Posts Tagged ‘patient safety’

Infographic: Patient Matching Errors

July 21st, 2017 by Melanie Matthews

Mistaken identities and unmatched patient healthcare records can have serious consequences, according to a new infographic by The Pew Charitable Trusts.

The infographic looks at common patient matching problems and the impact on healthcare quality and costs.

The Science of Successful Care Transition Management: Leveraging Home Visits to Improve Readmissions and ROIA care transitions management program operated by Sun Health since 2011 has significantly reduced hospital readmissions for nearly 12,000 Medicare patients, resulting in $14.8 million in savings to the Medicare program.

Using home visits as a core strategy, the Sun Health Care Transitions program was a top performer in CMS’s recently concluded Community-Based Care Transitions (CBCT) demonstration project, which was launched in 2012 to explore new solutions for reducing hospital readmissions, improving quality and achieving measurable savings for Medicare.

The Science of Successful Care Transition Management: Leveraging Home Visits to Improve Readmissions and ROI explores the critical five pillars of the Arizona non-profit’s leading care transitions management initiative, adapted from the Coleman Care Transitions Intervention®.

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Infographic: Reducing the Risk of Medical Errors in Healthcare

February 1st, 2017 by Melanie Matthews

Medical errors cause more than 250,000 deaths annually, a problem that can be addressed by leveraging modern technologies to coordinate care efforts and ensure stakeholders have all the data they need to keep patients healthy. Simple data management errors can lead to mistakes that put patients at risk, according to a new infographic by Appian.

The infographic provides details on why data plays such a major role in medical errors and best practices for improving quality of care.

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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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

3 Ways to Use Registries to Close Care Gaps

September 3rd, 2013 by Jessica Fornarotto

There are many benefits to registries, including identifying groups of patients who require certain tests, as well as those who are at high-risk, says Dr. Gregory Spencer, chief medical officer of Crystal Run Healthcare. Dr. Spencer also explained how registries are useful for identifying gaps in patient care in three areas: health maintenance, disease management and quality measures.

Health maintenance looks at who is due for what and when, based on a subset of people that you are looking at. The lines blur as to why this registry is different than just saying it’s everybody over 50; it’s the same thing. That is part of the demystification of registries; you are doing this already in the areas of health maintenance, quality measures and then disease management (DM). The two registries that we often use are for patients with diabetes — first, those that are poorly controlled, and second, patients on Coumadin®, because they are very high risk for serious health events.

In using the registries in our practice, we have 12 clinical divisions. Each one is headed by a physician from that specialty. Quality efforts and information is dealt with on the front line there. We have a quality committee that works with the divisions to develop these registries and then implement them for quality efforts. We then have a higher practice-level committee for quality and patient safety. In addition to clinical people, there are also facilities people and the billing office, to name a few. This way, we have a more broad-based view of these data.

We try to collect necessary data only once and not have people re-enter things. Use data over and over and over. If you gathered it and spent the effort, you might as well try to use it for many purposes.

For our quality measures, we collect what we can easily measure and there are repeated themes. We involve the IT team early and often. The more specific you can be, the better; they will want detailed specifications. But at the same time, if you spend a lot of time thinking about something and it turns out to be completely undoable, you wasted some of your time, too. Having a good relationship with somebody who can work with you on the back end is important because they help shape that.

Also, know where the data is kept and entered. This requires somebody that knows your system, hopefully somebody in-house who has gotten to know it, perhaps a vendor. It has been very useful for us to have somebody who can work as a clinician. In our practice, that is me. I am also the chief medical information officer, so I meet with the IT experts all the time. I am able to act as an information broker. I can rephrase questions if there is confusion, and then also assure that the data coming out is appropriate. You need somebody that can talk the talk and make sure that the right information is being delivered and gathered.

Infographic: Reducing Catheter Infections

February 1st, 2013 by Melanie Matthews

Central line catheters are commonplace for intensive care unit patients. Approximately 48 percent of all intensive care unit patients have catheters at some point during their hospital stay in the United States.

Central lines, like any venous catheter, disrupt the integrity of the skin, which can lead to bloodstream infections: studies show that 90 percent of catheter-related bloodstream infections occur with central lines, making proper catheter insertion and maintenance an important patient safety area to address.

