Posts Tagged ‘Reducing Readmissions’

Targeting Heart Failure Readmissions with Telehealth Monitoring

January 30th, 2014 by Cheryl Miller

To further investigate gaps in care, Central Maine Medical Center expanded a team already focused on outcomes improvement for 30-day readmissions to include providers, nurses, home care and hospice. The resulting intervention incorporated home health visits supplemented with telehealth, explains Susan Horton, DNP, APRN, CHFN, executive director of Central Maine Heart and Vascular Institute. This innovative work also led to other home-based interventions that were not always restricted to individuals identified by Medicare as homebound.

About that time our home care and hospice group approached us. They had the opportunity to write a grant for telehealth monitors. They wanted to know whether Central Maine would support that application so that they could then target these telehealth monitors for our heart failure population.

We supported that grant, and they got it. However, that decision caused us to determine that we needed to be more strategic in our partnership with home care and hospice. From that, we developed a job description and hired a full time equivalent: 20 hours on the medical center payroll, and 20 hours on the home care and hospice payroll.

That’s where the home visit program really took off. We were able to say that whether Patient A meets Medicare criteria for homebound or not, home care would go into the patient’s home as a guest of Central Maine Medical Center. We explained to each patient at the time of discharge that we wanted to evaluate their home situation to make sure they were safe.

This was important because we are looking at all-cause readmissions. If a heart failure patient living in an unsafe situation trips and falls and gets readmitted with a head injury, that’s still going to be a black mark for heart failure readmission. It’s all-cause readmission. We felt that we needed to assess what was going on in the home. Who was there for the patient? What were they doing in terms of support? Could they take their medication? Did they have a scale? Could they read the scale? And we would offer telehealth.

Excerpted from: Guide to Home Visits for the Medically Complex.

Collaboration, Medication Reconciliation, Yoga Key to Successful Population Health Management

January 30th, 2014 by Cheryl Miller


Zumba, yoga, Thank God it’s Free Fruit Friday (TGIFF)?

Maybe not top-of-mind elements of accountable care, but all three are helping healthy employees to stay healthy, and luring others to engage in their own health self-management, the keys to successful population health management (PHM), says Elizabeth Miller, vice president of care management at White Memorial Medical Center, part of Adventist Health, in a recent webinar at the Healthcare Intelligence Network.

In Managing Risk in Population Health Management, Ms. Miller shared the key features of the PHM program at White Memorial, the program’s impact on Adventist’s 27,000 employees and how the program was being rolled out to its patient population.

By incorporating elements of the Triple Aim, and collaborating with all stakeholders, including patients, providers, health plans, employers, hospitals and local community members, a PHM program can achieve optimal outcomes, including minimizing the need for ED visits, lowering costs, maintaining and improving individuals’ health across the continuum of care, and reducing readmissions, Miller says.

Medication reconciliation plays a key part in preventing populations from being admitted or readmitted to the hospital, Miller continues, because it is one of the chief causes for readmission. She cites numerous instances where nurse practitioners go into people’s homes to do medication reconciliation only to find that they are going to two cardiologists simultaneously and taking medications from both of them, not realizing how detrimental it is to their health.

Elements of the PHM program include using robust data sets, risk stratification, and predictive modeling to identify populations, and target high-risk individuals with one or more chronic diseases, including the top five: coronary heart failure (CHF), chronic obstructive pulmonary disease (COPD), asthma, diabetes, HIV. Once eligible populations are targeted and enrollment criteria met, analytics, intervention and program development are established for the top 5 percent, or very high risk, and 10 percent, or high risk, and then wellness programs for the 85 percent, or medium risk.

Ongoing assessments and evaluations of interventions follow, usually by care managers, including periodic reassessments of goals, and measuring outcomes with set metrics.

The goal of any PHM plan is to eventually graduate patients by setting up decision support and self-management tools that will help them do so. Offering employees the right incentives is a key contributor to this. White Memorial was able to engage 95 percent of its employee population in a PHM program by reducing monthly insurance premiums by $50 a month. That percentage grew to 98 percent when the reductions were extended to employees’ spouses,’ Miller says.

Ultimately, says Miller, “we really want to focus on the population and modify the behaviors so that we prevent illness in the future. Right now we have a disproportionate investment in illness after it has already occurred. Once it has occurred, it’s difficult to manage and treat…Our goal is to keep the population as healthy as possible.”

It can be labor intensive, Miller points out, but the outcomes are worth it. Improved health status leads to improved performance, and projected financial savings of $49 million by 2017.

Healthcare Business Week in Review: Healthcare Costs; Health Insurance Marketplaces, Diabetes Management

November 22nd, 2013 by Cheryl Miller

The United States spends more money on healthcare than other developed countries, and yet their outcomes are worse, according to a new study from Johns Hopkins.

