Posts Tagged ‘Care Coordination’

Infographic: Collaboration for Better Care

October 7th, 2015 by Melanie Matthews

Technology can help break down communication barriers and extend more immediate care, according to a new infographic by CDW Healthcare.

The infographic showcases health IT components that support connected care.

Collaboration for Better Care

The rapid evolution of healthcare payment reform requires a sea change of both hospital and physician behavior. As healthcare providers are held more accountable for the quality and cost of care delivered, the physician-hospital organization (PHO) provides an efficient framework for collaboration and resource consolidation.

Physician-Hospital Organizations: Framework for Clinical Integration and Value-Based Reimbursement describes the relevance of the PHO model to today’s healthcare market, offering strategies to leverage the physician-hospital organization for maximum clinical outcomes, competencies and value-based reimbursement.

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Infographic: Coordinated Care Models Needed for Cancer Care

September 28th, 2015 by Melanie Matthews

Coordinated Care Models Needed for Cancer Care

Overall satisfaction among cancer patients and caregivers with the care they received has improved significantly since the 2012, according to new data from the 2015 Cancer Experience: A National Study of Patients and Caregivers, reflected in a new infographic.

The survey results also mirror the ongoing national healthcare debate and reveal significant gaps between patients’ expectations and the quality of care they receive. While having access to advanced oncology therapies is important, survey respondents indicated that healthcare providers need to address their dissatisfaction with the lack of care coordination, confusion and frustration surrounding healthcare terminology (literacy), and the inability to obtain timely information from their care team.

The infographic drills down on these survey results and examines how healthcare providers can respond to these patient concerns.

Anthem's Cancer Care Quality Program: Pathways to Improve Care and Reduce CostsDespite enormous innovations in the field, average costs for oncology drugs are skyrocketing and thousands of people in the U.S. die from cancer each week. Some payers, including Anthem, Inc., have turned to the use of pathways in an effort to make sure patients get the most appropriate evidence-based care that is still cost-effective.

Anthem’s Cancer Care Quality Program: Pathways to Improve Care and Reduce Costs discusses the specifics of the insurer’s Cancer Care Quality Program, its expectations in terms of outcomes and cost control, lessons it has learned and changes already made in the initial plans.

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Infographic: Standardization, Collaboration Across Care Teams Improves Care Quality

August 3rd, 2015 by Melanie Matthews

Failures in care coordination can increase healthcare costs by between $25 and $25 billion annually, according to a new infographic by Elsevier.

The infographic examines the impact of poor care coordination on the patient experience and healthcare costs and how healthcare organizations can address this challenge.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations Asked by its C-suite to quantify contributions of its multidisciplinary care team for its highest-risk patients, AltaMed Health Services Corporation readily identified seven key performance metrics associated with the team. Having demonstrated the team’s bottom line impact on specialty costs, emergency room visits, and HEDIS® measures, among other areas, the largest independent federally qualified community health center (FQHC) was granted additional staff to expand care management for its safety net population.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations chronicles AltaMed’s four-phase rollout of care coordination for dual eligibles—a population with higher hospitalization and utilization and care costs twice those of any other population served by AltaMed.

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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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Driving Quality Care Transitions: Infographic

May 25th, 2015 by Melanie Matthews

When transitions of care are poorly coordinated, both the patient and the healthcare organization suffer. Without proper education, timely follow-up and tools to self-manage, patient complications and readmissions increase significantly. Healthcare organizations need effective and scalable ways of engaging and empowering patients to take active roles in their health post-discharge.

A new infographic by Emmi Solutions examines the importance of patient engagement for care transitions.

2015 Healthcare Benchmarks: Care Transitions ManagementManagement of patient handoffs—between providers, from hospital to home or skilled nursing facility, or SNF to hospital—is a key factor in the delivery of value-based care. Poorly managed care transitions drive avoidable readmissions, ER use, medication errors and healthcare spend.

In 2015 Healthcare Benchmarks: Care Transitions Management, HIN’s fourth annual analysis of these cross-continuum initiatives, examines programs, models, protocols and results associated with movement of patients from one care site to another, including the impact of care transitions management on quality metrics and the delivery of value-based care.