In this infographic by Curos, see what your organization can do to reduce the chances of catheter-related bloodstream infections.

Catheter Infections

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You may also be interested in this related resource: Infection Control in Ambulatory Care

Meet Healthcare Case Manager Patti Tipton: Former Air Force RN Empowers Patients On the Ground

January 14th, 2013 by Cheryl Miller

Patti Tipton, BSN, RN, LNC, CCM, National Care Management, Richfield Dedicated Unit

Tell us a little about yourself and your credentials.

I am a registered nurse (RN), and achieved my BSN in 1988. I have over 24 years of experience in the nursing industry, which includes intensive care unit (ICU), trauma level emergency room (ER), labor and delivery, long term nursing, home healthcare, management, and case management. I am certified in case management by the Commission for Case Manager Certification, and also completed the legal nurse consultant certification program in 2000.

What was your first job out of college and how did you get into case management?

With great pride, upon graduation from nursing school, I entered into active duty as an RN in the United States Air Force (USAF). I served active duty during Desert Storm, from 1988 to 1991. Thereafter, I remained in Indefinite Ready Reserve, until I was honorably discharged from the USAF in 2005.

Like most nurses, I acquired a variety of nursing experiences before transitioning into case management. My initial case management experience began as a perinatal case manager in the home health industry in 1996, when I transitioned from the labor and delivery unit of a university-based hospital system to their home health division; I was an integral part of the creation of their first perinatal home health program, PerinatalConnection. Due to the need for more flexible hours to care for my family and an elderly parent, I returned to the trauma ER for a nursing agency, until I began working for Aetna as a RN case manager in October 2006.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road?

I have had many defining moments in my career, all of which support my reasons for going into the healthcare field: the desire to help others. One of my first defining moments was while in nursing school, picking glass from a 20-something year old man’s head and face, while he lay in his ICU bed after his auto accident. He looked at me and said, “You are a Christian, aren’t you? I can tell that you care just by the way you treat me.” I thought to myself, “Wow…actions do speak louder than words,” and I knew I had chosen the field that was for me.

In brief, describe your organization.

Aetna is one of the nation’s leaders in healthcare, dental, pharmacy, group life, disability insurance, and employee benefits. Dedicated to helping people achieve health and financial security, Aetna puts information and helpful resources to work for its members to help them make better informed decisions about their healthcare. I am very proud to work for Aetna, and on a daily basis, embrace and connect with patients in their situations, and empower them with the knowledge to make educated decisions regarding their healthcare needs.

What are two or three important concepts or rules that you follow in case management?

First, I truly believe in treating people as you would like to be treated, embracing people as though they were your own family.
Secondly, I firmly believe that people can make better healthcare decisions when they have the appropriate knowledge. As a case manager, I ensure patients understand their medical benefits, as well as their medications and physician’s treatment plan.

Do you see a trend or path that you have to lock onto for 2013?

It is no surprise that healthcare needs to be more affordable for everyone. We need to advocate solutions that will support and motivate patients to be in charge of their own health. I know that for myself, I really think about what an ER visit will cost, versus waiting to see my primary care physician (PCP). This helps me to decide “is it really all that urgent?” As a case manager, I know that reduction of ER visits and avoidable hospital readmissions are one small part of decreasing healthcare costs. Having worked in ER departments, I have seen patients use the ER as their PCP, despite encouragement to select a PCP or follow up with their PCP. Patients many times use the ER because it is more convenient or accessible for them. Motivating patients to be more proactive with their health means promoting more cost effective ways that enable accessible and appropriate healthcare services.

What is the most satisfying thing about being a case manager?

It is all about the opportunity to connect with a patient and make a difference in their life. Sometimes, it is educating a patient about a medical benefit they did not know they had. Other times it is outreaching to the physician to make sure he/she understands their patient’s current situation, or assisting with the transfer of a member from a facility in one state to a facility in another state.

What is the greatest challenge of case management and how are you working to overcome this challenge?

Promoting self change in our members. It is obvious that someone who is obese should lose weight, someone who smokes should quit. Use of motivational interviewing techniques improves communication with patients to promote self change, where the patient identifies the agenda and goals.

