Posts Tagged ‘patient safety’

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.

Over 2600 U.S. Hospitals Graded on Patient Safety

June 11th, 2012 by Cheryl Miller

It’s the end of the school year, but not just students are getting graded on their performance.

According to a new study from the non-profit Leapfrog Group, more than 2600 U.S. hospitals received grades on their patient safety performances, or how many errors, accidents, and infections patients acquired while in their care. Studies show that one in four Medicare patients leave a hospital with a potentially fatal issue they didn’t have prior to hospitalization, and more than 180,000 Americans die every year from hospital accidents, errors, and infections. This study, free to all, is intended as a public service. There were some anticipated results, including A’s for well-known hospitals including the Mayo Clinic, and some surprises, including A’s for hospitals not as well-known or well-located. Details inside.

Primary care physicians that provide enhanced services for their Medicare patients also get high marks this week. In its continued efforts to bolster the primary care workforce, CMS has launched a new initiative that compensates PCPs that provide extended quality care to their patients. The Comprehensive Primary Care program rewards physician groups that offer enhanced hours and accessibility, and use EHRs among other services. Approximately 75 primary care practices will be selected to participate in the initiative in each designated market. Interested PCPs have until July 20th to submit applications.

And Kaiser Permanente gets an A for providing us with a new medical term: video ethnography, or the anthropological use of videos to study specific human (patient) cultures. Designed as part of their quality improvement program, the process involves videotaping patients and caregivers as they are being interviewed, and observing how they interact with each other in a clinic, hospital or at home. The tool is proving particularly effective with vulnerable populations such as frail elders, patients nearing the end of life, and those with multiple chronic conditions, because it enables caregivers to “see nuances that otherwise might be missed, and discrepancies between what people say, what they do, and what they may think,” according to a lead researcher.

And finally, don’t forget to chart your own progress in the patient-centered medical home model in our survey. Two years post-healthcare reform, we’re taking our sixth annual look at adoption and support of the PCMH. Describe your organization’s progress and outcomes in this area by June 15th and we will reward you with a free e-summary of the results. And remember, there are no wrong answers!