Infographic: End-of-Life Care in California

May 17th, 2013 by Patricia Donovan

Californians, like many Americans, frequently do not get the kind of care that they want at the end of their lives. This infographic from the California Healthcare Foundation documents research on end-of-life care for Medicare beneficiaries, and analyzes it in light of what is known about Californians' preferences for care as they approach death.

The research found sharp variation that cannot be explained by differences among patients in age, sex, or race.

End-of-Life Care in California

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High-Risk Patient Roster Helps Atrius Pioneer ACO ‘Beat the Benchmark’

May 17th, 2013 by Patricia Donovan

Webinar Replay: Lessons from Atrius Health Pioneer ACO

They don't call them pioneers for nothing.

A high-risk patient roster, a retooled geriatric care model and a preferred SNF network are just a few Atrius Health innovations on the healthcare frontier.

Atrius Health is one of 32 participants in the CMS Pioneer ACO program testing alternative payment and program design models for accountable care organizations. Emily Brower, Atrius Health executive director of accountable care programs, shared first-year lessons during a recent webinar, Medicare Pioneer ACO: Case Study on Atrius Health's Focus on the Triple Aim.

Atrius was drawn to the three-year Pioneer ACO program for a number of reasons. First, it offered the non-profit alliance of six independent medical groups a chance to showcase its core competencies, including its rich data environment, foundation in the patient-centered medical home (PCMH) model and new home care services, Ms. Brower said.

Also, it gave the Massachusetts organization a chance to build a population-based approach to managing its Medicare population as a whole, with Triple Aim goals as a foundation.

And finally, they had a lot of faith in the staff of the CMS Center for Medicare/Medicaid Innovation, where the project resides. "We feel they really understand the issues we face in being accountable for care across the continuum," noted Ms. Brower.

The Pioneer ACO shared savings and loss model challenges participants to perform against nationally identified trends. CMS take a participating ACO's population and creates from the national Medicare database a reference population, she explained. "We’re trying to beat the trend in that national population, or 'beat the benchmark.'"

In 2012, Atrius launched six clinical and technical initiatives to address the program's 33 quality measures — "the gate through which the ACO achieves savings." Key among them is its eight-step high-risk patient roster review, a hallmark of Atrius's redesigned geriatric care model.

"We used a new risk stratification tool to identify our high-risk patients, who go on a roster reviewed by a multidisciplinary team in the primary care practice to identify care gaps, including a need for advance directives." One outcome of the roster's use has been an increase in end-of-life conversations, she says.

On the technical support side, Atrius Health developed new tools within its EPIC® electronic health record (EHR) for tracking quality efforts, advanced care planning, medication reconciliation and other key metrics.

Ms. Brower estimates the total investment to launch the ACO, including the EHR, quality measurement tools and other efforts, to be between $2 and $3 million; the medical groups themselves likely spent that much again for additional care management resources.

"In terms of payback, we expect that we will be able to reduce the cost of care — to bend the cost curve so that we are beating the benchmark and creating savings that then support our additional investments."

Among programs on the drawing board: new ways to use the geriatric well visit, a home-based primary care program for high-risk patients, two programs for dual eligibles, and a patient advisory group.

Atrius Health is committed to the Pioneer ACO program, despite concerns from some participants over the program's quality measurement process communicated to CMS last month. "We know it’s going to take time. As we would say, ‘We’re not called pioneers for nothing.’ It took us that first year to identify develop most of the tools and infrastructure that CMS needed."

She continues: "The new measures that I mentioned that are coming out of the EHR being reported directly to CMS — that piece that we had to put together. There just wasn’t an existing pool of data to build benchmarks for those measures. Now that we have data, CMS will use this to create empirical benchmarks, which was one of the recommendations in that Pioneers communication."

Listen to an audio interview with Atrius Health's Emily Brower.

