Posts Tagged ‘medical home’

8 Effective PCMH Tools to Protect the Medical Home Investment

March 19th, 2015 by Cheryl Miller

The patient-centered medical home (PCMH) model is one of the top five investments in 2015, according to Accenture’s recent analysis of government-sponsored State Health Innovation Plans. Researchers from Accenture found that states are investing in PCMHs in order to strengthen primary care integration with specialists and community health workers. Most will also integrate physical and behavioral care.

Embedding care coordinators in physician offices so they can work with case managers is one way to achieve this integration, according to respondents to the seventh comprehensive Patient-Centered Medical Home (PCMH) survey by the Healthcare Intelligence Network (HIN). We asked survey respondents what other tools they felt were most effective in implementing the medical home. Following are their responses:

  • Electronic communications that include actionable data and access to patients to initiate the change, and a focus on minimal hassle to physician office.
  • The NCQA PCMH tool.
  • Pre-visit planning and ‘huddles.’
  • Patient registries.
  • Monitoring. We fundamentally changed how we operate daily and monitor change. We incorporated our goal measures into the very fabric of what we do.
  • Using templates in electronic medical records (EMRs) for pre-visit planning and coordination of relevant visits.
  • Home care nurse management system.
  • Patient-centered scheduling.

Source: 2014 Healthcare Benchmarks: The Patient-Centered Medical Home

2014 Healthcare Benchmarks: The Patient-Centered Medical Home is the Healthcare Intelligence Network’s in-depth analysis of medical home adoption, tools, technologies, challenges, benefits and outcomes. Based on HIN’s PCMH survey administered in February 2014, this resource takes the industry’s pulse on patient-centered activity. Now in its seventh year, it is designed to meet business and planning needs of physician practices, clinics, health plans, managed care organizations, hospitals and others by providing critical benchmarks in medical home implementation and results.

Infographic: Calculating the Cost of Home Care

June 6th, 2014 by Jackie Lyons

The cost of nursing and assisted living facilities in the United States ranges from $41,124 to $94,170 annually, while the average cost of in-home care is $29,640 per year, according to a new infographic from Interim HealthCare.

This infographic also outlines some of the key factors that compare in-patient facilities to in-home healthcare options in terms of reliability, convenience and affordability.

Remote monitoring is a key care coordination strategy for at-home individuals with complex illnesses. 2014 Healthcare Benchmarks: Remote Patient Monitoring delivers a comprehensive set of metrics from more than 100 healthcare organizations on current practices in and ramifications of remote monitoring for care management of chronic illness, the frail elderly and remote populations.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

HINfographic: The Medical Home Neighborhood

November 18th, 2013 by Jackie Lyons

There are more than 6,037 PCMH sites in the United States, according to the NCQA. To further reduce fragmented care, many PCMHs are expanding to house the entire care continuum – a phenomenon known as the Medical Neighborhood.

Medical home neighbors include specialists along with primary care clinicians to better coordinate care, according to a new infographic from the Healthcare Intelligence Network. This HINfographic also includes successful tactics for medical home ‘neighbors,’ signs of a desirable medical neighborhood and medical home neighborhood advice and comments from actual healthcare organizations.

The Medical Home Neighborhood

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Information presented in this infographic was excerpted from: Medical Home Neighborhoods: Uplinking Specialists To Create Integrated Systems of Care. If you would like to learn more about medical home neighborhoods, this resource includes even more information, including how to help physicians understand the link between meaningful use, care coordination across the neighborhood, and detailed lessons learned in building medical neighborhoods.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Infographic: Why the Patient-Centered Medical Home Works

March 29th, 2013 by Patricia Donovan

The five key features of the medical home model — patient-centered, comprehensive, coordinated, accessible, committed to quality and safety — are included in this infographic from the Patient-Centered Primary Care Collaborative (PCPCC). It includes definitions for each of these features, sample strategies used by health professionals, employers, and payors, and their collective impact on the health system.

patient-centered medical home

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

You may also be interested in this related resource: 2012 Healthcare Benchmarks: The Patient-Centered Medical Home.

Infographic: Patient-Centered Medical Home Functions, Attributes

February 25th, 2013 by Melanie Matthews

A new infographic from Greenway Medical Technologies answers some key questions about the medical home and its impact on the health care system, including private sector support, a breakdown of reimbursement models used, and much more.

Functions, Attributes of a PCMH

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

You may also be interested in this related resource: New Models in the Patient-Centered Medical Home: Incentives, Infrastructure and IT to Support Accountable Care.

