Infographic: Inefficient Health Communications

January 30th, 2015 by Melanie Matthews

Inefficient communication in the healthcare setting can waste healthcare providers' precious time during all facets of a patient encounter, according to a new infographic by imprivata.

The infographic looks at the average time wasted with inefficient communication tools during the patient admission and transfer processes and for an emergency response team, as well as the annual cost of this inefficiency.

Blueprint for a Medical Neighborhood: Building Care Coordination Between Specialists and PCPsWhile addressing the needs of individual patients, a medical neighborhood also encompasses population health and overall community health needs. Almost 31 percent of healthcare organizations actively engaged in population health management initiatives belong to a medical neighborhood, according to 2014 market data on population health management from the Healthcare Intelligence Network.

Blueprint for a Medical Neighborhood: Building Care Coordination Between Specialists and PCPs provides a framework in which to evaluate the patient-centered medical neighborhood (PCM-N) model.

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Healthcare Payor Strategies for Co-Located Case Management

January 29th, 2015 by Cheryl Miller

How to best strategize the co-location of case managers at points of care? The key is to understand the population you’re serving, be very targeted, and direct your services appropriately, says Dorothy Moller, managing director in the government healthcare solutions business unit of Navigant Healthcare.

Question: New market data on embedded case management found that two-thirds of respondents have co-located case managers at points of care, including primary care practices, hospital ERs and patients’ homes. What are some payor strategies for matching case managers with providers, and how do health plans benefit from co-location?

Response: (Dorothy Moller) I must acknowledge the safety net payors, who have been co-locating case managers for a number of years — in particular in hospital ERs. Very often the case managers you co-locate are not healthcare case managers, but behavioral health or social services case managers.

In terms of strategies for co-location, it depends on the population you’re serving and what you’re trying to accomplish with that population. There are a number of places where you can co-locate case managers — not so much case managers as case or care coordination services. Very often in large multi-specialty or primary care practice settings such as federally qualified health centers (FQHCs), community clinics, or multi-specialty clinics, case managers are sometimes nurses, sometimes social workers, sometimes physician assistants performing various functions. They may link members with specific services that are non-health related or coordinate care.

The key is to understand the population you’re serving and to make sure you include case management and care coordination services appropriate for that population. If you have a very acute population with high risks or readmission or other health complications, clearly you’re going to have a different kind of co-located service and you’re going to place them in a different location than you would otherwise. If you’re trying to encourage more effective access of services, use of preventive services, use of nurse call lines, and so on, you might place those services in a primary care practice. Those are going to be very different.

Embedded case managers could even be community health workers. In fact, I’ve worked with payors in the Southwest using community health workers in that role. They are sometimes co-located within the practice but then go into the community and deliver education services there as well, sometimes in collaboration with medical and education specialists.

It depends on the population you’re serving, the types of services you want to encourage or direct members to, and the most efficient staffing model for those services. Ultimately, you must remember you’re trying to develop a better staffing pyramid within the practice so that physicians do the most complex work — where a physician’s skills and capabilities are most needed. Nurses and other staff deliver care and services appropriate for their skills, education and capabilities. Be very targeted, understand your population, and direct the services appropriately.

healthcare trends
Dorothy Moller, MBA, is a managing director in the Government Healthcare Solutions business unit of Navigant Healthcare. She has nearly 30 years of experience specializing on a wide range of strategic issues from business intelligence and competitive analysis, to market, business and product strategy and design, business and product innovation, and business and operations turnaround and repositioning.

Source: Healthcare Trends & Forecasts in 2015: Performance Expectations for the Healthcare Industry

Majority Back Medicare Timeline for Value-Based Reimbursement

January 29th, 2015 by Patricia Donovan

For the first time in Medicare history, HHS has set explicit goals for alternative payment models and value-based payments.

The healthcare industry took notice earlier this week of Medicare's ambitious timeline for moving Medicare payments from volume- to value-based models—an agenda validated by the majority of respondents to HIN's eleventh annual Healthcare Trends and Forecasts survey.

Ninety-two percent of respondents to the December 2014 survey endorsed healthcare’s transition to rewarding healthcare value and quality over volume of services, noting the trend has boosted accountability and revenues.

In a related data point, 26 percent view the adoption of value-based reimbursement and rewards as the most promising area of healthcare.

