Posts Tagged ‘gaps in care’

Infographic: How the Affordable Care Act Is Changing Medicare

June 19th, 2015 by Melanie Matthews

One of the Affordable Care Act’s lesser known goals is to improve Medicare’s coverage, care and financial outlook, according to a new infographic by the Commonwealth Fund.

The infographic drills down on the impact that the ACA has had on reducing gaps in care, improving chronic care management, emphasizing high-value care and slowing healthcare spending.

11 Profitable Value-Based Reimbursement Models: Lessons from Early AdoptersCMS’s ambitious agenda for moving Medicare into alternative payment models is driving the U.S. healthcare system toward greater value-based purchasing at a furious rate. Private payors also have pledged to continue to shift payments away from fee for service and into alternative payment models such as accountable care organizations (ACOs). Fortunately, many healthcare organizations are already exploring value-based payments—often a single innovation at a time—testing models that reward providers for meeting Triple Aim goals of improving patient experience and population health while reducing healthcare’s per capita cost.

11 Profitable Value-Based Reimbursement Models: Lessons from Early Adopters encapsulates nearly a dozen such approaches, from Bon Secours’ building of a business case for its multidisciplinary care team to the John C. Lincoln ACO’s deep dive into data analytics to identify and manage the care of high-risk, high-cost ‘VIP’ patients to ‘beat the benchmark’ to WellPoint’s engagement of specialists in care coordination.

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6 Key Elements of Population Health Management

May 20th, 2014 by Patricia Donovan

A carefully curated population health management program begins with risk stratification and fosters collaborations with stakeholders that can raise the bar on health outcomes while educating participants about appropriate utilization of services such as the hospital emergency room.

Beyond that framework, for the great majority of respondents to a 2012 survey on population health management by the Healthcare Intelligence Network, this strategy should also encompass health coaching.


With healthcare’s value-based purchasing increasingly favoring a population-centric approach to health management, the top PHM program components cited by respondents are the following:

  • Health coaching: 78.7 percent
  • Provider feedback on care gaps: 46.8 percent
  • Support group: 29.8 percent
  • Telemonitoring: 25.5 percent
  • Other: 23.4 percent
  • Group visits: 19.1 percent

Excerpted from: 57 Population Health Management Metrics: Assessing Risk to Maximize Reimbursement

Using Registries to Improve Population Health

March 5th, 2013 by Jessica Fornarotto

Patient registries help to provide a bigger picture view of a specific patient population, making it easier to identify patients at high-risk and those who need certain tests, states Dr. Gregory Spencer, chief medical officer of Crystal Run Healthcare. Crystal Run’s use of registries has helped patients to maintain their health, including those with poorly controled diabetes, and to identify gaps in care. However, meaningful use does pose some challenges for Crystal Run registries.

Question: What results have you achieved from your registry data?

Response: Early on, we used registries for routine health maintenance issues, specifically for women that were due for a mammogram. We went from about 60 or 65 percent of women getting mammograms early on to the high 80 percent range. Similarly, prostate specific antigens increased to above 90 percent. Registries do work when there is a concerted effort of everybody thinking about these groups of patients, reporting on it on a regular basis and then sharing results with people.

Through our dashboard, we can show people where they stand. We are incorporating more of these registry data into dashboards. People that are due for prostate specific antigens, for instance, are incorporated onto the dashboard. The other more dramatic use has been a list of patients who have diabetes with an A1C greater than 9; very poorly controlled. We use that registry for our quarterly calls. We have a primary care physician who is on a conference call once a quarter with a dietician and an endocrinologist, and we go over the registry of patients who have poorly controlled diabetes. We talk about the patient, look at them in detail and have the dietician reach out to them. We could also have the patient schedule an appointment or have them make a change to their behavior to help them better manage their diabetes. We have had a dramatic improvement in the A1C’s, where currently, poorly controlled is below 9 percent at this point.

Question: Besides mammograms and diabetes, what other measures do you use to identify gaps in care?

Response: We use most of the common quality measures such as mammograms, prostate specific antigens, colonoscopies, and most of the shots specifically for adults such as Pneumovax®, tetanus and flu shot. For kids, we have all the childhood immunizations. We have a program that tracks immunizations as well as high-risk patients with diabetes with A1C’s greater than 9.

And we have good registries. For patients with well-controlled diabetes or hypertension, there are positive and negative lists. If you are going to gather the information, you know where the blood pressure field is kept. You know that there are good quality measures and bad quality measures, and you can leverage that. Then, you have two items to look at rather than just one. We are developing a library of these, and we are going from meaningful use that has many measures in registries that are required and we are working toward that as well.

Question: What lessons have you learned in terms of meaningful use?

Response: We try to keep the measures and the list standard to the quality measures that already exist. We do many of the NCQA clinical quality measures already. The difficult areas that we have are the same that many other companies have. We are having a difficult time getting an extensive clinical summary out to a patient within three days of a visit. Then, there is e-prescribing rates. Depending on the patient population that is served, patients insist on a printed prescription. We told the staff that if they want it printed, they get it sent electronically as well. You need the threshold there.

8 Successes Achieved by Diabetes Management Programs

August 23rd, 2012 by Jackie Lyons

Patient-Centered Diabetes Management: Driving Outcomes with Education and Behavior Change

Large payoffs in patient compliance, patient satisfaction and medication adherence resulted from programs aimed at managing diabetes, according to respondents to HIN’s 2011 “10 Questions on Diabetes Management” survey. In their own words, respondents described the greatest successes achieved by their diabetes management programs:

1. “Our greatest success is knowing the impact we have already made helping our patients, friends and families realize that they are not alone in this battle. We have produced results time and time again, proving this epidemic can be managed.”

2. “Diet and nutritional talks and cooking demonstrations have stirred consciousness and thoughtfulness towards dietary protocols.”

3. “The indigent population we manage through our program has had only one hospital admission for a diabetes-related problem in 2011. That’s impressive!”

4. “Improved mental status and treatment compliance in other spheres.”

5. “High level of patient engagement; increased patient-provider contacts and communication; and reduced hospitalizations and overall costs.”

6. “Significant ROI in one year using randomized control trial (RCT) methodology.”

7. “More knowledge of the condition and decrease in gaps in care.”

8. “Standardization of diabetes management programs, incentives, benefit enhancements and enhanced methods to reach members who opt out of one-on-one nurse coaching.”

2012 Healthcare Benchmarks: Diabetes Management provides more actionable data from the 83 responding organizations on current diabetes management programs and their impact on population health outcomes and healthcare spend.