Posts Tagged ‘healthcare cost’

Guest Post: Building the Right Health Management Program

February 10th, 2015 by Ann Wyatt, Regional Vice President, HealthFitness

 Ann Wyatt

Ann Wyatt, Regional Vice President, HealthFitness

While Sibson’s Healthy Enterprise Study found that 40 percent of all health management programs are not effective, research shows that organizations adopting the most effective programs—those in the top 25 percent– experienced 16 percent lower healthcare costs and a 35 percent lower rate of increase in costs than the rest.1,2

Well-designed programs lead to improved retention, better employee morale and increased productivity. Reams of data support that.3,4,5

It would seem the answer is simply to build a good program. However, it’s not that simple; what works varies by workplace, income, age and a host of other factors. The task is to develop the right program for your target group. Research6 published in September found comprehensive workplace programs do work, but their success depends on program goals, design and implementation. The program must fit into the organization’s culture.

For instance, a focus group conducted for a client of HealthFitness – a large manufacturing plant population, found that some of wellness program names sounded too “feminine” to attract the rural, blue-collar, mostly male workers. Messages about the importance of good health weren’t effective, but “Get fit for hunting season” was.

Another example: A technology company with employees making six figures launched a health management program. The incentive to complete a health assessment and attend a biometric screening? A $25 gift card. The participation rates were dismal.

Employees want meaningful and relevant programs.7,8

It needn’t be costly, and success isn’t reserved for the mega-firms. Kramer Beverage, a small company in New Jersey, earned American Heart Association recognition for its efforts to keep employees healthy. The company provides gym membership discounts, offers healthful food options at meetings and in vending machines, and has created a walking track outside the building.

Another small company with a limited budget wanted to test the wellness program waters but was concerned it didn’t have the funds to make a big splash. The company started by putting a bowl of fruit in every break room once per week. The buzz it created revealed that employees were hungry for health.

It comes down to finding out what employees are “hungry” for and “feeding” them the means to reach their goals. That can vary widely, from shaving 10 seconds off a 5K time to being readier to hunt. You don’t have to build the perfect health management program–just the right one.

1Healthy Enterprise Study, Sibson Consulting, (Winter 2011)

2Steven F. Cyboran and Sadhna Paralkar, MD. “Wellness Program ROI Depends on Design and Implementation” Society for Human Resource Management, July 26, 2013

3Parks, K., et al. “Organizational Wellness Programs: A Meta-Analysis.” Journal of Occupational Health Psychology, 2008

4Goetzel RZ, et al. “Do workplace health promotion (wellness) programs work?” J Occup Environ Med. 2014 Sep;56(9):927-34

52013 Aflac WorkForces Report conducted by Research Now

6J Occup Environ Med. 2014 Sept. op. cit.

7Aon Consumer Health Mindset,

8“Five voluntary trends to watch in 2014.” BenefitsPro , Dec. 13, 2013

Infographic: Hidden Costs of Healthcare

November 28th, 2014 by Melanie Matthews

Rising consumer out-of-pocket (OOP) healthcare spending also impacts hospitals, life sciences companies and health plans, according to Deloitte’s Center for Health Solutions.

Government data shows rising OOP spending for consumers, but excludes some types of health-related items and services that can add significantly to the total amount and consumer share of spending. This infographic exposes these “hidden costs” that account for almost one-fifth of total health care spending.

Bundled Payment Models: Bottom-Line Strategies for InsurersCase studies of two insurers that have developed bundled payment systems to reimburse providers for several episodes, including total joint replacements, congestive heart failure and colonoscopy. From how the payers got started to the pitfalls they encountered and the latest financial and quality outcomes seen, this report walks through the entire process of building a bundled payment system.

Bundled Payment Models: Bottom-Line Strategies for Insurers provides the details of how two insurers — Horizon Healthcare Services, Inc. and Arkansas Blue Cross and Blue Shield — developed successful programs to reimburse providers for episodes of care, combining payments for all aspects of treatment rather than paying providers individually for tests, office visits and procedures.

