Posts Tagged ‘chronic disease’

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Health Risk Stratification Model: How Well Do You Manage ‘Falling Risk’ Populations?

November 3rd, 2015 by Patricia Donovan

Health risk stratification is scalable, according to the experience of Ochsner Health System, whose scaling and centralization of risk stratification and care coordination protocols across its nine-hospital system drive ROI and improve clinical outcomes and efficiency.

Here, Mark Green, system AVP of transition management at Ochsner Health System, explains why health plans and providers need better control over ‘falling risk’ patients.

Regardless of your patient population, no matter how small or large, you’ve got a segment of your population that are healthy patients. You’ve got a certain percentage, about 40 percent, who are at very low risk.

About 20 percent of your population falls into a ‘rising risk’ segment. Those are patients with chronic diseases who are somewhat adherent and compliant. You’ve got some that are newly diagnosed with depression, and a comorbidity. Then you’ve got this very top 3 to 5 percent, which are your poorly controlled multiple comorbidities that need your absolute highest touch, whether it’s through complex case managers or other programs that are the highest touch of those patients.

That is the typical model in the United States where you see this segmentation. In this country, we do a relatively good job of understanding ‘rising risk’ patients. Those are your patients that are diabetic, and suddenly you see their A1C go out of control. You know they’re going off-track for some reason, whether it’s compliance, adherence, needing medication adjustments, or some other social interactions happening outside your care model. These are your ‘rising risk’ patients.

As the country begins to understand this risk stratification, it understands the ‘falling risk’ patients, too. For example, we had a congestive heart failure (CHF) clinic that was pretty successful in managing patients; they had approximately 100 patients in their CHF clinic. They were taking these complex CHF patients and sending them through education and hooking them up with complex case managers. Pretty soon they filled their entire clinic up and didn’t have any more access for new patients. It failed pretty quickly because they weren’t able to churn these patients.

As we began to do a root cause analysis of why this happened, to understand why we didn’t see the sustainability in this program, we realized it was because we never moved patients down that risk stratification model. We kept them in there forever. We received them, we managed them and we got them better. But we never moved them down, so we never had room for another newly diagnosed, out-of-control CHF patient.

That’s a really critical step to understand: managing not only your rising risk but also your falling risk patient population within the sub-categories of your overall risk segmentation. It’s a living organism moving in and out of these different components.

Source: Scalable Models in Health Risk Stratification: Results from Cross-Continuum Care Coordination

http://hin.3dcartstores.com/Rethinking-Readmissions-Patient-Centered-Collaborations-in-Care-Transition-Management_p_4646.html

Scalable Models in Health Risk Stratification: Results from Cross-Continuum Care Coordination explores Ochsner’s approach, in which standardized scripts, tools and workflows are applied along the care continuum, from post-hospital and ER discharge telephonic follow-up to capture of complex cases for outpatient management.

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Challenges of Chronic Care Management in Senior Populations: Infographic

May 20th, 2015 by Melanie Matthews


Eight million of the 40 million older adults in the United States have multiple chronic conditions and receive help with activities of daily living (ADLs), according to a new infographic by the GRACE Team Care (Geriatric Resources for Assessment and Care of Elders) program at Indiana University School of Medicine.

This 20 percent of the senior demographic comprises 40 percent of healthcare spending, and the per capita healthcare spending for these seniors is about double than for those without the need for help in ADL. Medicare hospitalization collective cost to the healthcare system is more than $140 billion.

The infographic illustrates how participation in the GRACE program has been proven to provide person-centered care, enhance quality of life, optimize health and functional status, and decrease excess healthcare use.

2015 Healthcare Benchmarks: Chronic Care ManagementThe desire to improve health outcomes for individuals with serious illness coupled with opportunities to generate additional revenue have prompted healthcare providers to step up chronic care management initiatives. The Centers for Medicare and Medicaid Services now reimburses physician practices for select chronic care management (CCM) services for Medicare beneficiaries, with more private payors likely to follow suit.

2015 Healthcare Benchmarks: Chronic Care Management captures tools, practices and lessons learned by the healthcare industry related to the management of chronic disease.

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Infographic: Population Health Management Costs and Risks

January 14th, 2015 by Melanie Matthews

Some 45 percent of Americans have at least one chronic disease, according to a new infographic by Lexis Nexis.

The infographic also examines the impact of chronic disease on deaths associated with these diseases and healthcare spending, along with details on a population health management program by PepsiCo.

