Posts Tagged ‘Disease Management’

Infographic: Managing Hemophilia Costs

May 17th, 2019 by Melanie Matthews

Hemophilia treatment costs can vary greatly depending on the severity of disease. Total annual costs up to or more than $1 million per year for individual patients are not uncommon, according to a new infographic by Optum, Inc.

The infographic examines how Optum Inc. is applying consistent management and holistic care coordination for patients with hemophilia.

2019 Healthcare Benchmarks: Reducing Avoidable Healthcare UtilizationMedicaid expansion programs, newly covered individuals under healthcare insurance exchanges, the rise of big data, and shifts in healthcare delivery models have influenced emergency department and hospital utilization.

2019 Healthcare Benchmarks: Reducing Avoidable Healthcare Utilization is a comprehensive analysis by the Healthcare Intelligence Network of how healthcare organizations define and address avoidable healthcare utilization. The report captures key actionable metrics on reducing avoidable healthcare utilization initiatives, challenges, case studies and innovative programming.

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Infographic: Impact of New Hypertension Guidelines

November 27th, 2017 by Melanie Matthews

OM1, an AI health outcomes and data company, has released an analysis on the impact of the new American College of Cardiology (ACC) and American Heart Association (AHA) high blood pressure guidelines. Using the OM1 Intelligent Data Cloud, OM1 performed preliminary analyses to evaluate the impact of the new guidelines on approximately 19 million adults over 20 years of age with more than 120 million blood pressure measurements, who had been seen for a scheduled visit over the last year.

A new infographic by OM1 highlights the findings of this data analysis.

Health Analytics in Accountable Care: Leveraging Data to Transform ACO Performance and Results Between Medicare’s aggressive migration to value-based payment models and MACRA’s 2017 Quality Payment Program rollout, healthcare providers must accept the inevitability of participation in fee-for-quality reimbursement design—as well as cultivating a grounding in health data analytics to enhance success.

As an early adopter of the Medicare Shared Savings Program (MSSP) and the largest sponsor of MSSP accountable care organizations (ACOs), Collaborative Health Systems (CHS) is uniquely positioned to advise providers on the benefits of data analytics and technology, which CHS views as a major driver in its achievements in the MSSP arena. In performance year 2014, nine of CHS’s 24 MSSP ACOs generated savings and received payments of almost $27 million.

Health Analytics in Accountable Care: Leveraging Data to Transform ACO Performance and Results documents the accomplishments of CHS’s 24 ACOs under the MSSP program, the crucial role of data analytics in CHS operations, and the many lessons learned as an early trailblazer in value-based care delivery.

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5 Trends in Chronic Care Management by Physician Practices

March 17th, 2015 by Cheryl Miller

One hundred percent of physician practices rely on face-to-face and telephonic visits to administer chronic care management (CCM) services, according to respondents to the Healthcare Intelligence Network’s 10 Questions On Chronic Care Management survey administered in January 2015.

A total of 119 healthcare organizations described tactics employed, 17 percent of which were identified as physician practices. A sampling of this sector’s results follows.

  • Less than half of physician practices (46 percent) admitted to having a chronic care management program in place. But they overwhelmingly agree (100 percent) that CMS’s CCM initiative will drive similar reimbursement initiatives by private payors.
  • This sector’s criteria for admission to existing chronic care management programs is on par with other sectors except for asthma; just 17 percent of physician practices use this as an admitting factor versus 49 percent of all respondents.
  • Not surprisingly, this sector assigns major responsibility for CCM to the primary care physician, versus 29 of all respondents. This sector also relies on healthcare case managers (40 percent versus 29 of all respondents) and advanced practice nurses (APNs) (20 percent versus 8 percent overall) to assist with CCM.
  • This sector relies most heavily on face-to-face visits for CCM services (100 percent versus 71 percent for all respondents) and telephonically (100 percent versus 87 percent of all respondents).
  • Among the biggest challenges for this sector is reimbursement (33 percent versus 20 percent overall) and documentation (17 percent versus 2 percent overall). Unlike other sectors, patient engagement is not a major challenge (17 percent versus 33 percent overall).