Q&A: Predicting 2013 Healthcare Trends

January 29th, 2013 by Jessica Fornarotto

“There will be a significant investment in EHRs in 2013,” predicts Dennis Eder, managing director of Strategic Health Group. Eder also expects there will be more physician-run ACOs in 2013 compared to 2012.

Prior to their presentations during an October webinar on Healthcare Trends & Forecasts in 2013: A Strategic Planning Session, Eder, along with Hank Osowski, managing director of Strategic Health Group, and Steven Valentine, president of The Camden Group, shared the changes they see coming in 2013 for the healthcare industry, including future payment models, ACO administration, and demands for services.

HIN: Physician payment models are getting a lot of retooling — from the addition of pay for performance incentives for hitting quality metrics to care coordination payments for patients and members in medical homes. Is this going to change much in 2013? Are we going to see a shift toward shared savings or another payment model in the coming year?

(Hank Osowksi): Watching the trends over the last year or two and many of the innovations that are being tried, the industry is moving toward value-based purchasing and population risk-based purchasing. We think this is going to accelerate as we look at 2013, 2014 and beyond.

(Dennis Eder): I would agree with Hank. We believe with the events of 2012 and the significant interest in ACO participation, it will mature and continue into the future.

HIN: In comparing some results from our 2011 and 2012 surveys on accountable care organizations, we noticed a sizeable shift in ACO administration from hospital-run to physician-administered. Why do you think so many hospitals backed away from this role when the ACO model seemed so promising?

(Dennis Eder): One of the reasons we think this may be occurring is that hospitals administering ACOs is not part of their core competency. Many of the characteristics of an ACO are a health plan or a management service organization (MSO). And this is not what hospitals do, for the most part. In addition, hospital margins are thin, and have even become thinner, so any overhead that they can offload is a good thing. Physician organizations do this and they’re the ones who are responsible for the medical management and other care management in an ACO. I think it makes logical sense to have the physician organization take on more of an administrative role for an ACO.

(Hank Osowski): I think the point Dennis made is critically important. It is the physician organization that is controlling the array of services that the beneficiary is receiving. It makes sense for them to take a lead in running an ACO. They are the ones who best understand how all the pieces fit together and where the opportunities are to get efficiencies to improve quality and reduce the costs of care.

HIN: The IOM has recommended better and shared use of health data, particularly at the point of care, where key health decisions are made. What will be the technology to invest in or embrace in 2013 to improve data analytics for population health management?

(Dennis Eder): We’re going to continue to see a significant investment in EHRs. We know that it’s an important tool in some health plans. Kaiser, for example, is gaining significant market share. We see further investments in that particular area.

(Hank Osowski): It’s also important to take a self-examination of us as an industry. We have mountains of data. We have very little intelligence about where the value is in our system. Where can we leverage the most efficient of the care providers and change some of the things that are inefficient, that don’t contribute to high quality care and that drive up the costs? It’s digging into that mountain of data and pulling out the real healthcare intelligence that we as a system, and as an industry, can use to provide better care to patients.

HIN: What’s ahead for population health management?

(Steven Valentine): We will begin to see more fierce competition, if you will, around population health management. People are going to try to concur and grab more populations to work with in their delivery systems. We’re expecting that we should have slightly soft demands for services. We would find that even with the population getting older, and with these new delivery systems and lower utilization rates, we don’t expect to see an uptick in volume — stable to a slight decline — which means you have to reduce your expenses and go after an additional market share population.

Infographic: Home Sweet Medical Home

October 11th, 2012 by Melanie Matthews

The patient-centered medical home results in better quality care, reduced readmissions, lower costs and the elimination of racial disparities in accessing care, according to a new Commonwealth Fund infographic.

Medical home team members also report higher job satisfaction than non-medical home staff.

Home Sweet Medical Home
Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

10 Considerations When Preparing a Practice for the Embedded Case Manager

September 20th, 2012 by Cheryl Miller

Embedded case management

Practice-based case management is driving improvements in healthcare delivery and efficiency.

As practice-based case management continues to grow, resulting in more efficient and high quality care coordination of high-risk patients and chronically ill health plan members, one question looms large: how does a practice determine if it’s ready to take the leap?

We asked our case management experts for their opinions, and found that while there was no ‘one-size fits all’ method, many considerations were considered essential to a successful ECM practice.

  1. Find the right practice.

    Are your head physicians proponents of the medical home model? Because you don’t want to put efforts into a group that isn’t interested in embracing a new model of care. Says Irene Zolotorofe, administrative director of clinical operations at Bon Secours, “We began with the physicians who were absolutely willing to go ‘medical home,’ who were excited about this model of care. We like to go into a practice where they are motivated to do that type of transition with their patient population.”

