Posts Tagged ‘EHR’

Community ‘Feet on the Street,’ HRAs Improve Dual Eligibles’ Health

January 14th, 2014 by Jessica Fornarotto

A local approach — the integration of public health with managed care — is what a lot of states and CMS are starting to look for, explains Pamme Taylor, vice president of advocacy and community-based programs for WellCare Health Plans.

In HIN’s special report, Community Care Connections for Dual Eligibles: Closing Social Gaps to Improve Health Outcomes, Taylor describes some of WellCare’s efforts to connect its dually eligible population to health services, including making contact, identifying services for each member and assessing health status via health risk assessments (HRAs) that are part of these community services.

Question: What is WellCare’s strategy and practice for contacting dual eligible members and ensuring follow-through with recommended referrals to community support services?

Response: This question is two-fold; first, how do we reach the members and get them engaged? And second, how do we verify that services were rendered? For members, we have street teams that go out into the community investments. We also have community health workers on our interdisciplinary team. It’s their job to connect with our members on a face-to-face basis while also connecting them to community supports. It’s through that model that we heavily rely on engagement and connectivity, etc.

Our first line of outreach is through the phone; our second line is through the community health workers and the individuals that are ‘feet on the street.’ And then, how do we verify that services were rendered, and how is that data collected? We have a command center, which is the warehouse of all that information, and then the social service electronic health record (EHR), which bolts onto the member’s medical record. That process produces a provider roster that we then put into the hands of our field teams, who use that as part of relationship management, much like a provider relations representative would use in their engagement with the primary care physician (PCP). We meet with them on a regular basis to confirm that services were rendered, and review the successes.

The secondary piece to that is our case managers also reach out to the members that they have referred to services and activities. They verify through the members they received it and their level of satisfaction. So there’s two points of feedback: one from the provider themselves and one from the member.

Question: How do you identify community services to meet members’ needs?

Response: It’s similar to the United Way 2-1-1 directory. We did community health needs assessments, which identified a number of different needs. And using epidemiological information, we come at it in terms of identifying the need, and then determining the service model. Then we took it a step further and asked, ‘How do we define the services so it’s a blend between public health, social supports and managed care terminology?’

We use about 67 different categories of social supports. We turn that into research. We go ‘feet on the street’ to canvas the neighborhoods to make sure that we have all of the organizations represented. Then that’s put into a ‘pend’ status in our databases and it is vetted on a secondary level of review by our team of liaisons. Once it’s vetted and confirmed, it’s then put into the final database, which is used for searching by our case managers. It’s a combination of public health practice using both public health and managed care terminology.

There is no magic number of categories or organizations. No one’s ever systematically inventoried or catalogued the network of social services. That’s what we’re hoping to do — explain and quantify what organizations exist, then identify their service area, their reach, their service portfolio, and the volume of connectivity that the health plans have with these organizations for specific services. It’s an exciting time.

Question: What other components of the comprehensive health assessment are administered to the duals as they come on board?

Response: A number of different factors go into the HRA that’s completed. There are health factors, socioeconomic factors, living environment, and activities of daily living (ADL). What are their social needs, what are their social supports, etc.? There’s a whole number of different tiers of questions that we ask as part of the HRA. We use very specific tools that are either state-dictated or guidelines produced by the state or in partnership with CMS. It depends on which side of the equation that we’re being contracted for, and it depends on what’s already in existence.

New! HIN on SlideShare: 2013 Benchmarks in Accountable Care

December 24th, 2013 by Jackie Lyons

Sixty-six percent of organizations participate in an ACO, according to a new SlideShare presentation from the Healthcare Intelligence Network. This presentation contains charts and data points that depict highlights from 138 healthcare companies’ responses to HIN’s third annual accountable care survey.

Busy healthcare executives may not have time to read an entire benchmarks book, but this quick and easy-to-follow SlideShare presentation offers an exclusive glimpse into some of the most important points of accountable care. HIN will share even more vital healthcare data from various topics on SlideShare in the future.