What is the single most effective workflow, process, tool or form case managers are using today?

Motivational Interviewing (MI). Using MI techniques makes Aetna’s care management program different by encouraging engagement of the member when exploring the root cause of their health issues or concerns. MI is successful in guiding members to transition from unwillingness to discussing their issues to seriously considering self change. MI helps case managers improve health behaviors and outcomes, increase member engagement in Aetna programs, and improve member satisfaction.

Where did you grow up?

That is a loaded question! My father was a Methodist minister, so I moved a great deal; however, the majority of my childhood was in various towns in Tennessee. Cumulatively over my lifespan, I have lived in eight different states: Ga., Fla., Tenn., Colo., N.C., Ark., Ill., Ohio.

What college did you attend? Is there a moment from that time that stands out?

I received my Liberal Arts degree from Martin Methodist College in Pulaski, TN, then received my BSN from Tennessee Technological University in Cookeville, TN. In 2000, I completed the first Legal Nurse Consultant certificate program that was offered by Cuyahoga County Community College in Parma, OH.

I must admit nursing school was a tough and competitive program, sometimes feeling like it was a weeding out process of the strong versus the weak. Therefore, it was a huge accomplishment to complete nursing school as well as pass my state nursing boards. When I returned to college in 1999 for the Legal Nurse Consultant program, I found it to be a different level of learning for me. I did not feel it was a forced to learn situation; rather, I had the strong desire to learn something new and incorporate my nursing experience into the legal arena.

Are you married? Do you have children?

I have been married to my best friend, Michael Tipton, since 2003. We share a blended family of boys, ages 17 to 26.

What is your favorite hobby and how did it develop in your life?

Sewing, which I learned from my mother. At a very young age, I was making my own Barbie doll clothes, then my own clothes once I became a teenager. I enjoy the creativity and usually can’t wait to see the final product!!

Is there a book you recently read or movie you saw that you would recommend?

The movie, “The Pursuit of Happyness.” I love Will Smith as an actor, and appreciated the challenges his character faced and overcame. It showed what desire, perseverance and integrity can achieve.

Any additional comments?

As I mentioned before, I am very proud to work for Aetna, and be part of their focus toward solutions for improved, affordable, and accessible healthcare systems. It is also rewarding for me to help our members realize that we, as case managers, are genuinely here to help them. It makes my day when I hear “Wow, you really do care….I guess the bad name that insurance companies have out there is not always true.” Every day, I strive to provide the core values of Aetna: integrity, caring, excellence, and inspiration.

Click here to learn how you can be featured in one of our Case Manager Profiles.

Meet Healthcare Case Management Manager Teresa Treiger: Helping Clients Bridge Gaps To Self-Advocacy, Self-Management

September 14th, 2012 by Cheryl Miller

This month we provide an inside look at a healthcare case management manager, the choices she made on the road to success, and the challenges ahead.

Teresa M. Treiger, RN-BC, MA, CHCQM-CM, CCM, Founder of Ascent Care Management, LLC

HIN: Tell us a little about yourself and your credentials.

Teresa Treiger: My given name is Teresa, but most people know me as Teri. I am a registered nurse although my educational background also includes degrees in healthcare administration and business. I have over 30 years of cumulative experience in the healthcare industry with more than 20 of those devoted to care coordination and care management. I am certified in case management by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP,) the Commission for Case Manager Certification (CCMC,) and the American Nurses Association (ANA.) I am also certified as a chronic care professional by the Health Sciences Institute (HSI.)

What was your first job out of college and how did you get into case management?

As so many of us did, I started off with bedside nursing on a general medical-surgical floor before moving to neurosurgery, orthopedics, respiratory intensive care, and urgent/emergent care. When it was time for a change of pace, I shifted to the business side of healthcare for a couple reasons:

  • I did not believe that the business of healthcare was enough of a concern for the people who worked within the sector. It was far too easy to not consider the financial implications of care when all I had to do was take a sticker off of a piece of equipment and place it on a patient’s supply charge sheet. I’ll expand on that more in a bit, and
  • I did not feel as though I was making an impact on the bigger picture of healthcare; bedside nursing was and is a wonderful experience but I knew I needed to make a different kind of impact. Subsequently, I worked in case management in a variety of settings – managed care, acute hospital, rehabilitation and long term care settings eventually focusing on care coordination program design/implementation and education.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road?

