Posts Tagged ‘patient-centered care’

Infographic: From Volume to Value: Designing a Patient-Centered Health System

March 9th, 2016 by Melanie Matthews

Healthcare payment and delivery models have come a long way, according to a new infographic by Astellas Pharma US, Inc.

But are they truly patient-centered? The infographic lays out a timeline of the move toward a value-based system and the key to making the system truly patient-centered.

Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and MethodologyIf one trend has transformed the healthcare industry post-ACA more than any other, it is the market’s new business model rewarding value over volume.

Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and Methodology provides a framework for healthcare’s new value proposition, with advice from thought leaders steeped in the delivery and reimbursement of value-based care.

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Infographic: Connected Care

November 9th, 2015 by Melanie Matthews

As the healthcare industry makes the shift to patient-centric care, where the secure delivery of reliable information to patients and their families can be sent and consumed in seconds, consumers can expect to see faster coordination of healthcare logistics and improved access to patient information and collaboration with healthcare providers, according to a new infographic by Cisco.

The infographic looks at how healthcare organizations are delivering connected healthcare experiences.

Connected Care

Despite reimbursement challenges, the healthcare industry is charged up about remote patient monitoring to manage chronic illness: two-thirds of respondents to HIN’s 2015 Telehealth and Telemedicine survey monitor high-risk patients in this fashion. Encouraged by early success in coaching 23 patients to wellness at home via remote monitoring, CHRISTUS Health expanded its remote patient monitoring (RPM) enrollment to 170 high-risk, high-cost patients. At that scaling-up juncture, the challenge for CHRISTUS shifted to balancing its mission of keeping patients healthy and in their homes with maintaining revenue streams sufficient to keep its doors open in a largely fee-for-service environment.

Remote Patient Monitoring for Chronic Condition Management: Leveraging Technology in a Value-Based System chronicles the evolution of the CHRISTUS RPM pilot, which is framed around a Bluetooth®-enabled monitoring kit sent home with patients at hospital discharge.

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WellPoint ‘Leaves No Primary Care Practice Behind’ on Road to Value-Based Payment Reform

November 4th, 2013 by Patricia Donovan

To foster its ambitious goal of moving 75 percent of its physician practices from visit- to value-based reimbursement over the next three years, WellPoint has placed a variety of resources at the practices’ disposal.

Building on its successes with the patient-centered medical home, a model it has deployed since 2008, WellPoint is transitioning its practices from a fee-for-service world to one that rewards doctors when they improve both the quality and affordability of the care they provide. The payment reform starts with a care coordination fee for activities that are not “visit”-based. Once physicians meet an established quality gate, they are eligible to share in any savings achieved.

Supports for providers in WellPoint’s 14 markets as they transition to the new payment system are designed to meet the needs of all its practices, explains Julie Schilz, director of care delivery transformation for WellPoint — from small individual practices to large integrated health systems.

“We have a ‘Leave No Primary Care Practice Behind’ philosophy,” said Ms. Schilz. “Some practices have wonderful systems or enhanced capabilities, like a Patient-Centered Medical Home recognition. How we bring ourselves to these practices certainly looks different than [our presentation to] a practice just starting on its transformation journey.”

Resources range from toolkits, Web-based care delivery software and a learning collaborative that offers live and recorded training sessions and virtual “call-in” hours to access to three consultants with distinct areas of expertise.

During a recent webinar on Aligning Value-Based Payment with Physician Practice Transformation, Ms. Schilz described how the three consultants assist the practices virtually, via site visits or by curating content for the learning collaborative:

  • The Provider Clinical Liaison helps practices develop essential care coordination and care management skills, such as developing a care plan, and also acts as the interface between the primary care provider and WellPoint.
  • The Community Collaboration Manager helps providers make sense of reports and data and get on track for transformation, while contributing to learning collaborative content.
  • The Patient-Centered Care Consultant works with practices to boost quality improvement efforts and connect providers to community tools and resources.

To maximize a practice’s financial rewards, providers must routinely mine patient data to identify opportunities to improve care. WellPoint’s nine separate reports available to care teams tabulate everything from no-longer-active patients to a practice’s “hot spotters” — patients at risk of readmission or whose chronic illness history turns up glaring care gaps.

While primary care practices acclimate to the new payment model, WellPoint is simultaneously participating in Comprehensive Primary Care initiatives in four states, a program whose value-based focus meshes well with WellPoint’s ongoing payment transformation.