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Infographic: EMR Investments for Care Coordination

April 24th, 2015 by Melanie Matthews

Healthcare providers are making significant EMR investments to improve coordinated care and achieve new clinical efficiencies. EMC and MeriTalk recently surveyed 151 Health IT leaders to find out how they are preparing their IT infrastructure to support an expanding set of clinical and business workload requirements leveraging an enterprise hybrid cloud framework.

A new infographic by the two organizations examines survey results, including: Health IT leaders’ cloud status and plans; anticipated benefits and impact of emerging cloud models – private, managed private, and public; and next steps as healthcare providers mature their cloud ecosystem.

2015 Healthcare Benchmarks: Chronic Care ManagementThe desire to improve health outcomes for individuals with serious illness coupled with opportunities to generate additional revenue have prompted healthcare providers to step up chronic care management initiatives. The Centers for Medicare and Medicaid Services now reimburses physician practices for select chronic care management (CCM) services for Medicare beneficiaries, with more private payors likely to follow suit.

2015 Healthcare Benchmarks: Chronic Care Management captures tools, practices and lessons learned by the healthcare industry related to the management of chronic disease.

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Infographic: Why Care Coordination Matters

January 23rd, 2015 by Melanie Matthews

As a result of poor coordination of care, one in five Medicare patients is readmitted within 30 days of discharge from the hospital, according to a new infographic by Primaris.

The infographic also examines the level of post-discharge care for Medicare beneficiaries who are re-admitted and the cost of these readmissions.

Scalable Models in Health Risk Stratification: Results from Cross-Continuum Care Coordination Health risk stratification is scalable—whether grouping diabetics in a single practice without an EMR or drilling down to an ACO’s subset of medication non-adherent diabetics with elevated HbA1cs who lack social supports. That’s the experience of Ochsner Health System, whose scaling and centralization of risk stratification and care coordination protocols across its nine-hospital system drive ROI and improve clinical outcomes and efficiency.

Scalable Models in Health Risk Stratification: Results from Cross-Continuum Care Coordination explores Ochsner’s approach, in which standardized scripts, tools and workflows are applied along the care continuum, from post-hospital and ER discharge telephonic follow-up to capture of complex cases for outpatient management.

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Incentives Advance PCP-Specialist Communications in Value-Based Health System

January 6th, 2015 by Cheryl Miller

In a value-based reimbursement model, primary care physicians need to be quarterbacks for their patients, taking an additional interest in their care and following them to the end zone, or to other specialists providing care, says Chip Howard, Humana’s vice president of payment innovation in the provider development center of excellence. This will foster communication between physicians and specialists, a fundamental problem of the classic fee-for-service model.

Question: How can you manage and reward the complex interactions between primary care physicians (PCPs) and sub-specialists?

Response: (Chip Howard) That’s a pretty common question in the industry these days. If you think back to the old model, the classic fee-for-service model, the PCP potentially loses track of the member as they go to a specialist. The volume-based model is very fragmented. You don’t have communication, a fundamental problem of the model. But I think we’re on a discovery to potentially address that. Some thoughts that come to mind are putting incentives in place that will promote communication between PCP and specialists.

At the end of the day in a primary care model, we’re encouraging the PCPs to be the quarterback of the member’s care, to take that additional interest and follow the member through the path to other specialists that are providing care. There are also obligations on the specialist’s part that you would have to engage because it’s a two-way street.

Some other thoughts: we are starting to explore specialist engagement programs, whether it’s looking at bundled payments or at other sorts of programs that incentivize the specialist to achieve the Triple Aim: higher quality, lower cost, best outcomes. Then, putting data and analytics into the hands of PCPs that will enable them to potentially steer those members to specialists that are proving that they can work to achieve the Triple Aim on behalf of the patient.

There are also some ideas about how to promote interactions between PCPs and sub-specialists and start the ball rolling. That is a lot easier in an integrated system-type environment where there is one system that owns the continuum of care for the most part from PCP to specialist, to outpatient, inpatient, etc.

value-based reimbursement
Chip Howard is vice president, payment innovation in the Provider Development Center of Excellence, Humana. He is responsible for advancing Humana’s Accountable Care Continuum, expanding its Provider Reward Programs, innovative payment models and programs that enable providers to become successful risk-taking population health managers.

