Infographic: Aetna’s Approach to Value-Based Healthcare

September 15th, 2014 by Melanie Matthews

With a new focus on quality of healthcare over quantity, Aetna is reporting improvements in outcome-based measures and reduced costs. In its new infographic, Aetna details its value-based healthcare options and results its achieving.

Quality over Quantity

Value-Based </p>
<p>Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and MethodologyIf one trend has transformed the healthcare industry post-ACA more than any other, it is the market's new business model rewarding value over volume.

Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and Methodology provides a framework for healthcare's new value proposition, with advice from thought leaders steeped in the delivery and reimbursement of value-based care.

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Infographic: 7 Ways to Improve Patient Satisfaction

September 12th, 2014 by Melanie Matthews

With healthcare transparency and the patient experience playing a larger role in not only the rating of healthcare organizations, but also reimbursement formulas, healthcare providers are playing closer attention to patient satisfaction levels.

Leading Reach, a patient engagement company, outlines seven strategies for healthcare providers to improve patient satisfaction levels.

7 Ways to Improve Patient Satisfaction

Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and MethodologyIf one trend has transformed the healthcare industry post-ACA more than any other, it is the market's new business model rewarding value over volume. Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and Methodology provides a framework for healthcare's new value proposition, with advice from thought leaders steeped in the delivery and reimbursement of value-based care.

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6 Ways to Overcome Pushback to Embedded Case Management

September 11th, 2014 by Cheryl Miller

Change always incites pushback, and when Sentara Medical Group went from an embedded case management program to a hybrid approach, patient and provider pushback prevailed, recalls Mary M. Morin, RN, NEA-BC, RN-BC, nurse executive with Sentara Medical Group. Among the six ways Sentara overcame resistance was to establish and maintain patient-centered relationships, by conducting comprehensive initial and ongoing assessments with patients, and developing plans of care and coaching education for both patients and their caregivers.

  • We maintained patient lists by populations within our electronic platforms. We came up with a standardized screen or view for all care managers. There was a lot of pushback against standardization but the key is standardizing the workflows. Should someone go out on family and medical leave, you can transfer your patient list. It all looks the same.
  • They were given and are still given assignments. We set expectations, which is critical. We send patient letters from the primary care physician (PCP) on behalf of your primary care provider that state we have this resource to help you should you be admitted to the hospital. We’re very focused on engaging patients. We have a brochure, and each care manager has a bio form that talks about their background.
  • We built workflow within the practices, within care management and within our electronic platform. We had issues: Optima, our health plan, is on a different EMR, as are the practices within our clinically integrated network. Unfortunately, the ambulatory-based care managers, the medical group care managers have to move between these two other platforms as well as our platform.
  • We held many meetings with home health and in-patient care coordination. Putting a face to a name is very helpful, as is lots of education and training. We had to do the electronic medical record (EMR) training. We discussed how to engage and motivate patients. how to motivate patients? What’s motivational interviewing? We have a requirement that within two years you are required to have your specialty certification.
  • We defined the care manager's role. The main piece is to establish and maintain patient-centered relationships. They conduct comprehensive initial assessments and ongoing assessments, identify ongoing needs of the patients and possibly their caregiver, developing plans with care and then providing coaching support to the patient, caregivers, and family members.
  • We managed resources such as transportation. We contract with the taxi service for our few patients that don’t drive but need to get to their appointments or to keep them out of the EDs in the hospitals. They manage transitions of care. They conduct advanced care planning.

value-based reimbursement
Mary M. Morin, RN, NEA-BC, RN-BC, is a nurse executive with Sentara Medical Group, where she is responsible and accountable for non-physician clinical practice within the Sentara Medical Group (160 clinics/practices) to ensure integration and alignment with Sentara Healthcare, regulatory compliance, standardization of nursing practice/care, and patient safety.

Source: Hybrid Embedded Case Management: New Model for Cross-Continuum Care Coordination

Infographic: Large Employers Lead the Way With Worksite Wellness

September 10th, 2014 by Melanie Matthews

As a growing number of employers realize the impact that employees' health has on the bottom line, the number of employer-sponsored wellness programs has increased with larger employers leading the way.

An infographic by MBA Healthcare examines the types of wellness programs that employers are offering and the impact the programs have on employee health.

Big Companies Leading the Way in Preventive Care

7 Patient-Centered Strategies to Generate Value-Based ReimbursementHealthcare companies seeking a roadmap to richer reimbursement should begin with the seven value-based healthcare priorities for 2014 identified by the healthcare C-suite: population health management, care coordination, integrated care delivery, e-health and telehealth, access to care, health and wellness, and dual eligibles. 7 Patient-Centered Strategies to Generate Value-Based Reimbursement explores the seven healthcare areas ripest for development in 2014, prioritized by 136 respondents to HIN’s ninth annual Trends & Forecasts survey.

