Posts Tagged ‘physicians’

WellPoint Referral Preparedness Tools Support Physician-Specialist Care Compacts

October 2nd, 2014 by Cheryl Miller

With the help of care compacts that drive accountability between primary care physicians and specialists, WellPoint has launched a medical neighborhood pilot for three specialties with clear care coordination alignment opportunities with primary care medical homes. Here, Robert Krebbs, director of payment innovation at WellPoint, Inc., discusses how Wellpoint supports the care compact model with Referral Preparedness Tools— add-ons devised for physician/specialist patient handoffs.

One thing we found interesting was the uniform request from physicians for what we call ‘Referral Preparedness Tools.’ That’s a name we made up. These are add-ons to care compacts that call out common conditions for a given specialty, the conditions for which they often get referrals or consult requests from PCPs. It specifies for that condition what the specialist would like to see for the initial consult or regular repeating referral, and what they want the PCP to do first and send to them and specifically, what they want the PCP not to do—that is, things to avoid before sending the patient over.

On the flip side, the tool lists for that condition what the specialist intends to send back to the PCP. The practice will work on this together for common conditions. The tool doesn’t list everything that could possibly happen, but rather specifies the patient flow for common conditions.

We didn’t initially include this tool in our care compact expectations. The practices asked us for this; they see this as a true opportunity to drive improvement and efficiency in the system, to avoid unneeded care and to make sure that the correct care is provided for all patients.

We’re going to monitor development of these tools throughout the pilot to determine common themes so we can provide a good template starting place on this run as well as for future pilot practices in this program. We’re excited that specialists have made this template their own. They’re hard at work identifying what they’d like to see in these scenarios.

dual eligibles care
Robert Krebbs is the director of payment innovation at WellPoint where he has accountability for the design, development and rollout of value-based payment initiatives. He works directly with network physicians and facilities on innovative performance measurement programs aimed at delivering healthcare value by promoting high quality, affordable care.

Source: Care Compacts in the Medical Neighborhood: Transforming PCP-Specialist Care Coordination

Infographic: Physician Adoption of Health IT

September 29th, 2014 by Melanie Matthews

Physician interest in mhealth is strong, according to Deloitte’s 2014 Survey of U.S. Physicians. Access to clinical information is the most cited benefit of health IT by physicians, the survey also found.

A new Deloitte infographic looks at the difference between physician users and non-users of health IT, patient support of health IT and analysis of meaningful use.

Physician Adoption of Health IT

Transforming Health Care: The Financial Impact of Technology, Electronic Tools and Data Mining The healthcare technology revolution is just around the corner. And when it arrives, it will change and enrich our lives in ways we can only begin to imagine. Doctors will perform blood pressure readings via video chat and nutritionists will analyze diet based on photos taken with cell phone cameras.

Transforming Health Care: The Financial Impact of Technology, Electronic Tools and Data Mining combines healthcare, technology, and finance in an innovative new way that explains the future of healthcare and its effects on patient care, exploring the emergence of electronic tools that will transform the medical industry.

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8 Challenges to Medical Home Success

August 21st, 2014 by Cheryl Miller

“The reality of today is that the healthcare world as we know it is changing more than any time since the advent of Medicare,” says Dr. Terry McGeeney, director of BDC Advisors. System coordination, patient-centeredness and patient engagement are some of the new industry goals, he says, which bring new challenges, chief among them being physician reluctance to change.

  • First, there are some real challenges to making the changes to patient-centered medical homes (PCMHs). A lot of physicians are reluctant to change. Physicians have been trained to be change-averse and variable-averse to avoid making mistakes at two o’clock in the morning, etc.
  • Second, physician leadership and physician champions are critical, and again, sometimes this has to be trained and taught.
  • Third, there’s a culture that is very traditional in healthcare; we need to think and talk about that. There is also a culture within individual practices and health systems that creates barriers to successful transformation.
  • Fourth, some providers are not able to function effectively in a team environment and this needs to be supported and transformed with the appropriate training provided.
  • Fifth, communication is critical at multiple levels. Successful medical neighborhoods and clinically integrated neighborhoods (CINs) are built around communication, care plans, care that’s delivered, data, quality metrics, lab data, etc.
  • Sixth, there has to be trust between all of the entities as systems are transforming and payor data becomes more critical. Partnerships with payors around shared savings or shared risk are becoming more common. Trust is critical, and again, that hasn’t always existed.
  • Seventh, we need to make sure there are aligned incentives; you can’t ask people to do more work for the same compensation. You can’t ask them to assume more risk for the same compensation. Incentives need to be aligned around what is now called ‘value-proposition’ or ‘pay-for-value,’ or to where there is an expectation to improve quality and lower cost.
  • And finally, there needs to be full recognition that PCMH transformation is not easy. It’s very difficult, it’s time consuming, but at the end it’s highly rewarding.

