Archive for the ‘e-Health’ Category

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Q&A: HRHC Diabetes Collaborative Relies on Tiered Care Management, Registries

January 23rd, 2012 by Jessica Papay

Patient care partners, innovative weight management tactics, patient registries and even telepsychiatry are part of the team approach to diabetes management at Hudson River HealthCare (HRHC) Diabetes Collaborative. The New York-based network of FQHCs finds that tiered care management generates the best outcomes for its patients with diabetes, explains Kathy Brieger, RD, CDE, HRHC’s chief operations officer, prior to her presentation on Diabetes Management in the Medical Home.

HIN: The Hudson River HealthCare (HRHC) Diabetes Coalition uses a patient-centered team approach to manage diabetes in its more than 3400 adult patients with the disease. HIN recently did a survey to find out about disease-focused programs in particular, those that manage diabetes. Our respondents told us that weight management is the most challenging aspect of this disease. Would you concur? If so, how does HRHC address weight management in its population?

(Kathy Brieger): I would agree with this. Weight management is one of the most challenging focuses of this condition. In order to meet this challenge, we’ve had to look at programs from a variety of aspects. We started walking clubs in some communities to encourage physical activity. There’s also a Taking off Pounds Sensibly group, which is a Weight Watchers format but at a lower cost for patients who may be at a low income. We’ve done programs on mindful eating and general ways of looking at portions. We’ve also done a lot of work related to children and preventions. I think this is a big target. We focus on prevention and giving people the options of attending a variety of program formats for weight loss.

HIN: Over the last 12-18 months we’ve seen that case managers are increasingly employed on site, in primary care practices, to assist with the management of chronic illness. Are there any case managers in the HRHC mix?

(Kathy Brieger): This is a key question to diabetes management. We’ve found that a team-based approach to care is really the most effective. We have several team members who help to case-manage the patients. And that includes everyone from a dietician to people called patient care partners. Patient care partners may not have a clinical license, but are trained in motivational interviewing and help to serve as a bridge between the clinical team and the patient. We also have sophisticated, high-level RN care managers who work in a targeted way with patients who have diabetes. Those are usually the patients who have comorbidities and who may have poor control over their diabetes. At Hudson River HealthCare, we look at a team-based approach using different levels of care to get the best outcomes. We find that that really is the most effective.

HIN: The more sophisticated care managers are for the sicker patients with comorbidities. How do you assign patients to the other two levels of management?

(Kathy Brieger): We have some reporting systems because we do have an electronic health record; we use eClinical Works® (ECW). We have different cutoffs for the care manager. We’ve run the registries. For people who have hemoglobin A1Cs of over 8 or 9, the care manager reviews them and she’ll pull off people who may have some of those indicators. Also, the medical providers will tell us, “This person may not have a hemoglobin A1C of over 8 or 9, but they’ve been in and out of the hospital several times.”

Right now, we’re also working with hospitals to get us hospital discharge summaries so we can see if those people who may have some unstable situations that we’re not aware of can be pulled in. For every single person who has diabetes, their care is also managed by the patient care partners. We taught them how to use the registries, how to call people in for group classes and how to send letters out for our programs. These levels are done in a three-tiered approach using the care team so that the patient care partner who is assigned to the care team, the nurse who is assigned to the care team and the provider assigned to the care team would together be able to route or send people to the right place. The bulk of our patients are able to do the low-level patient care part. It’s just the top 15 percent that are having some issues.

HIN: It sounds like registries are important to the program.

(Kathy Brieger): Yes, they are. Over 10 years ago, we started with the Patient Electronic Care System (PECS) as part of the federal government’s move to get a population health underway, but it was a limited standalone registry. And then about three years ago when we became fully electronic, we were able to get our registries and our reports done on all patients with all conditions, and that is valuable. We’ve done a lot of work on training our staff on how to use registries; it’s not so helpful just to have registries; you have to know how to use them.

We’ve tried to use registries as a teaching tool for everyone from even clinical assistants in training all the way up to the providers. They know how they can use it to have more effective team-based care, more effective disease-based focus, and even prevention of things like, “When did you get your mammogram done last?”

HIN: And finally, are there any applications in telehealth, telemedicine or remote monitoring that you are using successfully in the management of diabetes?