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Posted in Accountable Care Organizations, Electronic Medical Record, Healthcare Quality Ratings, Healthcare Reform, Medicare, Population Health Management, Quality Improvement | No Comments »

Infographic: Cost of Newly Insured Under Affordable Care Act

May 16th, 2013 by Patricia Donovan

Research sponsored by the Society of Actuaries (SOA) predicts ACA-driven changes in individual market composition of the individual healthcare market could drive up underlying claims costs by an average of 32 percent nationally by 2017.

The research also predicts high variability among states, with as many as 43 states experiencing a double-digit claims cost increase. This SOA infographic appeared in The Bailey Group blog.

Cost of the Newly Insured Under the Affordable Care Act

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Infographic: The Cost of Obesity

May 15th, 2013 by Patricia Donovan

Designed to shed light on the national epidemic of obesity, this infographic from the School of Public Health & Health Services at George Washington University illustrates the financial impact of obesity on U.S. communities and the overall economy, preventive measures the nation can take to positively affect change at a national level, and three key programs that are getting results.

Note: This infographic was the national winner in the 2013 Infographic Contest sponsored by the American Public Health Association.

Cost of Obesity

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Infographic: The Business of Healthcare

May 14th, 2013 by Patricia Donovan

With insurance premiums continuing to rise, a population growing increasingly divided on how to fix the healthcare system, and public health taking a back seat to corporate interests, many are losing the hope for a healthy future. Healthcare costs are spiraling out of control, but where does this unprecedented amount of spending go?

This infographic from BestHealthcareMBA.com illustrates where healthcare dollars are being spent and take a look at the profits of some key players behind the healthcare scene.

The Business of Healthcare

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Healthcare Business Week in Review: End-of-Life Care, Hospital Costs, New Medicare Plan

May 14th, 2013 by Cheryl Miller


However difficult, end-of-life care issues need to become an integral part of the public health agenda, according to a new article from the American Journal of Public Health by two Johns Hopkins Bloomberg School of Public Health faculty, and advance directives are a critical part of this agenda.

Despite being free, legally binding and readily available, however, too few Americans have completed an advance directive. They need to become routine parts of the conversation between doctors, nurses, and other key health providers and their patients, and viewed as another aspect of preventive care, the authors note.

End-of-life care consumes an estimated 30 percent of Medicare expenditures, and the impact on Medicaid and commercial insurance costs is substantial as well. Increasing the rate of completion of advance directives could conceivably lower these expenses and would do so by respecting patients’ values and wishes.

Want to know what your hospital bill is really charging you for? CMS has now launched a new Web site with detailed information on the charges for services that may be provided during the 100 most common Medicare inpatient stays. The data shows significant variations across the country and within communities in what hospitals charge for these services, CMS officials warn. Even within the same geographic area, hospital charges for similar services can vary significantly. The Web site is part of a new three-part program from the agency to give healthcare consumers more price transparency.

Today's Medicare patients are sicker and have more chronic illnesses, and are driving up the costs of emergency department (ED) care, according to a new report by the American Hospital Association (AHA).

Between 2006 and 2010, the severity of illness of beneficiaries receiving services in the ED increased, as did the rate of use, driving up the intensity of ED care and resources. The report outlines a number of factors that are contributing to this trend, and are detailed in our story.

A proposed Medicare plan that combines hospital, physician, and prescription drug coverage with private supplemental coverage into one health plan could produce savings of $180 billion over a decade and improve care for beneficiaries, according to a new study by researchers at The Johns Hopkins Bloomberg School of Public Health and The Commonwealth Fund.

Under the proposed plan, called "Medicare Essential," Medicare beneficiaries could save a total of $63 billion between 2014 and 2023, with total premium and out-of-pocket costs for beneficiaries estimated to be 17 percent to 40 percent lower than current costs.

According to the article, Medicare Essential would create financial incentives for beneficiaries to select high-quality, cost-effective healthcare services — also known as value-based benefit design. Beneficiaries would be encouraged to choose a primary care physician and providers who meet standards of high value. Beneficiaries selecting such providers would pay lower deductibles and co-pays.

