Infographic: Hospital Adoption of Alternative Payment and Delivery Models

May 18th, 2018 by Melanie Matthews

Hospitals and health systems continue to test and adopt alternative payment and delivery models, such as ACOs, medical homes, and performance-based payment, according to a new infographic by the American Hospital Association.

The infographic examines market trends for value-based payment and delivery models.

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS SuccessA laser focus on population health interventions and processes can generate immediate revenue streams for fledgling accountable care organizations that support the hard work of creating a sustainable ACO business model. This population health priority has proven a lucrative strategy for Caravan Health, whose 23 ACO clients saved more than $26 million across approximately 250,000 covered lives in 2016 under the Medicare Shared Savings Program (MSSP).

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success examines Caravan Health’s population health-focused approach for ACOs and its potential for positioning ACOs for success under MSSP and MACRA’s Merit-based Incentive Payment System (MIPS).

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10 Critical Care Coordination Model Elements for Medicaid Managed Care Members

May 17th, 2018 by Melanie Matthews

There are 10 critical elements of the care coordination model for Independent Health Care Plan (iCare) Medicaid managed care members, according to Lisa Holden, vice president of accountable care, iCare.

The first element and touchpoint for Medicaid managed care members is their care coordinator. “Every single one of our incoming SSI Medicaid members is assigned to a care coordinator,” Holden told participants in the May 2018 webinar, Medicaid Member Engagement: A Telephonic Care Coordination Relationship-Building Strategy, now available for replay. “That person is responsible for everything to do with that member’s coordination of care.”

Care coordinators are assigned to every Medicaid member and are responsible for engaging and coordinating member’s care needs.

“We want our care coordinators to make an initial phone call as early as a couple of days after the member is enrolled in our plan,” she said. “If the member is interested in having a conversation, we offer to conduct a health risk assessment. But if the timing isn’t right, then we offer to schedule another appointment. There’s no pressure except that we want them to feel engaged by us.”

Once completed, the health risk assessment forms the basis of an interdisciplinary individualized care plan created by the care coordinator with the member.

The care coordinator, who is a social worker by background, has access to a nurse, who is available for medically complex members, said Holden.

iCare also relies on health coaches. Health coaches are now teaming up with a care coordinator as much as, if not more than, the nurses are historically, Holden said.

“Our health coaches are literally assigned to work in the community to become very familiar with the resources that are available,” she added. “They are becoming steeped in the communities in which they serve. Each one is assigned to a neighborhood, and we’ve asked them, ‘Get to know the police. Get to know the fire. Get to know the food organizations and food pantries. Get to know the housing specialists in your area.'”

The health coaches also help the care coordinators locate difficult-to-contact members by being in the community as a boots on the ground force. They’re also focused on assessing and addressing social determinants of health.

“We really believe that health coaches are going to be the key to our success in this year and in years to come,” Holden explained.

In addition to the care coordinators, health coaches and nurses, the care coordination team includes two specialized positions…a trauma-informed intervention specialist and a mental health and substance abuse intervention specialist. “We brought those two specialties into this program for our Medicaid members because we know that there’s a high instance of behavioral health conditions, which usually has another diagnosis of alcohol and drug use, not always, but quite often. We wanted to have the team ready to engage the member,” said Holden.

Once the member is engaged, iCare’s care coordination team begins to identify unmet needs, she explained. “We want to know, ‘Is their life going well? Do they have appropriate medical care? Are they in a relationship with a primary care provider that they feel is co-respectful? Are they getting their answers to their questions?'”

To begin talking about medical needs, the care coordination team has to establish trust, said Holden. “We have to talk with the member in an honest way that reflects our respect for them and also engages them in order for them to tell us how they really feel.”

iCare uses the Patient Activation Measure tool to help identify where the member is in a spectrum of four different levels of activation. iCare then tailors its member engagement approach to build a trusting relationship and provide member education by recognizing where they are in their activation level.

Following up on preventive measures are key for the iCare care coordination model. Care coordinators reach out to members for care plan updates. The care plan has to be alive and very member-centric, said Holden. The health risk assessment is repeated each year and the care plan is updated based on those results.

iCare is also focusing on social determinants of health with the recognition that they impact a members’ health more than clinical care. Clinical care attributes to only about 20 percent of somebody’s health outcomes; the rest of that 80 percent is made up of by health behaviors, social and economic factors, and physical environment. “If we don’t get underneath those issues, we can ask for things to improve, but we’re going to see minimal success,” Holden added.

