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Organ Donation and 5 More Reasons Healthcare Should Follow Consumers to Social Media

May 1st, 2012 by Patricia Donovan

Now that Facebook users can post their organ donor status as easily as photos of last night’s dinner, it might be time for healthcare to “like” social media a little more.

Starting today, Facebook users can indicate in their timeline that they’re an organ donor. They can also share stories about their decision to become a donor and register for state and national organ donor registries.

Facebook’s move reflects the increasing integration of social media and health behaviors. Consumers, especially 18- to 24-year-olds, are heavily invested in social media use for health-related matters — for education, provider and treatment reviews, physician interactions, and decision-making, according to new research by the Health Research Institute (HRI) at PricewaterhouseCoopers (PwC).

Healthcare organizations that ignore these trends may miss a chance to engage and do business with these consumers, say authors of the new report, Social media likes healthcare: From marketing to social business.

The report found that social media activity by hospitals, health insurers and pharmaceutical companies is miniscule compared to the activity on community sites such as patientslikeme®, where 146,438 members (today’s count at 1:56 pm EDT) share thoughts on more than 1,000 medical conditions.

For example, the report notes that while eight in 10 healthcare companies (as tracked by HRI during a sample one-week period) had a presence on various social media sites, community sites had 24 times more social media activity than corporate sites.

For the uninitiated, the idea of social media can be intimidating. There are also legitimate concerns related to patient confidentiality and privacy. To this end, the General Medical Council (GMC) has drafted guidance for doctors on managing the risks of using social media Web sites such as Twitter and Facebook to connect with patients. Rule number 1: maintain a professional boundary between doctor and patient.

Still not convinced? If Facebook’s organ donation tool doesn’t motivate, here are five more trends in health-related use of social media identified in the HRI research:

  • One-third of consumers now use social media sites such as Facebook, Twitter, YouTube and online forums for health-related matters, including seeking medical information, tracking and sharing symptoms, and broadcasting how they feel about doctors, drugs, treatments, medical devices and health plans.

  • Four in 10 consumers say they have used social media to find health-related consumer reviews (e.g. of treatments or physicians); one in three have sought information related to other patients’ experiences with their disease; one in four have “posted” about their health experience; and one in five have joined a health forum or community.

  • When asked how information found through social media would affect their health decisions, 45 percent of consumers said it would affect their decision to get a second opinion; 41 percent said it would affect their choice of a specific doctor, hospital or medical facility; 34 percent said it would affect their decision about taking a certain medication; and 32 percent said it would affect their choice of a health insurance plan.

  • While 72 percent of consumers said they would appreciate assistance in scheduling doctor appointments through social media channels, nearly half said they would expect a response within a few hours.

  • Young adults are leading the social media healthcare charge. More than 80 percent of individuals between the ages of 18 and 24 said they were likely to share health information through social media channels and nearly 90 percent said they would trust information they found there. By comparison, less than half (45 percent) of individuals between the ages of 45 and 64 said they were likely to share health information via social media.

Posted in Disease Management, Healthcare Trends, Wellness/Prevention, e-Health | No Comments »

Q&A: Non-Compliance Drives Need for Telephonic Case Management

April 23rd, 2012 by Jessica Papay

Though it emerges in different ways, non-compliance with care plans drives telephonic case management protocols for three distinct populations at Carolina Behavioral Health Alliance (CBHA), explains Jay Hale, its director of quality improvement and clinical operations.

Prior to his presentation on Telephonic Case Management: Protocols for Behavioral Healthcare Patients, Hale defines the distinct groups of behavioral health patients, indicators of non-compliance for each, barriers faced by telephonic case managers, the involvement of PCPs and red flags signaling the need of an in-person visit.

HIN: What is the number one reason behind high levels of inpatient or ER use by the behavioral health population?

(Jay Hale): When we look at the behavioral health population, we’re looking at three different groups of individuals, but with one reason driving all of their care. The three groups are adult mental health, adults with substance abuse issues and children/adolescents, which is generally mental health but can be substance abuse as well. The number one condition that we see is non-compliance with treatment. This comes out in various ways with our mental health population. It comes out as having suicidal thoughts or homicidal thoughts, or other impulsive or dangerous actions that would cause someone to be referred to the ER.

With our substance abuse population, we often see people who stop going to meetings, and/or who stop working with their sponsor and return to the behaviors that they were doing when they were drinking or using, which leads them back to drinking or using. Many of the relapse behaviors lead to using.

Our child/adolescent population is usually a little more complex. Because they don’t have the same control over their environment that adults do, many times they will act out more in either school or home, and that acting out escalates to a point where they’re referred to an ER.

