Posts Tagged ‘Population Health Management’

Infographic: Patient Attribution Guide for Population-based Payment Models

January 2nd, 2017 by Melanie Matthews

Patient Attribution Guide for Population-based Payment Models

Patient attribution is a foundational component of population-based payment (PBP) models, which are based on a simple concept: providers accepting accountability for managing the full continuum of care for their patients, according to a new infographic by the Health Care Payment Learning and Action Network.

The infographic outlines the key steps in patient attribution.

Chronic Care Management Reimbursement Compliance: Physician Requirements for Value-Based RevenueBeyond providing added revenue, billing via Medicare Chronic Care Management (CCM) CPT codes helps to bridge physician practices to value-based care delivery models like the accountable care organization (ACO) or patient-centered medical home (PCMH). Use of the CCM codes is also an opportunity to launch or enhance a chronic care management program. According to 2015 market data, nearly half of responding healthcare organizations lack a formal chronic care management structure, leaving critical reimbursement dollars on the table.

However, practices poised to bill under CCM codes must contend with vague guidance from CMS in certain areas and conflicting interpretations from outside sources on CCM implementation.

Chronic Care Management Reimbursement Compliance: Physician Requirements for Value-Based Revenue sets the record straight on CCM reimbursement compliance, offering strategies for navigating obstacles and meeting requirements.

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Infographic: Is Your Healthcare Organization Data Rich But Insight Poor?

December 16th, 2016 by Melanie Matthews

Is Your Healthcare Organization Data Rich But Insight Poor?Healthcare organizations with access to electronic healthcare record, claims, socio-demographic and administrative data, have to apply that data through all available lenses to act properly on the data to improve health, according to new infographic by Optum.

The infographic details three possible lenses through which healthcare data should be examined, as well as finding opportunities for intervention and measuring intervention success.

The move from fee-for-service to value-based healthcare is driving the need for increased capabilities in population health management, including addressing all of the areas that may impact a person’s health. There is growing recognition that a broad range of social, economic and environmental factors shape an individual’s health, according to the New England Journal of Medicine. In fact, 60 percent of premature deaths are due to either individual behaviors or social and environmental factors. Healthcare providers who adopt value-based reimbursement models have an economic interest in all of the factors that impact a person’s health and providers must develop new skills and data gathering capabilities and forge community partnerships to understand and impact these factors.

During Social Determinants and Population Health: Moving Beyond Clinical Data in a Value-Based Healthcare System, a December 8th webinar, now available for replay, Dr. Randall Williams, chief executive officer, Pharos Innovations, shares his insight on the opportunity available to providers to impact population health beyond traditional clinical factors.

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HINfographic: The Rising Risk: Harvesting Population Health’s Low-Hanging Fruit

October 5th, 2016 by Melanie Matthews

Paramount to population health management success under risk-based contracts is strategic oversight of the ‘rising risk’—individuals with two or more unmanaged health conditions. One quarter of respondents to the 2016 Population Health Management survey by the Healthcare Intelligence Network zero in on their own ‘rising risk’ populations.

A new infographic by HIN examines the health risks served by population health management programs and how population health management services are delivered.

2016 Healthcare Benchmarks: Population Health Management2016 Healthcare Benchmarks: Population Health Management analyzes responses of more than 100 healthcare organizations to HIN’s third comprehensive industry survey on PHM trends administered in spring 2016. It delivers the latest metrics on current and future PHM initiatives, providing actionable data on the most effective PHM tools and workflows, risk identification strategies, communication and engagement tools, program delivery modalities, results and challenges, and much, much more.

2016 Healthcare Benchmarks: Population Health Management is supported with more than 50 graphs and tables and describes many successes respondents have achieved with a PHM approach. Participating organizations also weigh in on the sustainability of a population health management approach. Click here for more information.

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Infographic: Population Health and Children’s Hospitals

June 15th, 2016 by Melanie Matthews

More than two-thirds of children’s hospitals consider population health a top priority, according to a new survey by the Children’s Hospital Association (CHA).