(Kathy Brieger): Yes. We’re involved with telemedicine, focusing on telepsychiatry at one site. We have purchased equipment and are right now getting it cabled for six different locations, so that we’ll be able to expand our services in the telemedicine area. We do have some sites that are located in remote areas. We are unable to get some specialists that may help in the management of diabetes. We think telemedicine will be a great resource in improving some access to services that may not be available in some of those remote areas. Even though we’re in New York, people think we have all types of access to specialists, but there are areas where they do not exist, even in New York. We’re looking forward to having that happen.

Posted in Case Management, Disease Management, Health IT, Patient-Centered Medical Home, Telehealth & Telemedicine, Wellness/Prevention, e-Health | No Comments »

Q&A: With Hospital Core Measures, 90% Doesn’t Cut It

December 22nd, 2011 by Jessica Papay

Good core measure performance is good patient care, explains Dr. Steve Berkowitz, president at SMB Health Consulting and former chief medical officer for the central and west Texas division of HCA at St. David’s HealthCare. Prior to his presentation on Healthcare Performance Improvement: Exceeding Core Measure Targets for Value-Based Reimbursement, Dr. Berkowitz discussed the most challenging clinical measures to improve, tools for collecting core measure data and physician incentives to improve performance.

HIN: St. David’s healthcare system has specifically improved care related to heart attacks, heart failure, pneumonia and surgical care. What was the most challenging clinical measure among those to improve and what process changes sparked the improvement?

(Dr. Steve Berkowitz): Every one of those measures has unique challenges that we needed to handle. Frankly, a general challenge that we had was developing these protocols over eight hospitals in two different markets. Having said that, the most challenging measures are the surgical care improvement program (SCIP) measures because they are resource-intensive as well as require physician buy-in and input to make sure they get done appropriately. One thing I want the audience to come away with is a sense of enthusiasm that your organization can get it done. You can achieve virtual 100 percent performance with some hard work, checking and rechecking, and dedication of your physicians, nursing, pharmacy and administration. But most important, the establishment of good core measure performance is good patient care.

HIN: Can a hospital or health system that does not have an electronic health record share this type of data efficiently?

(Dr. Steve Berkowitz): Absolutely. When we first started this, we had very little of an electronic record at St. David, and that’s improving fast. What we were able to do was just develop internal processes to track those patients very early, have concurrent review of those patients, and get the data widely disseminated and available. Not only can we track our performance now, but we can use that data to identify outliers, whether they be physicians, nursing, pharmacists, etc., so that we can specifically target approaches to go for our goal of zero misses.

HIN: In the absence of the EHR, did you use registries at all to either collect the data or disseminate the data?

(Dr. Steve Berkowitz): We had some internal processes that we developed. But it really was a function of downloading all of the data from our system and then individually tracking and monitoring. I want to emphasize that to be excellent in core measures, it’s very labor intensive. You have to check, check and recheck, and there needs to be redundancies built into the system because we need zero misses. Ninety percent doesn’t cut it anymore, 95 percent doesn’t cut it anymore, and even 99.6 percent performance leaves a lot of dollars on the table.

HIN: What physician incentives were in place, or are in place, at St. David to encourage performance improvement?

(Dr. Steve Berkowitz): We have very little physician incentive there, although there is an incentive plan for the hospital lists because they are the driver of these measures, particularly with heart attacks, pneumonia and heart failure, and maybe less so with SCIP. But we instituted an incentive program for our hospital lists and they led the charge. They got us to outstanding performance quickly in those three categories.

Posted in Healthcare Administration, Healthcare Quality Ratings, Hospital Readmissions, Physician Practices, e-Health | No Comments »

Clinical Integration Update: APP Embeds Case Managers in Select Practices

November 16th, 2011 by Patricia Donovan

In an expansion of its highly regarded clinical integration program, Advocate Physician Partners (APP) has embedded 60 outpatient case managers in select physician practices.

“The case managers are focused on the sickest 2 to 3 percent of our population,” explained Mark Shields, MD, MBA, APP senior medical director and VP of medical management for Advocate Health Care, in a recent interview. “There is active discourse between the physicians and RNs about which patients should participate in the case management program.”

APP placed the case managers in the practices in early 2011, after studying the success enjoyed by Geisinger Health Plan’s embedded case managers.