2014 Healthcare Benchmarks: Population Health ManagementPopulation health management, with its focus on stratifying and managing care of high-risk, high-utilization sectors, is the area of healthcare most ripe with opportunity, according to 2014 HIN market data. Population health metrics drive quality and reimbursement returns in the current value-based healthcare environment.

2014 Healthcare Benchmarks: Population Health Management delivers an in-depth analysis of population health management (PHM) trends at 129 healthcare organizations, including prevalence of PHM initiatives, program components, professionals on the PHM team, incentives, challenges and ROI.

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Hospitals: Chronic Disease Leading Cause of Avoidable ER Visits in 2014

December 4th, 2014 by Cheryl Miller

High utilizers continue to be responsible for the majority of avoidable emergency room (ER) visits, with chronic disease edging out pain management as the top complaint among this population, according to respondents to the third comprehensive survey on reducing avoidable ER visits, conducted in August 2014 by the Healthcare Intelligence Network (HIN). A total of 125 healthcare organizations described tactics employed; nearly one third (32 percent) of which were identified as hospitals/health systems. A sampling of this sector’s results follows.

While the majority of hospitals/health systems were likely to have such a program in place (53 percent versus 69 percent of all respondents), of those that didn’t, just 25 percent planned a future program, compared to 47 percent of all respondents. Less than one half of hospital respondents (47 percent) felt that eased telehealth regulations would curb avoidable ER use.

This sector was twice as likely to find high utilizers generating the majority of avoidable ER visits (78 percent versus 31 percent of all respondents) and least likely to target Medicaid (10 percent versus 28 percent of all respondents). Chronic disease was the most frequently presented problem among this sector’s high utilizers (78 percent versus 54 percent).

In terms of patient level solutions, this sector was half as likely to utilize telephonic outreach (33 percent versus 60 percent), and twice as likely not to conduct follow-up phone calls with those discharged from the hospital (30 percent versus 15 percent). In terms of staff level solutions, this sector was more likely to use hospitalists (22 percent versus 10 percent for all respondents) and onsite educators/coaches (22 percent versus 11 percent for all respondents) and least likely to use disease-specific care coordination (11 percent versus 38 percent for all respondents). This sector was also least likely to notify PCPs of care gaps (22 percent versus 41 percent).

When asked to identify the greatest impact on overall ER efficiency, 70 percent of hospital respondents cited fast-tracking of non-urgent care, versus 33 percent of all respondents. Among the challenges of reducing avoidable ER visits, redirecting the non-urgent was considered a top obstacle for 3 percent of hospital/health system respondents, versus 18 percent of all respondents.

And 40 percent of this sector saw reductions in avoidable ER visits of between 0 to 5 percent, versus 26 percent of all respondents.

Source: 2014 Healthcare Benchmarks: Reducing Avoidable ER Visits

http://hin.3dcartstores.com/2014-Healthcare-Benchmarks-Reducing-Avoidable-ER-Visits-_p_4942.html

2014 Healthcare Benchmarks: Reducing Avoidable ER Visits delivers actionable metrics from 125 healthcare organizations on their efforts to foster appropriate use of hospital emergency departments. Enhanced with more than 50 easy-to-follow graphs and tables, this third edition of comprehensive data points presents year-over-year trends and best practices for engaging ER and hospital staff, primary care physicians, community providers and patients in reducing avoidable ED utilization.

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Posted in Affordable Care Act, Avoidable ER Use, Care Coordination, Care Management, Care Transitions, Case Management, Healthcare Utilization, Hospital Readmissions, Hospitals | Comments Off on Hospitals: Chronic Disease Leading Cause of Avoidable ER Visits in 2014

CMS Chronic Care Management Medicare Reimbursement: Sizeable Revenue, Health Outcome Opportunities

November 21st, 2014 by Cheryl Miller

Beginning January 2015, Medicare will pay a flat, monthly chronic care management (CCM) fee to providers coordinating care for beneficiaries with more than one chronic condition. This change will expand the current Medicare payment policy to include non face-to-face management services previously included within payments for evaluation and management (EM) services, amount to about $40 a beneficiary, a sizeable new source of revenue for eligible providers.

The targeted population is also substantial; as recent news story reported by the Healthcare Intelligence Network (HIN), 87 percent of U.S. adults ages 65 and older have at least one chronic illness, and 68 percent have two or more, the highest rates in a new 11-country Commonwealth Fund survey.