A new infographic by CHA examines the defined populations for which hospitals have aligned payment models for population health management, funding sources for population health programs, the percent of organizations with risk-based contracts and the need for reliable data for population health management.

2016 Healthcare Benchmarks: Population Health ManagementPopulation health management remains a top-ranked healthcare development opportunity, according to 2016 industry trends data from The Healthcare Intelligence Network, with many organizations deriving clinical and financial gains from population health’s data-driven, risk-stratified care management approach.

2016 Healthcare Benchmarks: Population Health Management drills down on the latest population health management (PHM) trends, including the prevalence of PHM initiatives, program components, targeted conditions, PHM care team members, challenges and ROI.

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Infographic: How EMS Can Help Reduce Gaps in Care

May 18th, 2016 by Melanie Matthews

Emergency management services (EMS) can fill gaps in the care continuum with 24/7 medical resources that improve the patient care experience, improve population health, and reduces costs, according to the National Association of Emergency Medical Technicians (NAEMT). EMS is uniquely positioned to support healthcare transformation by assessing and navigating patients to the right care, in the right place, at the right time.

NAEMT created an infographic to explain the EMS role in healthcare transformation and how EMS can expand its services to fulfill this new role.

Yale New Haven Health System (YNHHS) takes an on-site, embedded face-to-face approach to coordinating care for its highest-risk, highest-cost patients—whether identified within its own employee population, inside a patient-centered medical home (PCMH), or among the geriatric homebound. The Connecticut-based health system believes this vision of care management is the most direct path to success in a value-based healthcare industry.

In 3 Embedded Care Coordination Models to Manage Diverse High-Risk, High-Cost Patients across the Continuum examines YNHHS’s three models of embedded care coordination that deliver value while managing care across time, across people, and across the entire continuum of care.

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HINfographic: Data Analytics Frenzy Fueled by Population Health Management

May 16th, 2016 by Melanie Matthews

With reimbursement for healthcare services increasingly based on clinical outcomes, patient experience and cost of care, the motivation to slice and dice patient and population data has never been stronger. Population health management is the top driver of data analytics for more than a quarter of respondents to the 2016 Data Analytics and Integration Survey by the Healthcare Intelligence Network.

A new infographic by HIN examines which populations are targeted using data analytics, the type of data collected and the percent of the population for which data analytics is collected.

2016 Healthcare Benchmarks: Data Analytics and IntegrationThe 2016 Healthcare Benchmarks: Data Analytics and Integration assembles hundreds of metrics on data analytics and integration from hospitals, health plans, physician practices and other responding organizations, charting the impact of data analytics on population health management, health outcomes, utilization and cost.

2016 Healthcare Benchmarks: Data Analytics and Integration examines the goals, data types, collection processes, program elements, challenges and successes shared by healthcare organizations responding to the January 2016 Data Analytics survey by the Healthcare Intelligence Network. Click here for more information.

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Infographic: 10 Steps To Preventing Patients from Falling Through Population Health Cracks

April 6th, 2016 by Melanie Matthews

As healthcare organizations seek to manage population health under value-based care and reimbursement models, there are a number of steps these organizations can take to make sure that patients do not fall through the cracks, according to a new infographic by NextGen Healthcare.

The infographic provides a step-by-step overview to understanding and managing population health.

Care Coordination in an ACO: Population Health Management from Wellness to End-of-LifeWhen acknowledging its position as a top-ranking Medicare Shared Savings Program (MSSP), Memorial Hermann is quick to credit its own physicians—who in 2007 lobbied for a clinically integrated network that formed the foundation of the current Memorial Hermann accountable care organization (ACO). Now, eight years later, collaboration and integration continue to be the engines driving the ACO’s cost savings, reduced utilization and healthy patient engagement rates associated with Memorial Hermann ACO’s highest-risk population.

Care Coordination in an ACO: Population Health Management from Wellness to End-of-Life details Memorial Hermann’s carefully executed journey to quality and the culmination of the ACO’s community-based care management program.

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HINfographic: 10 Healthcare Game-Changers for 2016

February 29th, 2016 by Melanie Matthews

Of all the currents disrupting healthcare, from consolidation to the swing toward value-based care delivery and reimbursement, population health management topped the list of transformative industry trends for the second consecutive year, according to the 2016 Healthcare Trends & Forecasts survey by the Healthcare Intelligence Network.