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Community Health Network Retools Readmissions Ruler for High-Risk Heart Failure Patients

September 9th, 2014 by Patricia Donovan

From the many evidence-based health risk stratification tools available, Community Health Network has adapted a popular hospital readmissions indicator for use with medically complex patients at high risk of readmissions. Deborah Lyons, MSN, RN,NE-BC, network disease management executive director for Community Health Network, describes the adaptation process.

HIN: Where do home visits for heart failure patients enter the picture?

Deborah Lyons: We do a high-risk home assessment while we have patients in the hospital. Fully 100 percent of our patients that are admitted to inpatient status are automatically screened and ranked in terms of readmission risk. That’s where we use the LACE/ACE tool. We embedded that tool in our software so it can predictively tell us which patients to focus on.

HIN: How did you decide on the LACE tool? Is the ACE tool different than the LACE tool?

Deborah Lyons: The LACE itself is evidence-based. We work with the advisory board. And they had just done an analysis of all the predictive models out there in terms of readmission risk when we started this work. There were only two tools that were moderately predictive for risk. LACE was one of them. LACE looks at length of stay (L), acute admission (A), (meaning they came in through the emergency room), their Charleston Comorbidity score (C) and the number of ED visits (E) they’ve had in the past six months.

All this information was easily available to us at the time that we did this because we were on a different computer system. But the concern was that the L factor (length of stay), might lead us to place the patient at high risk when they were leaving the hospital. Maybe they started at low risk and then on the fourth day of stay, because they had been there four days, now they moved to high risk but they’re being discharged. You really can’t do anything at day of discharge. We first set a threshold for LACE, which we tested and validated and then ran a correlation and asked ourselves, “If this threshold is a LACE high risk, what would a correlating threshold be if we dropped the length of stay?” That’s how we moved to an ACE score.

Source: Stratifying High-Risk, High-Cost Patients: Benchmarks, Predictive Algorithms and Data Analytics

Stratifying High-Risk Patients


Stratifying High-Risk, High-Cost Patients: Benchmarks, Predictive Algorithms and Data Analytics
Reviews a range of risk stratification practices to determine candidates for health coaching, case management, home visits, remote monitoring and other initiatives designed to engage individuals with chronic illness, improve health outcomes and reduce healthcare spend.

Infographic: Creating Digitally “Mature” Healthcare Providers

September 8th, 2014 by Melanie Matthews

While consumers are taking charge of their digital health by downloading health apps and searching for health data online, only 33 percent of healthcare providers are digitally "mature," according to a new survey by Capgemini Consulting.

Capgemini highlights the survey findings in a new infographic that looks at the differences between digitally mature and non-digitally mature healthcare providers and provides strategies for moving up the digital curve.

Is the Healthcare Industry Digitally Fit?

2013 Healthcare Benchmarks: Mobile HealthUsed a smartphone app for health reasons lately? Chances are your patients and health plan members have, too. The use of mobile health technologies (not simply wireless) to monitor health is revolutionizing the exchange and consumption of healthcare data. From mobile apps that monitor blood sugar and heart rhythms to text-based medication reminders, mHealth technologies could save from $1.96 billion to $5.83 billion in healthcare costs by the year 2014, some studies indicate. 2013 Healthcare Benchmarks: Mobile Health delivers a snapshot of mobile health (mHealth) trends, including current and planned mHealth initiatives, types and purpose of mHealth interventions, targeted populations and health conditions, and challenges, impact and results from mHealth efforts.

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Infographic: Clinical Documentation

September 5th, 2014 by Melanie Matthews

Correct coding based on complete clinical documentation boosts first time clean claim rates and decrease denials.

MRS Information Services has developed an infographic that details the regulatory impacts of correct clinical documentation and how to improve your health information management department for maximum performance. The infographic also highlights how ICD-10 will impact healthcare organizations and how organizations are preparing for ICD-10.

Electronic Health Records: Strategies for Long-Term Success Electronic Health Records: Strategies for Long-Term Success is a comprehensive reference for the design, implementation, and optimization of electronic health records (EHRs). The authors offer a detailed road map for avoiding common pitfalls during conversion and achieving higher-quality care after system implementation. A glossary of important terms and references to additional resources are also included in the book.

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10 Things to Know About Population Health Management in 2014

September 4th, 2014 by Patricia Donovan

A population-based approach to health and care management is sustainable, say 96 percent of respondents to the latest Population Health Management (PHM) Survey by the Healthcare Intelligence Network, with home visits and social media expanding PHM's reach along the care continuum.