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5 Market Trends Affecting Value-Based Reimbursement

March 25th, 2014 by Patricia Donovan

physician compensation

A new economy is reshaping healthcare delivery, measurement and funding.

Changes in the way healthcare is delivered, evaluated and funded are having a serious impact as the industry gradually shifts from productivity- to population-focused compensation, according to Cynthia Kilroy, senior vice president of provider strategy and business development at Optum.

We are seeing five trends in the healthcare industry that are affecting value-based reimbursement, with implications for each.

First, there is a consolidation of the provider community: physicians are organizing, and hospital systems or large integrated delivery networks (IDNs) are actually purchasing physicians. We’re seeing both affiliated and employed models going on in the market right now.

Another influential trend is system affordability. We’ve talked about this a lot, but premiums have been increasing significantly— more than 30 percent over the last five years. A lot of the challenges and what CMS and some payors are trying to focus on is, how can we make healthcare more affordable to the community at large?

A third area of trends is the value-based care models, or the alignment of economic and practice incentives to create accountability. This does not just relate to volume, but also to how to manage populations. Which leads into the next trend, which is the investment of provider organizations in capabilities and tools to manage populations. The result is that the incentive models are moving more toward that population-based care, which is much more challenging to measure.

And then finally, we have a lot of interest in performance metrics—HCAHPS,® for example. With just about every other payor asking for different performance metrics from organizations, how do we really focus, especially from an incentive program for physicians, into the right incentive? More than likely, each organization is going to be different about what they’re trying to achieve; each market is very different.

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

Infographic: Paying More Under PPACA

February 7th, 2014 by Jackie Lyons

Forty-eight percent of Americans surveyed in a recent study reported they would repeal the Patient Protection and Affordable Care Act (PPACA) if they could, while 38 percent would keep it in place.

However, experts claim there have not been large premium increases, according to a new infographic from LifeHealthPro. This infographic shows the effects of the PPACA on part-time and full-time workers, the American response to the PPACA, as well as changes experienced in the past year including higher costs, fewer doctors and more.

12 Questions to Measure Population Health Management

 title= The most encouraging post-ACA metrics have been achieved by healthcare organizations that customize a model or intervention to better serve their population’s needs. Healthcare Innovation in Action: 19 Transformative Trends examines a set of pioneering efforts supporting the industry’s seismic shift from a volume-based culture to one rewarding value and patient-centeredness.

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Medication Adherence Gets Boost from CMS Innovation Advisors

August 1st, 2012 by Jessica Fornarotto

“Payors are interested in finding ways that they can improve medication adherence for their members using community pharmacy resources,” says Dr. Janice Pringle, director of the program evaluation research unit at the University of Pittsburgh School of Pharmacy. This is just one of many lessons Dr. Pringle learned after being selected for the Centers for Medicare and Medicaid Services Innovation Advisors Program.

During an interview with HIN’s executive vice president and chief operating officer, Melanie Matthews, Dr. Pringle discussed why she applied for the Innovation Advisors Program, the medication adherence intervention she developed with Highmark and Rite Aid, other initiatives supporting medication adherence, and much more.

HIN: What prompted you to apply for the Innovation Advisors Program?

(Dr. Janice Pringle): I have always been interested in innovations and I teach a course on healthcare innovations at the University of Pittsburgh. I also have been involved in a program where we took some strategies that are used in behavioral health and applied them in community pharmacy services, and we looked to see if that had an impact. I considered that an interesting innovation. And I have to emphasize that I did this with my collaborators: Highmark, which is a commercial payor and is now Gateway, a Medicaid payor; and Rite Aid Corporation and CECity have all been part of this particular program. We’re funded through the Pharmacy Quality Alliance (PQA).

HIN: What have you learned thus far?

(Dr. Janice Pringle): We’ve learned a lot. First of all, we’ve learned that pharmacists want to have a greater impact on their patients, so when you’re giving them the opportunity to do so, they rise to the occasion. We’ve also found that community pharmacy organizations such as Rite Aid are interested in supporting this. We also know that the payors are interested in finding ways that they can improve medication adherence for their members using community pharmacy resources. We know that CECity, which provides some platforms to help us scale things, is a very important and necessary partner.

