Posts Tagged ‘ACOs’

Embedding Case Managers as Ambassadors of Advanced Primary Care

October 18th, 2013 by Cheryl Miller

Embedded case managers are carefully being groomed as ambassadors for the evolving patient-centered healthcare landscape, a perspective that seeks to achieve the Triple Aim objectives of better care, experience and cost.

And while challenges to employing embedded case managers persist, including staff buy-in and communication, reimbursement is less of an obstacle today than in the past, due to funding-friendly care models and pilots descending from healthcare reform, says Annette Watson, senior vice president of community transformation for Taconic IPA (TIPA), a participant in CMS Innovation Center’s Comprehensive Primary Care (CPC) initiative. TIPA helps physician practices in New York’s Hudson Valley to improve population health and care for their sickest patients with the use of embedded RN case managers. Watson shared TIPA’s deployment strategy during an October 9, 2013 webinar, Improving Population Health with Embedded Case Managers in an Open, Multi-Payor Community.

One of the first steps is finding case managers with the right combination of education, experience and attitude, says Watson. The immediate past chair of the Commission for Case Manager Certification, she has served as a commissioner since 2007. They must meet strict requirements, including having either the Commission for Case Management Certification (CCMC) or RN board-certified designation from the American Nurses Credentialing Center (ANCC). Both of those organizations have mandatory continuing education requirements around case management, important because case managers must be current clinically in order to meet the ever changing field of disease management, and be effective in dealing with either the chronically ill, or those with complex comorbidities.

Embedded case managers must also be ready to address such issues as redesigning workflows and conducting risk stratifications. These issues tend to be obstacles to effective management of patient panels, so case managers with that skill set are highly valued, she explained.

Once deployed, the embedded case manager assumes various roles in physician practices, from supporting the CPC to meeting accountable care organization (ACO) and patient-centered medical home (PCMH) requirements. The Medicare ACO measures and specifications talk specifically about care coordination and patient safety activities, Watson says. Within Comprehensive Primary Care, there are requirements and milestones around managing their high-risk patients and active engagement and care coordination across medical neighborhoods.

Watson also shared effective ways to use electronic medical records (EMRs), patient registries, payor data and other tools within a practice to support the embedded case manager.

But one of the final frontiers might be physician buy-in, Watson says. One of the ways to get physicians on board is when initially implementing the case manager into the practice. Getting just one physician champion in the practice to help with the change is key to the overall success of embedding case managers.

Annette Watson talks more about embedding case managers in an open multi-payor community in this Healthcare Intelligence Network webinar.

Healthcare Business Week in Review: Health Insurance Exchanges, Navigators, Medication Adherence

August 30th, 2013 by Cheryl Miller

Contrary to popular opinion, young adults between the ages of 19 and 26 do not think they’re immortal and do think they need health insurance. In fact, according to a study from The Commonwealth Fund, if members of this population don’t have health insurance, it’s because they can’t afford it.

Nearly half of the 15 million young adults enrolled in a parent’s health plan last year most likely would not have been eligible for coverage without the health reform law’s dependent coverage provision.

The survey also found that only 27 percent of young adults were aware of the state health insurance marketplaces launching October 1. The demographic that would benefit most from these marketplaces are those without coverage and those from low- or middle-income households, or, those least likely to be aware of them.

But these young adults, and all other adults, can seek out help through a coterie of navigators funded by the HHS. The agency has granted $67 million to 105 applicants in federally run and state partnership marketplaces, for navigators trained to help Americans who need assistance in shopping for and enrolling in plans in the health insurance marketplaces beginning this fall.

Health information navigators are trained to provide unbiased information in a culturally competent manner to consumers about health insurance, the new HIEs, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program (CHIP). Funding was available to eligible private and public groups and the self-employed who met certain standards to promote effectiveness, diversity, and program integrity, HHS officials say.

If all the health reform changes have made Americans’ blood pressure soar, there is help: a large scale study from Kaiser Permanente found that single pill combinations and consistent follow-ups with hypertension patients helped improve the rate of blood pressure control by nearly twice as much. Through one of the largest community-based hypertension programs in the nation, Kaiser Permanente Northern California nearly doubled the rate of blood pressure control among adult members with diagnosed hypertension between 2001 and 2009, helping to reduce the risk of stroke and heart attack for patients.

And speaking of soaring, accountable care organizations are flooding the healthcare landscape; with the number of public and private ACOs nearing 500, participants and pundits alike are looking more closely at the model’s structure, challenges and benefits.

How is your organization participating in ACOs? Take HIN’s third annual survey on ACOs by September 6, 2013 and receive a FREE executive summary of the compiled results.

Healthcare Business Week in Review: Urgent Care Growing; Medical Overuse; Pioneer ACOs, Readmissions

July 26th, 2013 by Cheryl Miller


Urgent care centers alternative care centers for time-challenged patients, or costly care convenience centers?