But political infighting is preventing the country from achieving ways to deliver care more effectively and efficiently.

The study, published in JAMA, attempts to dispel several common misconceptions informing the current healthcare debate. Among them: that the aging of the population and the large numbers of tests and treatments being prescribed have been primarily responsible for escalating healthcare costs. Researchers assert that the prices of drugs, medical devices and hospital costs have driven up the costs of healthcare in this country over the last decade, and that it’s not the elderly that are ratcheting up healthcare costs, but those under 65 with chronic conditions.

What is needed to fix the system? An investment in primary care doctors, and a unified government, among other things.

Policymakers can start coming together on the latest news from the White House: insurers can extend current insurance plans that would otherwise be canceled into 2014, and Americans whose plans have been canceled can choose to re-enroll in the same kind of plan.

In the past few weeks, some Americans have been notified by their health insurance companies that plans they bought on the old individual insurance market were being cancelled, often because these plans no longer met the ACA’s requirement to cover basic benefits like prescription drugs or doctors’ visits. These people now have an additional year of coverage.

Some news that no one can debate: 106,185 Americans selected health plans in the first reporting period of open enrollment (October 1st through November 2nd) ; 975,407 customers made it through the process but have not yet selected a plan; and an additional 396,261 customers were determined eligible for Medicaid or the Children’s Health Insurance Program (CHIP). These results, from an issue brief from HHS, show that the level of interest is strong, and that enrollment should grow substantially throughout the next five months.

In other news: diabetic patients treated in the ED who were enrolled in a program sending daily automatic text messages improved their level of control over their diabetes and their medication adherence, according to a study from the Keck School of Medicine at the University of Southern California in Los Angeles.

The text messaging program, called TExT-MED, is low cost and widely available for those patients who have no other source of medical care.

Don’t forget to participate in our fourth comprehensive Reducing Hospital Readmissions Benchmark Survey. While great strides have been made in the reduction of 30-day all-cause hospital readmissions, CMS still docked reimbursement for more than 2,200 hospitals in 2013 for exceeding 30-day readmission rates for heart failure, pneumonia and myocardial infarction. In 2015, CMS penalties will extend to acute COPD and elective hip and knee replacements. Describe how your organization is working to reduce hospital readmissions by January 3, 2014 and receive an e-summary of the results once they are compiled.

Patient Satisfaction Key to New ACCO, Readmissions Reductions Program

March 8th, 2013 by Cheryl Miller

The movement to improve patient satisfaction continues, with a new ACCO, a not so new solution for newly discharged emergency patients, and a continued investment in employees’ health and wellness.

The Rhode Island-based Lifespan and UnitedHealthcare have launched an Accountable Coordinated Care Organization (ACCO) will include Lifespan’s acute care hospitals and physicians who will provide coordinated care to about 21,000 people in Rhode Island who are enrolled in UnitedHealthcare’s employer-sponsored benefit plans. Designed to enable across the board communication among physicians to improve care and satisfaction, its emphasis will be on outcome-based payments, rather than reimbursement based solely on volume of services delivered.

And a simple phone call post-discharge could keep rising readmissions rates at bay. A patient satisfaction survey from Kaiser Permanente Medical Center of more than 1000 patients newly discharged from the ER found that those who received a follow-up email or phone from their emergency physician were nearly 90 percent satisfied with their hospital stay; as opposed to an 80 percent satisfaction rating from those who did not hear from their emergency physicians after they left the hospital. The implications for high satisfaction scores are wide ranging; they can lead to better patient compliance, improved discharge plans, smoother care transitions and higher staff morale, researchers note.

In news guaranteed to satisfy patients invested in their own well being, corporate employers are spending nearly double on health incentives than they spent in 2009, according to a new employer survey conducted by Fidelity Investments® and the National Business Group on Health (NBGH).

Employers plan to spend an average of $521 per employee this year, an increase of 13 percent from the average of $460 reported for 2011, and double what they spent on employees in 2009, or $260 per person. Employees who participate in these programs can expect to see popular incentives such as reduced health premiums, gym memberships, and cash or gift cards. And a majority of employees may also be able to extend the incentive to their families: more than half of survey respondents said they will expand their wellness-based incentives to their employees’ dependents, and almost half (49 percent) plan to include spouses/dependents in communications about wellness programs.

And in other news, patient satisfaction could be one of the long range goals of a recent survey analyzing how our key healthcare leaders approach the industry.

According to a survey from Kaiser Permanente’s Institute for Health Policy, physicians, health reporters and policymakers differ significantly in the way they talk about health issues that impact Americans. Overall, physicians prioritize health education, while members of the media are more focused on the business of health, and members of Congress more in step with the legislative, judicial, and administrative policies of health. If Americans are to be properly educated, however, these three groups need to better aligned in their public conversations.