Finally, the PQA is important because they provide us with the national contacts. We’ve learned that the implementation barriers can be attenuated; we can get over them. Where there’s a will there’s a way. Even though pharmacists are very busy in community pharmacy settings, they can learn to have meaningful discussions with patients about their adherence and learn to fit it into their work. We’ve also learned that once they see this, they can continue to do it even more.

Our preliminary results have demonstrated to us, when we compare the medication adherence rate for the medication classes we’ve studied, that the pharmacy is better involved. 118 pharmacies improved medication adherence for the patients who received services there, compared to the pharmacies that we used as controls that were not using this intervention. What’s really key is that this effect seems to improve or increase over time, which shows us that the pharmacist gets better and better at it as they go forward. We’ve studied these data over a 12-month, or in some cases, a 13-month period. That’s everything that we’ve learned and we’re excited to see if we can continue to push this forward, and maybe change the conversation about the importance of community pharmacy in the healthcare arena and landscape.

HIN: What role do you believe medication adherence will play in the recommendations developed by the Innovation Advisor program?

(Dr. Janice Pringle): Medication adherence is definitely an important issue for many of my advisors. They’re programmed by looking at adherence, and it came up multiple times whether we were looking at transitions of care, palliative care issues, whether it was looking at issues of integrating and doing models using primary care, and so forth. Medication adherence has definitely come up. I would imagine, especially given we know that Dr. Will Shrank is a member of Brigham & Women’s Hospital Department of Medicine, Division of Pharmacoepidemiology & Pharmacoeconomics and his expertise is in medication adherence, it’s an important issue for them, and also for CMS in general and the innovation center.

HIN: Of the innovators selected to participate, what other types of initiatives support medication adherence? How do these programs complement or differ from yours?

(Dr. Janice Pringle): There was much interest in the issue of medication adherence, specifically some of what we were doing in our program and how they could apply it to their models. For most of the models that I heard about, the vast majority seem to have an interest in how they can improve medication adherence because they understood that this was an issue for them in improving health — or their “three-part aim” as they call it, which is improving health, improving care and reducing cost.

HIN: Can you briefly describe the intervention you’ve developed with Highmark and Rite Aid to improve medication adherence rates?

(Dr. Janice Pringle): The intervention involves screening, brief intervention (SBI) of patients for medication adherence issues. This way, you can place them in a risk profile. You use any screen that has validity in that purpose. You can sort your patients based on prior data and information. You can also do a universal screen where you ask them questions when they come in, but you want to bring up those patients that seem to be at greater risk than others. You can then apply a brief intervention, which is a two to five minute conversation that is based on motivational interviewing principles that address the issues of how we can help you improve your medication adherence. This is called a facilitative manner — you’re trying to have the patient and the pharmacist work together to address that issue.

HIN: When you spoke with us in May 2011, you were evaluating the preliminary results for the community pharmacist’s intervention. Can you share what results the program has achieved to date?

(Dr. Janice Pringle): With the pharmacies that were involved in the intervention, we looked at the patients that came to those pharmacies and looked at their formulary claims data. We found that their adherence significantly improved and continued to improve over time, so there was an acceleration of an effect over time. For the 13 months or so that we examined the data, compared to the control pharmacies that were fairly similar in many different ways, we examined the similarities to the intervention pharmacies on the same medication classes and the same adherence measures.

HIN: What did you learn in year one of the intervention and how have you modified the intervention based on these findings?

(Dr. Janice Pringle): One of the things that we’ve learned is that you have to keep in touch with the pharmacists consistently to make them aware, if they’re applying this innovation, that this is an innovation that has importance. Pharmacists have many competing requirements; immunizations, different tasks that come through in a community pharmacy chain. We keep in regular monthly contact with the pharmacists to determine what issues or concerns they may have or limitations. We want to get the issues addressed as quickly as possible. We also keep track of where they stand in the innovation process. That’s one thing that I think is important.