During the webinar, Holden also shared: how the care coordinators helps Medicaid members overcome barriers to care; seven rising risk/acuity identification tools; readmission prevention initiatives for high-risk patients; three programs aimed at reducing high emergency department utilization; and details on a Follow-to-Home program for members who are homeless. Holden also shared: details on language to use…and not to use…when engaging members; advice on the best time to connect with members by phone, such as time of day, specific days of the months; the role of the specialist interventionist compared to the care coordinator; and the background of iCare’s care coordinators and health coaches.

Click here to view the webinar today or order a DVD or CD of the conference proceedings.

Infographic: Health as a Whole: How Does Your Community Measure Up?

May 16th, 2018 by Melanie Matthews

The U.S. Census measured different facets of a community and ranked the best counties of the United States according to the health of those communities. The components used to measure community health can be used as a gauge for a community’s health, according to a new infographic by Pepid.

The infographic examines the 10 components used to rank community health as well as their weighted impact.

2017 Healthcare Benchmarks: Community Health PartnershipsIncreasingly, healthcare organizations are forging community partnerships to bridge care gaps and improve population health status. This alignment of care and resources ranges from providing transportation to doctors’ appointments to scheduling EMT visits to visit the homebound elderly following their hospitalization. Working in tandem with community groups addresses social determinants of health (SDOH) and produces clinical and financial benefits that are recognized and rewarded by today’s value-based healthcare reimbursement models.

2017 Healthcare Benchmarks: Community Health Partnerships documents the efforts of 81 healthcare organizations to align clinical interventions with neighborhood collaborations to improve health, wellness and socioeconomic factors in the populations they serve. These metrics are compiled from responses to the October 2017 Community Health Partnerships survey by the Healthcare Intelligence Network. Click here for more information.

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Guest Post: How States are Funding Better Care with Medicaid 1115 Waivers

May 15th, 2018 by Elizabeth Lagone

As a result of the shift toward value-based reimbursement models, states are designing and implementing innovative programs to reform how healthcare is delivered and reimbursed.

As healthcare transitions to value-based care models, optimal health system performance is being defined as enhancing the experience and outcome of the patient, improving the health of populations, and reducing the per capita cost of healthcare, also known as the triple aim in healthcare.

As a result of this shift, states are designing and implementing innovative programs to reform how healthcare is delivered and paid for. To fund innovation and provide more resources for collaboration and care management, many states have leveraged funds available under federal Section 1115 Medicaid demonstration waiver programs.

Many states such as California and New York have enacted successful initiatives to improve population health outcomes through better care coordination, population health, and patient engagement. Known as Delivery System Reform Incentive Payment (“DSRIP”) Programs, many states are requesting funds under the 1115 waiver and are starting the process of encouraging enhanced collaboration to meet outcomes and satisfaction performance incentives. Following the passage of the Affordable Care Act in 2010, the federal government approved the first DSRIP initiatives in California.

As of February 2018, 10 states are using Section 1115 waivers to implement DSRIP initiatives.

As more states look to reduce unnecessary and costly healthcare utilization and improve patient outcomes through delivery reform, there are many ways that the funds can be used to drive success. From augmenting community resources such as affordable housing and transportation services to incentivizing better care management and coordination of health services, state organizations are taking positive steps to improve their community’s health. While taking these steps can be challenging, the potential rewards are massive.

Current DSRIP Programs are Improving Patient Care

States further along in their DSRIP journeys are seeing great success. To date, the funds have been used to deploy care management programs, such as in the case of New York State’s popular DSRIP program, 2di, healthcare coaching and navigation. Under this program, providers are helping provide patients with the tools necessary to take control of their care. With community referrals and care navigators, patient care is better managed and tailored to each individual’s needs.

Meanwhile, in California, project funds have already been shown to drive success in preventive care measures such as increasing cancer screening and flu vaccination rates among the older DSRIP-eligible patients. These early success indicators provide a baseline for what other states can achieve. As new states such as Texas and Washington take advantage of the 1115 waiver, there are many possibilities for how Medicaid patients may benefit from the grants and investments provided to participating providers.

What States Can Do to Take Full Advantage of the Waiver

As new states begin their own DSRIP journeys, understanding what criteria is most beneficial to meet, how to meet them, and how to report on them is critical. Specifically, there are three things that states should consider when implementing their programs—develop data-driven insights, manage implementation processes, and scale care coordination.

1. Manage Implementation Processes with a Goal for Sustainability: Many of the DSRIP initiatives encourage providers and community partners work together to align local needs and priorities. Since there is a significant administrative lift involved in reaching DSRIP initiatives, time and resources are key investments to ensure long-term success. This includes fostering stakeholder engagement and education; establishing IT, reporting, and reimbursement infrastructure; allocating resources dedicated to legal and financial administration of DSRIP entities; allocating appropriate resources for project selection, implementation, and ongoing management to support sustainability; and identifying and funding new services to empower partners in achieving their DSRIP goals. Although initial phases of DSRIP projects focus on building infrastructure, it is important to develop these processes with a focus on the long-term measurement and improvement of clinical processes and value-based payment models.