Source: 2015 Healthcare Benchmarks: Chronic Care Management

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.

Registries Identify High-Risk Patients, Support Evidence-Based Protocols

January 6th, 2015 by Cheryl Miller

Obtaining a clear snapshot of a patient population is the first step in managing health outcomes in an accountable care organization (ACO), says Gregory Spencer, MD, FACP, chief medical officer with Crystal Run Healthcare. Registries are a major part of that, and at Crystal Run Healthcare, care managers use them to identify high-risk patients, implement evidence-based protocols, and coordinate care inside and outside the office.

We have used care managers for about seven years. Groups of nurses use our registries to identify high-risk patients and implement evidence-based protocols. We have used an EHR, and we use e-mail and Blackberries ® extensively within our practice so that when we have a new development, we can get the word out quickly to mobilize people or alert them that certain things are happening. Registries are a major part of this: getting your list of people with a high-risk condition.

Our care managers are nurses that pull the list of patients from the registry using evidence-based guidelines. They contact them, make sure they get certain things done that they need to have done, and smooth those efforts. They do care planning and then communicate with the patients outside of the office. We are also embedding a care manager at a few of our sites to try and catch patients while they are in the office as well.

The template we use is pretty basic. It keeps track of the patient’s last test, and includes certain results so that if the patient has a question or is due for some lab work, the care manager can quickly order it. If it’s not protocol-driven, they can send it to the physician for review or potentially do it themselves if we are able to cover it with a protocol. This is one way we use registries of patients who require referral tracking.

Again, workflow is the Achilles heel of some brilliant quality efforts. You don’t want to destroy your workflow and patient flow. Not to say that you can’t redesign your workflow if it is important, but this process can end in tears. Sometimes if the change is not well thought out, it has negative effects on workflow.

Source: Population Health Management Tools for ACOs: Technologies and Tactics to Support Accountable Care

Population Health Management Tools for ACOs: Technologies and Tactics to Support Accountable Care examines the building blocks of population health management that drive improvements in healthcare quality and efficiency in ACOs — while positioning healthcare organizations for core measure improvement and increased reimbursement. In this 40-page resource, Dr. Gregory Spencer, chief medical officer of Crystal Run Healthcare, demystifies registry use and shares patient registry best practices.

12 Core Competencies for the Hybrid Embedded RN Care Manager

December 30th, 2014 by Cheryl Miller

Core competencies for a registered nurse (RN) are different than those for an RN care manager, says Mary M. Morin, RN, NEA-BC, RN-BC, vice president, nurse executive with Sentara Medical Group. When Sentara officially converted to a hybrid embedded case management model, RN care managers’ job descriptions had to be rewritten; to be successful in this new model, they didn’t necessarily have to have care management experience; instead, having a strong clinical background and experience doing patient assessments were more important.

To get RN care management away from the embedded telephonic model, we had to rewrite the job descriptions, and if you’re going to rewrite job descriptions, have a new position. This is different work.

We found out people will hear it, but until they go through it, until they feel it, they’re all for it until it actually happens. If I were to do this again, I would make everybody reapply for their job because this requires a certain type of individual. These people need to be able to engage patients for a long-term relationship. They have to know how to work with hospital-based caregivers, home health, life care and not just within our own healthcare system.

We established core competencies. Core competencies for an RN care manager are different than those for an RN. We have an ambulatory-based RN. We were looking for people that didn’t necessarily have previous care management experience, but who had experience doing patient assessments. They also had to have a strong clinical background.