Calling patient-centered care “the new normal,” Ms. Schilz said WellPoint is also laying the foundation for construction of medical home neighborhoods. Expected to launch in 2014: WellPoint’s first iteration of patient-centered specialty care (PCSC). This limited venture, which encompasses four key areas, will expand care coordination to a few willing specialties: cardiology, endocrinology and OB-GYN.

“We will start the dialogue between specialists and primary care to talk about how we assure that our patients are flowing back and forth from our offices in an effective way.”

Click here to listen to an interview with Julie Schilz.

SNF Community Partnership Shores Up Accountable Care

October 1st, 2013 by Jessica Fornarotto

To support ACO construction, industry thought leaders advise hospitals to monitor what goes on across its care continuum and to partner with facilities it discharges its patients to most often to reduce 30-day readmissions. A prime example is the skilled nursing facility (SNF) network coordinated by Summa Health System, discussed here by Carolyn Holder, manager of transitional care for Summa Health System, and Michael Demagall, administrator of Bath Manor & Windsong Care Center.

(Carolyn Holder) We have been working on a pilot model for accountable care. Accountable care is the focus on primary care wellness in population health. Patients and families need to be actively engaged in this process. It coincides with having the right level of care provided to the patient where they need it, and that is what we are talking about with accountable care. You need partnering relationships between hospitals and physicians and through all levels of care to be able to support that individual in their wellness or illness effectively.

What is the value of this care coordination that worked in the accountable care model of care? It relates to the Triple Aims and looking at providing safe, patient-centered, timely care. We are collaborating to do that with our partner facilities. We have been working at improving health and patient populations in communities. Patients in this situation need rehab, so they have had some functional impairments and frailty. We are trying to get them back to their optimal level of function. To do this, we partner with our SNFs to support that level of care and lower the per capita cost of healthcare.

We also work with community-based long-term care. That has certainly not taken away from any of our nursing facilities any patients that are appropriate or keeping them in the optimal function that they would want.

(Mike Demagall) Through this development of the ACO on the skilled nursing side in working with the hospitals, one thing we focused on was the key indicator comparisons for our 2010 data.

Along with the hospital, we will provide standardized numbers of information that we can get back, that we are going to be held accountable for from the SNF side. The hospital knows what we do is safe and efficient, patient-centered and equitable for everybody involved. As we move forward with the ACO through care coordination, we will look at numbers and information that we can share as a community with the health system so they know what the facilities are doing. There are many reasons that is done, but one of the greatest accomplishments is everybody working together.

Out of 39 homes in the county, the collaboration has been incredible. Initially there was some hesitation, but the collaboration has moved forward, and we are not afraid to share that information. The information is blocked and as we provide information back, it will be blocked from other members except for the hospital, who knows who those numbers are. However, from my facility, I may see a readmission rate at one facility lower than ours although we have the same type of case mix index. I need to look at our facility and ask, “What can we do to get better? What are they doing that we aren’t?” Therefore, everybody gets better as a group, and that is ultimately the goal of the community and the health population in the community we serve.

4 Ways Aetna Identifies Cases for Compassionate Care Outreach

August 5th, 2013 by Jessica Fornarotto

People often think about an oncology diagnosis first when considering advanced illness care needs. However, Aetna’s Compassionate Care program benefits individuals across the advanced illness spectrum and across the disease spectrum — lots of patients with kidney disease, CHF, COPD and other diagnoses can and do participate, explains Dr. Joseph Agostini, senior medical director of Aetna Medicare.

During HIN’s webinar, Advanced Illness Care Coordination: A Case Study on Aetna’s Compassionate Care Program, Dr. Agostini listed four ways Aetna identifies cases for the Compassionate Care program, specialized case management that provides additional holistic and patient-centered care and support not only to Aetna Medicare members with advanced illness but to their families and caregivers.

Case identification is important for the Compassionate Care Program; you need to identify who you’re going to help. We have four ways to do this:

First, we have a claims-based algorithm that helps to identify and predict members using diagnoses that we know about and other informational data to identify patients with early to mid-stage advanced illness. This way we can reach out to them and engage them early in the process.

Not everyone has an identifiable condition prior to end-of-life, so the algorithm is never 100 percent. But it gets us there to create a cohort of patients we know are really in need. For those without a predictive algorithm, most clinicians should be able to construct a list of diagnoses and diseases to identify a potentially eligible cohort who would benefit from services in advanced illness care.

The second way we identify members for the program is through the assessments and clinical judgments of Aetna case managers. We reach out to many members — nearly one in five on an annual basis — and through those conversations we identify patients at a certain stage in illness who could benefit from engaging with a nurse case manager for their advanced illness needs.