Achieving real cost containment or quality improvement is difficult unless patients and consumers become more active, informed and engaged. How to achieve this? Tailoring your approach towards your low-activation patients and understanding their needs is one way to monitor and create better patient engagement, explains Dr. Judith Hibbard, the professor of health policy at the University of Oregon and the developer of PAM, the Patient Activation Measure.

And lastly, don’t forget to take our latest e-survey, Healthcare Case Management 2013. Care coordination by healthcare case managers is helping to drive clinical and financial outcomes in population health management and bolster emerging models of care such as the patient-centered medical home and the accountable care organization. Share your organization's case management strategies by May 17 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

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Posted in Accountable Care Organizations, Affordable Care Act, Avoidable ER Use, Behavioral Health | No Comments »

Infographic: The Dedicated Doctor

May 13th, 2013 by Patricia Donovan

But what does it take to attain that lofty position? Years of school and residency may seem daunting, and illustrate how intense a doctor’s dedication is to their profession.

This infographic from Soliant Health details educational and admissions requirements for those considering medical school, the current and future job outlook for physicians, medical school applicants by gender, and more.

The Dedicated Doctor

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Infographic: Should Medicare Change the Way It Pays for Care? Could Save Billions

May 10th, 2013 by Patricia Donovan

Improving the way Medicare pays for care could strengthen primary care, promote innovation and care coordination, and save $1.3 trillion systemwide, according to a new Commonwealth Fund study.

This infographic from the Commonwealth Fund depicts the organization's three-pronged strategy for switching to a fee-for-value reimbursement system, and the savings that could result for individuals, employers and state and federal governments.

Changing the Way Medicare Pays for Care Could Save Billions

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Ideas to Ease Challenges of Mobile Health Adoption

May 10th, 2013 by Patricia Donovan

Many older patients are adept at mobile health technologies.

With the average worker accessing information via three or more mobile devices — laptop, tablet and phone — it stands to reason that 45 percent of this year’s Mobile Health respondents now offer smart phone apps, text messaging and mobile Web applications to engage and educate “three-screeners.”

But just because the healthcare industry has launched headlong into social business strategies hinging on mHealth technologies does not mean that all strategies are successful. Growing pains from early mHealth adoption include the challenges of cost, interoperability and infrastructure — not to mention the difficulty of measuring mHealth’s impact on cost and utilization, a concern noted by more than 60 percent of the 150 respondents to HIN's inaugural survey on Mobile Health trends.

Before jumping into mobile, social and cloud solutions, Andrew Dixon, senior vice president of marketing and operations, Igloo Software, proposes this three-point strategy for adoption:

  • Define the problem. Are you seeking to deliver consistent information to patients? Improve the efficiency of collaboration? Support connections between staff and practitioners?
  • Establish a method of measurement. What is the benchmark with the current solution? What are your objectives once your social technologies are in place?
  • Evaluate the main organizational requirements. Consider technology, operations and the culture of your audience.

Cullman Regional Medical Center’s award-winning Good to Go® program, launched in conjunction with ExperiaHealth™, is a winner on all three counts. Faced with the problem of many patients leaving the hospital without thoroughly understanding their discharge instructions, Cullman decided to train some of its staff to use an iPod Touch® to record providers giving their patients discharge instructions.

Patients and family (and soon providers) access the cloud-based recordings via the Internet or smart phone, cutting down on questions and misunderstandings about post-hospital care. Audio-only recordings are available via land line. The positive response was immediate: by dramatically improving this critical care transition, Good to Go has resulted in a 15 percent decline in readmission rates for patients who received recorded discharge instructions and a 58 percent increase in HCAHPS satisfaction scores.

The technology is simple. The program plugs into Cullman’s operations with a minimum of training and investment. The culture has embraced the practice — even older patients, who Cullman feared might be uncomfortable with the technology. Caregivers and family who don’t live nearby are pleased they can access and replay loved ones’ instructions. It also has the added benefit for staff members of providing a complete record of instructions given.