value-based reimbursement
Terry McGeeney, MD, MBA, is a director at BDC Advisors. He was recently appointed a visiting scholar in Economic Studies for the Brookings Institute in Washington, D.C.

Source: Driving Value-Based Reimbursement with Integrated Care Models

Communication Key to ‘Healthy Handoffs’ in Medical Neighborhood

June 26th, 2014 by Cheryl Miller

Consultations and referrals have long been a source of frustration for physicians and specialists; physicians refer patients to specialists without the necessary tests or pre-work, or a physician refers a patient to a specialist, but hears nothing back from that specialist, says Robert Krebbs, director of payment innovation at WellPoint, Inc. There needs to be better, effective communication between the two, and established processes for consultations and referrals between physicians and specialists to ensure “healthy handoffs,” a key component of care coordination.

Care coordination is important to us and is the main pillar of our Patient-Centered Specialty Care program. What we mean by that is that care coordination is about effective communication. Practices need to establish communication timeliness expectations, agree on core default patient information regardless of the condition, and make sure the information flows back and forth between the two practices that are exchanging the patient or experiencing the care transition for that patient.

We actually refer to those as ‘healthy handoffs.’ That’s what we’re shooting for, care exchanges in which the patient moves between practices in a healthy fashion and everything moves back and forth between the practices in an ideal and efficient manner. It’s about establishing data exchange; that is, how is the information going to get back and forth between two practices?

Every practice is different. Every practice has different capabilities in terms of data exchange. We’re looking for practices to make sure that they understand each other’s capabilities so there are no assumptions to cause missed care opportunities for patients.

It’s about establishing processes for requests in consultations and referrals in the first place and expectations around interactions related to those referrals. It’s about agreeing on the types of consultations that are available: face to face, phone, e-mail from patient to provider. It’s making sure that the entire landscape of consult or referral is clear for both parties.

Excerpted from Care Compacts in the Medical Neighborhood: Transforming PCP-Specialist Care Coordination.

6 Metrics to Engage Physicians in Value-Based Payments

May 22nd, 2014 by Cheryl Miller

As incentive models change for physicians and their practices along with the industry’s move to value-based care, it is key to engage them in the evolving process, says Cynthia Kilroy, senior vice president of provider strategy and business development at Optum. After you find a common value-based vision, you need to spend time with the physicians discussing what value-based care is, including how it is going to impact them, and what it means for their practice, among other things.

When you think about engaging physicians, which is how we typically roll this out across organizations, six key performance metric steps are needed to move this along. This is not something that happens in a couple of months. It takes one to three years to move a compensation model to a large 20 to 25 percent of incentives.

After you find the common value-based vision, you need to spend time with the physicians discussing what value-based care is, including how it is going to impact them, what it means for their practice, how we support them, etc.

Once you have alignment with that, the finding and designing of incentive metrics has to be done by the physicians. This cannot be done in a vacuum. It needs to be physicians from all different types of practices or specialties and different locations within the organizations that you look at. What are the incentives I want to measure?

Then you publish the incentives and blind those incentives so that physicians can digest and challenge them. Something may need to be modified. Therefore, you should give that time and feedback. Once you have that feedback, you can unblind it. Organizations find unblinded incentives to be a very powerful tool, but you need to make sure that you have the alignment and agreement and that people believe in the metrics, because if you put metrics out that are incorrect or not of value, you have lost the opportunity to change that behavior.

Then you create a shadow incentive reimbursement model, letting physicians know where and how it is going to impact them, allowing them to potentially change how they are practicing or leveraging the care team more.

Finally, you implement the incentive compensation model. There are two phases. One is to meet the minimum, which is typically the first way that the incentives compensation is executed. The next is a rating factor around the quartile, and that is something that takes time as well.

