Posts Tagged ‘Care Management’

Guest Post: Cracking the Care Management Code: How Providers Can Get Paid for Remote Services

February 21st, 2019 by Melanie Matthews

With a successful remote care management model in place, healthcare organizations can increase annual revenues by about $500 per patient.

Healthcare organizations and physician practices are stepping up efforts to reduce avoidable healthcare utilization and ensure patients receive care in lower-cost settings when appropriate.

As part of these efforts, many providers are considering remote care services, such as e-visits, remote health monitoring, secure messaging, and regular check-in calls with patients. These remote interactions can increase patient adherence to treatment plans and lead to faster interventions when problems arise.

While payers have been slow to reimburse for remote care services (despite the clinical benefits), providers today can take advantage of Centers for Medicare and Medicaid Services reimbursement for Chronic Care Management (CCM) services to improve care management for many of their Medicare patients.

To qualify for CCM reimbursement, practitioners must spend at least 20 minutes of non-face-to-face clinical staff time per month on care coordination for CCM patients. To be included in a CCM program, patients must have two or more chronic conditions expected to last at least one year or until death, and those conditions must place patients at significant risk of death, acute exacerbation, or functional decline.

Payments for CCM services, which can be provided by physicians, physician assistants, nurse practitioners, nurse midwives and their clinical staffs, can range from approximately $43 to $141, depending on how complex a patient’s needs are, according to CMS.

When a successful remote care management model is put in place, healthcare organizations can increase annual revenues by about $500 per patient, which translates to $50,000 per year for an organization with 1,000 CCM patients.

Getting Involved

Recent data show that many providers have yet to take advantage of CCM. In fact, as of 2016, the program had touched only 684,000 Medicare patients, according to a 2017 CCM report. That’s less than 2 percent of all Medicare recipients.

One reason is that providers face many barriers when attempting to implement remote care programs. Technology, of course, is one hurdle, but CCM services also take clinical and administrative staff time and resources (such as time spent billing for CCM services and ensuring compliance).

This is why many organizations are turning to outside partners that specialize in remote care management to deliver CCM. These partners can enroll patients into the CCM program (a step that is much harder than most practices anticipate), deliver remote services each month, ensure compliance, and bill for services.

The Wright Center, a safety-net primary care provider in northeastern Pennsylvania, is one provider that sought outside help to achieve its CCM goals. The result of its partnership with a remote services provider included net new revenue within 14 days of partnering with the company, an additional $536 per enrolled patient per year, a 73 percent patient retention rate after two years, lower hospital admission rates, and higher patient satisfaction scores.

Four Key Attributes

Because many providers have found delivering remote services challenging, it’s important to select a partner that has the right model and proven success improving patient engagement and outcomes. Key capabilities to look for in a partner include:

  1. Being staffed with nurses or other clinicians who become a trusted and integral part of the healthcare organization’s team. These clinical staff members should have a strong record of establishing productive relationships with providers in the healthcare organization and with patients remotely.
  2. Working seamlessly with the EHR and population health tools already in place at the healthcare organization. The partnership should not result in an additional burden on IT staff members at the healthcare organization.
  3. Providing a customized program to suit the healthcare organization’s specific needs, goals, and workflows. An organization’s CCM needs will vary depending on the patient population, in-house resources, and technology already in place. The partner should be able to tailor its services accordingly.
  4. Proactively addressing social determinants of health and barriers to care. For example, it should be able to share results that showcase its ability to engage a senior population and address their unique needs.

As value-based reimbursement gains traction, healthcare organizations that don’t start exploring remote healthcare services will fall behind. It’s time to get involved, and CCM is a great way to start.

Drew Kearney

Drew Kearney

About the Author: Drew Kearney has been a healthcare leader since 2010, with expertise in post-ACA market opportunities and experience leading expansion initiatives in multiple markets. In 2015, he co-founded Signallamp Health, a company that offers a unique solution operationalizing population health.

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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AMITA Health Places Patient at Center of Care Management Redesign

February 2nd, 2017 by Patricia Donovan
AMITA Health care management redesign

AMITA Health’s care management redesign began in one patient unit on one floor.

In rolling out a new connected care management strategy across its nine-hospital system, AMITA Health aimed to keep its target patient population at the heart of the initiative—unit by unit, floor by floor. Here, Susan Wickey, vice president, quality and care management at AMITA Health, shares one of the guiding principles of the Medicare Shared Savings Program Accountable Care Organization (MSSP ACO).

The key component for us in our redesign was making sure that the patient was at the center of everything we did. With that in mind, we developed structured processes and programs that would span the care continuum while retaining the patient at the center. We wanted to establish relationship-based care with the patient and the primary care physician. We wanted to be able to use available data to help drive our decisions. We wanted to ensure that our patients had regular access to care, and that we leveraged what we currently had in place.