The newly embedded case managers are accessing tools like “Active Advice,” which prompts the care managers with further data analytics, as well as a home-grown statistical tool employed to determine those patients at highest risk of readmission to the hospital as part of APP’s “Transitions” program.

Reducing avoidable ER visits is another mission for both outpatient and ER case managers, Dr. Shields notes. There are related incentives and training for providers, including the use of group visits, telephone visits and enhanced scheduling to impact this metric.

APP defines clinical integration as “physicians across specialties working together with hospitals to drive quality, patient safety and cost-effectiveness.” APP’s clinical integration has expanded in 2011 to include 3,800 physicians and 10 hospitals, who are subject to 147 individual performance measures. New measures added this year were chiefly in the areas of global cost of care, ambulatory conditions and readmissions, said Dr. Shields.

Looking ahead to future improvements, APP expects to roll out a fully operational patient portal in early 2012 to support meaningful use imperatives. Some APP sites are already trialing patient e-visits modeled after those in use by Group Health Cooperative, he said.

Keeping pace with other federal initiatives, Dr. Shields is leading the group analyzing CMS’s recently issued ruling on the Medicare Shared Savings program, which create accountable care organizations (ACOs) for Medicare beneficiaries.

“It’s a significant step,” said Dr. Shields of the revised rule. “It makes Shared Savings more approachable while still maintaining the rigor across many domains.

“It is the start of a universal set of metrics.”

Posted in Accountable Care Organizations, Case Management, Physician Practices, Reducing Readmissions, e-Health | No Comments »

More MGMA Highlights: Changing Where and How Healthcare Is Delivered

October 27th, 2011 by Patricia Donovan

The only way to revamp the existing healthcare system is to “change the places and the ways in which we deliver care,” advised Eric Dishman, Intel Fellow and director of health innovation and policy, during Tuesday’s opening session of the MGMA 2011 annual conference.

To illustrate, Dishman held aloft a small computer about the size of a pedometer that Intel gave to homebound elderly to wear. The computer generated data on their gait, information the scientific community can use to better understand how to prevent falls in this population, he explained during “Changing Practices: Home- and Community-Based Care Technologies for Independent Living.”

It’s just one of the ways Intel is studying the entire “human” system to better design the technologies to support their care, Dishman said.

Out in the conference exhibit hall, home monitoring technology by Alere supports the shift in care delivery locations that Dishman is proposing. The technology allows patients who take the anticoagulant Warfarin to test PT/INR levels regularly. Keeping PT/INR levels within a safe range can help individuals to avoid serious complications such as bleeding or stroke.

“These rapid and real-time diagnostic tests in home allow for more frequent testing, which provides additional data,” explained Clint Brown, Alere home monitoring national business director. “We can catch an INR drifting out of range, which is the essence of preventive care.”

By helping to reduce risk and adverse events, the technology helps to reduce the likelihood of readmissions, Brown added, “while contributing to the efficiency conversation.”

Patient portals were also part of the efficiency conversation at the conference, since they help to optimize EHR use, enhance patient engagement and clinical information exchange and shift some care management tasks to the patients themselves — everything from making appointments to paying bills to reviewing lab results. Most EHRs have a portal component that can be activated.

The conference’s Healthcare Innovations Pavilion featured a case study Tuesday on patient portal use, co-presented by Intuit and St. Vincent Medical Group. The 34-site, 150-physician multispecialty group launched the portal in May, explained Patti Ballman, St. Vincent’s director of operations, but is already experiencing improved patient flow, a decrease in telephone calls and an ability to see more patients.

The portal, which the medical group has branded “MySV,” positions the group well for the patient engagement requirement of meaningful use, but that wasn’t the primary driver for portal implementation, noted Ballman.

“We wanted to improve the care experience for the patients in the office. The online portal allows us to focus more on the patients who are in front of us rather than the ones on the phone.”

Physician practices considering the use of a patient portal should start collecting patients’ e-mails now to make the launch easier, Ballman recommended.

Portals are just one of the technologies that are helping physician practices to improve collections by providing a more private transaction. Another is automated voice messaging, contributes Marc Tumminello, vice president of healthcare practice sales for Televox, another exhibitor at the conference.

“Using automated reminders for accounts receivable is far less costly than call centers,” noted Tumminello. “Practices can also build in the option to speak to a live person. Giving the patients various payment options reduces the potential embarrassment of this transaction.”