These stories and more in this week’s issue of the Healthcare Business Weekly Update.

Infographic: Real World Strategies for Reducing Readmissions

December 12th, 2012 by Patricia Donovan

reducing readmissions

We’ve all seen the numbers on potentially avoidable Medicare readmissions, but new penalties from CMS for subpar readmission rates pack a little more punch into these often-published stats from CMS, the AHRQ, MedPac, and other sources. The hard truth is that more than 2,200 hospitals will lose a portion of their inpatient Medicare rates in FY 2013.

Proactive data analysis is one way to keep readmissions penalties at bay. And this new infographic from the Healthcare Intelligence Network consolidates the protocols and strategies many organizations are using to dramatically reduce the number of Medicare beneficiaries that return to the hospital within 30 days, drawing from responses from our annual Reducing Hospital Readmissions survey.

Among their ideas:

  • Follow-up appointments and phone contact shortly after discharge;
  • The use of transition coaches in hospitals, nursing homes and SNFs;
  • Group physical activity sessions that focus on physical, social and emotional well-being;
  • Upping use of telehealth and fall risk assessments.

We invite you to embed this infographic on your own Web site using the code that appears beneath it. Also, share it via your social media channels. A deeper dive into the latest trends to reduce hospital readmissions is reflected in 2012 Healthcare Benchmarks: Reducing Hospital Readmissions.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics. Click here to sign up today.

Other Infographics from HIN:

Nearly 6 Million Visit Retail Medical Clinics in 2009; Older Patients and Preventive Services on Rise

August 20th, 2012 by Cheryl Miller


Retail medical clinics continue to grow in popularity, particularly among those 65 and up seeking preventive services, a new report from the RAND Corporation shows. Nearly half of visits between 2007 and 2009 occurred on weekends, when physician offices are typically closed. But despite their rising popularity, they still account for a small proportion of outpatient medical care overall.

The elderly are targets of a new initiative from the HHS, which has partnered with five pharmacies to help educate customers about their Medicare benefits. The pharmacies will provide educational materials to beneficiaries about available preventive services and savings on prescription drug spending in the “donut hole” coverage gap, among other things.

Efforts to decrease hospital readmission rates remain stagnant, as the national average readmission rate continues to hover slightly above 19 percent, according to a recent news report from Kaiser Health News. Nearly 300 hospitals, some of them nationally recognized, could lose an estimated $280 million in Medicare funds over the next year as the government starts paying healthcare providers based on the quality of care they provide.

And don’t forget to participate in on our Health and Wellness Incentives Survey. A review of 36 peer-reviewed studies of wellness programs in large firms found that average employer medical costs fell $3.27 for every dollar spent on wellness programs, and costs for days that employees were absent fell an average of $2.73. Please share the details of your incentives program by completing our fourth annual survey by August 31 and you’ll receive a free executive summary of the compiled results.

Read all of these stories in their entirety in this week’s Healthcare Business Weekly Update.

11 Innovations in Healthcare Case Management

July 23rd, 2012 by Jackie Lyons

According to respondents from HIN’s third annual healthcare case management survey, successful case management efforts focus on transition coaching, discharge planning, reward programs and a patient-centered approach to case management.

Despite the challenges of staffing and operating a successful case management company brought on by healthcare reform and the changing industry, respondents contributed innovative interventions that improve health and reduce costs in the populations they serve.

Eleven case management program interventions that proved to be successful are:

1. Working with local community collaboratives for transition coaching. For example, respondents collaborate with a company that performs in-home health assessments on members identified with chronic diseases. The information is sent to them and they use it to direct care for their members.

2. Scheduling home visits by nurse practitioners for selected patients.

3. Redirecting to in-network providers and coordinating services in an efficient manner to prevent delay in discharges.

4. Holding case conference meetings with the treating physicians, case managers, medical directors and other related parties to address issues related to challenging or high-risk patients.

5. Verifying medication and home healthcare strategies to prevent readmission for chronic illness within 24 to 48 hours.

6. Partnering with social workers who will spend time dealing with complex family problems and end-of-life care.

7. Getting high-risk obstetrical clients to assume greater accountability for the outcome of their pregnancies and communicating with providers and educators. Respondents noted a significant decrease in low birth weight infants for RN case-managed programs focused on these objectives.

8. Utilizing diabetes reward programs to keep measures in line.

9. Integrating case management (medical and behavioral health) for a patient-centered approach.

10. Using neutral assessment and family trust to establish realization that case managers can identify affordable and appropriate resources.

11. Attaining the Advanced Achievement in Transplant Management Certification (through Interlink Health Services) so case managers better understand and educate patients about the benefits of using a Transplant Center of Excellence for the best possible clinical and financial outcomes when a transplant is needed. Respondents report successful clinical outcomes and savings range in the 40-50 percent range.

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.