Our congestive heart failure clinic was key in this process. Navigating through the care continuum is not an easy process for many of our patients. We wanted to make sure we could help them through that, and construct some processes for them to be able to navigate. We wanted to make sure we were continuing to build the health literacy of our patients and our families. We wanted to establish interventions for the most vulnerable population of patients. We wanted to make sure we had a dedicated, multidisciplinary team to help us. We had psychiatrists, dieticians, pharmacists, primary care physicians and physician champions along the way to help us.

We began implementation very slowly, starting with a specific cohort of patients on one specific unit. This cohort was small; the number of people touching the cohort at the time was small. As we went along, we were able to define problem areas where we needed to intervene, quickly readjust and then go down the right path.

Slowly, over a period of time, we were able to add additional floors in our acute care hospitals, which then meant adding additional staff. Those additional staff then became the super users who helped us roll out the program on the next floor.

Source: Centralized Care Management to Reduce Readmissions and Avoidable ED Visits in High-Risk Populations

Centralized Care Management to Reduce Readmissions and Avoidable ED Visits in High-Risk Populations

Centralized Care Management to Reduce Readmissions and Avoidable ED Visits in High-Risk Populations describes how the nine-hospital system inventoried, reexamined and revamped its care management resources, ultimately implementing a centralized care management model.

HINfographic: Digital Health Connects Complex Comorbid to Care Management

June 27th, 2016 by Melanie Matthews

In evaluating candidates to engage in digital health, those with chronic comorbidities are prime targets, say 58 percent of respondents to the 2016 Digital Health Survey by the Healthcare Intelligence Network. Diabetes tops the list of chronic conditions ripe for connected health interventions, report 58 percent.

A new infographic by HIN examines which populations are targeted by digital health initiatives, the percent of healthcare organizations that have adopted digital health and how digital health programs are staffed.

2016 Healthcare Benchmarks: Digital Health2016 Healthcare Benchmarks: Digital Health assembles hundreds of metrics on digital health strategies from hospitals, health insurers, physician practices and other responding organizations, charting the growth of digital health and its expanding role in population health management.

2016 Healthcare Benchmarks: Digital Health examines program goals, platforms, components, development strategies, target populations and health conditions, patient engagement metrics, results and challenges reported by more than 100 healthcare organizations responding to the February 2016 Digital Health survey by the Healthcare Intelligence Network. Click here for more information.

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.

2016 Population Health Management Snapshot: Most Interventions Telephonic and 9 More PHM Trends

May 19th, 2016 by Patricia Donovan

Most population health management interventions are conducted telephonically, according to HIN's latest PHM metrics.

The majority of outreach in the burgeoning field of population health management is delivered telephonically, according to 84 percent of respondents to an April 2016 Population Health Management (PHM) survey by the Healthcare Intelligence Network.

This third comprehensive PHM assessment also determined that data analytics use in population health management continues to rise, though more slowly than it did from 2012 to 2014, when EHR and registry use tripled.

Additionally, the survey found that 70 percent of respondents have committed to population health management, up from 56 percent in 2012. At the same time, many lament payor reluctance to cover essential PHM services like health coaching and group visits they see as critical to PHM success.

To accrue clinical and financial gains from PHM’s data-driven, risk-stratified care coordination approach, 90 percent provide chronic care management (CCM) services, a strategy that results in PHM ROI between 2:1 and 3:1 for 12 percent of these CCM adopters.

In condition-specific PHM metrics new for 2016, diabetes tops the list of health targets for PHM interventions, say 88 percent.

A health risk assessment (HRA) remains the primary instrument for identifying individuals for PHM interventions, say 70 percent, up from 64 percent in 2014.

Also paramount to PHM success under value-based healthcare reimbursement is strategic oversight of the ‘rising risk’— individuals with two or more unmanaged health conditions. One quarter of 2016 respondents focus PHM attention on their ‘rising risk’ populations, the April 2016 survey determined.

In recent years, population health management (PHM) has ranked as the healthcare space richest with opportunity, according to HIN’s annual industry trends snapshots.

Download an executive summary of 2016 Population Health Management survey results.

10 Tools to Complement Chronic Care Management

April 23rd, 2015 by Cheryl Miller

Despite new CMS payments to physician practices for select chronic care management (CCM) services, almost half of healthcare organizations lack a formal chronic care management program, leaving critical reimbursement dollars on the table, according to new market metrics from the Healthcare Intelligence Network (HIN). Almost 45 percent of 119 respondents to HIN’s 2015 Chronic Care Management survey, conducted in January 2015, have yet to launch a CCM initiative, the survey determined. However, 92 percent of respondents believe the Medicare CCM reimbursement codes that became effective January 1, 2015 will prompt comparable quality overtures from private payors, underscoring care coordination’s importance in a value-based healthcare system.