Phreesia, which calls itself “The Patient Check-in Company,” puts this transaction back in the waiting room by building payment options into the self check-in process. Patients can check themselves in on the company’s bright orange portable tablets, then render their co-pay or outstanding balance by swiping their credit card on the side of the tablet. The technology verifies eligibility, and also offers customized disease management education at the end of each transaction.

Patients have been receptive to this technology, notes Phreesia representative Katie Ray, who was demonstrating the tablet. “Patients are used to self-service in other aspects of their lives; why not in healthcare?”

On the clinical side, several presenters described how they are embedding case managers in the primary care practice. In separate sessions, both Advocate Physician Partners (APP) and Marshfield Clinic said they have embedded case managers in physician practices in the last year.

Sixty colocated outpatient case managers were added to APP’s clinical integration program in early 2011, explained Dr. Mark Shields, senior medical director and vice president of medical management for Advocate Physician Partners and Advocate Health Care. “They will focus on the sickest 2 to 3 percent of our population.”

Marshfield Clinic has embedded 55 nurse care coordinators in its 35 NCQA-recognized level III patient-centered medical homes, explained Dr. Theodore Praxel, medical director of quality improvement and care management. On average, the nurse care coordinators have been working for about six months in the practices, which have been very positive about this addition to the care team.

Watch this blog for more detail on these hot topics for practices — as well some innovative strategies for coping with HIPAA compliance, physician shortages, acquisition, decreased reimbursements and other challenges.

Posted in Affordable Care Act, Case Management, Healthcare Costs, Healthcare Quality Ratings, Patient-Centered Medical Home, Physician Practices, e-Health | No Comments »

Four Transitions for Back-To-School

September 12th, 2011 by Cheryl Miller

It’s back to school time, and the healthcare industry is undergoing its fair share of transitions.

  • NCQA is launching a new accreditation program for ACOs this fall. The organization worked with consumer advocates, purchasers and other healthcare and managed care experts to develop seven standards by which it will evaluate ACOs. Early bird adopters of the accreditation effort can get reduced rates on survey fees, online education tools and promotion. Order the NCQA ACO standards.
  • The one-year report card on Cigna’s ACO approach with Medical Clinic of North Texas (MCNT) is in; and both healthcare systems are reporting excellent grades in four key areas: reducing avoidable emergency room visits, following evidence-based medicine, lowering medical costs and better controlling diabetes. Since the accountable care program began, MCNT has received the highest level of recognition from NCQA for meeting national quality standards for physician group medical homes. Cigna helped by sharing patient-specific data that identifies individuals who could benefit most from additional outreach and follow-up care.
  • Medical students, rather than teachers, are getting apples this year: Apple iPads. Many universities, including Yale Medical School, profiled here, are downloading curriculum onto the tablets in an effort to be more “green,” save money, and protect patient confidentiality. Computer security has been a particular concern for the Yale School of Medicine, and the iPad is compliant with security and privacy laws and does not carry the same risk of information loss that a laptop might, Yale officials say.
  • And finally, a lesson that can’t be taught enough: smoking just a few cigarettes can kill. A new report from the CDC shows that smokers are smoking less: the percent of daily smokers who smoke nine or fewer cigarettes per day rose to nearly 22 percent in 2010, up from an estimated 16 percent in 2005. But smokers need not be heavy or long-term smokers to be affected with a smoking-related disease, or suffer a heart attack or asthma attack, CDC officials say. And states with the toughest anti-smoking campaigns, like like Maine, New York and Washington, have the fewest smokers. Which just goes to show that even the most resistant students can be taught to change their ways.

    • Posted in Accountable Care Organizations, Affordable Care Act, Avoidable ER Use, Behavioral Health, Case Management, Consumer-Driven Healthcare, Disease Management, HIN Blog, Health IT, Healthcare Costs, Healthcare Quality Ratings, Healthcare Trends, Hospital Readmissions, Telehealth & Telemedicine, Uncategorized, Wellness/Prevention, e-Health | No Comments »

    mHealth: There’s a Grant for That

    August 5th, 2011 by Cheryl Miller

    By 2015 more than 500 million smartphone users worldwide will be using healthcare applications, research studies show. So it’s not surprising the FDA is taking a closer look at some of these apps, specifically, those whose misuse could endanger its users.

