations for social determinants of health (SDOH) as part of ongoing care management, one-third are challenged by a lack of supportive services, according to the December 2016 SDOH survey by the Healthcare Intelligence Network.

A new infographic by HIN examines priority populations for SDOH screening, the greatest SDOH need and SDOH integration and tools.

2017 Healthcare Benchmarks: Social Determinants of HealthInitiatives such as CMS' Accountable Health Communities Model and other population health platforms encourage healthcare organizations to tackle the broad range of social, economic and environmental factors that shape an individual's health. To underscore the need to address social determinants of health, Healthy People 2020 included "Create social and physical environments that promote good health for all" among its four overarching goals for the decade.

In one measure of their impact, 2015 research by Brigham Young University found that the social determinants of loneliness and social isolation are just as much a threat to longevity as obesity.

2017 Healthcare Benchmarks: Social Determinants of Health documents the efforts of more than 140 healthcare organizations to assess social, economic and environmental factors in patients and to begin to redesign care management to account for these factors.

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Infographic: What Millennials Want From Healthcare

April 24th, 2017 by Melanie Matthews

Millennials are the healthcare wildcard for policy makers, insurers, healthcare providers and employers, according to a new infographic by Benenson Strategy Group.

The infographic explores whether Millennials will redefine healthcare based on their unique experiences, attitudes and viewpoints or engage more predictably with the healthcare industry based on a lifecycle model.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry Not in recent history has the outcome of a U.S. presidential election portended so much for the healthcare industry. Will the Trump administration repeal or replace the Affordable Care Act (ACA)? What will be the fate of MACRA? Will Medicare and Medicaid survive?

These and other uncertainties compound an already daunting landscape that is steering healthcare organizations toward value-based care and alternative payment models and challenging them to up their quality game.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry, HIN's 13th annual business forecast, is designed to support healthcare C-suite planning during this historic transition as leaders prepare for both a new year and new presidential leadership.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

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