Posts Tagged ‘accountable care’

HINfographic: 9 Measures of ACO Success

March 12th, 2014 by Jackie Lyons

What is the mark of a successful accountable care organization (ACO)? For healthcare organizations, clinical outcomes topped the list of ACO success metrics.

This HINfographic depicts nine key ACO metrics identified by 138 healthcare companies. Also among the top three measures was patient satisfaction and health utilization.

9 Measures of ACO Success

 title= You may also be interested in this related resource: Guide to Accountable Care Organizations. This 160-page resource lays the groundwork for an ACO program. It includes a framework for clinical integration, a key ACO prerequisite that puts participating providers on the same performance and payment page, and much more.

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Infographic: Differences Between ACO Patients and Non-ACO Patients

February 21st, 2014 by Jackie Lyons

The average total cost for a non-accountable care organization (ACO) patient is $470 more than the total cost of care for an ACO patient, according to a new infographic compiled by Health Affairs.

This infographic breaks down the two types of patients by race, Medicaid eligibility, income by geography, participating hospitals and more.

Differences Between ACO Patients and Non-ACO Patients

You may also be interested in this related resource: 2013 Healthcare Benchmarks: Accountable Care Organizations. This 65-page report documents the numerous ways in which accountable care is transforming healthcare delivery, particularly in the area of care coordination, where the ACO model has had the greatest impact for this year’s respondents.


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Pioneer ACO Repurposes Care Management for Accountable Care

February 4th, 2014 by Jessica Fornarotto

As a top performer in Year 1 of the CMS Pioneer ACO program, Monarch HealthCare is paving the way to accountable care with a foundation of patient- and provider-centered strategies that support Triple Aim goals, which is to improve quality, improve health outcomes and reduce cost. Here, Colin LeClair, executive director of ACO for Monarch HealthCare, recounts how Monarch recast its Medicare Advantage (MA) care management program to target about 1,200 high-risk patients who have a similar constellation of issues.

Monarch repurposed our Medicare Advantage (MA) care management program for the ACO. Monarch’s ACO care management team was designed to anticipate and prevent acute events and then to facilitate transitions of care for patients post-discharge.

This interdisciplinary team is comprised of a primary care physician who quarterbacks the team, and a care navigator, also known as a care coordinator, who performs most of the patient onboarding into the care management program and performs an initial triage of the patient’s needs. The care manager is often a non-complex patient’s primary point of contact. The complex care manager is responsible for most of the complex cases.

Then as needed, we also deploy a behavioral health clinician, a community services coordinator, a clinic dietician and a palliative care nurse. The other resources may include a pharmacist or Pharm D to perform post-discharge medication reconciliation. Then we have a team of medical directors, employed and contracted hospitalists, and employed and contracted skilled nursing facilitators (SNFs) to support us as well.

The idea is that the team is tailored for the patient’s need at enrollment, and it can then be augmented as the patient’s health status changes. This model scales best when you can target large patient populations with a fairly common list of conditions, which allows you to hire and assign clinicians with the appropriate expertise to each patient. For example, we can afford to hire and assign a registered nurse (RN) or a nurse practitioner (NP) who has experience in a dialysis clinic or a nephrologist office if we have enough renal disease patients to fill their case load.

Excerpted from: Tactics from a Top-Performing Pioneer ACO: Engaging Patients and Providers in Accountable Care

4 Trends for Healthcare Providers in 2014

January 30th, 2014 by Jessica Fornarotto

Dual-track medical homes, e-visits, retooled patient handoffs and more post-acute care are predicted provider trends for 2014, according to Steven Valentine, president of The Camden Group. HIN interviewed Valentine prior to his presentation during an October webinar on Healthcare Trends & Forecasts in 2014: A Strategic Planning Session.

HIN: What is the physician practice going to look like in 2014? How has the primary care team evolved to meet the Triple Aim values inherent in the PCMH and accountable care models?

(Steven Valentine): We should expect to continue to see consolidation amongst the medical groups. The independent practice associations will begin to assimilate together because they need to put more money into their infrastructure. And many of the organizations have underperformed, in all honesty.

The primary care team is still critical. We’ve benefitted by keeping many primary care doctors around because they were negatively hurt with their net worth in the recession in 2008-2010. But it’s slowly coming back and we’re starting to see those physicians thinking about retirement again. The reality is, we’re never going to replace all of these primary care doctors as they wind down their practice. We need to do a better job of getting telehealth going and utilizing e-visits. We’re seeing the health plans starting to pay for those e-visits, as well as having the consumer who uses them use a credit card and pay at that time, just like a visit.

We’re going to have to look at different models. Obviously, the nurse practitioner is getting more involved with the primary care. And yes, they’re still pursuing the Triple Aim. We know that quality scores, satisfaction scores and trying to manage cost per unit is still a critical focus of the triple aim moving forward with population health.

Lastly, with a PCMH in accountable care, while some of the pioneer accountable care organizations (ACOs) reduce themselves out of pioneer into the Medicare Shared Savings Program (MSSP), we still have a number of organizations and it’s growing. The commercial ACOs have been very successful in California.