Following are 10 more core competencies for the hybrid embedded RN care manager:

  • Job descriptions: BSN requirement
  • Maintain patient lists by populations
  • Accept assignments
  • Meet expectations
  • Send patient letter from primary care physician (PCP)
  • Engage patients
  • Send contact letter, brochure
  • Standardize work flow
  • Use SMG, Optima (Health Plan), and clinically integrated network (CIN) electronic medical record (EMR)
  • Hold meetings with home health and inpatient care coordinators
  • Complete education/training
  • Achieve specialty certification

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

11 Statistics About Remote Patient Monitoring

December 23rd, 2014 by Cheryl Miller

Remote monitoring of individuals with multiple chronic conditions reduced hospitalizations, hospital readmissions and ER visits for more than 80 percent of respondents and boosted disease self-management for nearly all of these monitored patients, according to the 119 respondents who participated in the Healthcare Intelligence Network’s inaugural survey on Remote Patient Monitoring in March 2014. Other targets of a remote monitoring strategy included frequent utilizers of hospitals and emergency rooms (ERs) (62 percent) and the recently discharged (52 percent).

Following are seven more statistics from the Remote Patient Monitoring survey:

  • Fifty percent of respondents rely on specific diagnoses sets to identify candidates for remote monitoring.
  • More than a quarter of respondents (27 percent) target the frail and/or home-bound with remote monitoring programs.
  • Reimbursement for remote monitoring, followed by the education of patients in this technology, were identified by respondents as the chief challenges of these remote care management efforts.
  • Two-thirds of respondents said remote monitoring reduced bed days.
  • Telephonic case management is a component of remote monitoring efforts for 71 percent of 2014 respondents.
  • About a third of respondents report the use of either a Web interface or a dedicated mHealth app to supplement remote monitoring.
  • A patient-centered touch, such as a follow-up phone reminder to use a monitoring device or a personal coaching session, was frequently cited as a noteworthy supplement to remote monitoring technology.

Source: 2014 Healthcare Benchmarks: Remote Patient Monitoring

2014 Healthcare Benchmarks: Remote Patient Monitoring delivers a comprehensive set of metrics from more than 100 healthcare organizations on current practices in and ramifications of remote monitoring for care management of chronic illness, the frail elderly and remote populations.

11 Statistics about Stratifying High-Risk Patients

November 20th, 2014 by Cheryl Miller

Healthcare organizations use a range of tools and practices to identify and stratify high-risk, high-cost patients and determine appropriate interventions. Most critical to the stratification process is clinical patient data, say an overwhelming 87 percent of respondents to the Healthcare Intelligence Network’s (HIN) inaugural survey on Stratifying High-Risk Patients. However, obtaining and verifying patient data remain major challenges for many respondents. Following are 10 more statistics from our survey.

  • „„Hospital readmissions is the metric most favorably impacted by risk stratification tools, according to a majority of respondents.
  • „„In addition to high utilization, clinical diagnosis is considered a key factor in stratifying high-risk patients, according to 16 percent of respondents.
  • „„Case management as a post-stratification intervention is offered by 83 percent of respondents; health coaching by 56 percent.
  • Reducing heart failure (HF), pneumonia (PN), and atrial myocardial infarction (AMI) are among the greatest successes of risk stratification programs.
  • Diabetes is considered the prominent health condition among high-risk populations, according to 37 percent of respondents; other prominent conditions include hypertension (20 percent) and mental health/psychological issues (15 percent).
  • Physician referrals are cited by 76 percent of respondents as an important input for stratification, followed by case/care manager referrals (71 percent).
  • „„Home health and/or home visits are available to risk-stratified populations of 56 percent of respondents.
  • „„LACE (Length of stay, Acute admission, Charleston Comorbidity score, ED visits) is considered the primary indice and screen to assess health risk, according to 33 percent of respondents.
  • Nearly half of respondents (45 percent) cite high utilization of the emergency department (ED) or hospital as the most critical attribute of high-risk patients.
  • „„While more than half of respondents have a program in place to identify and risk-stratify complex cases, the majority admit it is too early to tell the ROI achieved.

Source: 2014 Healthcare Benchmarks: Stratifying High-Risk Patients

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.

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

Collaboration, Medication Reconciliation, Yoga Key to Successful Population Health Management

January 30th, 2014 by Cheryl Miller

Zumba, yoga, Thank God it’s Free Fruit Friday (TGIFF)?