This is an interesting question because my defining moment was not necessarily what got me into case management but rather what validated the choice I made as being perfect.

I was at a crossroads, having just undergone a corporate restructuring which left me unemployed. I attended a Case Management Society of New England (CMSNE) chapter conference on leadership and it literally changed the trajectory of my career path, but not because it was case management-focused. It validated that the business of healthcare delivery was in dire need of a focus point. With all due respect to clinician providers, their job is not to coordinate how the care is delivered – and they aren’t all that good at it. By and large, they are great at diagnosing and providing the blueprint of an individual’s care, but how that all gets accomplished — not so much.

In brief, describe your organization.

I am a case management consultant and have my own company, Ascent Care Management, LLC. I work with individuals who desire their own case manager, but the bulk of my business is focused on business clients who want to revamp their case management departments in one way or another. Frequently, I help organizations through process flow redesign, documentation, case management IT projects, and accreditation preparation. I also enjoy public speaking on a variety of healthcare and care management topics.

What are two or three important concepts or rules that you follow in case management?

  • Don’t ever lose sight of the fact that behind every number is a patient.
  • Treat others with the courtesy and respect with which you hope to be treated.
  • How you are perceived as a case manager will be a reflection on every other person who refers to themselves as a case manager, so I make it a good experience for the client.

What is the single most successful thing that your organization is doing now?

I have a case management boot camp that has been well received. Often what I have found is that individuals transition into case management because of the work hours or other reason rather than actually wanting to make case management a professional adventure. Training is so vastly different from one organization to another that there is really very little actual training aside from the information system and day to day work flow process. The boot camp focuses on the actual steps of the case management process through interaction and exercises to help individuals to have a better framework for working with clients toward measurable and achievable goals. The way I see it, the case manager should be considered to be a bridge to self-advocacy and self-management of their own healthcare rather than a crutch.

Do you see a trend or path that you have to lock onto for 2012? 2013?

I see a few things…

  • Many PPACA provisions kick in during 2012 to 13. Knowing what is coming up for implementation will help case managers ramp up for what they need to understand.
  • Many health systems are implementing their own brand of case management and unfortunately it simply requires a change in an individual’s job title rather than an evaluation of skill sets and provision of training and development opportunities in order for that person to be successful. These types of programs are going to be running aground and a need for knowledgeable case management consultants will bloom as the C-suite opts to address these less-than-successful programs.
  • The home care sector needs for case management are going to blossom as transition of care programs begin to engage more services to avoid readmissions.

What is the most satisfying thing about being a case manager?

Having an impact.

Some days it might be a very small thing, but to the individual I have worked with, whether mentoring a newer case manager or working with a client, it is something of great importance. I like that what I do is a positive contribution rather than a negative detraction. It is too easy to whine about this or that. Then I look around at the challenges others are facing and realize how fortunate I am to be able to help improve the lives of others. That is a gift.

What is the greatest challenge of case management and how are you working to overcome this challenge?

The biggest challenge is that of complacency. I wrote about this in a recent blog post and summed up with the following… “Health care is always changing… consumer expectations are on the rise… and case managers are being viewed by many as a critical factor of successful patient-centered care coordination. I believe that an overwhelming number of case managers are up to the challenge being placed before them. The essential element that we must remain mindful of is to never fall into the pit of thinking that we know it all or that do not need to consistently and continuously improve the quality of the service we bring to the health care team.”

What is the single most effective workflow, process, tool or form case managers are using today?

This is a great question for which I do not know an answer exists. Because case managers work in so many different settings of care, a tool or process that is great in one setting may not work in the next. However, with that said, I think that technology has the greatest potential for being the most effective tool… but it depends on the case manager and his/her ability to use it effectively and efficiently.

Where did you grow up?

I was born in Boston, Massachusetts and lived there for the first few years before moving to Hawaii for three years. We returned to live just south of Boston for the rest of my childhood and adolescence.

What college did you attend? Is there a moment from that time that stands out?

I have an ongoing love of learning so my education has progressed through a number of institutions: Laboure College, Stonehill College, Boston University, University of Phoenix. Currently, I am considering a return to school to earn my Doctor of Nursing Practice degree.