Ultimately, it all comes back to failing to follow through with treatment for various reasons. Many times we begin to get some treatment early on and we get past the crisis, but it’s hard for people to accept that they have a chronic ongoing illness that needs ongoing treatment. Once they start to feel better, they stop or cut back on treatment, but then things begin to deteriorate for them and they don’t catch it until it’s at a crisis point where they’re back in the ER.

HIN: What barriers may a telephonic case manager encounter when contacting someone with a mental health issue? What advice do you give the case managers on establishing rapport during these calls?

(Jay Hale): One big barrier that we see is making sure that we have the member’s correct phone numbers. We want to make sure that we have updated information so that we’re calling the correct people. Another barrier is having the member on the other end trust us enough to accept our help, or accept our support, in their care.

I advise our case managers to work with other people who are working with the member early on. We want to work with the hospital earlier before the person is discharged to get correct contact information and to let the member know that we’re going to be contacting them. We want to be part of that discharge plan and operation, and we want our case management program to be part of that plan as well — a plan that shows that the patient is going to the psychiatrist, or a therapist, and that they’re going to be followed up by us telephonically.

When one of our case managers calls a member to invite them to be part of our program, we want to talk to the member about how the program helps them. We want to emphasize how this is helping them in their recovery for either a mental illness or for a substance abuse episode. With substance abuse individuals, we want to make sure that we are using the language that they are comfortable with in early recovery — language where we’re making sure we’re supporting their recovery program, they’re working their steps, they’re following through with their meetings, etc. We are letting them know that we understand their situation and that we’re supportive of them in their recovery. With mental health individuals, we want to make sure that they feel comfortable with us, that we are understanding their situation, and that we are not here to do counseling. Rather, we are here to support them in their recovery and to help them see the improvements that they’re seeing as they follow through with treatment.

With our child/adolescent population, we’re usually working with the parents. Many parents are appreciative of the support that we can give them as they try to help their child or adolescent do better in school, do better at home and have a more successful life early on. We’re about letting the parent know that we’re not here to blame anyone for any situation that the child is in, but rather, we’re there to support them in having a healthier family and a healthier child.

HIN: How involved is the individual’s primary care provider or any other providers in this process?

(Jay Hale): The member’s providers are a very important part of our program. We want to make sure that the member is going to their sessions, is seeing their psychiatrist or therapist, is going to meetings, etc. We reach out early to those behavioral health providers to let them know the member is involved in the program, that we are not there to be between their relationship — we’re an adjunct to support that ongoing relationship — and to let them know we solicit their support in this service so that the member understands that we’re all working toward one goal. And that one goal is improvement of the member’s care and helping them be and live successfully outside of a hospital environment. One of the things we’re looking at in care management, or case management, is making sure that they’re attending sessions. Behavioral health providers often like to hear that the insurance company is encouraging people to go to sessions rather than limiting sessions. We usually get a lot of support from our providers for what we’re doing.

HIN: You defined three very different groups. What are some indications or red flags that might arise during a call with a behavioral health client that could mean an in-person visit with a provider is warranted?

(Jay Hale): One of the things we’re looking for is changes in symptoms. Those changes in symptoms, or changes in habits, could be asking the individual at each call about their depression; any type of mania that they may be experiencing, if there’s a history of such. We’re asking about any other psychiatric symptoms that they’re having and asking the member to rate them. Then, we look at our information to see how much of a change that is from the last time we spoke.

If we start to hear about any kind of deterioration, we explore those issues further to see how serious it is — if it’s something that is temporary or something that is more ongoing. We’re also going to be looking for other factors, such as medication compliance. Is the person still following through with their medication? Did they have any difficulty with it? If they have, have they let their provider know they’re having difficulty with those medications? If we start to hear any kind of decompensation when we’re concerned about someone’s safety, or we’re concerned that someone is starting to slide back and return to the more unhealthy behaviors that they had in the beginning, we will make a phone call to that provider to see if we can get an appointment set up for that member to be seen quickly. This way, they can be assessed and changes in treatment can be arranged. Or it could be getting the member back into treatment again if they’ve fallen back or stopped going.

With our substance abuse individuals, often we’re looking for frequency of going to AA meetings, frequency of contact with their sponsor or any kind of irritability, especially over going to meetings. Many times individuals will start to talk about how the meetings are not helping them. We want to help them problem-solve around other things that could help them more and encourage them to start going back to those meetings or start working with that sponsor. If that’s not working, we may help them get in contact with an outpatient therapist who specializes in substance abuse issues to help see if there are other mental health concerns that are driving some of these relapse behaviors.