That’s the debate in a new study by the Center for Studying Health System Change (HSC) on the rapid growth of these centers throughout the country. Once an occasional independently-owned, standalone facility, there are now 9,000 urgent care centers.

Three key factors are driving the surge, among them, their accessibility. Urgent care centers fill a gap by providing walk-in care, especially during evening and weekend hours, when primary care physician (PCP) offices are generally closed. They are particularly appealing to those patients unable to schedule a PCP appointment during weekday hours, or for those patients without a PCP.

There is little debate over a series of recommendations that could reduce five medical interventions that are commonly used but not always necessary, according to a paper released by The Joint Commission and the American Medical Association-Convened Physician Consortium for Performance Improvement® (PCPI).

Left unchecked, overuse, described as the provision of medical interventions that provide zero or negligible benefit to patients, is a leading contributor to problems with quality and patient safety, can affect millions of patients, and can drive up healthcare costs.

Researchers estimate that $1 billion is spent annually on unnecessary antibiotics for adults with viral upper respiratory infections (URIs) alone, one of the five areas of overuse. Strategies to reduce this include developing clinical definitions for viral and bacterial URIs, aligning contradictory national guidelines, partnering with the CDC and initiating public awareness. Other strategies and treatment areas are outlined inside.

Developing consistent guidelines is key to another set of recommendations tackling an equally common and costly healthcare problem: heart failure readmissions. Researchers have identified six steps hospital staff can take to help heart failure patients avoid readmittance to the hospital within 30 days after they’re discharged, according to research in the American Heart Association’s journal Circulation: Cardiovascular Quality and Outcomes.

While each step alone has had some impact on patients’ recovery, researchers found that if all six recommendations were followed, readmissions could drop as much as two percent. This translates to a savings of more than $100 million a year.

A lack of savings is prompting seven of 32 provider groups that signed up for the Pioneer Accountable Care Organizations (ACOs) program sponsored by CMS to switch to the Medicare Shared Saving Program (MSSP), according to the CMS.

Two other Pioneer ACOs are leaving the program completely, CMS officials say. Overall, more than 250 organizations participate in the Pioneer ACO Model and the MSSP, serving 4 million Medicare beneficiaries.

CMS said in a statement that 13 out of 32 pioneer ACOs produced and shared savings with CMS, generating a gross savings of $87.6 million in 2012 and saving nearly $33 million to the Medicare Trust Funds.

One of the key features of the Pioneer program, and one that differentiates it from the Medicare Shared Savings Program, is that it is accountable for all Medicare A and B benefits, so it includes end stage renal disease patients, hospice patients, and dual-eligibles.

How is your organization meeting the unique care coordination needs of dual eligibles? Share your organization’s approach by July 31st by participating in our online survey and you will receive a free summary of survey results once it is compiled.

Infographic: ACOs’ and PCMHs’ Tools for Success

June 21st, 2013 by Melanie Matthews

The primary motivator for becoming an ACO or PCMH is to improve patient outcomes (66%). That consideration is seconded by two separate motivators: being able to better utilize resources across the health care system (41%) and maintaining market share (40%), according to a new study by eClinicalWorks.

eClinicalWorks has released an infographic on the study results, highlighting the biggest challenges for ACOs, along with the most valuable tools in an ACO.

ACOs and PCMHs Tools for 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.

You may also be interested in this related resource: Guide to ACOs.

Healthcare Week in Review: Hospital Trends, Suggestions for Reducing Readmissions

April 22nd, 2013 by Cheryl Miller

Physicians have them; so do nurses, and even teachers. So why not case managers?

Aides, or extenders, could be one of several new key trends for case managers, says case manager Teri Treiger. Because they are often faced with large amounts of administrative work in addition to clinical assignments, aides can help take care of details and allow case managers to be much more efficient.

Efficiency and collaboration could help the widespread number of preventable hospital readmissions among Medicare beneficiaries, according to researchers at Penn State, the Weill Cornell Medical College and the University of Pennsylvania. But it will take time, more time than many healthcare professionals originally anticipated, time that is costing the nation nearly $18 billion annually, because of the lack of collaborative relationships among providers in different care settings, researchers say.

A majority of hospitals are in agreement that ACOs are key to remaining competitive. According to a new study from L.E.K. Consulting, over 80 percent of surveyed hospitals are making future plans to join or are already participating in an ACO.

Hospital executives also intend to invest significantly on information technology (IT) and facilities over the next five years in order to stay ahead, researchers found. Hospitals are investing in mechanisms that will help them improve quality metrics and outcomes and gain a competitive advantage in the marketplace, researchers note. Researchers also found that there will be major changes in purchasing dynamics, as we detail in our story here.

Nearly half of adult residents living in the metropolitan Texas area are uninsured, making it the highest area of uninsured adults in the metro United States for the second year in a row, according to the Gallup-Healthways Well-Being Index.