Are you married? Do you have children?

Yes, I am married to Dave Treiger. We will celebrate our 10th anniversary in August 2013. I have two furry children, cats whose names are Tang and Skooch.

What is your favorite hobby and how did it develop in your life?

I enjoy photography. It was something I used to do with my Dad that started when I was in high school. I still have both of our old SLR cameras… but now I primarily use a digital Nikon SLR.

Is there a book you recently read or movie you saw that you would recommend?

It’s a classic but it remains my favorite book of all times, A Tale of Two Cities by Charles Dickens. I can’t tell you how many times I have read it since high school. As for a movie, I hate to sound so down on them but the quality of movies that have been made in the past 5 to 10 years has been less than overwhelming. Nothing really stands out that I would risk recommending to a friend.

Any additional comments?

Case management has changed my life and afforded me opportunities to travel around the world to share my experiences and learn about how case management is done in other healthcare systems.

I think that the case managers of today (and tomorrow) have to find ways in which to be proud and passionate about what they do and the critical part that they play in the healthcare delivery system. Our opportunities are endless so if a job isn’t working out to your expectations, find another one. Don’t allow complacency and resignation to direct your career choices. Envision your goals and then make them happen.

Click here to learn how you can be featured in one of our Case Manager Profiles.

10 Hallmarks of a Health-Literate Organization

August 23rd, 2012 by Jessica Fornarotto

Recorded Webinar: Patient Engagement in the Patient-Centered Medical Home — A Continuum Approach

Leadership committed to health literacy and easy access to health information are two attributes of an organizational environment that fosters health literacy, suggests a new study reported in the Institute of Medicine (IOM).

It is possible for a healthcare system to redesign its services to better educate patients in the handling of immediate health issues and also become more savvy consumers of medicine in the long run, says the University of California, San Francisco (UCSF) and San Francisco General Hospital and Trauma Center (SFGH) study. The study identified ten attributes that healthcare organizations should adopt to make it easier for people to better navigate health information, make sense of services and better manage their own health — assistance for which there is a profound societal need.

The ten attributes of a health-literate organization are:

  1. Has leadership that makes health literacy integral to its mission, structure and operations.

  2. Integrates health literacy into planning, evaluation measures, patient safety and quality improvement.
  3. Prepares the workforce to be health-literate and monitors progress.
  4. Includes populations served in the design, implementation, and evaluation of health information and services.
  5. Meets the needs of populations with a range of health literacy skills while avoiding stigmatization.
  6. Uses health literacy strategies in interpersonal communications and confirms understanding at all points of contact.
  7. Provides easy access to health information and services and navigation assistance.
  8. Designs and distributes print, audiovisual, and social media content that is easy to understand and act on.
  9. Addresses health literacy in high-risk situations, including care transitions and communications about medicines.
  10. Communicates clearly what health plans cover and what individuals will have to pay for services.

Some 77 million people in the United States have difficulty understanding very basic health information, which clouds their ability to follow doctors’ recommendations, and millions more lack the skills necessary to make clear, informed decisions about their own healthcare, said senior author Dean Schillinger, MD, a UCSF professor of medicine, chief of the Division of General Internal Medicine at SFGH, and director of the Health Communications Program the UCSF Center for Vulnerable Populations at SFGH. “Depending on how you define it, nearly half the U.S. population has poor health literacy skills. Over the last two decades, we have focused on what patients can do to improve their health literacy,” said Schillinger. “In this report, we looked at the other side of the health literacy coin, and focused on what healthcare systems can do.”

The importance of enhancing health literacy has been demonstrated by many clinical studies over the years, said Schillinger. Health literacy is linked directly to patient wellness. People who can understand their health information tend to make better choices, are able to self-manage their chronic conditions, and have better outcomes than people who do not.

Adults with low health literacy may find it difficult to navigate the healthcare system, and are more likely to have higher rates of medication errors, more ER visits and hospitalizations, gaps in their preventive care, increased likelihood of dying, and poorer health outcomes for their children.