A new infographic by HIN examines the top areas for development in the healthcare industry in 2016, areas with the greatest budget impact in 2015 and the trend toward value-based reimbursement.

Healthcare Trends & Forecasts in 2016: Performance Expectations for the Healthcare IndustryFrom cost pressures, consumerism and consolidation to a proliferation of patient-centered, value-based delivery and payment models, the state of healthcare continues to challenge organizations in the industry.

Healthcare Trends & Forecasts in 2016: Performance Expectations for the Healthcare Industry, HIN’s 12th annual business forecast, pins down the trends destined to impact the industry in the year to come and proposes tactics C-suite executives can employ to distinguish their operations in a dynamic marketplace. Click here for more information.

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Infographic: Population Health Communication Breakdown

July 6th, 2015 by Melanie Matthews

There’s a fundamental problem standing in the way of improving population health — doctors and nurses still struggle to get in touch with each other to coordinate care, according to a new infographic by PerfectServe.

The infographic examines the problems clinicians face when trying to coordinate care and how technology is not adequately being used to coordinate care.

2014 Healthcare Benchmarks: Population Health ManagementPopulation health management, with its focus on stratifying and managing care of high-risk, high-utilization sectors, is the area of healthcare most ripe with opportunity, according to 2014 HIN market data. Population health metrics drive quality and reimbursement returns in the current value-based healthcare environment.

2014 Healthcare Benchmarks: Population Health Management delivers an in-depth analysis of population health management (PHM) trends at 129 healthcare organizations, including prevalence of PHM initiatives, program components, professionals on the PHM team, incentives, challenges and ROI.

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BCBSM Physician Incentives Target 5 Root Causes of High-Cost Healthcare

February 17th, 2015 by Cheryl Miller

Designed to target underlying reasons for high-cost healthcare, Blue Cross Blue Shield of Michigan’s (BCBSM) Physician Group Incentive Program (PGIP) rewards and incentivizes providers to enhance the delivery of care. To address poorly aligned incentives, for example, they developed tiered fees based on performance measured at the population level, not just at the individual physician level or patient’s level, says Donna Saxton, BCBSM’s field team manager of BCBSM’s value partnerships program.

How has the program evolved? The several root causes of high-cost healthcare within our system were readily apparent: poorly aligned incentives, a lack of population focus, very fragmented healthcare delivery, a lack of focus on process excellence or process improvement and a weak primary care foundation. As we’ve developed our Physician Group Incentive Program (PGIP) initiative, we were strategic and deliberate in how we were going to address the root causes of our high-cost system, keeping in mind the tenets and the philosophy of the PGIP program.

To address poorly aligned incentives, we developed tiered fees based on performance measured at the population level, not just at the individual physician level or patient’s level.

Tiered performance fees also addresses the lack of population focus and places emphasis on all patients and payor registries.

The one thing that really makes our PGIP program unique is that we are payor-agnostic. The incentive dollars we have distributed through the life of the program readily help and incentivize other payors in the state, because if these capabilities are implemented, they ultimately serve all the patients in our state. We’re very proud of that because we feel that that is part of the servant leadership we need to do for patients and members in our state.

To attack the fragmented healthcare delivery, we’ve organized our systems of care, aligning our incentives for primary care physicians, hospitals and specialists.

We also have collaborative quality initiatives, which help sharpen our physicians, specialists and care delivery people on the science of process improvement.

Our PCMH initiative is our pinnacle initiative, which we believe has strengthened our primary care foundation across the state.

generating medical home savings
Donna Saxton, field team manager of Blue Cross Blue Shield of Michigan’s (BCBSM) value partnerships program, currently oversees the team of representatives that support the statewide collaborative relationships with 44 physician organizations (PO) and 39 organized systems of care (OSCs) that participate in the BCBSM Physician Group Incentive Program (PGIP).

Source: Generating Medical Home Savings and Quality Improvements Through Outcome-Based Measures