This simple, successful intervention is now being tested in other areas of the hospital as well.

“We started with 4 East, a 31-bed step down unit where all of our CHF, stroke and acute MI patients go,” explains Cheryl Bailey, vice president of patient care services at Cullman Regional Medical Center. “We knew if we could make a difference on 4East, and we could reduce readmissions, then we would be able to replicate that same process in other areas of the hospital.”

Good to Go has been rolled out to preadmission testing, one day surgery, and maternity — not so much to reduce readmissions, but to help improve the communication process, she explains. “We realized with preadmission testing and one day surgery, we often had patients calling back saying, ‘Now was I supposed to take this medicine before my surgery?” or even, ‘Where am I supposed to enter the hospital when I come for my surgery?’ or ‘What did you tell me about umbilical cord care for our baby?’ So we rolled the Good to Go solution to these areas.”

Cullman also uses the program in its emergency room, respiratory therapy, physical therapy, CPAP Care Center and patient financial services — any area where communication could be enhanced.

With a half a billion Americans expected to carry smartphones in a couple of years, mobile health’s capacity to help individuals manage and prevent disease and healthcare organizations to track outcomes is nearly limitless. However, some foresight and planning is advised to avoid flooding the healthare industry with useless apps and games.

Posted in Care Transitions, Patient Engagement, Telehealth & Telemedicine, Transitions in Care, e-Health, mHealth | No Comments »

Meet Nurse Health Coach Elizabeth Scala: Helping RNs Avoid Burnout, Achieve Balance

May 10th, 2013 by Cheryl Miller

This month's inside look at a health coach, the choices she made on the road to success, and the challenges ahead.

Elizabeth Scala, MSN, MBA, RN, professional nurse coach, and founder of Living Sublime Wellness.

HIN: What was your first job out of college and how did you get into health coaching?

(Elizabeth Scala) My first job out of college was as a psychiatric nurse at the Johns Hopkins Hospital on a general adult inpatient unit. I got into coaching because the way I was living my life while I worked as a nurse was completely unhealthy. I had no spiritual life; my mental/emotional health was a roller coaster ride; my physical health was in the toilet. So I took a huge risk — against my parents' wishes — and left that job to take care of me. I went to work at a wellness center, running their physician referral exercise program. At the gym, I was surrounded by exercise, nutrition, and people who could help me. I realized (and remembered) that I enjoyed being and living healthy! So I got into a health coaching training program so that I could do more at the club. That led to me loving it and deciding to open up my own practice so that I could help more nurses like me — who had lost their love of life and their passion for their career.

Have you received any health coaching certifications? If so, please list these certifications.

I went through the Wellcoaches certified health and wellness coaching training program.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road?

Not yet. I know this is what I want to do, but I still have fears and doubts (as any human being would and does). I still work part-time at Johns Hopkins, as my coaching business doesn't fully support me, but I have faith and optimism (and hard work, dedication, passion, commitment, and self-care practices) that sustain me and help me to know that I am meant to do this work!

In brief, describe your organization.

My company is called Living Sublime Wellness. I use a variety of modalities with my work. As a nurse, health coach, and Reiki Master, I primarily work with nurses and healthcare professionals who are looking to make and sustain healthy lifestyles. I also host a bi-weekly radio show that is available via my iTunes channel and the Blog Talk Radio archive page. I put on monthly wellness workshops via interactive webinar, which vary each month in topic to speak to my belief that well-being is holistic. I love doing in-person talks on the essential steps to well being for nursing associations, nurse conferences, nurse departments, and anything/anybody nursing! I run small group coaching programs and work with clients one-on-one. And I tie Reiki into it all. I use distance Reiki with my coaching clients; participate in Reiki sharing and clinics; work on Reiki research at my hospital job; give Reiki treatments; and teach Reiki to groups.

