Archive for the ‘Healthcare Toolkits’ Category

Infographic: 2018 Healthcare Provider Referral Trends

October 10th, 2018 by Melanie Matthews

While 77 percent of healthcare providers recognize the importance of keeping patients in-network for care coordination, a notable 79 percent say they refer patients out of network, according to a new infographic by Kyruus.

The infographic looks at contradictions in today’s referral behaviors, key barriers to keeping patients in-network and turning obstacles into opportunities.

When the prestigious Memorial Sloan Kettering Cancer Center (MSKCC) began to face tougher competition from hospitals with managed care contracts and limited networks, the state-of-the-art specialty hospital decided to implement a team-based care coordination approach to attract and retain healthcare payors focused on value-based care.

Integrated Case Management: Elevating Quality and Clinical Metrics with Multidisciplinary Team-Based Care details the framework and implementation of the service-based multidisciplinary program MSKCC adopted to demonstrate that the care it provides to more than 25,000 admitted patients each year is both cost-effective and cost-efficient.

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Infographic: The Guide to the Future of Medicine

November 19th, 2013 by Jackie Lyons

Digital literacy is readily available to patients and meaningful use of social media is already in progress, while home diagnostic tools still need time to develop, according to a new infographic from Science Roll.

This infographic shows which stage of healthcare delivery and the practice of medicine is affected by emerging trends, whether the trends affect patients or healthcare professionals, and the practicability of trends and whether they are already available or not.

The Guide to the Future of Medicine

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You may also be interested in this related resource: Drug Benefit Trends and Strategies: 2013.

Healthcare Hotspotting: Camden Coalition Drives Interventions with Data

July 11th, 2013 by Patricia Donovan

Look out, big data: a coalition of providers in one of the most dangerous cities in the country is tapping widely available hospital claims data to defragment the healthcare system and close gaps in the care continuum.

The process is called “hotspotting,” explains Ken Gross, director of research and evaluation for the Camden Coalition of Healthcare Providers. In a recent interview with the Healthcare Intelligence Network, Gross described the coalition’s plans to evangelize the use of hotspotting to develop key care interventions via its Healthcare Hottspotting Toolkit. In the first of two blog posts on hotspotting, Gross provided a primer on healthcare hotspotting.

HIN: What is the Camden Coalition of Healthcare Providers?

Ken Gross: It’s a membership organization made up of representatives from three Camden hospitals. The city of Camden is nine square miles. It’s one of the most dangerous cities in the country, and it has one of the lowest average income per person in the country as well. Members come from a number of organizations, including hospitals, clinics and private primary care providers.

We are the spoke in a fragmented healthcare system; we bring everyone together to see what kind of programs are needed to fill in the gaps — between hospitals and clinics, between social services and mental or behavioral health. We are a nonprofit and we’ve been in existence for about 10 years now.

HIN: There’s a lot of emphasis today on drilling down to local healthcare data in order to identify high-risk patients and better coordinate their care. Where does hotspotting fit into this trend?

Ken Gross: We believe health interventions should be data driven. But first, you need to quantify the problem and understand the population health issues — whether that population is in the geography of Camden or the population of patients coming to a particular hospital.

To be data driven, you can wait for the data to come down from the state or government level, but it’s rarely released in small enough geographies to look at the health needs of the community in order to plan. Planning means looking at how many utilizers do you have? How many high utilizers are ED-only high utilizers? How many are inpatient high utilizers? What are the top diagnoses and how much did the most expensive patient in aggregate cost the system?

To do this, you need local solutions, local data. Most organizations and technology focus on the electronic medical record (EMR). Well, there are a lot of EMR companies out there, and many different data formats. It’s hard to aggregate reporting from EMRs.

But there’s something sitting off to the side that is a lot easier to make use of, and that’s claims data. People ignore claims data as a means of understanding the population problem because they think it’s to get bills paid and that’s it. But claims data is useful for both clinical and economic purposes. It includes basic demographics: the patient’s age, insurer, top 20 diagnoses, procedure codes, charges and receipts. That data can help.

It’s also more readily available. It’s easy to activate to quantify the problem and start to plan programs that are data driven to say, “We have x amount. The problem is this big.” Every hospital keeps that data in the same format, so you don’t run into that problem of different formats across different hospitals like you do with EMRs. It’s powerful information and it’s easier to get started than any other data source in healthcare.

HIN: Hotspotting advocates the use of hospital claims to pinpoint heavy users. Don’t you also need payor and other provider data to get the total picture?