  2. Involve all members of the practice in the selection process.

    Getting all members involved in selecting the case manager is key to sustaining a successful transition, says Diane Littlewood, RN, BSN, CDE, regional manager of case management for health services at Geisinger Health Plan. “We found great value incorporating and including the primary care doctor, the site and the team in the selection process. That case manager is embedded; she’s part of their team and that’s where she spends 100 percent of her time. It is key to each site’s success that the provider be involved with the selection. With this model, we’ve brought the provider at the medical home sites into the process and said, “Sit down with us, interview the candidates and help us with the final selection.’ “

  3. Assemble case manager hiring criteria.

    Although experience, education and training is important in this role, they should not be the main selection criteria, says Zolotorofe. “Is the case manager able to think quickly and critically given the newness and lack of infrastructure in place for this new program?” Other criteria for choosing a solid case manager included strong communication skills, people skills, patient engagement and activation skills, and negotiating and conflict resolution skills.

  4. Determine how much control your practice will have over your case manager’s work.

    Keeping everyone in the loop fosters an atmosphere of collaboration, says Littlewood. “As you roll out your model and educate providers and staff, you have to explain the case manager’s role and educate the site as to her duties.”

  5. Spend time building strong relationships among group members.

    Once the case manager is part of the team, it’s important that she sustains good relationships with all, says Dr. Randall Krakauer, Aetna’s Medicare medical director, during a recent HIN webinar: “You need to work out an arrangement in each case that works best for this particular medical or provider group. They’re all going to be somewhat difernt and it’s going to be up to your own management and your own embedded case managers to work out how best to work with this particular group, how best to support this group and how best to relate to this group. That relationship is absolutely key. The case manager and your staff must build a good supportive relationship. Your case manager has to feel to them like their case manager.”

  6. Allow case managers to build strong relationships with their patients, and provide tools to facilitate this.

    Geisinger Health Plan implemented a direct telephone line to embedded case managers for all patients, says Littlewood. “As simple and basic as it sounds, the ability for our case managers to have a direct line at the site for patients makes a difference. All the patient has to do is pick up a telephone, say hello and they will have a case manager on the phone. They’re not trying to navigate through the complex telephone lines as they call in to the clinic sites, which could be confusing for the patient. This is a direct access phone line. The case manager does the assessment and collects the information, and then the patient meets with the provider. This process takes out all of the middle people and we’re able to then handle acute issues much sooner. Since the nurse case manager is embedded in the site, she can walk right down the hallway and have a personal conversation with the provider about the person on the phone and their problem or issue. That leads to success with our communication.”

  7. Ensure you have the proper IT tools on hand for an effective program.

    Is there a minimum IT requirement for practices to participate in a practice-based case program, such as a patient registry or EMR? Explains Dr. Krakauer: We do have participating practices that don’t have EMR’s. An EMR will facilitate the process and will make collaborative care management and the work of the participating physicians easier. I don’t think it’s a requirement that there be an EHR. Going forward, as we start getting into more and more information exchanges and more and more reporting requirements promulgated by others, for sizeable groups doing this type of work, increasingly an EHR will be important.

  8. Make sure that your practice has enough eligible patients and the right case mix.

    It’s essential to consider both patient population and eligibility in the beginning, says Charlene Schlude, director of case management at CDPHP. “First, we consider the case mix in a practice. We use a predictive modeling tool that allows us to see the chronic nature of the patients in the practice. We like to see what products they have: is there a higher ratio of Medicare and Medicaid or even chronically ill commercial members in the practice? We use some reporting to do that. Another key element is an EMR in the practice because we want to be efficient and have information at the nurses’ fingertips to make this a valuable experience. We want them to have enough information to interact with the patients in a practice in a way that is going to impact that cost and quality.”

  9. Establish how the case manager will be reimbursed.

    Having a mutually agreed upon reimbursement plan is key to the program’s success, explains Dr. Krakauer. “Normally Aetna will provide this resource; we will provide our own trained experienced case manager who is capable of doing everything. Under certain circumstances, when the medical group already has case managers that are doing a good job, and knows how to do it, some assistance in this regard might be in order. But case management is a specialty in its own right. It’s not something you just hire a nurse to do — have her read a manual and put her at the desk or on the telephone. That’s kind of a prescription for it not to work.”