The third way is through direct referrals from physician offices. Sometimes we get direct calls, and sometimes we have an Aetna Medicare nurse embedded in that practice who works side by side with the provider group or healthcare system and generates direct referrals.

The last way we identify cases is via self-referrals; an Aetna patient may call about another issue. We identify through the questions they’re answering whether they could have a potential need for an advanced illness-related concern.

One important thing is that our program is not designed around any one particular diagnosis. Some patients have multiple comorbidities, particularly in the Medicare population. Managing the whole person is key.

Infographic: Dissecting Patient-Centered Care

July 24th, 2013 by Jackie Lyons

Patient-centered care is evolving, and healthcare providers are redirecting their focus to meet the unique needs of every patient.

Beginning this year, 30 percent of hospital Medicare reimbursements will be determined based on patient experience, according to a new infographic from the University of Arizona College of Nursing. This infographic also details healthcare reform’s effect on nursing professions, the need for advanced nursing education, chronic illness in the United States, switching from disease-centered to patient-centered care, and more.

Dissecting Patient-Centered Care

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You may also be interested in this related resource: Improving Patient Care: The Implementation of Change in Health Care, 2nd Edition.

4 Benefits of Online Health Communities in Chronic Care Management

July 12th, 2013 by Jessica Fornarotto

Can blogs, chats and forums replace a cadre of skilled healthcare providers? Probably not, but they can contribute to information exchange, self-management and collaboration among physicians.

Flummoxed by the rapid aging of Western societies, the scarcity of skilled providers to care for people with complex healthcare needs, and the threatened unaffordability of care, researchers recently looked at the use of online health communities (OHCs) as a tool to address some of these challenges.

The OHCs are Internet-based platforms that unite either a group of patients, a group of professionals, or a mixture of both. Members interact using modern communication technologies such as blogs, chats and forums.

There are four benefits to using OHCs in chronic care, according to researchers from the Journal of Medical Internet Research (JMIR):

  • Facilitate the Exchange of Medical Experience and Knowledge: Due to rapid advances in medical knowledge, many health professionals lack specific expertise and experience to address complex healthcare needs. Therefore, healthcare is increasingly organized within specialized networks whose processes occur largely offline during physical encounters, such as medical conferences.

    However, modern communication technologies now support professional networks online. Within OHCs, professionals connect and communicate more easily, regardless of their working place within the network, and regardless of time. OHCs can be used to develop disease-specific expertise among all community members, patients and professionals interested in a particular chronic condition.

  • Enhance Interdisciplinary Collaboration Across Institutions and Traditional Echelons: Healthcare delivery can become fragmented for chronic patients when they acquire relationships with multiple professionals and institutions. To manage complex patients with multiple comorbidities, health professionals must collaborate to make coordinated decisions and share responsibilities in health outcomes.

    OHCs offer a platform for supporting medical decision-making and interdisciplinary collaboration across professionals caring for complex patients. OHCs enable communication between community members, bridging geographical distances and enable interaction across institutions and traditional echelons.

  • Provide a Platform to Support Self-Management: Typically, patients have a passive role and lack the tools to self-manage their condition. However, modern patients search the Internet for medical information, wish to have open communication channels with their physicians, and prefer to participate in making treatment decisions. Supporting patients with chronic diseases like type 2 diabetes, arthritis, and asthma to self-manage their condition helps to improve the quality and safety of care and reduces costly and inappropriate use of healthcare resources.

    Chronic patients using online communication tools become more knowledgeable, feel better socially supported and empowered, and have improved behavioral and clinical outcomes compared to nonusers. Examples that include OHC principles are patient participation in online peer support groups and access to personal health communities (PHCs). PHCs allow patients to have access to medical records, control their own online information, and enable individualized health communication.

  • Have the Ability to Improve Patient-Centered Care: Patient-centeredness is about engaging patients to become active participants in their care to reduce healthcare utilization and improve efficiency, patient-doctor communication, treatment compliance, and health outcomes. OHCs enhance patient-centered care by improved access to personalized information, emotional support and patient participation.

    PHCs are essentially patient-centered, while they engage patients in their care process and tailor care to their individual needs. Professionals can benefit from patient peer-to-peer conversations that take place in OHCs by knowing that they have more effectively addressed their patients’ needs. Blog and forum items often involve aspects of patient-centered care, such as information and emotional support needs, patients’ willingness to participate in treatment decisions, or an experienced lack of continuity of care.

The researchers concluded that OHCs are a powerful tool to address some of the challenges chronic care faces today. Further evaluation should address user needs, risks, benefits, and cost implications before OHCs can be fully adopted in daily practice.