Ken Gross: We would love to have more data on outpatient visits and primary care. It’s harder to get all that data and link it together. It is correct that with hospital data, we will get only a part of the picture, such as ED and inpatient visits. Often, that’s pretty powerful to paint the picture for a community. If a lot of people are going to the ED for say, asthma-related conditions, that’s a proxy for the health of the community and barriers to the primary care system. It speaks to utilization and why people are going to the ED: that there aren’t enough primary care physicians or the hours aren’t good, or there’s a behavior change needed to educate people and link them to primary care.

Another value of getting claims data from the hospitals themselves is that it gives you an idea of the level of charity care, which is a proxy for the uninsured. Payor data would miss that, because there isn’t a payor in these cases.

What’s unique about getting it from the hospital is that we can ‘hot spot’ to see geographically where people are receiving charity care and do outreach efforts to enroll them in ACA coverage. You wouldn’t get that information from any other data source.

HIN: What are some examples of hotspotters?

Ken Gross: We look by neighborhood or particular address. In our community, we saw there were high-rises and assisted living nursing homes that had lots of utilization. We didn’t know exactly what to do in those areas, but it narrowed things down for separate discussions. It led to discussions with the people who managed one high-rise: what can we do in that building to provide better access to care? And a clinic opened up.

In other hotspotting examples, we focus on what claims data shows from utilization patterns: how many ED visits and inpatient visits come from a particular location? Hotspotting could also identify people with the primary diagnosis of diabetes in certain geographic areas. You would then look at whether you have enough resources. We have diabetes education programs as part of our coalition.

We can then overlay this on a map: where there’s a high instance of diabetes in the community and where we offer our programs, to see if we need programs in other places.

Hotspotting isn’t just geographic. It really is segmentation of the population to get a better understanding of different utilization patterns. And then the next step as we’re doing that is spatial, but it doesn’t have to be just spatial.

HIN: How do you create a map, and what you would do with that map?

Ken Gross: The first step is allowing for the hospital to provide address level information from claims data. Often the data needs to be cleaned up a bit to make use of it. There are a number of software packages that allow you to do “geocoding:” — taking those addresses and putting them as dots on the map. Once that dot is on the map, you have all the underlying data, so you can query the dots that are just diabetes or just ED high utilizers. And then we aggregate it to specific buildings.

There are ways to display the data in aggregate in small geographies. The census block group is a geography we often use. Then we can make maps to identify different utilization patterns by neighborhood.

It’s important to do it both at the address level and the neighborhood level. For example, if there’s a high rise within a block group with high utilization, high variance, and we only looked at it at the neighborhood level, you would think this is a neighborhood problem. But then if you notice they’re all coming from one address, you realize it’s a building-related problem to address.

There’s two levels — mapping point level or address level and the aggregate by the address.

HIN: If collecting local data is not that difficult, why have organizations been slow to do this?

Ken Gross: There are three common reasons. First, no one is looking in that direction because they don’t see the value of the claims data. They forget that there’s useful information there.

Second, when people do see it there, they have legal concerns. They think, I can’t share that with anyone because of HIPAA. We actually recommend and will have on our toolkit site information about our business associates agreement, which allows the sharing of data in specific circumstances.

The third barrier is the cost data in the claims. In a competitive hospital environment, they don’t want that data out there. There’s concern that one hospital is doing this many procedures or seeing this many would be market or business intelligence versus competitive market. In agreements with our three hospitals, we agree we’re never going to report that Hospital A is doing this, or has this many, Hospital B is doing that compared to C. We say the only way to report on the health of the population is to get aggregate data from all three — for example, the residents of Camden go to these three hospitals, and we’ve seen these aggregate number of visits, this aggregate number of costs.

That seems to ease some concerns. Start with the ‘ why’ and get everyone on board to understand why we want this data, then start the legal conversation and the contract discussions.

HIN: We’re starting to see some of this cost information, with CMS’s recent release of cost data by facility for Medicare.

Ken Gross: That was a great first step. And that was claims data. For CMS to have taken that step shows transparency. And there’s been lots of discussions since about what to do about that data.

Similarly, hotspotting creates a context for people to start talking about either trends they didn’t know about or knew anecdotally, but didn’t know the total sum of the problem.

Editor’s note: In a future post, Gross describes the coalition’s Hotspotting Toolkit, developed with a grant from the Commonwealth Foundation.