The HHS timeline will tie 30 percent of traditional or fee-for-service (FFS) Medicare payments to quality or value through alternative payment models by the end of 2016. Alternative payment formulas include accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and bundled payment arrangements for episodes of care, which CMS has tested in a range of pilots in recent years.

The HHS said it will tie 50 percent of payments to these models by the end of 2018. In 2011, Medicare made almost no payments to providers through alternative payment models, but today such payments represent approximately 20 percent of Medicare payments.

With views toward value-based reimbursement mostly favorable, 2015 Trends survey respondents shared some spoils of a value-over-volume approach:

  • „„“Higher levels of accountability in order to be well positioned to execute in a value environment.”
  • „„“As a high quality provider, shift to rewarding this behavior has increased revenue.”
  • „„“Not as much direct impact as implied and perceived focus on quality and reporting.”
  • „„“We built a provider network upon this principle.”

In other trends documented by the survey, declining reimbursement and cost constraints posed considerable challenges for respondents in the last 12 months, while interventions to tighten transitions in care, reduce hospital readmissions and integrate care via the patient-centered medical home (PCMH) model—all value-based initiatives—were among business successes recounted by this year’s participants.

Infographic: Telehealth Index

January 28th, 2015 by Melanie Matthews

Sixty-four percent of Americans would be willing to have a physician visit over a video platform, according to a new survey conducted by Harris on behalf of American Well.

An infographic by American Well drills down into the survey results, including details on consumer perceptions of telehealth.

Remote Monitoring of High-Risk Patients: Telehealth Protocols for Chronic Care ManagementReal-time remote management of high-risk populations curbed hospitalizations, hospital readmissions and ER visits for more than 80 percent of respondents and boosted self-management levels for nearly all remotely monitored patients, according to 2014 market data from the Healthcare Intelligence Network (HIN).

Remote Monitoring of High-Risk Patients: Telehealth Protocols for Chronic Care Management profiles a successful eight-year initiative by New York City Health and Hospitals Corporation's (NYCHHC) House Calls Telehealth Program that significantly lowered patients' A1C blood glucose levels.

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9 Hospital Discharge Communications Tactics to Curb Readmissions

January 27th, 2015 by Cheryl Miller

For heart failure patients making the transition from hospital to home, an effective discharge summary can mean the difference in whether the patient recovers quickly or returns to the hospital, according to two new studies from Yale School of Medicine researchers. To be effective, discharge summaries must have three key factors: they must be timely, be quickly forwarded to the outside physician, and contain detailed and useful information.

We asked the 116 respondents to the fourth annual Healthcare Intelligence Network’s (HIN) Reducing Hospital Readmissions Survey, conducted in December 2013, what hospital discharge communications tools they used to lower their readmissions rate. Following are their responses.

  • Follow-up with patient post-facility discharge by case managers embedded in our physician practices.
  • Improved communication between inpatient (hospital) care coordination and outpatient (medical group) services.
  • Follow-up appointments with the doctor and home care arrangements are made prior to discharge from the facility if appropriate. Discharge information with medications are sent to the doctor’s office by the facility doctor on discharge for availability on follow-up appointment.
  • Increased oversight of high-risk patients; increased communication among clinical teams and health providers.
  • We utilize a transitional care program to engage with patients while in facility and continue to follow with in-home visits on discharge to continue education and teach-back as well as monitor and oversee progress.
  • Post-acute touch (home health) within 24 hours of discharge; medication reconciliation, signs and symptoms education and scheduling primary care physician (PCP) office visit appointment.
  • All discharges are called by our nursing supervisor or other designee to determine their post-discharge status and ensure they keep their follow-up primary care appointment.
  • Reaching the patient within one to two days post-discharge. Assuring the patients have a follow-up appointment and transportation, understand discharge medications, red flag symptoms and who to call if necessary.
  • Follow-up in the home for 35 days post-transition to home.

Source: 2014 Healthcare Benchmarks: Reducing Hospital Readmissions

http://hin.3dcartstores.com/2014-Healthcare-Benchmarks-Reducing-Hospital-Readmissions_p_4786.html

2014 Healthcare Benchmarks: Reducing Hospital Readmissions documents the latest key initiatives and partnerships to reduce readmissions by patients with these costly conditions and others by more than 100 healthcare organizations.