2. Engage Patients in a New Way: To encourage preventive health efforts, reduce avoidable hospitalizations and readmissions, and improve healthcare outcomes for low-income patients, providers need to engage patients in a new way while optimizing available resources. Enhancing communication and connectivity between patients and their care teams and improving the ability to navigate and obtain needed clinical and social services is critical for changing the Medicaid healthcare landscape. Simultaneously, it is essential that systems consider available resources (and constraints) and optimize available technologies. Through embracing workflow enhancements and innovation, systems will enhance their ability to outreach and engage high and at-risk patient populations.

3. Scale Care Coordination: Participating providers will need to work with multiple provider types across the care continuum to optimize project design, implementation, and funds flow. Since care management services and providers traditionally operate in silos, DSRIP entities must establish effective integrated care management systems with partners. This will mean needing to face interoperability issues head-on to effectively coordinate care and promote collaboration across different regional providers. As processes are created, it is key to develop clearly-defined roles for each partner type, expected activities, appropriate metrics and outcomes, and reimbursement methodology to promote interoperable communication and documentation systems.

In this era of value-based care, successful transformation of healthcare at the system and state levels requires trusted partnership across the care continuum. Healthcare organizations across the country can make the most of the funds through the 1115 waiver by putting the right people, processes, and technologies in place early on. It will be exciting to see over time how these programs aim to improve access, quality, and coordination of care for at-risk patient populations by enhancing care transitions between healthcare systems and community support services.

Liz Lagone

Liz Lagone

About the Author:

Elizabeth Lagone, MPH, is the Vice President of Government Programs at CipherHealth. Prior to her current role at CipherHealth, Lagone served as the Primary Care Strategy and Improvement Director for DSRIP Initiatives at One City Health, a subsidiary of NYC Health + Hospitals focused on population health, care management, and implementation of the state’s DSRIP program.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remains with them. The company accepts no liability for any errors, omissions or representations.

Infographic: Big Data Healthcare Trends Will Improve Outcomes

May 14th, 2018 by Melanie Matthews

Improved technology will play a pivotal role in the collection and analysis of big data for healthcare facilities. Healthcare providers will have access to large data sets to help improve their patients’ overall well-being, according to a new infographic by Compliant Healthcare Technologies.

The infographic examines how big data analytics will drive healthcare forward.

Predictive Healthcare Analytics: Four Pillars for SuccessWith an increasing percentage of at-risk healthcare payments, the Allina Health System’s Minneapolis Heart Institute began to drill down on the reasons for clinical variations among its cardiovascular patients. The Heart Institute’s Center for Healthcare Delivery Innovation, charged with analyzing and reducing unnecessary clinical variation, has saved over $155 million by reducing this unnecessary clinical variation through its predictive analytics programs.

During Predictive Healthcare Analytics: Four Pillars for Success, a 45-minute webinar on March 29th now available for replay, Pam Rush, cardiovascular clinical service line program director at Allina Health, and Dr. Steven Bradley, cardiologist, Minneapolis Heart Institute (MHI) and associate director, MHI Healthcare Delivery Innovation Center, shared their organization’s four pillars of predictive analytics success…addressing population health issues, reducing clinical variation, testing new processes and leveraging an enterprise data warehouse. Click here for more information.

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Infographic: Health Systems Rely on Distribution

May 11th, 2018 by Melanie Matthews

Nearly all hospitals and health systems rely on healthcare distributors to optimize their supply chain, according to a new infographic by the Health Industry Distributors Association.

The infographic details supply chain executives’ satisfaction with distributors’ expertise, and other healthcare supply chain trends.

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS SuccessA laser focus on population health interventions and processes can generate immediate revenue streams for fledgling accountable care organizations that support the hard work of creating a sustainable ACO business model. This population health priority has proven a lucrative strategy for Caravan Health, whose 23 ACO clients saved more than $26 million across approximately 250,000 covered lives in 2016 under the Medicare Shared Savings Program (MSSP).

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success examines Caravan Health’s population health-focused approach for ACOs and its potential for positioning ACOs for success under MSSP and MACRA’s Merit-based Incentive Payment System (MIPS).

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Infographic: Healthcare Access and Affordability

May 9th, 2018 by Melanie Matthews

Affordability of healthcare plays a key role in advancing access to care. Community and legislative efforts are increasingly focused on this issue.