But healthcare organizations do not have that much time to prepare for the newly released 2015 Medicare Physician Fee schedule, which finalized the CCM reimbursement. Who can bill for CCM, what constitutes a chronic condition, which patients are eligible to receive CCM services, and the scope of services required were among the issues discussed during Chronic Care Management Medicare Reimbursement: New Revenue Opportunities for Care Coordination, a November 19th webinar, now available for replay. Rick Hindmand, an attorney with McDonald Hopkins, a law firm that advises a nationwide client base extensively on healthcare reimbursement, shared insight on these issues and how to best prepare for this reimbursement opportunity.

Those allowed to bill for CCM reimbursement fall into one of five categories: physicians, advanced practice registered nurses (APRNs), physician assistants (PAs), clinical nurse specialists and certified nurse midwives. If these practitioners are part of a practice entity, that entity can bill for it as well.

Beneficiary requirements are not as clear cut, Mr. Hindman continued. Eligible patients must have at least two chronic conditions that are expected to last at least 12 months or until death, and those conditions need to create a significant risk of death, acute exacerbation/decomposition or functional decline. Specific definitions of conditions can be found at CMS’s Web site.

And because CMS does not want to pay for duplicative services, CCM is not allowed for beneficiaries who receive services for transitional care management, home healthcare supervision, hospice supervision, and various end stage renal disease (ESRD) conditions. Patients attributed under the Multi-payer Advanced Primary Care Practice Demonstration (MAPCP) and the Comprehensive Primary Care (CPC) Initiative are also excluded.

Once these requirements are satisfied, providers must offer and document 20 minutes of CCM services a month, which enhance access and continuity of care, care management, transition management, and coordination, Mr. Hindman continues.

The CCM fee comes to about $40 a beneficiary, a significant revenue source once applied to all patients within a practice. Why the change now? Mr. Hindman speculates that CMS is finally realizing that care management is a crucial component of primary care. But questions and details await future guidance from CMS, and satisfying and documenting compliance with the CCM reimbursement requirements is going to present a challenge for many practices.

But the time and effort is worth it, he says. “With careful structuring, chronic care management can provide the potential to improve the health of their patients, while also providing some significant financial benefits for the practice.”

To listen to an interview with Mr. Hindman, click here.

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Sentara Home Visits for High-Risk ‘VIPs’ Drive Hybrid Case Management Outcomes

November 13th, 2014 by Cheryl Miller

When the Sentara Medical Group evolved to a hybrid embedded case management model in 2012, case managers spent time in the practice, but also managed care through other touch points, including home visits, explains Mary M. Morin, RN, NEA-BC, RN-BC, vice president, nurse executive with Sentara Medical Group. How to identify high-risk patients for case management, and home visits in particular? Here, Ms. Morin addresses that question posed by The Healthcare Intelligence Network during a recent webinar.

Question: How does Sentara identify high-risk patients for case management in general and for home visits in particular? Do all patients in the case management program receive home visits?

Response: (Mary M. Morin) This program started as a pilot in 2012. It was targeted at patients that we called very important patients — high-cost, high-utilizers, the top of the pyramid. There are about 2,300 patients within 11 of our primary care sites. We kept it small, with five RN care managers. That population included all payors, most importantly our health plan patients. Because of our health plan, we were able to really study whether RN care management had an impact on the total cost of care — not unlike other organizations, if you can find a cost savings and justify the expense of having RN care managers, it makes the case much more solid moving forward with formalizing the program.

We sorted those patients by high-risk, high-cost or high-cost, high-utilizers because of chronic diseases. We looked at patient with congestive heart failure (CHF), chronic obstructive pulmonary disorder (COPD), asthma, renal failure and diabetes. We excluded patients that had any traumatic event like a car accident or something that led to high-cost, or they had cancer or they were a transplant patient.

The purpose was to engage that population. It is voluntary. We studied that population for three years. It allowed us to measure our outcomes over time because we weren’t sure if there was seasonality to the patients with chronic disease: did they just not use services because of seasonal issues or because it’s a cycle issue within the chronic disease phase? After three years of data, we determined there is definitely a difference in the outcomes of this patient population and their utilization.

Home visits was one of the big differences in the model. The main reason to do home visits is not to do patient care, but to do an assessment of the patient’s environment. A lot of times, patients don’t share with us their actual living situation. They tell you that they’re walking, and then you find out they walk within a five-foot radius. The real emphasis for home visits was to get in and meet the patient in their environment.