What are two or three important concepts or rules that you follow in health coaching?

I don't tell people what to do. It is my core belief that the answers, the healing, the help is all within us. We just need to take and make the time to listen and get to know ourselves. As a coach, I help people get the inside stuff out and allow them to really hear themselves. Then together we find the answers, ideas, and tools that work for them!

My second belief is that health is holistic. If I am eating well, but hating my job, am I healthy? If I work out all day but then go eat take-out and binge drink all night, am I healthy? No! There are many, many aspects that go into total well-being: in addition to the obvious three (physical, nutritional, and mental/emotional). We've got career, social, spiritual, environmental aspects to consider. Wellness is a total lifestyle. We can't fix ourselves overnight with a quick pill. It is a lifestyle that takes time, support, and a broad scope. I work with clients on living healthy in all aspects of their lives.

What is the single-most successful thing that your company is doing now?

My RejuveNation Collaboration. It is a two-week, 14-speaker, and 14-topic video event. It is a virtual conference that offers a balanced dose of self-care. This event brings unique and diverse experts together from across the country. We have interactive and experiential workshops that the registrants actually participate in. We share a series workbook with reflective exercises; a secret social networking group for interaction with speakers and each other before, during and after the event; and so much more! This time around we added daily mini-meditation breaks and healthy samples of chocolate for participants to take time for themselves and enjoy peace and chocolate meditations. I absolutely love this event. The speakers have a great time getting to know me and each other. And since I do this twice a year, the speakers become a part of the family. We have a ton of fun and each time we do something different to change it up and take it up a notch! In the past this event was targeted at nurses, but we have future visions of expanding our audience and engaging on a larger level.

What is the single most effective workflow, process, tool or form that you are using in coaching today?

Using Reiki as a tool for everything I do. I have seen clients have amazing shifts, just from using distance Reiki in our one-on-one coaching sessions. It helps them to calm down, quiet that extra mental chatter, and really hear themselves so that amazing shifts can occur. Change happens and growth occurs. But I not only bring my Reiki into my coaching calls, I use it in all that I do. I bring my Reiki to my own goals, my health and well-being, and my nurse associations. It is a simple, but wonderful tool.

What is the most satisfying thing about being a health coach?

I love seeing other people figure things out for themselves. Being in healthcare for this long, this model doesn't work. A provider tells a patient or prescribes a treatment and more often than not the patient never does it. Why? We are adults… we like making our own choices. We think for ourselves. Quite frankly, we don't like being told what to do. So as a coach it is awesome to partner with folks so that they choose help, but of course with my gentle nudge. It is then so satisfying to hear back from them about what worked, how they have improved, and maintain it in a lifestyle.

What is the greatest challenge of health coaching, and how are you working to overcome this challenge?

Being patient. Sometimes I want things to go quicker than they are happening. I just have to relax, let go, breathe, and use some of my own spiritual practices and self-care techniques to remind myself to stay in the moment. It is challenging at times, but so rewarding when possible.

Where did you grow up?

Carmel, N.Y.

What college did you attend? Is there a moment from that time that stands out?

For undergraduate, the University of Delaware. For graduate school, Johns Hopkins University.

Are you married? Do you have children?

Yes, no children, but two dogs.

What is your favorite hobby and how did it develop in your life?

Yoga. I love how strong, yet calm I feel afterwards. I love relaxing and breathing and being with myself and my body. I feel very balanced and I need that sense of balance. So even though I enjoy other exercises that may make me sweat more and have my heart beating fast, I love yoga for the hard work yet gentle softness it creates for me.

Is there a book you recently read or movie you saw that you would recommend?

I loved Pamela Miles' book Reiki: A Comprehensive Guide. I also recently enjoyed the Living Yoga book. I always, always recommend Jon Kabat-Zinn's books, especially Full Catastrophe Living.

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Posted in Care Coordination, Health Coach Profile, Health Coaching | No Comments »

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