Posts Tagged ‘COPD’

ROI and 12 More Rewards from Stratifying High-Risk, High-Cost Patients

May 21st, 2015 by Patricia Donovan

Health risk stratification—for example, grouping diabetics in a single physician practice or drilling down to an ACO’s subset of medication non-adherent diabetics with elevated HbA1cs—followed by risk-appropriate interventions can significantly enhance a healthcare organization’s clinical and financial outlook.

For 9.4 percent of respondents to HIN’s 2014 Health Risk Stratification Survey, risk stratification resulted in program ROI of between 3:1 and 4:1, while 6.3 said return on investment was greater than 5:1.

Stratification and targeted interventions also generated a healthy drop in healthcare cost, nursing home stays, ER utilization and time off work while boosting quality ratings, patient engagement levels and care plan adherence.

Survey respondents further quantified successes achieved from health risk stratification in their own words:

  • “„„Decreased readmissions and decreased skilled nursing facility (SNF) utilization.”
  • “Improved treat-to-target for diabetes, blood pressure, and depression care.”
  • “Reduction in readmissions by 20+ percent.”
  • “Reducing heart failure, pneumonia, acute myocardial infarction (AMI) and chronic obstructive pulmonary disorder (COPD) Medicare readmissions.”
  • “Patient compliance to care plan.”
  • “Patient health outcomes, quality of life, and satisfaction with services.”
  • “Member satisfaction.”
  • “More referrals to patient-centered medical homes and fair retention with limited resources.”
  • “Decreased primary care-sensitive ED visits and increased quality metrics.”
  • “One-on-one interaction w/members to promote behavior change.”
  • “A reduction of costs in the range of 6 to 8 percent of target spend.”
  • “Lower readmission rates for those patients on AIM 2.0 program with home health and more compliance with meds. We meet with FQHCs every other month and discuss issues and case management.”

Source: 2014 Healthcare Benchmarks: Stratifying High-Risk Patients

http://hin.3dcartstores.com/2014-Healthcare-Benchmarks-Stratifying-High-Risk-Patients_p_4963.html

2014 Healthcare Benchmarks: Stratifying High-Risk Patients captures the tools and practices employed by dozens of organizations in this prerequisite for care management and jumping-off point for population health improvement — data analytics that will ultimately enhance quality ratings and improve reimbursement in the industry’s value-focused climate.

6 Health Plan Trends in Remote Patient Monitoring

February 12th, 2015 by Patricia Donovan

CHF and COPD are the health conditions most frequently targeted by health plan remote monitoring programs.

Frequent emergency room users, individuals with chronic comorbidities and members recently discharged from the hospital are the populations most often monitored remotely by health plans, according to 2014 market data.

Payors comprised 16 percent of respondents to the Healthcare Intelligence Network’s 2014 survey on remote patient monitoring.

The survey identified the following payor trends in remote care management:

  • Forty percent of health plans said they had a remote monitoring program in place, versus a high of 64 percent for case management and a low of 24 percent for hospital/health systems.
  • Health plans principally rely on case management assessments to identify remote monitoring candidates (80 percent) a fraction more than case management organizations themselves (78 percent). They were also most likely to depend upon direct member/patient referrals—a high of 44 percent versus a low of 0 percent for health plans and a median of 25 percent for hospital/health systems.
  • Health plans were most likely to monitor frequent hospital/ER utilizers remotely (100 percent) versus a low of 55 percent for case management and a median of 75 percent for hospital/health systems. They were also most likely to monitor those patients recently discharged (80 percent) versus a low of 44 percent for case management and a median of 50 percent for hospital/health systems.
  • Of the top five chronic diseases monitored by remote technologies (CHF, COPD, asthma, hypertension, and stroke), health plans were most likely to monitor CHF (100 percent versus a low of 25 percent for hospital/health systems and a median of 89 percent for case management); COPD (100 percent versus a low of 50 percent for hospital/health systems and a median of 67 percent for case management); and asthma (80 percent versus a low of 44 percent for case management and a median of 50 percent for hospital/health systems.
  • In terms of payor challenges associated with remote monitoring, patient education was a strong concern (60 percent) versus a low of 25 percent for hospitals/health systems and a median of 56 percent for case management, as was reliability of self-reported data (60 percent) versus a low of 25 percent for hospitals/health systems and a median of 44 percent for case management.
  • Across the board, all three sectors (100 percent) said telephonic case management was key to remote monitoring.

Source: 2014 Healthcare Benchmarks: Remote Patient Monitoring