A new infographic by the American Hospital Association examines healthcare affordability concerns.

Healthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare IndustryHealthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare Industry, HIN’s 14th annual business forecast, is designed to support healthcare C-suite planning as leaders react to presidential priorities and seek new strategies for engaging providers, patients and health plan members in value-based care.

HIN’s highly anticipated annual strategic playbook opens with perspectives from industry thought leader Brian Sanderson, managing principal, healthcare services, Crowe Horwath, who outlines a roadmap to healthcare provider success by examining the key issues, challenges and opportunities facing providers in the year to come. Following Sanderson’s outlook is guidance for healthcare payors from David Buchanan, president, Buchanan Strategies, on navigating seven hot button areas for insurers, from the future of Obamacare to the changing face of telehealth to the surprising role grocery stores might one day play in healthcare delivery. Click here for more information.

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Infographic: Children’s Health and Neighborhood Amenities

May 7th, 2018 by Melanie Matthews


Ten percent of children nationwide (approximately 7,059,000 children) lived in neighborhoods with no amenities in 2016, defined as a neighborhood without any parks, recreation centers, sidewalks, or libraries, according to data from the U.S. Census Bureau’s 2016 National Survey of Children’s Health (NCSH), which was recently released.

A new infographic by the Robert Wood Johnson Foundation’s State Health Access Data Assistance Center highlights state-specific findings from the 2016 NCSH on measures that illustrate where states are closer to achieving a culture of health and where improvements can be made.

2018 Healthcare Benchmarks: Telehealth & Remote Patient MonitoringAs one of the poorest urban congressional districts in the country, the Bronx, a New York City borough, was also rated as the last county (#62) in New York for health outcomes and health factors by the Robert Wood Johnson Foundation. In reaction, the Bronx Health REACH initiative formed the “#Not62,” campaign to transform the health of the community.

Innovative Community Health Partnerships: Clinical Alliances to Reduce Health Disparities in Underserved Populations highlights the models of change and key initiatives developed through Bronx Health REACH’s community health transformation project.

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Infographic: The Big Tech Healthcare Invasion

May 4th, 2018 by Melanie Matthews

The healthcare industry is ripe for disruption and big tech companies are taking advantage of that disruption, according to a new infographic by Koeppel Direct.

The infographic examines why technology companies are investing in healthcare; technology advancements in healthcare; and the benefits of technology to patients and providers.

2018 Healthcare Benchmarks: Telehealth & Remote Patient MonitoringArtificial intelligence. Automation. Blockchain. Robotics. Once the domain of science fiction, these telehealth technologies have begun to transform the fabric of healthcare delivery systems. As further proof of telehealth’s explosive growth, the use of wearable health-tracking devices and remote patient monitoring has proliferated, and the Centers for Medicare and Medicaid Services (CMS) has added several new provider telehealth billing codes for calendar year 2018.

2018 Healthcare Benchmarks: Telehealth & Remote Patient Monitoring delivers the latest actionable telehealth and remote patient monitoring metrics on tools, applications, challenges, successes and ROI from healthcare organizations across the care spectrum. This 60-page report, now in its fifth edition, documents benchmarks on current and planned telehealth and remote patient monitoring initiatives as well as the use of emerging technologies in the healthcare space.

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Infographic: Enabling a 360-degree View of Patient Data

May 2nd, 2018 by Melanie Matthews

As healthcare organizations move toward more integrated and personalized service delivery, they need the ability to securely access and analyze all data along the patient journey, according to a new infographic by BridgeHead.

The infographic examines how an Application Independent Clinical Archive (AICA) provides this type of patient-data view.

Health Analytics in Accountable Care: Leveraging Data to Transform ACO Performance and Results Between Medicare’s aggressive migration to value-based payment models and MACRA’s 2017 Quality Payment Program rollout, healthcare providers must accept the inevitability of participation in fee-for-quality reimbursement design—as well as cultivating a grounding in health data analytics to enhance success.

As an early adopter of the Medicare Shared Savings Program (MSSP) and the largest sponsor of MSSP accountable care organizations (ACOs), Collaborative Health Systems (CHS) is uniquely positioned to advise providers on the benefits of data analytics and technology, which CHS views as a major driver in its achievements in the MSSP arena. In performance year 2014, nine of CHS’s 24 MSSP ACOs generated savings and received payments of almost $27 million.

Health Analytics in Accountable Care: Leveraging Data to Transform ACO Performance and Results examines program goals, platforms, components, development strategies, target populations and health conditions, patient engagement metrics, results and challenges reported by more than 100 healthcare organizations responding to the February 2016 Digital Health survey by the Healthcare Intelligence Network.

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