Source: Physician Value-Based Reimbursement: Quality Rewards for Population Health

CMS Chronic Care Management Medicare Reimbursement: Sizeable Revenue, Health Outcome Opportunities

November 21st, 2014 by Cheryl Miller

Beginning January 2015, Medicare will pay a flat, monthly chronic care management (CCM) fee to providers coordinating care for beneficiaries with more than one chronic condition. This change will expand the current Medicare payment policy to include non face-to-face management services previously included within payments for evaluation and management (EM) services, amount to about $40 a beneficiary, a sizeable new source of revenue for eligible providers.

The targeted population is also substantial; as recent news story reported by the Healthcare Intelligence Network (HIN), 87 percent of U.S. adults ages 65 and older have at least one chronic illness, and 68 percent have two or more, the highest rates in a new 11-country Commonwealth Fund survey.

But healthcare organizations do not have that much time to prepare for the newly released 2015 Medicare Physician Fee schedule, which finalized the CCM reimbursement. Who can bill for CCM, what constitutes a chronic condition, which patients are eligible to receive CCM services, and the scope of services required were among the issues discussed during Chronic Care Management Medicare Reimbursement: New Revenue Opportunities for Care Coordination, a November 19th webinar, now available for replay. Rick Hindmand, an attorney with McDonald Hopkins, a law firm that advises a nationwide client base extensively on healthcare reimbursement, shared insight on these issues and how to best prepare for this reimbursement opportunity.

Those allowed to bill for CCM reimbursement fall into one of five categories: physicians, advanced practice registered nurses (APRNs), physician assistants (PAs), clinical nurse specialists and certified nurse midwives. If these practitioners are part of a practice entity, that entity can bill for it as well.

Beneficiary requirements are not as clear cut, Mr. Hindman continued. Eligible patients must have at least two chronic conditions that are expected to last at least 12 months or until death, and those conditions need to create a significant risk of death, acute exacerbation/decomposition or functional decline. Specific definitions of conditions can be found at CMS’s Web site.

And because CMS does not want to pay for duplicative services, CCM is not allowed for beneficiaries who receive services for transitional care management, home healthcare supervision, hospice supervision, and various end stage renal disease (ESRD) conditions. Patients attributed under the Multi-payer Advanced Primary Care Practice Demonstration (MAPCP) and the Comprehensive Primary Care (CPC) Initiative are also excluded.

Once these requirements are satisfied, providers must offer and document 20 minutes of CCM services a month, which enhance access and continuity of care, care management, transition management, and coordination, Mr. Hindman continues.

The CCM fee comes to about $40 a beneficiary, a significant revenue source once applied to all patients within a practice. Why the change now? Mr. Hindman speculates that CMS is finally realizing that care management is a crucial component of primary care. But questions and details await future guidance from CMS, and satisfying and documenting compliance with the CCM reimbursement requirements is going to present a challenge for many practices.

But the time and effort is worth it, he says. “With careful structuring, chronic care management can provide the potential to improve the health of their patients, while also providing some significant financial benefits for the practice.”

To listen to an interview with Mr. Hindman, click here.

Infographic: Getting Paid for the New Chronic Care Management Code

November 21st, 2014 by Melanie Matthews

Under CMS’ new Chronic Care Management (CCM) program, which takes effect in 2015, physician practices can receive reimbursement for non-encounter based follow up care to coordinate care for those with chronic conditions.

A new infographic by HealthFusion provides details on the physician practice and patient responsibilities for practices to be eligible for this reimbursement.

Chronic Care Management Medicare Reimbursement: New Revenue Opportunities for Care CoordinationStarting January 2015, physician practices will be eligible to receive reimbursement for chronic care management services provided by physicians, advanced practice nurses, physician assistants, clinical nurse specialists and certified midwives to Medicare beneficiaries with multiple chronic conditions. The 2015 Medicare Physician Fee schedule, which finalized the Chronic Care Management reimbursement, was just released, leaving healthcare organizations with little time to prepare for the final aspects of this new reimbursement opportunity.

During Chronic Care Management Medicare Reimbursement: New Revenue Opportunities for Care Coordination a November 19th webinar, now available for replay, Rick Hindmand, attorney with McDonald Hopkins, will share critical insight into how physician practices can best structure their practice to receive this additional reimbursement. The McDonald Hopkins law firm advises a nation-wide client base extensively on healthcare reimbursement.

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