2013 Benchmarks in Accountable Care from Healthcare Intelligence Network

For more informative healthcare presentations, follow HIN on SlideShare.

You may also be interested in this related resource: 2013 Healthcare Benchmarks: Accountable Care Organizations.

How Taconic IPA Embedded Case Managers Risk-Stratify High-Risk, High-Cost Patients

November 5th, 2013 by Jessica Fornarotto

Using a self-developed approach that combines elements of Geisinger’s Proven Health® Navigator, Johns Hopkins Guided Care Nursing and the Wagner Chronic Care Model, Taconic Professional Resources is assisting physician practices in the New York Hudson Valley to improve population health and care for their sickest patients through the use of embedded RN case managers.

During HIN’s webinar on Improving Population Health With Embedded Case Managers in an Open, Multi-Payor Community, Annette Watson, senior vice president of community transformation for Taconic, described how case managers identify high-risk, high-cost patients.

How does a case manager go in and identify who is high-risk or who is high-cost? You can do it a number of ways, and they can be formal and informal. You can use internal sources and when we do go in, that’s one of the baselines you have to understand. Who are the patients and what is the population? If they have not been using data or have not been in an Advanced Primary Care initiative, it’s highly unlikely that a practice has a quantitative method in place when we arrive.

We begin by asking the practice providers who are the sickest patients? We can then use data that’s available at the practice level, such as registries or reports, that can be run from the EHR. We also look at what kind of data they’re getting from external sources. Are they getting reports from payors that perhaps show some utilization activity?

One thing about many of those reports is that they may be somewhat aged. They’re not necessarily timely, which creates actionable questionability. But we’re finding more and more reports about recent ER use or discharges from payors that are more and more timely that allow the practices to look at data retrospectively in most cases, but much more quickly than they were getting in the past.

And when it comes to hospital admission and discharge information, many times in a primary care practice depending on the model, if they are not the admitting physician, whether it’s a specialist or a hospitalist or someone that comes through the ER, it’s not a given. People think they know about their patients being in the hospital. They don’t always, and that is a challenge and a workflow implementation that we often spend a lot of time on when we get into a practice — how to get the timely information about admissions and discharges.

We also implement new processes in the practice to formally assess the risk of patients using validated tools. In the Hudson Valley, the tool that was easily adopted and modified in a variety of EHR’s is from the American Academy of Family Physicians (AAFP). This tool allows for a quantifiable way to put a risk level on every patient in a practice who is seen, and it changes over time. It’s the kind of tool that when a case manager goes into a practice, we look at risk stratification as an important characteristic of identifying those patients and managing those patients over time.

Infographic: Electronic Health Records Growing in Importance

December 10th, 2012 by Melanie Matthews

The rise of EHRs is one of the most critical evolutions currently occurring in the field of medicine, particularly within the Veterans Administration and Department of Defense health systems.

An IronMountain infographic provides background data on the scope of the VA and DOD EHR system as well as integration challenges.

When the VA and DoD have a fully integrated EHR, they will be able to see the full medical history, creating the Virtual Lifetime Electronic Health Record (VLER).

Electronic Health Records Growing in Importance

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Guest Post: Healthcare Management Enters 21st Century via EMR, Point of Care Technology

September 17th, 2012 by Cheryl Jacque

In today’s post, guest blogger Cheryl Jacque tackles the pros and cons of implementing electronic medical records (EMRs) and point-of-care technology and whether or not they can improve efficiency of patient care without increasing costs to patients. A recent Healthcare Intelligence Network post about the most effective ACO tools and policies supports Cheryl’s claim that despite high initial costs, EMRs and point-of-care technology benefit patients and healthcare providers alike.

The recently upheld Affordable Care Act has been the subject of contentious political debate for the past few years in the United States, and for good reason. By 2019, the annual cost of healthcare is expected to balloon to almost $4.7 billion, or 20.9 percent of Gross Domestic Product (GDP). Though the United States spends more on healthcare than nearly any other industrialized nation, the quality of care often suffers for many, and millions remain uninsured. However, as healthcare management adjusts to a rapidly changing world, many health professionals are not looking to government for improved care and reduced costs, but to technology. Recent advancements like EMRs and point-of-care technologies could expedite care and dramatically decrease costs, perhaps having a more dramatic effect on healthcare than any legislation ever could.

