Infographic: Overcrowding in the ER

July 30th, 2014 by Melanie Matthews

Between 1995 and 2010, annual emergency room visits in the United States grew by 34 percent, while the number of hospitals with ERs declined by 11 percent, according to a new infographic from the George Washington University MHA program.

The infographic also looks at the impact of overcrowding on U.S. emergency rooms, including the major causes of congested ERs and the impact on care delivery and proposed solutions to the problem of overcrowding.

Overcrowding in the ER

Evidence is lacking to support the effectiveness of public policy interventions based on performance measurement, such as public reporting of data and pay for performance. To succeed, emergency clinicians need to understand and practice in alignment with national performance measures.

Quality And Performance Measurement: A Guide For Emergency Physicians reviews the origin and evolution of performance measurement, explains the current landscape of reporting, and discusses projections for future hospital quality measure implementation through 2014.

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Home Visits for the High-Risk: Targets, Timelines and Training

July 29th, 2014 by Patricia Donovan

Many patient-centered medical home (PCMH) initiatives have added home visits to care transition management to reduce avoidable hospital readmissions and ER utilization. Jessica Simo, program manager with Durham Community Health Network for the Duke Division of Community Health, describes likely candidates for home visits, the structure of a typical home visit and recommended staff training.

HIN: Which diagnosis or patient profile benefits most from a home visit?

(Jessica Simo) As a general rule for the patient population we serve, the people who get the most home visits are middle-aged individuals with at least two chronic health conditions. These are not generally healthy individuals who had one adverse event that brought them to our attention. These are people living day in and day out with chronic health problems they struggle with managing. Those people benefit the most from the amount of time it takes to do a home visit.

HIN: What is the average length and typical format of a home visit?

(Jessica Simo) The average home visit lasts 45-60 minutes. It would be longer for the initial home visit when an assessment is being done—where the Care Partner (a partnering stakeholder from across the Duke University health system and the Durham community) collects information for the first time about medications the patient takes, their sources of support, ADL deficits, etc. Those visits tend to be a bit longer, certainly an hour at a minimum, but once that rapport has been established, the weekly visits are often less than an hour. They become briefer as a patient transitions from phase one to phase two of the Care Partners Pathway because there is less to talk about at that point. This is a good thing; it means they are improving.

The home visits are structured around assessments and protocols, but as the home visits progress and the care partner becomes more familiar with the patient, there is less reliance on assessments and more on follow-up from the previous week.

HIN: How do you prepare and train staff to conduct home visits?

(Jessica Simo) The best way to prepare somebody to do home visits is to have them shadow a more experienced staff person. There are too many independent variables at play when you go into somebody’s home and you just don’t have control over that environment. Nor should you. It’s impossible to anticipate every possible scenario. Therefore, we do a lot of shadowing for at least a month before someone does a home visit on their own.

Excerpted from: Home Visit Handbook: Structure, Assessments and Protocols for Medically Complex Patients

Infographic: Care Teams Help Fill Gaps in Care

July 28th, 2014 by Melanie Matthews

Care Teams Are Good BusinessWithout the help of a care team, physicians would not have enough hours in the day to adhere to all the protocols for chronic care patients, according to a new infographic by Phase Space.

The infographic looks at the number of individuals with chronic conditions, the capacity of providers to care for these patients appropriately and how care teams fill these gaps.

With the advent of the medical neighborhood, care coordination is no longer the sole domain of the primary care practice (PCP) but a responsibility shared among all providers that touch the patient. But how to formalize co-management of patients by PCPs and specialists ‒ in a way that both assures efficient delivery of high-quality healthcare and addresses the 'pain points' of each provider group?

Care Compacts in the Medical Neighborhood: Transforming PCP-Specialist Care Coordination describes WellPoint's efforts to clearly define these roles and responsibilities: the testing of care compacts in its Patient-Centered Specialty Care (PCSC) program.

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Infographic: Physician Social Media Use

July 25th, 2014 by Melanie Matthews

Physicians have mixed opinions about leveraging social media use in their practices, according to a new infographic by MedData Group.

The infographic looks at the top two social media channels that physicians use, the top five physician specialties that engage in online physician communities and the top concerns preventing physicians from using social media for professional reasons.

Physician Use of Social Media

The growth of social networking has been dramatic, and the applications are quickly finding their way into healthcare organizations. This expanded best-seller provides an overview of the social media tools healthcare organizations are using to connect, communicate, and collaborate with their patients, physicians, staff, vendors, media, and the community at large.