We fully expect accountable care to continue. We think the PCMH will evolve into two tracks. The first track is a primary care PCMH. The spinoff is a chronic care medical home that has the multidisciplinary team organized around a chronic disease. This is a model developed by CareMore years ago in Southern California and it’s been expanded across the country. As I travel the country, I run into organizations that have set up these chronic care centers around the chronic disease.

HIN: Regarding the Pioneer ACO program, one of the top performers in the CMS pioneer program, Monarch HealthCare, told us that it’s going to be working to engage specialists in care coordination roles in year two and year three. What’s ahead for specialists in terms of quality and performance improvement as well as shouldering perhaps more care coordination duties, especially for Medicare patients?

(Steven Valentine): The specialists are going to be a critical piece to this whole solution. They have been a tremendous asset in the area of bundled payments, where you have the facility fee and physician fee combined into one payment. That works for both the Medicare as well as the commercial side. You’re beginning to see more of the bundled payments within an ACO.

The ACO manages what we call ‘frequency’ — in other words, the number of procedures to be done. Specialists are involved in satisfaction, quality scores, and resource consumption once the decision is made that the procedure needs to be done.

We expect the specialists to be involved with quality and performance. Everybody is putting in incentive programs to help drive higher quality, better performance, and a lower cost.

HIN: Hospitals have tightened the patient discharge process as a means of shoring up care transitions. But what other work needs to be done in terms of collaborations, perhaps with skilled nursing facilities (SNFs), long-term care and home health, for example, to improve patient handoffs and reduce hospital readmissions?

(Steven Valentine): Handoffs have probably been one of the areas where we’ve seen the most disappointment or underperformance within many ACOs. They have not effectively involved the hospitalists and the care/case managers who are typically embedded within the medical group that would oversee the patient throughout the care continuum. Or if it’s a health system, emanate centralized care/case management function where they manage all of the transitions from pre-acute, acute to post-acute. We think this will get better. As the doctors are more at risk, they will get more engaged with the care/case managers to manage these transitions and handoffs.

We also know that, while not in 2014 but the trend will start, we’ll see lower acute care utilization, pushing more patients to post-acute care. This means, in any given area, acute care hospitals will begin to convert excess capacity to post-acute care services like skilled nursing, long-term care, palliative care, hospice care, home care and rehab care. You will begin to see a closer proximity. The care managers will be able to work more effectively with the doctors and hospitals to manage the patient through the continuum, smooth out these transitions and have a better patient experience with better satisfaction scores at a lower cost.

Excerpted from: Healthcare Trends & Forecasts in 2014: Performance Expectations for the Healthcare Industry

HINfographic: 12 Trends on the ACO Frontier in 2014

November 1st, 2013 by Jackie Lyons

The accountable care organization (ACO) movement shows no signs of slowing. In fact, looking ahead, there is a greater number of ACOs in the wings than one year ago.

Forty-four percent of developing ACOs will be helmed by physician-hospital organizations, according to a new infographic from the Healthcare Intelligence Network. This HINfographic examines 12 emerging ACO trends at 138 healthcare organizations and delivers tactics from a top performing Pioneer ACO, Monarch HealthCare.

12 Trends on the ACO Frontier in 2014

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Information presented in this infographic was excerpted from: 2013 Healthcare Benchmarks: Accountable Care Organizations. If you would like to learn more about accountable care organizations, this resource includes sector-specific qualitative data on comparative 2011-to-2013 data on key ACO metrics, metrics on use of case management, patient portals, evidence-based care and many other ACO program components.

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SNF Community Partnership Shores Up Accountable Care

October 1st, 2013 by Jessica Fornarotto

To support ACO construction, industry thought leaders advise hospitals to monitor what goes on across its care continuum and to partner with facilities it discharges its patients to most often to reduce 30-day readmissions. A prime example is the skilled nursing facility (SNF) network coordinated by Summa Health System, discussed here by Carolyn Holder, manager of transitional care for Summa Health System, and Michael Demagall, administrator of Bath Manor & Windsong Care Center.

(Carolyn Holder) We have been working on a pilot model for accountable care. Accountable care is the focus on primary care wellness in population health. Patients and families need to be actively engaged in this process. It coincides with having the right level of care provided to the patient where they need it, and that is what we are talking about with accountable care. You need partnering relationships between hospitals and physicians and through all levels of care to be able to support that individual in their wellness or illness effectively.

What is the value of this care coordination that worked in the accountable care model of care? It relates to the Triple Aims and looking at providing safe, patient-centered, timely care. We are collaborating to do that with our partner facilities. We have been working at improving health and patient populations in communities. Patients in this situation need rehab, so they have had some functional impairments and frailty. We are trying to get them back to their optimal level of function. To do this, we partner with our SNFs to support that level of care and lower the per capita cost of healthcare.

We also work with community-based long-term care. That has certainly not taken away from any of our nursing facilities any patients that are appropriate or keeping them in the optimal function that they would want.