How to best capitalize on these reimbursement opportunities? Follow-up with patients immediately following hospital discharge is the most common component of CCM initiatives, according to 81 percent of respondents. Following are nine more tools to complement chronic care management, in respondents’ own words:

  • Holding care manager, primary care provider (PCP) and clinical team reviews;
  • Any patient over a certain risk score gets a phone call from the physician or advanced practitioner registered nurse (APRN) for a follow up with the patient.
  • Utilizing a structured assessment tool in the electronic health record (EHR);
  • Coaching the patient to wellness and holding them accountable;
  • Addressing psychosocial issues with care coordination strategies;
  • Having a life planning agenda; knowing what to do if symptoms worsen, and what end-of-life agreements are in place;
  • Conducting motivational interviewing to support lifestyle changes;
  • Coordinating with nurse practitioners; and
  • Using remote monitoring devices for heart failure patients.

Source: 2015 Healthcare Benchmarks: Chronic Care Management

Chronic Care

2015 Healthcare Benchmarks: Chronic Care Management captures tools, practices and lessons learned by the healthcare industry related to the management of chronic disease. This 40-page report, based on responses from 119 healthcare companies to HIN’s industry survey on chronic care management, assembles a wealth of metrics on eligibility requirements, reimbursement trends, promising protocols, challenges and ROI.

12 Things to Know About Chronic Care Management

February 24th, 2015 by Cheryl Miller

Despite new CPT codes that reimburse physician practices for select chronic care management (CCM) services, almost half of healthcare organizations lack a formal CCM program, leaving critical reimbursement dollars on the table, according to 125 respondents to the Healthcare Intelligence Network’s (HIN) 2015 Chronic Care Management survey, conducted in January 2015.

However, 92 percent of respondents believe the Medicare CCM reimbursement codes that became effective January 1, 2015 will prompt equivalent quality overtures from private payors, underscoring care coordination’s importance in a value-based healthcare system.

We also asked respondents how they structured their CCM programs, and who had primary responsibility for CCM services. Following are their responses.

  • Almost 45 percent of respondents to HIN’s 2015 CCM survey have yet to launch a CCM initiative, the survey determined.
  • A diagnosis of diabetes is the leading criterion for admission to a CCM initiative, said 89 percent of respondents with existing CCM programs.
  • A primary care physician or healthcare case manager most often bears primary responsibility for CCM, say 29 percent of survey respondents.
  • Just over one-third of respondents — 35 percent — are currently reimbursed for CCM-related activities.
  • Patient engagement is the most difficult challenge of CCM, according to one-third of survey respondents.
  • The majority of CCM tasks are conducted telephonically, say 88 percent of respondents.
  • Almost three-quarters of respondents — 72 percent — admit patients with hypertension to CCM programs, respondents said.
  • Healthcare claims are the most frequently mined source of risk-stratification data for CCM, say 72 percent of respondents.
  • More than half of respondents — 51 percent — include palliative care or management of advanced illness in CCM programs.
  • On average, each CCM patient is seen monthly, say 29 percent of respondents.

Source: 2015 Healthcare Benchmarks: Chronic Care Management

http://hin.3dcartstores.com/2015-Healthcare-Benchmarks-Chronic-Care-Management_p_5003.html

2015 Healthcare Benchmarks: Chronic Care Management captures tools, practices and lessons learned by the healthcare industry related to the management of chronic disease. This 40-page report, based on responses from 119 healthcare companies to HIN’s industry survey on chronic care management, assembles a wealth of metrics on eligibility requirements, reimbursement trends, promising protocols, challenges and ROI.

11 Statistics About Embedded Case Managers

December 16th, 2014 by Cheryl Miller

CMS readmissions penalties and accountable care organization (ACO) cost savings were among circumstances driving some organizations to embed case managers, according to the Healthcare Intelligence Network’s (HIN) inaugural survey on Embedded Case Management.

The majority of the survey’s 125 respondents (68 percent) have embedded programs in place to meet the expanding demand for case management services across the healthcare continuum, with the intent of improving care and quality outcomes.

Sites for embedding or co-locating of case managers ranged from primary care practices (PCP) to the hospital discharge area.