This is nearly three times the national average of 16.9 percent; a percentage which has remained the same since 2011, but jumped by two percent in 2008. Metropolitan areas in Vermont, Massachusetts and New Hampshire had the lowest uninsured rates. Geographically, these rates haven’t changed; and demographically, one group in particular, Hispanics, remains uninsured.

Researchers expect these figures to change, however, as healthcare reforms take effect.

And lastly, young adults under 26 insured on their parents’ health insurance plans due to federal mandate are more likely to be treated for depression, substance abuse and pregnancy, according to new research from the nonpartisan Employee Benefit Research Institute (EBRI). This report is the first to identify the major treatments the coverage is used for, researchers note.

25 to 31 Million Americans Receive Care Through ACOs

December 11th, 2012 by Cheryl Miller

In just two years, the number of ACOs has swelled across the country, according to a new report from Oliver Wyman. A total of 25 to 31 million U.S. patients currently receive their care through ACOs, and an estimated 45 percent of the population live in regions served by at least one ACO. Researchers weren’t surprised by some of the ACO-intensive areas, namely urban areas like Los Angeles and Boston. But other ACO-rich areas were surprising, findings that support researchers’ claims that ACOs are poised to offer a competitive threat to traditional FFS medicine.

Increasing patient numbers, especially among the uninsured and Medicaid-eligible, has always been a problem for public hospitals, according to a study from the Center for Studying Health System Change (HSC), and will continue to be a problem in light of ongoing health reform. How to continue to service low-income patients without sacrificing care quality? Expanding primary care access and attracting privately insured patients are two of six strategies public hospitals are taking; other strategies are detailed in this issue.

Rising healthcare costs could be contained by an estimated $200 to $600 billion in savings over the next 10 years if care provider payments are reformed, according to a report from UnitedHealth Group’s Center for Health Reform & Modernization. Around half of these savings might apply to Medicare and Medicaid, but even under optimistic assumptions about net savings and speed of adoption, health spending would continue to grow faster than incomes. Researchers maintain that payment reform is not the only answer, and needs to be pursued with other alternatives.

One potential solution for the sadly soaring numbers of cancer patients: oncology-specific EMRs that chart evidence-based treatment plans, according to a clinicians at The Mount Sinai Hospital. These EMRs enable drugs to be prescribed and health records to be exchanged electronically. Quality-related clinical data can also be captured for analysis. A panel convened specifically to study the EMRs’ effectiveness found that nearly 80 percent of people using them felt they increased their day-to-day efficiency and improved the quality of patient care.

And lastly, one aspect of healthcare that needs to be increased: the use of health coaching as a critical tool in population health management. Studies are showing that health coaches help to boost self-management of disease and reduce risk and associated cost across the health continuum. What do you think? Take HIN’s fourth annual Health Coaching survey; results will demonstrate how healthcare organizations use health coaching as well as the financial and clinical outcomes that result. Complete the survey by December 21, 2012 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

Read all of these stories in their entirety in this week’s Healthcare Business Weekly Update.

7-Step National Action Plan Promotes Prevention, Wellness: HHS

June 18th, 2012 by Cheryl Miller

Plans to make Americans healthier continue, with a new national action plan from the HHS.

Seventeen federal departments and agencies are currently on board to enact a seven step national plan, including initiatives to clean up the air and water, renovate or create safe outdoor spaces for physical activity, make healthier foods more accessible, and assure violence-free environments. This is part of a comprehensive effort to tackle such issues as obesity, tobacco use, health disparities and chronic disease.

One federal initiative that has helped to keep young adults healthy was the ACA’s ruling that youths could stay on their parents’ health plans until they are 26. According to a new study from the Commonwealth Fund, millions of young adults stayed on or joined their parents’ health plans in 2011 who wouldn’t have been eligible prior to ACA passage. However, nearly 40 percent of young adults aged 19 to 29 went without health insurance at some time in 2011 primarily because their parents did not have healthcare coverage, and affordability of healthcare remains a crucial issue for young adults.

Keeping older adults comfortable, while at the same time minimizing their hospitalization and healthcare costs, is behind a new study from UCSF and published in Health Affairs. The study finds that creating specialized hospital units for elderly people with acute medical illness could reduce national healthcare costs by as much $6 billion a year. Researchers suggest that minor changes in current healthcare models can yield significant results. Leaving patients in their hospital beds, for example, or constantly interrupting them in the middle of the night for disruptive evaluations, often lead to longer recovery time and longer hospital stays. Creating interdisciplinary teams that specialize in the care of older patients, and that tend to elderly patients daily, can do much to minimize their discomfort and shorten their stays.

And one healthcare model that will likely stand the test of time, and a potential Supreme Court challenge, is the ACO. According to our latest market research, ACO activity has doubled in the last 12 months. Also in our white paper: data on how many ACOs participate in the CMS Shared Savings Program, and which kinds of ACOs were the most common.