Maybe not top-of-mind elements of accountable care, but all three are helping healthy employees to stay healthy, and luring others to engage in their own health self-management, the keys to successful population health management (PHM), says Elizabeth Miller, vice president of care management at White Memorial Medical Center, part of Adventist Health, in a recent webinar at the Healthcare Intelligence Network.

In Managing Risk in Population Health Management, Ms. Miller shared the key features of the PHM program at White Memorial, the program’s impact on Adventist’s 27,000 employees and how the program was being rolled out to its patient population.

By incorporating elements of the Triple Aim, and collaborating with all stakeholders, including patients, providers, health plans, employers, hospitals and local community members, a PHM program can achieve optimal outcomes, including minimizing the need for ED visits, lowering costs, maintaining and improving individuals’ health across the continuum of care, and reducing readmissions, Miller says.

Medication reconciliation plays a key part in preventing populations from being admitted or readmitted to the hospital, Miller continues, because it is one of the chief causes for readmission. She cites numerous instances where nurse practitioners go into people’s homes to do medication reconciliation only to find that they are going to two cardiologists simultaneously and taking medications from both of them, not realizing how detrimental it is to their health.

Elements of the PHM program include using robust data sets, risk stratification, and predictive modeling to identify populations, and target high-risk individuals with one or more chronic diseases, including the top five: coronary heart failure (CHF), chronic obstructive pulmonary disease (COPD), asthma, diabetes, HIV. Once eligible populations are targeted and enrollment criteria met, analytics, intervention and program development are established for the top 5 percent, or very high risk, and 10 percent, or high risk, and then wellness programs for the 85 percent, or medium risk.

Ongoing assessments and evaluations of interventions follow, usually by care managers, including periodic reassessments of goals, and measuring outcomes with set metrics.

The goal of any PHM plan is to eventually graduate patients by setting up decision support and self-management tools that will help them do so. Offering employees the right incentives is a key contributor to this. White Memorial was able to engage 95 percent of its employee population in a PHM program by reducing monthly insurance premiums by $50 a month. That percentage grew to 98 percent when the reductions were extended to employees’ spouses,’ Miller says.

Ultimately, says Miller, “we really want to focus on the population and modify the behaviors so that we prevent illness in the future. Right now we have a disproportionate investment in illness after it has already occurred. Once it has occurred, it’s difficult to manage and treat…Our goal is to keep the population as healthy as possible.”

It can be labor intensive, Miller points out, but the outcomes are worth it. Improved health status leads to improved performance, and projected financial savings of $49 million by 2017.

Guest Post: Group Health Coaching Improves Healthy Habits, Patient Wellness

January 10th, 2014 by Megan Coatley

Group health coaching is an evidence-based, cost-effective way to help individuals achieve their wellness goals.

For patients or health plan members who have trouble losing weight, getting active, or adhering to their doctor’s or nutritionist’s advice, it might be time to consider group health coaching. Studies show that group health coaching is an evidence-based, cost-effective way to support individuals in succeeding in their wellness goals.

Group coaching combines the following key elements in order to boost participants’ success and goal achievement:

  • Guidance from a behavior specialist to help participants break wellness goals into manageable steps and create a clear, actionable path to success.
  • Hands-on lessons about the science of habit change and take-home activities so that participants can immediately apply the information in their own lives.
  • Connections with others who share the value of healthy living, and are on a similar wellness journey, so that participants can draw strength from supportive peers.
  • Frequent celebration of accomplishments and specific praise and feedback from the health coach for participants’ small steps toward overall wellness.
  • Regularly scheduled group sessions that build in accountability and keep participants committed to healthy change.

Physicians Promote Group Coaching for Patient Wellness

Individuals managing a chronic illness shouldn’t have to struggle alone. Luckily, group health coaching is an up-and-coming model of care that physicians are using to help patients create a community where they can connect with others and learn to thrive.