Following are eight more statistics from the 2014 Embedded Case Management survey:

  • „„9 percent of respondents that don’t have such programs intend to implement them within the next 12 months.
  • The average monthly case load of an embedded case manager is 1 to 49, according to 34 percent of respondents. Slightly less than one third (32 percent) of respondents cite case loads of between 50 and 99 patients a month.
  • „„The majority of respondents (77 percent) prefer that embedded case managers be registered nurses; 55 percent prefer that they have a bachelor’s degree.
  • „„In addition to case management assessments (75 percent), provider referrals were a key factor in stratifying individuals for embedded case management, according to 52 percent of respondents.
  • „„In addition to the PCP and hospital locations, some respondents embed their case managers in skilled nursing facilities (SNF), sub-acute facilities, and oncologists’ practices.
  • Seven percent of survey respondents report program ROI between 2:1 and 3:1, and 3:1 and 4:1.
  • „„Patient satisfaction is among the greatest successes of embedded case management programs.
  • The biggest challenge of embedding case managers is maintaining a care management focus and communication, according to 22 percent of respondents.

Source: 2014 Healthcare Benchmarks: Embedded Case Management

http://hin.3dcartstores.com/2014-Healthcare-Benchmarks-Embedded-Case-Management-_p_4985.html

2014 Healthcare Benchmarks: Embedded Case Management provides actionable data from 125 healthcare organizations leveraging embedded or co-located case management to improve healthcare quality, outcomes and spend — including those who apply a hybrid embedded case management approach. This report also shares highlights from embedded case management initiatives at Caldwell UNC Health Care, where case managers are embedded with primary care and employer sites; and Sentara Medical Group, whose highly successful hybrid approach to co-located case management utilizes case managers during home visits, in the hospital, in the primary care provider office, on the phone or via online virtual sessions.

Communication Key to ‘Healthy Handoffs’ in Medical Neighborhood

June 26th, 2014 by Cheryl Miller

Consultations and referrals have long been a source of frustration for physicians and specialists; physicians refer patients to specialists without the necessary tests or pre-work, or a physician refers a patient to a specialist, but hears nothing back from that specialist, says Robert Krebbs, director of payment innovation at WellPoint, Inc. There needs to be better, effective communication between the two, and established processes for consultations and referrals between physicians and specialists to ensure “healthy handoffs,” a key component of care coordination.

Care coordination is important to us and is the main pillar of our Patient-Centered Specialty Care program. What we mean by that is that care coordination is about effective communication. Practices need to establish communication timeliness expectations, agree on core default patient information regardless of the condition, and make sure the information flows back and forth between the two practices that are exchanging the patient or experiencing the care transition for that patient.

We actually refer to those as ‘healthy handoffs.’ That’s what we’re shooting for, care exchanges in which the patient moves between practices in a healthy fashion and everything moves back and forth between the practices in an ideal and efficient manner. It’s about establishing data exchange; that is, how is the information going to get back and forth between two practices?

Every practice is different. Every practice has different capabilities in terms of data exchange. We’re looking for practices to make sure that they understand each other’s capabilities so there are no assumptions to cause missed care opportunities for patients.

It’s about establishing processes for requests in consultations and referrals in the first place and expectations around interactions related to those referrals. It’s about agreeing on the types of consultations that are available: face to face, phone, e-mail from patient to provider. It’s making sure that the entire landscape of consult or referral is clear for both parties.

Excerpted from Care Compacts in the Medical Neighborhood: Transforming PCP-Specialist Care Coordination.

3 ACO Opportunities to Improve Patient Engagement

April 17th, 2014 by Cheryl Miller

Patients are 30 percent more likely to enroll in care management during or immediately after an acute event if they are contacted directly and introduced to a program and services, as opposed to being contacted via telephonic outreach, says Colin LeClair, executive director of ACO for Monarch HealthCare, which was a top performer in year one of the CMS Pioneer ACO program.

Through trial and error we found three opportunities to identify opportunities to yield patient engagement. First, getting the principal caregivers’ endorsement or that of the physician staff was by far the most effective means of earning the patients’ trust and getting them actively engaged. If we can say to a patient that ‘your physician has asked us to speak to you’, we get a ‘yes’ from the patient 80 to 90 percent of the time.

The second most effective means of enrolling patients in our care management program is during or immediately after an acute event. The idea is to catch them in the hospital if you can — immediately after they are admitted — and introduce them to the accountable care organization (ACO), our services, and what we can do to help them stay out of the hospital in the future. We found that patients are 30 percent more likely to enroll in care management during or immediately after an acute event, versus the cold telephonic outreach alternative. But this approach requires partnerships with hospitalists or with other hospital staff to notify you of those admissions because we don’t receive those from care management services in real-time data.

And finally, we find that patients are also somewhat receptive to care management services following a new diagnosis and we’re looking for those markers in the claims data as we receive it.

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