Infographic: Medicare Spending Trends

January 26th, 2015 by Melanie Matthews

In the short term, Medicare spending per person is expected to be lower relative to previous projections and to grow more slowly than private health insurance, according to a "Visualizing Health Policy" infographic by the Henry J. Kaiser Family Foundation.

The infographic also examines long-term predictions for Medicare spending and projections on a Medicare shortfall.

Physician Reimbursement for Chronic Care Management: Identifying New Practice Revenue OpportunitiesStarting this month, Medicare is reimbursing physician practices for select Chronic Care Management (CCM) services not previously eligible for reimbursement, underscoring the vital role of care management in primary care.

Physician Reimbursement for Chronic Care Management: Identifying New Practice Revenue Opportunities offers practical guidance to prepare physician practices to maximize CCM reimbursement in the year ahead.

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Infographic: Why Care Coordination Matters

January 23rd, 2015 by Melanie Matthews

As a result of poor coordination of care, one in five Medicare patients is readmitted within 30 days of discharge from the hospital, according to a new infographic by Primaris.

The infographic also examines the level of post-discharge care for Medicare beneficiaries who are re-admitted and the cost of these readmissions.

Scalable Models in Health Risk Stratification: Results from Cross-Continuum Care Coordination Health risk stratification is scalable—whether grouping diabetics in a single practice without an EMR or drilling down to an ACO's subset of medication non-adherent diabetics with elevated HbA1cs who lack social supports. That's the experience of Ochsner Health System, whose scaling and centralization of risk stratification and care coordination protocols across its nine-hospital system drive ROI and improve clinical outcomes and efficiency.

Scalable Models in Health Risk Stratification: Results from Cross-Continuum Care Coordination explores Ochsner's approach, in which standardized scripts, tools and workflows are applied along the care continuum, from post-hospital and ER discharge telephonic follow-up to capture of complex cases for outpatient management.

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Guest Post: 10 Medication Adherence Facts to Know in 2015

January 22nd, 2015 by Troy Hilsenroth

medication adherence

$105 billion of avoidable U.S. healthcare costs is due to medication non-adherence.

With 50 percent of Americans suffering from at least one chronic condition in their lifetime, medication management affects nearly everyone at some point. Whether an individual takes multiple medications or cares for a family member who is, the importance of taking medications as prescribed is highly undervalued. While missing a pill one day may seem insignificant, the effects of these habits can be highly detrimental and far-reaching, as guest blogger Troy Hilsenroth explains.

Not taking medication as prescribed, or medication non-adherence, can result in costly hospital bills, declines in patient wellness, and medical complications among other outcomes. Due to these very real risks, additional awareness about this serious public health issue is crucial moving into 2015.

Pharmacists already possess the patient care tools necessary to help with this problem. Patients need to access available tools to improve their medication adherence and educate themselves about their meds. The first step in reversing these trends is to promote education around the severity of medication non-adherence.

The following are ten medication adherence statistics to know in 2015:

  • In the United States, avoidable healthcare costs add up to $213 billion, of which $105 billion is due to medication non-adherence, according to the Express Scripts 2013 Drug Trend Report.
  • Non-adherence causes 30-50 percent of treatment failures and 125,000 deaths annually. 1
  • 64 percent of readmissions within 30 days are due to medication issues, according to HIN's 2010 Benchmarks in Improving Medication Adherence.
  • Medications are not continued as prescribed in about 50 percent of cases, according to a 2013 Centers for Disease Control and Prevention (CDC) presentation.
  • Nearly 50 percent of Americans have one or more chronic conditions that require prescription medications, according to the CDC.
  • Medication adherence is higher among patients who see the same healthcare provider each time they have a medical appointment. In this group, the average adherence is 81 percent, according to "Medication Adherence in America: A National Report Card," a recent report from the National Community Pharmacists Association.
  • Non-adherent patients are 17 percent more likely to be hospitalized than adherent patients, with a cost that exceeds that of an adherent patient by $3,575. 2
  • Generic medications have higher rates of adherence than name brand prescriptions, with 77 percent of patients adhering to generics as opposed to 71 percent with the name brand. 3
  • For some classes of medication, up to 30 percent of prescriptions are never filled by the patient, according to the Network for Excellence in Health Innovation (NEHI).
  • Patients receive 3.4 more refills per prescription in a 12-month period when their refills are synchronized, according to the National Community Pharmacists Association.