Many health policy organizations have recognized that health literacy is not only important to people, but it can also benefit society because helping patients help themselves is a way to keep healthcare costs down. Successful self-management reduces disease complications, cuts down on unnecessary ER visits and eliminates other wasteful spending.

Click here for more information and for a complete description of the ten attributes.

Most Patients Want to Self-Manage Healthcare

July 9th, 2012 by Cheryl Miller


Most Americans want to manage their healthcare information electronically, but not at the expense of losing face time with their doctors.

At least that’s what the results of a new survey from Accenture Health show: a hefty 90 percent of patients prefer to monitor their medical information, refill prescriptions and book appointments online via e-mail, Web sites, and mobile devices.

Not only aren’t the majority of Americans willing to sacrifice personal interactions with their physicians, but they aren’t sure how they want their records managed. And a third admitted that they didn’t know if they could access electronic tools like ‘bill pay.’ More results from this survey inside this week’s issue.

Closer management is also key to a new tool from the Joint Commission Center for Transforming Healthcare, designed to improve patient handoffs. Data shows that an estimated 80 percent of serious medical errors result from miscommunication between caregivers when patients are transitioned from one facility to another. In addition to patient harm, defective handoffs can lead to delays in treatment, inappropriate treatment, and increased length of stay in the hospital. This new tool, which monitors current organizational handoff processes and provides proven solutions, has been effective in reducing readmissions and hospitalization time, and increasing patient, family and staff satisfaction.

Managing costs is at issue in a new global survey from Towers Watson, showing that the cost of providing employee medical benefits is rising at double-digit levels everywhere in the world but Europe, which is anticipating only single-digit increases. The survey goes on to state the reasons for these increases, and avenues that medical insurers are taking to contain their costs, including implementing wellness programs and health promotion strategies.

And young adults are letting their parents manage their healthcare coverage. According to a new study from Indiana University economists, children ages 19 to 25 are taking advantage of the ACA ruling that private insurance policies offer to cover dependents’ children up to age 26. The report goes on to cite other findings, including the gender, marital status and ethnicity of children being covered; details in this week’s issue of Healthcare Business Weekly Update.

And how do you manage your asthmatic population? Asthma accounted for nearly half a million hospitalizations in 2009 and nearly 2 million ED visits; the estimated total cost of asthma in the United States in 2007 amounted to $56 billion. Describe your organization’s efforts to manage what is one of the most common, lifelong chronic diseases by July 27, 2012 and you’ll receive a free e-summary of our survey results once it is compiled.

Joint Contracting Key Component of Clinical Integration Program

June 20th, 2012 by Cheryl Miller

Joint contracting is the ‘glue’ that keeps the Advocate Physician Partners (APP) clinical integration program together, explains Mark Shields, MD, MBA, APP senior medical director and vice president of medical management for Advocate Health Care.

To put together our clinical integration (CI) program, we have negotiated with all of the carriers in our marketplace. There are 10 clinically integrated contracts with our 10 lead carriers. The funding of the CI programs is based on a percentage of allowable physician billings. That is how we create the cash flow for our pay for performance (PFP) program and key infrastructure. The key component of CI is that our quality, patient safety and cost-effectiveness measures are the same across all of the health plans. Our program covers both risk contracts and FFS contracts. Therefore, both health maintenance organization (HMO) and preferred provider organization (PPO) contracts are covered.

We negotiate both base and incentive compensation for physicians. The key component to drive outcome is that the same measures and thresholds of performance are common across all of these contracts. That allows the providers to overcome what has been referred to as a “Tower of Babel” in the past. Even when different insurance companies had similar measures in their PFP programs, the thresholds and methods to collect and report the data were different. It became so confusing for providers that they were not able to focus on performance improvement. They threw up their hands and said, “Well, let the chips fall where they may.”

By having the common set of measures across all of the payors, we are able to develop tools and common reporting systems to drive change. This is our definition of CI: physicians across specialties working together with hospitals to drive quality, patient safety and cost-effectiveness. Joint contracting is a critical component of CI; it is the key glue to keep the program together. Joint contracting has been a key issue that has engaged APP in discussions with regulators, particularly the Federal Trade Commission (FTC). They have given us approval to continue with this CI program, and that is important for others who are thinking about doing this kind of program. It passes not only market acceptance, but also regulatory acceptance.