Next is the analytics platform. When finding, designing and publishing the incentive metrics, you build them, share them, get feedback and then approve the metrics. You need an analytic platform to understand and measure these new metrics that we are looking at.

Excerpted from 6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability.

Care Coordination Compacts: Establishing Accountability, Clarity between Physicians and Specialists

May 22nd, 2014 by Cheryl Miller


It’s a scenario that occurs time and time again, and is a deep source of frustration for all involved: a physician refers a patient to a specialist, but hears nothing back from that specialist. In fact, they learn that the visit happened only when the patient returns for his primary care visit, but without any necessary information.

Or, a specialist receives a patient who has none of the pre-work or test results necessary for an effective visit, which ends up delaying care for the patient. Or, on the flip side, the specialist receives patients that had numerous unneeded and avoidable tests done prior to the referral.

The culprit? Lack of accountability and clarity, the foundations of the Care Compact, an agreement between two practices that outlines the roles and responsibilities of each in order to promote patient-centered care, says Robert Krebbs, director of payment innovation at WellPoint, Inc., during Care Compacts: Forming the Foundation of Care Teams with PCPs and Specialists, a May 2014 webinar now available for replay from the Healthcare Intelligence Network.

The Care Compacts (also known as Care Coordination Agreements and/or Referral Agreements) are key to WellPoint’s patient-centered medical home neighborhood (PCMH-N) pilot, Patient-Centered Specialty Care (PCSC). The program was launched in January 2014 with a select number of pilot practices, ranging in size from solo practices to large group practices in markets where there is a strong patient-centered medical home (PCMH) foothold, says Krebbs.

PCSC is a value-based reimbursement program developed for three types of specialties with clear care coordination alignment opportunities with PCMHs: cardiology, endocrinology, and OB/GYN. These specialists work with existing patient-centered medical home partners to improve quality and coordinate care guided by cost and efficiency measures, Krebbs continued, ensuring the following:

  • Effective two-way communication between primary and secondary providers;
  • Appropriate and timely referrals and consultations with prompt feedback of findings / recommendations;
  • Effective co-management of patients when necessary; and
  • Commitment to practice in a patient-centered fashion across all physicians delivering care to a patient.

The reason these care agreements work is because they provide a standard set of processes for roles in care coordination, truly defining what care coordination is between two practices. While many practices across the country agree they need care coordination, they don’t always agree on what the concept of care coordination is, Krebbs continues.

At their simplest, they help to clearly outline who’s going to do what in a referral or consult situation. By cutting out inappropriate duties and maintaining appropriate ones, they help to curb healthcare spend and improve patient care, Krebbs says.

“The care compact isn’t intended to solve all the world’s problems. It’s not going to make care coordination perfect, but it’s a starting point. Just like the patient-centered medical home (PCMH) provides a foundation for the medical neighborhood, the care compacts provide a foundation for care coordination between practices. It’s an essential starting point to further care coordination expectations across that medical neighborhood,” says Krebbs.

Listen to an interview with Robert Krebbs.

8 Challenges to Medical Home Success

March 12th, 2014 by Jessica Fornarotto

“What’s important about patient-centered medical homes (PCMHs) is that they’re patient-centered. PCMHs are a partnership among practitioners, patients and their families that ensures and respects the decisions of the patients. And patients have the education and support they need,” explains Terry McGeeney, MD, MBA, director of BDC Advisors. Dr. McGeeney lists below the eight challenges in successfully changing to a PCMH.

The first challenge to PCMH success is that many physicians are reluctant to change. Physicians have been trained to be change-averse and variable-averse to avoid making mistakes at two o’clock in the morning, etc. Second, physician leadership and physician champions are critical. Sometimes this has to be trained and taught.

Next, there’s a culture that is very traditional in healthcare; we need to think and talk about that. There is also a culture within individual practices and health systems that creates barriers to successful transformation. Another challenge is that some providers are not able to function effectively in a team environment. This needs to be supported and transformed with the appropriate training provided.

The next challenge is communication, which is critical at multiple levels. Successful medical neighborhoods and clinically integrated neighborhoods (CINs) are built around communication, care plans, care that’s delivered, data, quality metrics, lab data, etc. The sixth challenge is that there has to be trust between all of the entities as systems are transforming and payor data becomes more critical. Partnerships with payors around shared savings or shared risk are becoming more common. Trust is critical and that hasn’t always existed.