Medication non-adherence poses a very real risk for patients and their providers. A collaborative care team including physicians, pharmacists, and the patient is crucial to continuing education on this issue and establishing a medication management strategy to stay healthy and out of the hospital.

About the Author: Troy Hilsenroth has been with Omnicell for over six years, and currently serves as its vice president of the non-acute care division. In this role, he develops and delivers solutions to help organizations develop new and better ways of doing business and cultivates programs that change healthcare dynamics. Throughout his 22-year career in healthcare, his mission has been to deliver higher clinical quality at a lower cost. Prior to working at Omnicell, Troy served as a licensed clinical pharmacist for 14 years in a broad range of pharmacy environments, while also working as a firefighter and paramedic.

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 remain with them. The company accepts no liability for any errors, omissions or representations.


1. Smith D, Compliance Packaging; a patient education tool, American Pharmacy, Vol. NS29, No 2, February 1989.
2. A. Dragomir et al. (May 2010.). Impact of Adherence to Antihypertensive Agents on Clinical Outcomes and Hospitalization Costs. Medical Care, 48 (418-425). doi: 10.1097/MLR.0b013e3181d567bd
3. O’Riordan, Michael. (2014, September 15). Generics Beat Brand-Name Statins for Patient Adherence and Improving Outcomes. Medscape. Retrieved from http://www.medscape.com/viewarticle/831707

Infographic: 10 Things You Should Know About PQRS for 2015

January 21st, 2015 by Melanie Matthews

CMS’ Physician Compare website has begun listing physician participation in its Physician Quality Reporting System (PQRS), which could potentially mean a loss of new patients based on nonparticipation in the program, according to a new infographic by HealthFusion.

The infographic lists 10 key features of the PQRS program.

Physician Value-Based Reimbursement: Quality Rewards for Population Health With more than a quarter-century of experience with value-based reimbursement models, Humana is ideally positioned to help physician practices navigate the transition from fee for service to fee for value. The payor's multi-level Accountable Care Continuum rewards physician practices for care coordination of Medicare beneficiaries along the population health spectrum.

Physician Value-Based Reimbursement: Quality Rewards for Population Health describes the four tiers of Humana's Physician Quality Rewards program as well as the support, training, technologies and outcomes associated with these pay-for-value relationships.

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14 Protocols to Enhance Healthcare Home Visits

January 20th, 2015 by Cheryl Miller

Use of telemonitoring equipment, electronic medical records (EMRs), a staff dedicated to monitoring home visits and engaged caregivers are just some of the protocols used to enhance home visits, according to 155 respondents to the Healthcare Intelligence Network’s most recent industry survey on home visits.

Following are 10 more protocols used to improve the home visit process:

  • Inclusion of home visiting physician in hospital rounds; and the collaboration of home visit physician with primary care physician (PCP) and complex case managers.
  • Using our medication management machines with skilled nursing follow-up to increase medication compliance.
  • Proactive phone calls to determine if a patient's condition is worsening and in need of home visits.
  • Daily workflow management algorithms with prioritization and mobile access to electronic case management records.
  • Using teach-back to assure comprehension.
  • Easy to use/wear multimodal, advanced diagnostics telemonitoring allowing patients total mobility and continuous real-time monitoring.
  • Medication reconciliation is crucial in eliminating confusion for the patient, and our electronic medical record (EMR) accurately reflects what the patient is taking, including over-the-counter (OTC) and supplements.
  • Hospital coach gathers information and prepares the patient for discharge, coordinates with home visit staff, home visit team (coach and mobile physician) and completes home visit.
  • Portable EMR to document and review medical information on the spot.
  • EHR-generated lists, community-based team, community Web-based tracking tool, telehome monitoring devices, preferred provider network with skilled nursing facility/long-term acute care (SNF/LTAC), home health and infusion therapy.

Source: 2013 Healthcare Benchmarks: Home Visits

http://hin.3dcartstores.com/2013-Healthcare-Benchmarks-Home-Visits_p_4713.html

2013 Healthcare Benchmarks: Home Visits examines the latest trends in home visits for medical purposes, from the populations visited to top health tasks performed in the home to results and ROI from home interventions.