    These “medical mobile apps,” as the FDA is calling them, are specific to medicine or healthcare and are designed for use on smartphones and other mobile computing devices and will offer everything from blood sugar monitoring to ECG machines.

    As we reported in a previous HBWU issue about IBM, the benefits of these health and medical apps are immeasurable, not just here, but in underserved, frequently rural communities around the globe, especially where patients have no access to doctors, these devices can save lives.

    And they can save billions of dollars as well. According to studies from Juniper Research using mobile health, or mHealth, technologies for health monitoring could save from $1.96 billion to $5.83 billion in healthcare costs by the year 2014. So the Center for Technology and Aging (CTA) (techandaging.org), with funding from The SCAN Foundation, has awarded nearly $500,000 in one-year grants to five organizations that will demonstrate the best ways to implement mHealth technologies for older, chronically ill adults, ironically, the population least likely to own a smartphone. The grants will help the CTA to meet its four areas of opportunity that it feels can best transform lives: medication optimization, remote patient monitoring, care transitions, and mobile health. And in a recently published paper the agency discusses how

    cell phones, smart phones, laptop and tablet computers, and other mobile enabled devices are being used to help millions of older Americans as well as their physicians and caregivers manage chronic disease, use their medications properly, avoid safety risks (e.g. fall detection), access online health information, and stay well.

    With the exploding growth of mHealth technology it seems that smartphones will eventually be used for everything but plain old talking. Hopefully the dialogue between a patient and physician won’t be relegated to a tiny FaceTime screen on an IPhone.

    Posted in Behavioral Health, Health IT, Healthcare Costs, Healthcare Toolkits, Healthcare Trends, Patient-Centered Medical Home, Telehealth & Telemedicine, Uncategorized, e-Health | No Comments »

    New Study Documents Dissatisfaction with Patient Satisfaction Scores

    August 1st, 2011 by Cheryl Miller

    Almost 85 percent of healthcare executives are dissatisfied with their patient satisfaction scores, according to our “Improving Patient Experience and Satisfaction” survey conducted in May 2011. But more than 80 percent of survey respondents said they have programs in place to improve satisfaction levels. We surveyed 146 healthcare organizations, and identified areas for improvement, providing details on patient satisfaction surveys, estimating the impact of programs designed to improve patient satisfaction, among other areas. Download an executive summary of the results.

    Healthcare costs for U.S. employers have slowed from last year. According to the Thomson Reuters Healthcare Spending Index for Private Insurance, medical costs for people in employer-sponsored health plans decreased by nearly 3 percent from the previous year. Hospital costs showed the steepest growth, with physician costs reflecting a 3 percent year-over-year hike, and drug costs increasing by less than one percent. More in this issue of the Healthcare Business Weekly Update.

    By 2015, more than 500 million smartphone users worldwide will be using mobile health and medical applications, research studies show. So it’s not surprising that the FDA is taking a closer look at some of these apps; specifically, those whose misuse could endanger their users. The FDA is currently seeking public input on its proposed approach.

    It’s not too late to complete this month’s e-survey on patient registries. Respond by August 15 and you’ll receive a free executive summary of the survey results once they are compiled to learn key benchmarks and metrics for using registries to improve reimbursement and patient outcomes. You may complete the survey online. Thanks for participating!

    Posted in Consumer-Driven Healthcare, Healthcare Costs, Hospital Readmissions, Telehealth & Telemedicine, Wellness/Prevention, e-Health | No Comments »

    One Third of Medical Homes Will Join an ACO

    July 18th, 2011 by Cheryl Miller

    New market research shows that one third of medical homes will join an ACO in the next 12 months. And more than half of those interviewed by the Healthcare Intelligence Network for our fifth annual survey on patient-centered medical homes said they had already established a medical home for their population. The PCMH is a favored model of integrated care delivery and a cornerstone of accountable care — two core elements of healthcare reform. More in this issue.

    About $216 million nationally is spent each year managing drug
    shortages in the hospital setting, with three drugs in particular
    affecting over 80 percent of health systems, says a new study
    released by the American Society of Health-System Pharmacists
    (ASHP). The problem is not only increasing hospital costs but
    harming patient care: nearly a third of the 353 pharmacy directors
    surveyed said they had to pull clinical staff to manage the crisis.