Social Media in Healthcare: Connect, Communicate, Collaborate, 2nd edition describes the major social media applications and reviews their benefits, uses, limitations, risks, and costs. It also provides tips for creating a social media strategy based on your organization’s specific needs and resources. Through real-world examples and up-to-date statistics on social media and healthcare, this book illustrates how social media can improve the efficiency, effectiveness, and marketing of your healthcare organization.

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7 Ways to Stratify Patients for Health Coaching

July 24th, 2014 by Cheryl Miller

Recruiting patients for health coaching is a multi-faceted process, says Alicia Vail, RN, is a health coach for Ochsner Health System. Health coaches can enlist the services of physicians, case managers and transition navigators for referrals to those patients who would benefit from coaching post hospital or physician discharge.

There are several ways we recruit patients. First, we have created health coach referral criteria to help physicians and staff identify patients who would benefit from health coaching. These patients would need coaching on self-management of chronic health problems such as hypertension, diabetes and obesity. We also get referrals from physicians when they see a patient in their office and identify that the patient could benefit from health coaching. Second, we also identify patients through pre-chart reviews.

Third, we look at labs and other needed or outstanding screenings prior to their appointment and notify the physician.

Fourth, we utilize different lists to help us identify patients. The hemoglobin A1C list helps us reach out to our diabetic patients who have not reached their goal of hemoglobin A1C of 7 or below. The emergency department list allows us to prevent readmissions by having the health coach reach out and capture these patients.

Fifth, HEDIS® measures allow us to focus on needed health screenings or tests for patients.

Sixth, when we meet with our patients for glucometer or insulin training, we have an opportunity to explain and offer our health coaching program at that point.

And lastly, sometimes our in-patient case managers or transition navigators, who help with patient discharge preparation, will refer patients to the health coach for post-hospital follow-ups.

Excerpted from Stratifying High-Risk, High-Cost Patients: Benchmarks, Predictive Algorithms and Data Analytics.

Infographic: Daily Drug Use in the United States

July 23rd, 2014 by Melanie Matthews

Every day in America millions of young adults use illicit substances, ranging from marijuana, heroin, and cocaine, to hallucinogens and inhalants. Out of the 35.6 million young adult population (from 2012) in the United States, one fifth used an illicit drug in the past month, and the percentage of those users has increased from 2008.

The infographic below shows how often drugs are used daily in the United States and the number of first-time illicit drug users on an average day.

Daily Drug Use in the United States

Bringing the most comprehensive research and information available today to the mental health field, the Dartmouth Psychiatric Research Center and Hazelden have redesigned the innovative Integrated Dual Disorders Treatment: Best Practices, Skills, and Resources for Successful Client Care curriculum.

Far surpassing its predecessor in ease of implementation and ongoing usability in clinical settings, this updated and expanded curriculum is redesigned not only to more effectively teach clinical skills and provide practitioners with resources and tools for their practice, but to offer the guidance necessary to align the work of departments and transform agencies into integrated treatment providers.

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5 Models for Engaging Community Partners in Dual Eligibles Care Coordination

July 22nd, 2014 by Patricia Donovan

Since healthcare is local, it's vital that health systems engage local providers, enlisting both clinical and administrative champions, advises Julie Faulhaber, vice president of enterprise Medicaid at Health Care Service Corporation. Ms. Faulhaber offers a variety of guidelines for engagement of community partners in care coordination for Medicare and Medicaid beneficiaries.

Our community care coordination partners may employ different models of care coordination. First, some may have care systems, larger accountable care organization (ACO)-type organizations; many take full financial risk, including risk on home- and community-based services. There are also waivers.

Second, some of these large care systems also have nurse practitioner (NP) models that provide mainly facility-based care. Those can be extremely successful with outcomes for the numbers, as well as from a cost perspective. Third, we also work with care management organizations and providers. Another example would be the Triple A’s—Adult Areas Agencies on Aging—and other behavioral health organizations. In our experience, these organizations will take on some financial risk, but really for those care coordination services.

Fourth, there are many different financial models you can use with both groups, particularly for the care management organization providers. For example, looking at a risk on care coordination, gain sharing—potentially in a new program—helping to pay for some startup infrastructure cost, providing loans with some paybacks. There are many different opportunities to make it financially viable for those important community partners to work with health plans in order to provide community-based, social model services to the member to meet all of their needs.