6 Effective ACO Tools and Procedures

August 3rd, 2012 by Jackie Lyons

To measure quality and efficiency, accountable care organizations (ACOs) must use the latest healthcare technology and the best tools and programs. The most effective tools can be used to monitor and increase patient satisfaction and overall program performance.

The use of EHRs, already vigorous in 2011 at 92 percent, is now universal, with all active ACOs using this health management tool, according to 200 healthcare companies who completed the second annual Healthcare Intelligence Network survey on Accountable Care Organizations. Respondents to the survey also revealed other tools and procedures crucial to accountable care:

1. “Technology-provider who understands both healthcare and IT.”

2. “Intensive case management program embedded in the primary care office is the most promising program.”

3. “A tool called HealthJibe, which is a personal health platform designed to engage people in better health.”

4. “CareTeam advanced clinical decision support.”

5. “Electronic patient profile.”

6. “Case management and care stratification tools.”

Healthcare Industry Not Prepared to Protect Patient Privacy; Data Breaches Rising

October 3rd, 2011 by Cheryl Miller

As new uses for digital health information emerge and access to confidential patient information expands, a majority of healthcare organizations are not prepared to protect patient privacy and secure data, says a new report from the Health Research Institute (HRI) at PwC US. And medical identity theft is on the rise; according to a recent PwC HRI survey, theft accounted for two thirds of total reported health data breaches over the past two years. Healthcare organizations need to update practices and adopt a more integrated approach to ensure that patient information doesn’t fall into the wrong hands, the report advises. We report on this story at length in this week’s Healthcare Business Weekly Update.

Annual premiums for employer-sponsored family health coverage increased to $15,073 this year, up 9 percent from last year, according to a recent Employer Health Benefits survey from the Kaiser Family Foundation/Health Research & Educational Trust (HRET). Premiums increased significantly faster than workers’ wages and general inflation.

To help its members navigate healthcare services and costs, BCBSF has introduced a new transparency tool, “Know Before You Go.” Designed to help its members navigate through the healthcare system, it provides information based on hospital data reported by CMS. The tool is customized to a member’s benefits and takes into account deductibles, copays and/or coinsurance amounts and estimates how much a treatment or procedure will cost.

And we are compiling research for our second annual survey on tactics to reduce avoidable emergency room visits. We will e-mail all respondents a summary of results once they are compiled. To participate, click here.

mHealth: There’s a Grant for That

August 5th, 2011 by Cheryl Miller

By 2015 more than 500 million smartphone users worldwide will be using healthcare applications, research studies show. So it’s not surprising the FDA is taking a closer look at some of these apps, specifically, those whose misuse could endanger its users.

These “medical mobile apps,” as the FDA is calling them, are specific to medicine or healthcare and are designed for use on smartphones and other mobile computing devices and will offer everything from blood sugar monitoring to ECG machines.

As we reported in a previous HBWU issue about IBM, the benefits of these health and medical apps are immeasurable, not just here, but in underserved, frequently rural communities around the globe, especially where patients have no access to doctors, these devices can save lives.

And they can save billions of dollars as well. According to studies from Juniper Research using mobile health, or mHealth, technologies for health monitoring could save from $1.96 billion to $5.83 billion in healthcare costs by the year 2014. So the Center for Technology and Aging (CTA) (, with funding from The SCAN Foundation, has awarded nearly $500,000 in one-year grants to five organizations that will demonstrate the best ways to implement mHealth technologies for older, chronically ill adults, ironically, the population least likely to own a smartphone. The grants will help the CTA to meet its four areas of opportunity that it feels can best transform lives: medication optimization, remote patient monitoring, care transitions, and mobile health. And in a recently published paper the agency discusses how

cell phones, smart phones, laptop and tablet computers, and other mobile enabled devices are being used to help millions of older Americans as well as their physicians and caregivers manage chronic disease, use their medications properly, avoid safety risks (e.g. fall detection), access online health information, and stay well.

With the exploding growth of mHealth technology it seems that smartphones will eventually be used for everything but plain old talking. Hopefully the dialogue between a patient and physician won’t be relegated to a tiny FaceTime screen on an IPhone.

Health Reform Toolkit Needs Focus on Health Management and Prevention

June 11th, 2009 by Melanie Matthews

The toolkit needed for healthcare reform is more broad-based than containing costs and improving quality, says Kenneth Thorpe, executive director, for the Partnership to Fight Chronic Disease. Thorpe is also a Robert W. Woodruff Professor and Chair of the Department of Health Policy and Management at Rollins School of Public Health, Emory University.