We found that RN care managers in the home facilitated advance care planning. That is best done in the patient’s home with a family member present, not in the doctor’s office or waiting until the patient is admitted to the hospital. We found that patients appreciated the visits. The RN care managers who went in really cleaned up the medications. Patients will hold on to medications.

value-based reimbursement
Mary M. Morin, RN, NEA-BC, RN-BC, is a nurse executive with Sentara Medical Group, where she is responsible and accountable for non-physician clinical practice within the Sentara Medical Group (160 clinics/practices) to ensure integration and alignment with Sentara Healthcare, regulatory compliance, standardization of nursing practice/care, and patient safety.

Source: Hybrid Embedded Case Management: New Model for Cross-Continuum Care Coordination

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Posted in Affordable Care Act, Care Coordination, Care Management, Care Transitions, Case Management, Disease Management, Embedded Case Management, Home Visits | Comments Off on Sentara Home Visits for High-Risk ‘VIPs’ Drive Hybrid Case Management Outcomes

9 Things to Know About Patient and Disease Registries

February 19th, 2014 by Jessica Fornarotto

In the environment of accountable and value-based healthcare, registries are a straightforward tool for creating realistic views of clinical practices, patient outcomes, safety and comparative effectiveness and for supporting evidence-based medicine development and decision-making.

The Healthcare Intelligence Network’s most recent analysis of registries and their impact on healthcare quality, efficiency and cost, reveals that the management of chronic disease is a key driver in the use of registries.

E-survey responses provided by 105 healthcare organizations also found that one-third of existing registries are a component of an electronic health record (EHR); the top reason for not having implemented a registry is because respondents already use an alternative, such as an EHR.

Other survey highlights include:

  • A disease- or condition-specific registry is the most popular type of registry, say 17 percent of respondents.
  • Diabetes is the condition most frequently targeted by respondents’ registries (78 percent), followed by CHF and asthma (both reported at 59 percent).
  • The most popular reason for using a registry is to measure quality and performance on key health outcomes, followed by disease management and the identification of high-risk patients.
  • Almost two-thirds of respondents who are not using registries at this time say they will launch a registry within the next 12 months.
  • A third of respondents include 20 percent or more of their population in registries.
  • Chart audits are the most common sources from which registries draw data, say half of respondents.
  • Engaging staff in registry use is the greatest challenge of implementing a patient registry, according to 29 percent of respondents.

Excerpted from: 38 Disease Management Metrics: Population Health Benchmarks to Drive Accountable Care

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Infographic: Sick! Epidemic of Chronic Diseases

August 29th, 2013 by Jackie Lyons

Chronic diseases account for 70 percent of deaths every year, which translates to higher healthcare costs and utilization rates.

Heart disease has been the leading cause of mortality for Americans every year since 1920, costing an annual $108.9 billion in healthcare and lost productivity, according to a new infographic from Best Master of Science in Nursing Degrees. This infographic identifies the top chronic illnesses, their costs and possible preventative measures.

Sick! Epidemic of Chronic Diseases

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You may also be interested in this related resource: Chronic Care Professional Manual 5.0 .

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Case Management, Disease Management Top Skills Sought in Burgeoning Health Coach Field

August 23rd, 2013 by Cheryl Miller

University of Delaware's Health Coaching Certificate recipients' presentation. Mike Peterson, top left, Kathleen Matt, Dean of College of Health Sciences to his left; faculty members, Katherine McCleary, Emily Davis, students.


Motivated by a recurring lament among local physicians and health professionals that patients weren’t following through on certain behaviors, the University of Delaware (UD) launched its first Health Coaching certificate program in 2011, and honored its first two recipients at a ceremony this past May. The 18-credit hour post-baccalaureate program prepares health professionals to work in a clinical setting as part of a team that facilitates behavior change among at-risk patients, decreases demand for healthcare services, and reduces morbidity across the life span.

To create this program, curriculum leaders consulted the Delaware Health Sciences Alliance, which comprises the UD, as well as the Christiana Care Health Systems, Alfred I. DuPont Children’s Hospital, and Thomas Jefferson University, a Philadelphia-based medical school. The school received valuable insight from a team of local physicians and health professionals, including nurses, clinical psychologists, nutritionists, behavioralists, and pharmacologists on perceived needs and deficiencies in the healthcare system, and the kinds of skills and competencies they would like to see in a health coach.

According to the report “Market Demand for Certificate Programs in Health Coaching,” from the Education Advisory Program in Washington, D.C., which stated that employer demand for health coaches has grown 408 percent since 2007, with the number of health coach job openings peaking a year after the ACA was passed.

And the top five skills sets employers are seeking in health coaches? Case management, disease management, motivational interviewing, chronic disease, and clinical experience.

Following is our discussion with Mike Peterson, chair of UD’s Department of Behavioral Health and Nutrition.