In the two years since HIN last administered this survey, PHM teams have narrowed their approach, targeting individuals with moderate and complex health risks more closely than two years ago. The same period reflects a dramatic surge in the use of data analytics tools barely on PHM’s radar in 2012.

Here are more metrics derived from the 2014 Population Health Management survey:

  • The use of health risk assessments (HRAs), registries and biometric screenings more than tripled in the last 24 months, while electronic health record (EHR) applications increased five-fold for the same period.
  • PHM team composition has also shifted to reflect a greater reliance on primary care: primary care physicians (PCPs) appeared on 86 percent of respondents’ PHM teams, versus 60 percent in 2012.
  • „The prevalence of population health management programs remained relatively stable from 2012 to 2014, with just over half of respondents reporting PHM initiatives.
  • „„Almost two-thirds of 2014 respondents—64 percent—identified the HRA as the primary tool for determining appropriate PHM intervention levels, replacing claims data, the preferred stratification tool in 2012.
  • „„Almost one-third of responding PHM programs belong to a medical neighborhood, a new metric derived from this year’s survey.
  • „The use of remote patient monitoring in PHM nearly tripled from 2012 to 2014—from 13 percent to 38 percent.
  • One-quarter of PHM programs use social media to engage members, a new metric derived from the 2014 survey.
  • „„In a PHM metric new for 2014, 43 percent of PHM programs incorporate home visits into population health management plans.
  • Patient satisfaction is the key metric to evaluate PHM success, say 79 percent of respondents.

Source: 2014 Healthcare Benchmarks: Population Health Management

Stratifying High-Risk Patients


2014 Healthcare Benchmarks: Population Health Management
Delivers an in-depth analysis of population health management (PHM) trends at 129 healthcare organizations, including prevalence of PHM initiatives, program components, professionals on the PHM team, incentives, challenges and ROI.

Infographic: Top 5 Health Data Breaches

September 3rd, 2014 by Melanie Matthews

Overall, 17 million people have been affected by the top five healthcare data breaches, according to the Information Security Media Group.

An infographic by the Information Security Media Group looks at each of these breaches...with details on when and how they happened.

Top 5 Health Data Breaches

Business Associate Manual The Business Associate Manual is a template-style manual that can be easily adapted to align with your compliance needs as a business associate (BA). All content complies with the Omnibus Rule.

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Home Visits 101: Empower the Patient, and Don’t Forget the Gloves

September 2nd, 2014 by Patricia Donovan

It's hard to plan a home visit for a recently discharged patient if you don't know they've been in the hospital. Obtaining data on hospitalized patients is one of the challenges of administering a home visits program, notes Samantha Valcourt, MS, RN, CNS, a clinical nurse specialist for Stanford Coordinated Care (SCC), a part of Stanford Hospital and Clinics.

Some of the challenges I’ve experienced with our home visits program is first of all, knowing when our patients are actually in the hospital. It’s easy to know when they’re at SCC; I get an electronic communications or an EMR. However, if patients go outside our system, I may not know. Sometimes that discharge summary is not available when I’m ready to go see the patient the day after. Holidays and weekends always increase that 48- to 72-hour window and I really do try to get in there the following day if possible.

For patients that don’t see primary care doctors within our clinic, it can sometimes be a challenge getting hold of their primary care doctor outside of SCC, and then explaining my role and why I need them.

On the back of our patient ID card, we emphasize to our patients to please contact us if they’re even considering going to the emergency department so that perhaps we can avoid a hospital admission or a readmission. If they are being seen in the hospital, we want them to call us as soon as they’re there, as soon as they’re able to, or to have their family member call so we can make sure that we’re involved in that transition.

Another lesson learned is definitely to empower the patient. Again, as a nurse I try to do as much for the patient as I can. But I have to keep in mind that when I’m in the home, my goal is to make sure will be able to identify the red flags and symptoms that indicate things are not going well, and that they’ll be able to contact the doctor’s office with their needs. I make sure that both handoffs are very clear; I never want to leave a patient wondering, ‘Oh I had this nurse and she came into my home and then she called me every few days and then all of a sudden she was gone.’

I need to make sure that I have good communication with that next transition.

And then last, I always carry a set of gloves, because you never know what you’ll walk into. I was not a home health nurse before I did these types of home visits, so I was ill prepared on one of my first visits to a patient with a dialysis catheter that was oozing blood. My nursing instinct caused me to run in there and try to clean things up.

Now I carry a good stock of gloves and supplies, because you just never know.

value-based reimbursement
Samantha Valcourt, MS, RN, CNS, a clinical nurse specialist for Stanford Coordinated Care (SCC), a part of Stanford Hospital and Clinics.

Source: Home Visits for High-Risk Patients: Tools, Timing and Outcomes