With the rise in chronic illness, there is a great need for patient-centered care that addresses lifestyle factors, increases patient education, and supports self-management of healthy habit change. Group medical visits are a relatively new model of patient care that allow physicians to deliver more comprehensive patient education and self-management instruction. During a group visit, 10 to 20 patients with similar chronic problems, such as diabetes or coronary artery disease, meet together with their physician to get a regular check-up and also discuss personal goals and barriers to treatment. Group visits offer patients with similar conditions more face time with their physician and also provide the opportunity to learn from and support one another in achieving wellness goals.

So, how does behavioral health coaching fit into the medical group visit model? Typically, the physician meets with the group to conduct the necessary elements of an individual patient visit (e.g., collection of vital signs, history taking and physical exam), and then a behavior specialist facilitates the educational component and group discussion, and addresses each patient’s psychosocial concerns.

With input from the physician, the behavior specialist spends the majority of the group visit covering topics such as medication management, stress management, exercise and nutrition, and community resources. He/she will also field questions and concerns from participants and offer suggestions and advice that applies directly to their particular situations at home. The group coach will also spend time helping each patient to create behavior-change action plans and set personalized goals that they aim to accomplish by the next session. Patients’ family members can also be included in these group sessions so that everyone is better informed and more committed to healthy change.

Organizations Consider Health Coaching for Employee Wellness

As an employer, your employees are your organization’s MOST important resources. We all know that effective wellness programming can help reduce employee sick time, decrease in staff turn over, improve work satisfaction, and increase staff productivity. And, group health coaching can be a key component in successful, employee-centered wellness programming.

When considering group health coaching for employees, there are several other metrics that could be analyzed to prove return on investment. Outside of the old standard of participation and number of unique users, employers are encouraged to track more customized measures that reflect the unique culture of their organizations. Some examples of these customized metrics might include:

  • Percentage of participants who meet their self-determined goals each week
  • Type of goals that are set (This information can be utilized to inform future site-specific wellness programming.)
  • Number of healthy behaviors that generalize outside of the program
  • Percentage of participants who enroll in additional employee wellness services and programs during/after group coaching
  • Percentage of participants that continue self-determined goal-setting after the program ends
  • Number of longer-term connections formed within the group (Employees who build a supportive network of peers are more likely to report job satisfaction.)
  • Perception of their power to change health habits before and after course
  • Productivity in the workplace during and after the group coaching program (Workplace productivity is often linked to healthy lifestyle change.)

An added benefit of group health coaching, as opposed to self-paced, independent employee wellness programs, is that it is a highly engaging program, led by a qualified professional. In building relationships with participants, the group coach can identify those who could benefit from additional supports and refer them for further medical or mental health consultation. The group coach can help employees overcome hurdles to preventive care by demystifying the health risk assessment and the process of reaching out for additional help. The same connections cannot be made via online gaming wellness programs or self-paced weight loss or walking challenges.

Group health coaching is effective and cost-efficient for individuals, families, patients with chronic illness, and employees. A health coach provides important education, tools and strategies for lasting change. And the added bonus of working with a group of peers means that individuals are more likely to stay engaged and accountable in the long run. For those keen to commit to healthier lifestyle habits, consider group health coaching to boost their chances of success.

Not sure whether group coaching is a good fit for your patients or members? Set aside your stereotypes of stale, boring support groups. Coaching circles can take the form of a hike, wine night, coffee shop chat, or an office party, and can incorporate an activity and location that is easily accessible (and even fun!) for participants. The group coach can lead dynamic lessons about the science of habit change, guide participants in health-focused goal-setting, and then open the floor for dynamic discussions about participants’ personal desires, motivations and barriers.

Megan Coatley, MA, BCBA, CPT, is the founder of SPARK Behavior Solutions, LLC, located in Boulder, Colorado. As a board certified behavior analyst and health coach, she specializes in teaching others the principles of behavior science, so that they can create lasting healthy habit change. The strategies she teaches participants during SPARK Coaching Circles help her clients to master healthy nutrition, fitness, stress management, and work/life balance. She partners with local physicians to provide group health coaching for their patients, offers individual sessions in-person and via phone and Skype, and also teaches employers to lead wellness coaching groups, so that organizations can continue boosting employee wellness long after her consultation ends.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.