HIN: What prompted you to offer this program now?

Mike Peterson: We created it to address the primary determinate of health, which is behavior, which accounts for about 40 percent of morbidity, according to the World Health Organization (WHO). Most doctors, because of the current health system, can only spend from seven to 15 minutes with a patient, which really isn’t a lot more than diagnosis and treatment.

The other thing is that most medical professionals, doctors and nurses don’t get any behavioral change expertise, knowledge or skills. They are trained in diagnostics and prescriptive treatment.

HIN: What insights did you receive from physicians and health professionals regarding skill sets and competencies needed for the certificate?

Mike Peterson: They have to have case management, disease management, and motivational interviewing experiences or knowledge. They have to have a basic understanding of chronic disease, which we provide; a course that covers about 20 of the major, common chronic diseases, their ideology, their treatments, diagnosis, pharmacology. They have to understand how to change people’s behavior, have good communication skills and a good working knowledge of basic health promotion and health education principles.

There’s clearly a skill set that’s currently not being taught in the other health disciplines. How do you extract information? How do you work with an individual? How do you motivate an individual? How do you communicate with them in a way that actually gets them to do the behaviors that are necessary to improve their health?

HIN: What recommendations were made on motivational interviewing techniques?

Mike Peterson: Motivational interviewing is important, but it doesn’t work in all cases. It’s somewhat oversold as a panacea for all problems. It’s a good tool to have but not every problem is a nail. Sometimes you need other tools in your toolbox to facilitate behavior change. So we teach other types of behavior change strategies as well: the use of contracting incentives, things to help facilitate and promote behavior change.

HIN: You would like to see health coaches affiliated with doctors’ offices and clinics. Should they be embedded or co-located in the practice or clinic?

Mike Peterson: Yes. We’re trying to get them placed right in the clinical office and become part of the healthcare team, for example, the medical home model where the doctor is in charge and the health coach is part of that team. We see health coaches not necessarily dealing with every patient a doctor has, but the primary, high-risk patients, or people of moderate risk who could have potential for high risk.

HIN: What about reimbursement for them?

Mike Peterson: That’s a good question and the one we’re all wrestling with right now. There’s been a shift in the demand for health coaches from payors to providers; we are seeing health coaches paid right from the insurance industry or hospital; they see that the coach is a good idea and so they decide to fund them privately within their own coffers. And under the new healthcare bill doctors are paid for outcomes. If they get better outcomes with patients they get a percentage of the potential savings reimbursed back to them. Some of those funds could be used to fund a health coach.

HIN: What insights did you receive on recommended caseloads for health coaches?

Mike Peterson: Ideally, if you have a 40-hour work week, about 25 hours could be engaged in client time, one-on-one face time. The other 15 hours would have to be a record keeping and perhaps telephonic communications with previous patients or communications with the medical staff about what’s going on with specific patients. So we figure in any week you could see 25 individuals.

HIN: How can health coaches help to improve care transitions, from hospital to home?

Mike Peterson: Again, going back to their primary role, which is helping people deal with behavior changes, their role in terms of transitions from hospital to home would be to follow up with some of the behaviors that they would need to do, such as out-clinic or out-patient activities. For example, if they just had physical therapy following a knee replacement, it could most likely be due to their being overweight. Health coaches could help them maintain a physical therapy program, and also help them with strategies to lose weight. They would work in tandem with the patient and healthcare professional.

HIN: Where do you see the profession of health coaches in the future?

Mike Peterson: Ultimately, we would like to see health coaches licensed, because too many people now are calling themselves health coaches and not anyone knows what it is. Someone says they’re a health coach and they deal with ADHD and another person says they’re a health coach and they deal with personal training, so they’re basically a glorified personal trainer.

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Infographic: Healthcare Cost Drivers

August 2nd, 2013 by Jackie Lyons

The United States spends approximately $2.7 trillion per year on healthcare. Twelve of the most overused tests and treatments cost the United States $6.8 billion per year, according to a new infographic from California Association of Health Plans. This infographic identifies tests and procedures that should be questioned, the high costs of new technology being implemented, medical inflation versus premium growth, and ways health plans are working to reduce underlying costs of care.

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: Achieving High Value Healthcare: Metrics from Medical Homes, Accountable Care and Case Management.

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Posted in Disease Management, Healthcare Costs, Healthcare Trends, Healthcare Utilization, Infographics, Prescription Drugs, Wellness/Prevention | Comments Off on Infographic: Healthcare Cost Drivers

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