For most Americans, medical data is not confined to one place. General physician check-ups, emergency room visits, even dentistry and orthodontic records are all kept at their respective facility data storage rooms. While hard copies of data will still be kept, EMRs store all of a patient’s medical data in a digital cloud, allowing medical professionals to immediately access and acquire important data from multiple sources and build a more complete and accurate portrait of an individual’s health. “(EMRs help) doctors assess the patient’s status and see exactly how the patient is performing,” said C. Martin Harris, chairman of the Cleveland Clinic Foundation’s technology division, in a 2011 U.S. News and World Report article. “And this information is available in real time.” Having medical records available to multiple specialists can also substantially limit the number of errors on records, and the chance of someone catching a mistake is increased substantially.

While EMR technology offers some clear benefits, opponents point to implementation costs of about $20,000 per physician, initially, nearly 100 percent more than most facilities anticipate, according to a 2011 report by Accenture, and lead to an IT operating cost increase of 80 percent. However, the report suggests that more effective EMR implementation can be achieved by designating a chief medical informatics officer to serve as a bridge between the healthcare IT organization and the hospital’s clinical and business operations.

While EMRs may eventually streamline and connect all of healthcare, information technology at the point of care has provided the most immediate benefit to patients and pharmaceutical companies. Improved payor data sets have rapidly increased the availability of real-world data in healthcare. Both patients and pharmaceutical regulators are anxiously awaiting the impact of this data, with a hope that costs can be driven down substantially while patient safety is protected. Pharmaceutical companies expect the data to aid in characterizing diseases and patient populations, targeting products and services and developing new products and therapies. According to a 2002 literature review on point of care barcode technology by Bridge Medical, at a hospital utilizing point of care, pharmaceutical packages embedded with computer chips were able to eliminate errors and improve efficiency substantially, protecting patient health while leading to annual savings.

While many of these technologies are still in a nascent stage, the potential for increased efficiency and patient safety is readily apparent. The ability for doctors to view a patient’s detailed history, including blood tests, hospital stays and x-rays could prove invaluable, and even life-saving. Once the high initial costs are absorbed, the enhanced ability for patients to communicate with their doctors and medical professionals to communicate with each other could lead to an era of more efficient and accurate medical care than ever before.

Cheryl Jacque is a writer and researcher for The Health Administration Project, an online resource providing valuable and up-to-date information about the health administration field, including education and recent policy changes.

11 Ways to Engage Consumers in Patient Portals

September 5th, 2012 by Patricia Donovan
patient portal

Patient portals increase engagement, support stage 2 meaningful use.

Patient portals are an ideal way to boost patient engagement, a metric getting lots of attention in stage 2 of the federal government’s incentive plan for meaningful use of EHRs. Stage 2, which will begin as early as 2014, increases health information exchange between providers and promotes patient engagement by giving patients secure online access to their health information.

Under the final rule issued last month, organizations vying for meaningful use incentives will not only have to demonstrate the availability of patient portals, but also the percentage of patients accessing health information via these channels.

There are plenty of portals already out there, but how can healthcare companies convince patients and health plan members to use the portal? Problems with portal awareness, functionality and health literacy can sink a portal project before it gets off the ground. In a Physicians Practice podcast, pediatrician Peter M. Kilbridge, a senior research director with The Advisory Board Company, suggests 11 ways to not only engage patients in portal use but also increase the likelihood they’ll return to the tool continually to manage their health:

  1. Make sure patients are aware of the portal. Staff should inform patients about the portal, and brochures and sign-in credentials should be readily available, recommends Dr. Kilbridge.
  2. Highlight functions patients care about, such as the ability to send secure messages or questions and schedule referrals.
  3. If patients aren’t scheduled to come in to the office for an appointment, send them an e-mail or snail mail announcement about the portal.
  4. When building a portal, it’s important that patients get there on the first try. Keep the instructions and path to the portal simple.
  5. Define the physician’s role in this process — the most important role, Dr. Kilbridge emphasizes. “Physicians have a greater ability than anyone else to influence. You must educate the physicians in proper portal use.” Even among physicians, the digital divide is great, he adds. “Show the physicians how the portal will help them — by reducing phone calls, by motivating patients to follow up on test results.” All of these benefits can improve overall clinical indicators for a practice.
  6. Encourage the healthy to use the portal. “Healthy patients will use the portal when it simplifies routine tasks, like making appointments.”
  7. Add health and wellness information, such as links to community activities such as walks or runs, that providers can point to during visits.
  8. For patients with chronic illness, offer logs for them to enter regular data, such as weight o A1C levels, and activate red flags when they reach warning levels.
  9. Pay attention to health literacy levels, making sure the information and tools available from the portal are easy to understand.
  10. Coordinate the portal with other means of patient access, such as a call center or nurse advice line. These groups can also refer patients to the portal for more information.
  11. Coordinate the portal with other communication modalities. “Some portals can be built to interact with texting,” notes Dr. Kilbridge, who estimates that about 85 percent of individuals are comfortable using texting.

What about the elderly? Will they use the portal? “There are always populations that won’t use it — minorities, elders, the less educated.”

But judging from the numbers of grandparents proudly sharing their grandchildren’s photos on social networks like Facebook, expecting them to tackle a patient portal may not be such a stretch.

Healthcare 80/20 Law Saves Consumers Over $1 Billion

June 25th, 2012 by Cheryl Miller

Consumers should check their mailboxes this August

Insurance policy holders just might have some extra spending money this summer.

According to the HHS, insurance companies that don’t meet the 80/20 healthcare rule of spending, which requires them to spend at least 80 percent of consumers’ premium dollars on medical care and quality improvement, and the remainder on administrative costs, must provide their policyholders a rebate for as much as $151 no later than Aug. 1, 2012. Consumers can expect a notice from their insurance company informing them of the 80/20 rule, whether their company met the standard, and, if not, how much of the difference between what the insurer did or did not spend on medical care and quality improvement will be returned to them.

Eligible healthcare organizations have already been reimbursed by the government for adopting EHRs for meaningful use. In fact, the CMS met its goal of getting 100,000 organizations on board with its EHR incentive program three months earlier than planned: more than 110,000 eligible healthcare professionals and over 2,400 eligible hospitals have received over $5.7 billion in payments as of the end of May. The end of 2012 was the original target goal. Officials hope the increasing use of EHRs will provide better patient care, cut down on paperwork, and eliminate duplicate screenings and tests.

Pharmacists could help manage the country’s healthcare costs if the results of a new study from Walgreens prove fruitful. Walgreens pharmacists trained over 4,500 patients starting self-injectable diabetes medication for the first time on appropriate injection technique, side effect management and the importance of adherence to therapy. Pharmacists also provided a follow-up assessment at the patients’ next refill meeting. Initial results showed that patients who received two counseling sessions with a pharmacist were 24 percent more adherent after 90 days and had an additional eight days of therapy compared to a usual care control group.

Employers, too, are looking for ways to keep their costs down, with employee healthcare plans a prime target. A study from J.D. Power and Associates reveals that almost 50 percent of employers might pursue alternate methods of employee healthcare coverage, including defined contributions, vouchers and exchange purchasing. A smaller percentage of fully insured and self-funded employers said they might discontinue sponsoring employee coverage completely. Details in this issue.

And lastly, we have a new survey on asthma management. Asthma drives a lot of healthcare utilization — half a million hospitalizations and nearly 2 million emergency department visits in 2009 alone. We invite you to share how your organization is managing asthma in the populations you serve by July 27, 2012. In return, we’ll e-mail you an executive summary of trends in asthma management.

All this and more in this week’s Healthcare Business Weekly Update.