    More than $300 billion each year is spent on care for dual-eligibles,
    the 9 million Americans currently receiving both Medicare and
    Medicaid benefits. HHS hopes to lower these costs — and improve
    care — with three new initiatives: financial models to better align
    finances between the agencies; a quality care program for nursing
    home residents, and a resource center program.

    Telemedicine continues to serve the underserved. A new remote
    monitoring pilot project from the University of Utah seeks to help the
    chronically ill who are unable to reach traditional care facilities easily
    on a regular basis. The project will feature a centralized care
    coordinator, four clinics monitoring 15 to 20 patients each and two
    locations using kiosks to monitor another 30 patients each. Read more in this week’s Healthcare Business Weekly Update.

    Posted in Accountable Care Organizations, Affordable Care Act, Behavioral Health, Case Management, Consumer-Driven Healthcare, Disease Management, Health IT, Healthcare Costs, Healthcare Quality Ratings, Healthcare Trends, Patient-Centered Medical Home, Prescription Drugs, Telehealth & Telemedicine, Uncategorized, Wellness/Prevention, e-Health | 1 Comment »

    Sensei mHealth App Coaches Diabetics Virtually

    June 10th, 2011 by Cheryl Miller

    Forget Angry Birds. There’s a new app on the market, and it’s promising to be a lot better for your health.

    Sensei, Inc., a technology company that designs mobile health, or mHealth solutions, has been awarded a National Institute of Health (NIH) grant for diabetes and prediabetes research in association with the University of Miami, the Miami VA healthcare System, and the Health Foundation of South Florida. Together, they will trial Sensei’s new mobile application for diabetes and prediabetes users.

    The application encourages simple lifestyle changes through personalized expert guidance. Users’ mobile devices are transformed into virtual health coaches that personally guide them to better health through healthier nutrition, fitness, weight loss and tips on self management.

    Research shows that modest lifestyle changes, including losing weight and increasing activity, can improve or delay the onset of diabetes in almost 50 percent of cases, according to the Diabetes Prevention Program. Participants in this trial will be prompted to measure key biometric data, eat healthier, and learn and practice appropriate self management of diabetes, hypertension and hyperlipidemia. There will be daily health coach alerts that teach and create calls to action supplemented by a daily agenda and reference information around the different conditions and wellness.

    Mobile Health, or mHealth, the utilization of mobile devices to improve health outcomes, is emerging as an important technology not only for developed countries but for developing countries as well. According to a survey conducted by the World Health Organization (WHO), more than 80 percent of countries across the globe are using mobile phone technology in different ways to improve their health services. In fact, only 19 of the 114 studied countries have no mobile health initiative, although many of the initiatives in place are at the pilot stage. The most popular mHealth programs globally are mobile technology call centers, emergency services management, including toll-free telephone services, telemedicine services like text messaging with pill reminders and health information and transmission of tests and lab results, and managing emergencies and disasters. The survey goes on to state that many of these countries’ citizens have no other means of access to health care.

    If this technology can be so beneficial for some of the poorest countries in the world, it isn’t hard to see how beneficial it can be for some of the richest countries in the world. And if users, like the diabetes and prediabetes patients being trialed with Sensei’s app, devote only a fraction of the time, passion and commitment to these kinds of health apps that others do to apps like Angry Birds, then they are sure to be an important resource for healthcare.

    Posted in Avoidable ER Use, Behavioral Health, Case Management, Consumer-Driven Healthcare, Disease Management, Health Coaching, Health IT, Healthcare Trends, Telehealth & Telemedicine, Uncategorized, Wellness/Prevention, e-Health | No Comments »

    Get Smokers to Quit in Four Months

    March 4th, 2011 by Jessica Papay

    Have payment and shipping bans for online cigarette purchases decreased traffic to cigarette-selling Web sites? Find out in this week’s issue of the DM Update, along with the kind of smoking cessation messages that get smokers to quit in four months.

    Also this week, learn how incentives can improve health outcomes and change end-of-life behavior, and take our second annual Health & Wellness Incentives Use e-survey.

    Posted in Behavioral Health, Disease Management, Health Coaching, Wellness/Prevention, e-Health | No Comments »

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