Reform efforts must also include population health management, health prevention and care coordination, Thorpe said during a panel discussion in conjunction with last week’s National Medicare Readmissions Summit and the 2009 Medicaid Congress.

“Getting to the Value Quadrant of Healthcare Reform,” sponsored by Pharos Innovations, highlighted several care management programs achieving positive returns, as well as the role of care coordination in health reform.

Thorpe underscored the importance of the primary care system in any reform efforts to help achieve the goals of population health management and care coordination especially among those with chronic conditions.

While declaring that he has pilot and demonstration fatigue, Thorpe called on the healthcare industry to build out the medical home engine to coordinate this care and to collaborate with smaller physician groups to bring the opportunity that the medical home model of care offers to these smaller groups.

Spreading the Word About Infectious Disease Control

June 5th, 2008 by Melanie Matthews

A cruise line I recently traveled with had an interesting method for infection and germ control. Each time we boarded the ship, they sprayed our hands with sanitizer. At the entrances and exits to every restaurant there were hand sanitizer dispensers. In the casinos, in the hallways and in the lounges — hand sanitizer. The cruise line’s attempt at controlling and preventing the spread of disease was a very visible means to calm the fears of many passengers who might be worried about the possibilities of obtaining and spreading diseases in such confined quarters. Moreover, the CDC has established a Vessel Sanitation Program within the organization to better prevent and control the introduction, transmission and spread of gastrointestinal illnesses (GI) on cruise ships.

This isn’t too far off from what many hospitals and healthcare organizations are doing to stamp out outbreaks of MRSA and other infectious diseases. This week’s Disease Management Update highlights some tactics for infection control and how better hand hygiene is reducing MRSA outbreaks.

ICP Associates, Inc., a national consulting company with the objective to provide quality products and services to healthcare facilities to facilitate their own infection control programs and initiatives, also offers a variety of free resources, educational material and Web links regarding infectious disease, transmission and control measures.

Making Web Videos on a Shoestring Budget: HIN’s Four-Part Video Series

April 25th, 2008 by Melanie Matthews

After launching our first video for the Web, Web 2.0 and Healthcare, we couldn’t help but think that other organizations might also want to learn how to do this. So we’ve created a 4-part video series on making videos for the Web called “Vlogging 101: Videos on a Shoestring.”

You can view Part 1, Getting Started, below. For the rest of the series, please visit:

Videos on a Shoestring Part 2: Creating the Script

Videos on a Shoestring Part 3: Video Production

Videos on a Shoestring Part 4: Distributing Videos on the Web

We welcome your comments! And invite you to view our other video, Diabetes and the Medical Home.

Incorporating Cultural Diversity into Your Healthcare System

August 17th, 2007 by Melanie Matthews

This week’s Disease Management Update features two recent studies published in the American Cancer Society’s journal CANCER that illustrate that race can and does play a part in disease management. For example, Asian men are have better prostate cancer survival rate, while African American women are worse off when it comes to breast cancer.

These studies highlight the fact that hospitals, physicians and the likes are incorporating diversity into their practices and treating the patient and not just the disease, recognizing that diagnoses and outcomes differ from patient to patient and from race to race.

How can hospitals and primary care providers take steps to incorporate diversity into their practices and accommodate the diverse nature of their patients?

SAMHSA toolkit

  • The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) has developed a free resource kit for American Indian, Alaska Native and Native Hawaiian populations that addresses fetal alcohol spectrum disorders (FASD). Native cultures are known for their understanding of healing, wellness, and the cycles of nature. The Native Initiative works with these strengths and the strengths of community elders to bring Native people messages about FASD that are culturally respectful and meaningful.

  • Patti Ludwig-Beymer, administrative director of education and research at Edward Hospital in Naperville, Illinois says just knowing a few key words of a foreign language helps healthcare providers develop a trusting relationship with their patients.

  • Barnes-Jewish Hospital created a Center for Diversity and Cultural Competence in May 2006 to promote diversity and cultural competence initiatives and programs throughout the hospital, reduce health disparities, promote dialogue for issues of diversity, recruit diverse staff and create an environment where all patients and staff are respected and included. The hospital believes it must face the racial, class and economic inequities in healthcare. The region is home to 52 percent of St. Louis’s African American population, and 17 percent of the population use a primary language other than English. In addition, 24 percent of the population in the region is diverse.

What initiatives are YOUR organization taking to address the issues of diversity and disparities within the healthcare industry? Leave a comment and let us know!