Finally, when working with community partners, it is critical to have both a clinical and administrative champion for the program. Clinically, it helps to have a physician nurse who can talk with their peers in the organization to help them understand the program. Clinicians want to provide care in a very uniform way, but if there is an opportunity to provide additional benefits in lieu of services for members, it helps to have that clinician champion to be able to share that.

Administratively, it is also important to manage the enrollment and care coordination paperwork. The plans are putting significant faith in these organizations to meet their contractual obligations, so having someone to follow up for those types of things is critical. It is also important to provide reporting and feedback on the results for these groups. We have done quarterly meetings in the past, which I found to be very helpful.

It is also helpful to provide benchmarking data. We look at how one organization serving the same population in a similar environment shapes up in comparison to another. This has improved results overall; it makes those organizations leading the pack feel good, and provides those trying to catch up with some role models to look at.

Excerpted from: Dual Eligibles Care and Service Planning: Integrative Approaches for the Medicare-Medicaid Population

Infographic: Physicians’ Salaries 2014

July 21st, 2014 by Melanie Matthews

Physicians are becoming more proactive in managing their incomes by being more selective about insurers and patients and providing ancillary services. In addition, a small but growing number of physicians are moving toward cash-only practices.

A new infographic from Medscape looks at these trends, along with details on how the Affordable Care Act is impacting physician practices, the income gender disparity among physicians and physician career satisfaction.

Physicians' Salaries 2014

In today's value-based healthcare sphere, providers must not only shoulder more responsibility for healthcare outcomes, cost and quality but also align with emerging compensation models rewarding these efforts — models that often seem confusing or contradictory. The challenges for payors and partners in creating a common value-based vision are sizing the reimbursement model to the provider organization and engaging physicians' skills, knowledge and behaviors to foster program success.

6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability examines a set of provider compensation models across the collaboration continuum, advising adopters on potential pitfalls and suggesting strategies to survive implementation bumps.

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Infographic: Rethinking Home Healthcare

July 18th, 2014 by Melanie Matthews

With more than 10,000 Americans turning 65 every day and a growing desire from seniors to age in place, there is a growing need for home healthcare services.

A new infographic from Barton Associates shows the growing need for home healthcare, as well as how home care improves the quality of life for seniors.

Rethinking Home Healthcare

Home Health Quickflips© can be used as a reference for documentation, patient eligibility and "how to" instructions for OASIS items which impact reimbursement and quality outcomes. This resource can be a teaching tool for new employees and home health managers.

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Telephonic Case Management Targets High-Risk, High-Cost Conditions

July 17th, 2014 by Cheryl Miller

While the complex comorbid are the primary targets of telephonic case managers, the newly discharged, those in acute stages of chronic illness, frequent utilizers and high-risk, high-cost patients also receive their fair share of attention from telephonic case managers, according to new market data from the Telephonic Case Management survey conducted in May 2014 by the Healthcare Intelligence Network.

To expand the scope of care coordination, telephonic case management is evolving as a cost-effective and efficient means of monitoring and engaging individuals with chronic illness or a weak circle of care, according to an inaugural survey on Telephonic Case Management by the Healthcare Intelligence Network (HIN).

More than 84 percent of respondents utilize telephonic case managers, according to this new market data, with more than half — 54 percent — making contact with patients from virtual home offices. And while the telephone is an essential tool of the trade, these case managers also draw on motivational interviewing and robust data from electronic health records (EHRs) and case management software to help them manage their populations.

The complex comorbid are the primary targets of telephonic case managers, the survey found, but the newly discharged, those in an acute stage of chronic illness, frequent utilizers and high-risk, high-cost patients also receive their fair share of telephonic attention from these case managers.

While charged primarily with the management of chronic illness and transitions in care, most telephonic case managers also find themselves in the role of patient educator and health coach, say 75 percent of respondents.

  • „„The case management assessment is the primary method of identifying candidates for telephonic contact, report 61 percent of respondents.
  • „„One-fifth of telephonic case managers work within a primary care practice.
  • „„Engagement of members in telephonic case management is the primary challenge of the program, say 43 percent of respondents.
  • „„Workloads of telephonic case managers fall into the 50-99 case range, say 30 percent of respondents.

Excerpted from 2014 Healthcare Benchmarks: Telephonic Case Management.