  10. Determine how you will judge the program’s effectiveness.

    Says Dr. Krakauer: “If I were to pick one single characteristic that’s positive of a good result, I would say it’s the level of commitment of the participating physicians to the concept, to the collaboration and to the idea that doing better will get good results, as opposed to those told to do it as a part of their job or those doing it just to receive an incentive payment.”

Physician Endorsement Helps ‘Sell’ Medical Home Model to Patients

August 28th, 2012 by Patricia Donovan
medical home patient

Recorded Webinar: Patient Engagement in the Medical Home

Nothing will engage patients and health plan members in the medical home model more than a ringing testimonial from the individual’s own physician, advises Horizon Blue Cross Blue Shield of New Jersey. That’s one of the lessons the payor has learned as it shops its patient-centered medical home (PCMH) model around its member population.

“The endorsement of a physician is key in this model,” explains Jay Driggers, Horizon’s director of consumer experience and engagement. “An insurance company isn’t going be able to [engage members] all on its own. If a PCP says this is a good program, and I want you to be a part of it, then typically patients will agree, and will want to be a part of it as well.”

A danger of leaving providers out of this messaging is that patients may sense a downgrading in their level of care, Driggers warned during a recent webinar on Patient Engagement in the Medical Home: A Continuum Approach.

Other key words and phrases with which to pepper conversations about the medical home: “coordinated comprehensive care” and “increased access.” “These issues are really prominent in the patient’s mind, in the consumer’s mind. They love the idea of somebody helping them, not have to repeat themselves, or working with their specialists to obtain all of their health records.”

Horizon has invested a lot of time and resources to research and test consumers’ perceptions of the medical home. The verdict? Awareness and understanding of the model is low, but interest is strong.

To maximize the transformative effect of the medical home, accountable care organizations (ACO) and episodes of care (also known as bundled payments), Horizon created a wholly owned subsidiary called Horizon Healthcare Innovations (HHI). To achieve its mission of creating “an effective, efficient and affordable healthcare system,” HHI decided to take a closer look not only at physician behavior, but also at the behavior of patients and health plan members. The consumer engagement team is charged with identifying tools to engage patients and encourage behavior change.

HHI has crafted a broader view of engagement as a four-part continuum: awareness, understanding, action (behavior change) and outcome. Of its seven key consumer engagement objectives, HHI ranks “becoming knowledgeable on care models and benefits” at the top, and employs a variety of strategies, including behavioral economics and the Patient Activation Measure (PAM) model, to segment consumers by need and motivation.

Tempted to employ technologies like smartphone apps and telemonitoring to communicate with and engage the population? Don’t assume everyone’s ready and willing to use them, advises Driggers. “Mobile health is not yet a silver bullet,” he said. “If you’re a senior citizen who doesn’t even really use a cell phone, I shouldn’t expect that you’re going be able to manage your diabetes using a smartphone app.”

Among the five key components of Horizon’s medical home model are a population care coordinator to manage the care of high-risk patients and close care gaps, as well as a playbook and learning network of best practices.

HHI’s efforts have increased awareness, interest and overall engagement in the medical home, but Driggers said HHI is not stopping there. “A ‘one and done’ approach doesn’t work. It takes repetitive, constant work to raise awareness. And interest rises with frequent contact.”

Video: 2012 Medical Home Starts Linked to Surge in Patient Satisfaction

August 9th, 2012 by Patricia Donovan

In a week when both Blue Cross Blue Shield of Michigan and CDPHP have considerably amped up their medical home game, a new video from the Healthcare Intelligence Network (HIN) documents a rise in patient satisfaction resulting from the construction of more medical homes.

In response to HIN’s sixth annual survey on the patient-centered medical home (PCMH) model, 52 percent of healthcare organizations who took the survey said they have established medical homes for their populations. This year’s survey results also reflected the highest levels of patient satisfaction to date in the survey’s six-year history, with 82 percent reporting a rise in patient satisfaction that they link to PCMH processes.

With patients at the center of the medical home care model, monitoring their satisfaction levels along with their health helps to paint a complete picture of PCMH success.

Earlier this week, Blue Cross Blue Shield of Michigan designated another 994 practices as medical homes, making it the country’s largest PCMH effort of its kind for the fourth consecutive year.

At the end of last month, CDPHP effectively doubled its medical home initiative when it added 70 practices to its Enhanced Primary Care effort.

Narrated by HIN COO and Executive VP Melanie Matthews, HIN’s sixth annual PCMH analysis delves into ACO activity planned by responding medical homes, health IT, PCMH team members, patient education and engagement strategies, and much more. Florida Blue’s Barbara Haasis also shares some details on the payor’s statewide rollout of a medical home program.

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.