The second is, Rite Aid has reported this whole program and that’s key. Rite Aid put some very talented people in charge, such as Jesse McCullough, who is the clinical services manager for Rite Aid, and Rick Mohall, the director of clinical services at Rite Aid. They cleared the way for this to become an initiative for the pharmacies where we’re implementing so that it would continue to be priority. And they changed how they are evaluating the pharmacists.

There are raises also related to the pharmacy, but not just the pharmacist’s performance. The pharmacies are being evaluated as a unit. We found that one pharmacist could be on board, another may be less on board, and they could cancel each other out as they move forward. If you’re now evaluating the pharmacy as opposed to the pharmacists, that changes the conversation.

HIN: Do you have plans to expand the program to include other pharmacy chains?

(Dr. Janice Pringle): Yes. PQA and CECity have been working on the second phase of this, which is called Equipp. They are targeting the entire state of Pennsylvania, looking at some other pharmacy chains and other payors. They also have been talking to some other states. Dr. David Nau, PQA’s senior director of research and performance measurement, has been involved with CE City and is moving this forward to the other states, especially Pennsylvania.

HIN: Are the pharmacists receiving any higher payment for their services?

(Dr. Janice Pringle): Rite Aid has many programs that they’re using to provide incentives to their pharmacists, or to make up the way in which they’re reimbursed. Some of them relate to this study and some do not. What I’m about to say is one aspect of the many ways in which the pharmacists’ salaries were determined. I’m not privy to all of them.

I do know that Rite Aid has, as of January of this year, decided to look at ways that the entire pharmacy is performing, and adherence is one way to be able to look at that. There are other things that they’re looking at as well, but this was partially in response to our study and in response to other things, too, that indicated that it’s good to have the pharmacy be one unit in terms of how the pharmacy takes on innovation, or approaches ways in which we can be considered productive.

We will also be looking at, with Highmark, ways in which we can provide additional pay for performance, or value-based purchasing strategies for the pharmacist. We’ll be testing and developing some models for our colleagues. I wouldn’t expect those to be moved into the field until some time in 2013.

HIN: The community pharmacists can have a measurable impact on medication adherence, according to the results of your program. After the pharmacists, where should organizations concentrate their efforts to boost medication adherence? What should be done within the primary care practice?

(Dr. Janice Pringle): For our next step, we should bring physicians and pharmacists together. The same strategies we’ve used with the pharmacists can be used in the physician’s business. What could be interesting is having the physicians and pharmacists together with an understanding of common quality metrics, such as what CECity provides and what PQA has suggested regarding the measurement. This way, you can keep track of what’s going on with the patients between the physician’s practice and the pharmacy practice.

I think it would change the whole conversation of how we’re receiving medications in our community — if pharmacists are working in collaboration with physicians and physicians are learning the same skills. We could greatly enhance medication adherence and we could change the health of our communities. Again, it’s a matter of will to do that.

New Video Documents ACO Activity: Accountable Care Doubles in Last Year

July 17th, 2012 by Patricia Donovan

Along with bundled payments, the accountable care organization would be the healthcare model to watch in 2012, predicted healthcare consultant Steven T. Valentine late last fall.

And as this new ACO video from the Healthcare Intelligence Network can attest, The Camden Group president knew what he was talking about. According to 200 healthcare companies who took the HIN ACO survey in May, participation in accountable care organizations doubled in the last year.

The survey also found that today’s ACO is leaner and more efficient, with more physicians at the helm than hospitals and less time necessary to get the ACO up and running.

For the uninitiated, ACOs create integrated delivery systems that encourage teams of physicians, hospitals and other providers to collaboratively coordinate care for ACO members. Built into the ACO model is a business opportunity: provide a focal point of care while attaining health and cost containment goals.

The bundled payment method referenced by Valentine refers to the practice of aligning payments for services delivered across episodes of care or “bundled” care.

Narrated by HIN COO and Executive VP Melanie Matthews, HIN’s second annual ACO analysis delves into ACO administration, size, and the model’s impact on healthcare utilization and care delivery. And in case you missed Valentine’s forecast last fall, his comments are included here.

If you prefer to read an executive summary of the survey results, download it here. A more detailed analysis is available in the HIN bookstore.