Next, we need to make sure there are aligned incentives; you can’t ask people to do more work for the same compensation. You can’t ask them to assume more risk for the same compensation. Incentives need to be aligned around what is now called ‘value-proposition’ or ‘pay-for-value,’ or to where there is an expectation to improve quality and lower cost.

The final challenge is there needs to be full recognition that PCMH transformation is not easy. It’s very difficult and time consuming, but in the end it’s highly rewarding.

Excerpted from: Driving Value-Based Reimbursement with Integrated Care Models

HINfographic: New Players on the Value-Based Healthcare Team

September 2nd, 2013 by Jackie Lyons

Healthcare reform is moving toward value-based reimbursement, which has created a mashup of care delivery and reimbursement models and a need to recruit some new talent.

Seventy-five percent of organizations offer some form of health coaching, and job postings for care transitions coordinators increased 40 percent from 2011 to 2012, according to a new HINfographic from the Healthcare Intelligence Network. This infographic describes a ‘roster’ of promising young players on the healthcare field, and some veterans whose recast roles support value-based healthcare.


Value-Based Healthcare Team

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Information presented in this infographic was excerpted from: Guide to Value-Based Reimbursement: Profiting from Payment Bundling, PHO Shared Savings, and Pay for Performance. If you would like to learn more about healthcare trends and forecasts in 2014, this resource explores emerging models of episode-based payments, physician-hospital organizations and physician bonus structures with advice and lessons from three successful healthcare executives.

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Patient Empowerment: Sharing Notes, Recording Conversations Lead to Better Self-Care

October 18th, 2012 by Cheryl Miller


The more patients know, the more likely they are to take better care of themselves.

That’s the bottom line from a new study on note sharing between doctors and patients, and a phone app that allows patients to legally record their doctors’ conversations.

According to the study from the Beth Israel Deaconess Medical Center (BIDMC), giving patients access to their physicians’ notes makes them feel more in control of their healthcare, have a better understanding of their medical issues, experience improved recall of their care plan and pay more attention to medication regimens.

The BIDMC-led study of more than 100 physicians participating in an OpenNotes trial at Geisinger Health System in Danville, PA and Harborview Medical Center in Seattle, and more than 13,500 patients also dispelled fears doctors initially had that their patients might inundate them with phone calls or messages, or be offended or worried. In fact, according to the study, many doctors reported deeper levels of trust, transparency and communication with their patients.

“Patients are enthusiastic about open access to their primary care doctors’ notes. More than 85 percent read them, and 99 percent of those completing surveys recommended that this transparency continue,” says Tom Delbanco, MD, co-first author, a primary care doctor at BIDMC and the Koplow-Tullis Professor of General Medicine and Primary Care at Harvard Medical School. “Open notes may both engage patients far more actively in their care and enhance safety when the patient reviews their records with a second set of eyes.”

Even more surprising, and clinically important, was that nearly 80 percent of patients reported increased adherence to medication, researchers added. And some doctors felt that patients were less likely to be worried about what was being written in the “little black book” because they knew what was in there, as opposed to those who didn’t know.

Or those who suffered from ‘bad news deafness.’

“Whenever a patient hears something they’re not happy with, they tend to blank out and they don’t listen to anything the doctor says,” said Dr. Michael Nusbaum, founder of Giffen Communications. “This is so important because a lot of the time, a doctor will give instructions to a patient, and it’s too much for the patient to handle in that moment.”

Giffen Solutions has created a phone app designed specifically for patients; it allows them to record physician phone calls. Giffen says MedXCom patient, a free app that can be found in the iPhone app store, is a HIPAA-compliant, secure way to record medical information. It enables patients to refer back to conversations when they can better absorb it, and then proceed from there, not unlike note sharing. Patients aren’t doctors, Giffen officials say, they don’t always understand medical terminology, or forget it in time.

Both ideas help to empower patients, and inspire them to take more active roles in their health. In fact, three out of five patients who participated in note sharing expressed their desire to add comments to their doctors’ notes, and 86 percent said that the availability of notes would influence their choice of providers in the future.

Infographic: The Changing Landscape for Physician Practices

September 29th, 2012 by Melanie Matthews

The changing landscape for physicians is reflected in this year’s National Physician Survey by the little blue book.

See how technology is changing the physician workflow, along with clinical tools used by physicians.

National 
Physicians Survey 2012

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