(Mike Demagall) Through this development of the ACO on the skilled nursing side in working with the hospitals, one thing we focused on was the key indicator comparisons for our 2010 data.

Along with the hospital, we will provide standardized numbers of information that we can get back, that we are going to be held accountable for from the SNF side. The hospital knows what we do is safe and efficient, patient-centered and equitable for everybody involved. As we move forward with the ACO through care coordination, we will look at numbers and information that we can share as a community with the health system so they know what the facilities are doing. There are many reasons that is done, but one of the greatest accomplishments is everybody working together.

Out of 39 homes in the county, the collaboration has been incredible. Initially there was some hesitation, but the collaboration has moved forward, and we are not afraid to share that information. The information is blocked and as we provide information back, it will be blocked from other members except for the hospital, who knows who those numbers are. However, from my facility, I may see a readmission rate at one facility lower than ours although we have the same type of case mix index. I need to look at our facility and ask, “What can we do to get better? What are they doing that we aren’t?” Therefore, everybody gets better as a group, and that is ultimately the goal of the community and the health population in the community we serve.

Kaiser Permanente Population Health Management: Team Approach, One Member at a Time

August 8th, 2013 by Patricia Donovan

Kaiser Permanente population health management

It takes a team to manage the health of Kaiser Permanente’s 9 million members. And like all winning teams, Kaiser’s has a mantra: total panel ownership.

That motto describes a transition within the integrated healthcare delivery system that occurred about ten years ago: when doctors shifted from being accountable solely for the patients presenting for care on a particular day in their clinic setting to being accountable for all patients in their panel, explains Jim Burrows, Ph.D., senior director of evaluation and analytics for Kaiser Permanente.

This quest for total panel ownership is achievable with a focus on three key areas: people, systems and technology, he says. Burrows shared highlights from these areas during a recent webinar on Managing Population Health with Integrated Registries and Effective Patient Touchpoints.

At the outset, Kaiser eschewed a condition-specific approach in favor of developing robust infrastructure that could support management of all conditions. At the heart is an integrated regional outreach system that tracks patients’ clinical touchpoints as they move through the system via an outpatient visit or a call to a nurse advice line.

In Kaiser Permanente’s “Proactive Care” approach, even specialists are part of its population health management approach: presenting at a dermatology appointment, a patient might be reminded of an overdue colonoscopy.

“The specialists themselves can view themselves as managers of populations and not only as physician specialists for whom individual patients are consulted,” notes Burrows.

At the primary care level, there’s an integrated panel management assistant who interacts with the physician and performs pre- and post-visit tasks so patients get the most from their visits.

Technology provides a backbone for Kaiser’s proactive care: its EPIC® EHR provides evidence-based support; its patient portal an opportunity to review past visits and perform a myriad of tasks; its proprietary integrated registry tool the identification of care gaps for all members and specific patient recommendations.

With Kaiser’s health registries in high demand within the organization, how does the health plan determine which ones to develop? “It comes down to a Triple Aim assessment where we think we can do the best job of improving health, improving care and improving the affordability of our system,” answers Burrows.

Kaiser Permanente has achieved excellent results in public reporting: the plan leads the five-star space, notes Burrows, with ninety percent of Americans in five-star Medicare Advantage plans belonging to a Kaiser plan. It can also boast of having the most HEDIS® measures in which it’s the number one health plan not in the local market area, but in the country.

Click here for an audio interview with Jim Burrows in which he discusses Kaiser’s registry use in more detail.

Video: 2012 Medical Home Starts Linked to Surge in Patient Satisfaction

August 9th, 2012 by Patricia Donovan

In a week when both Blue Cross Blue Shield of Michigan and CDPHP have considerably amped up their medical home game, a new video from the Healthcare Intelligence Network (HIN) documents a rise in patient satisfaction resulting from the construction of more medical homes.

In response to HIN’s sixth annual survey on the patient-centered medical home (PCMH) model, 52 percent of healthcare organizations who took the survey said they have established medical homes for their populations. This year’s survey results also reflected the highest levels of patient satisfaction to date in the survey’s six-year history, with 82 percent reporting a rise in patient satisfaction that they link to PCMH processes.

With patients at the center of the medical home care model, monitoring their satisfaction levels along with their health helps to paint a complete picture of PCMH success.

Earlier this week, Blue Cross Blue Shield of Michigan designated another 994 practices as medical homes, making it the country’s largest PCMH effort of its kind for the fourth consecutive year.

At the end of last month, CDPHP effectively doubled its medical home initiative when it added 70 practices to its Enhanced Primary Care effort.

Narrated by HIN COO and Executive VP Melanie Matthews, HIN’s sixth annual PCMH analysis delves into ACO activity planned by responding medical homes, health IT, PCMH team members, patient education and engagement strategies, and much more. Florida Blue’s Barbara Haasis also shares some details on the payor’s statewide rollout of a medical home program.

If you prefer to read an executive summary of the survey results, download it here. A more detailed analysis is available in the HIN bookstore.