Posted in Avoidable ER Use, Behavioral Health, Case Management, Health IT, Healthcare Administration, Healthcare Trends, Medication Management, Telehealth & Telemedicine, e-Health | No Comments »

Can Reality Programming Help to Prevent Diabetes? Stay Tuned

March 15th, 2012 by Patricia Donovan

Think “The Real Patients with Diabetes:” a reality series follows six patients with Type 2 diabetes.

While it may not draw the legions of viewers of a “Real Housewives” franchise, UnitedHealth Group hopes this type of programming can impact a more dire reality: the number of individuals who will develop type 2 diabetes.

To pilot the power of television as a diabetes prevention medium, the Minnesota-based payor and Comcast are seeking viewers in the Knoxville, TN area to watch the 16-episode NOT ME ® video on demand (VOD) programming. NOT ME uses a reality TV format to follows six adults with prediabetes as they go through the Diabetes Prevention Program.

Each VOD episode will feature a health and wellness coach leading a class of real participants who are working to reach a healthier weight and reduce their risk of developing type 2 diabetes. Between each episode, participants in the UnitedHealth Group study will practice at home the skills they learn from the program.

Participants in the pilot also will be given tracking assignments each week and opportunities to put what they learn into action.

NOT ME is based on the CDC-led National Diabetes Prevention Program, which brings evidence-based lifestyle interventions to communities by working through organizations that adhere to CDC-recognized, evidence-based standards.

Meanwhile, new market research by the Healthcare Intelligence Network indicates that successful diabetes management necessitates a delicate balance of primary care, patient education, case management and medication monitoring.

The 80-some healthcare organizations that responded to the 2011 e-survey report that while the primary care physician is still the primary influencer in diabetes care, case managers and certified diabetes educators (CDEs) increasingly round out the care team.

Also supporting the plan of care are health coaches (live and via telephone) and support groups.

Respondents’ efforts appear to be working: one-fifth of respondents report program ROI of between 2:1 and 3:1.

Since the goal of any diabetes management program is to guide the patient toward successful self-management of the disease, education is paramount. Many respondents reported the presence of case managers and/or nurses who have trained as CDEs. One respondent even offers patients a choice between a pharmacist, a registered dietician or a CDE.

Printed materials were overwhelmingly the most common educational component, reported by 78 percent of respondents. Thirty-five percent offer Web-based education tools.

With all of the challenges facing patients with diabetes, should patients be incentivized for successful self-management of their disease? Three-quarters of survey respondents say yes.

In fact, almost a third of respondents — 30.4 percent — already offer patients and health plan members incentives for compliance with their plans of care.

Posted in Case Management, Disease Management, Healthcare Trends, News, Telehealth & Telemedicine, e-Health | No Comments »

Hospitals Will Spend More on IT, Move Toward ACOs in Near Future

March 14th, 2012 by Jessica Papay

Hospital budgets are on the upswing but cost pressures and changing healthcare models are dictating how hospital leaders are determining their strategic priorities. Sixty-one percent of U.S. hospital executives expect budget increases in 2012, a trend that is expected to continue during the next five years, according to an L.E.K. Consulting Strategic Hospital Priorities Study.

Information technology (IT) is a top area for investment, with 57 percent of hospitals planning to increase their IT spending in this area through 2016, according to the study. During the same time period, one-third of executives are planning to increase spending for large medical devices after several years of delaying medical technology equipment purchases due to financial constraints. Other spending increases during the next five years include facilities (35 percent) and small medical devices (18 percent). Hospital leaders are also willing to pay a premium for disposable products that prevent infections and reduce medical errors — and they expect a 23 percent spending rise in this category.

Most respondents (89 percent) reported increased budgetary pressures during the past year. As a result, 80 percent of hospital administrators continued their aggressive supplier negotiations to better manage costs. Despite their best efforts, there is a concern that rising costs from manufacturers and suppliers, and added costs associated with new regulatory requirements, may raise overall supply costs.

To make the most of their budgets, the study found that 62 percent of hospital executives plan to increase their current Group Purchasing Organization (GPO) use in 2012, up from 52 percent last year. Hospital GPO use is expanding beyond low-cost, high-volume supplies and is increasingly used to purchase higher-priced medical equipment. And smaller hospitals anticipate using GPOs more than larger hospitals because larger hospitals can use their size to negotiate volume discounts with many of their suppliers.

Additionally, many hospital executives are centralizing purchasing to make the most of their buying power, which illustrates a departure from individual physicians taking the lead in procuring key medical products. The development of accountable care organizations (ACO) is also likely to push more centralized purchasing. Currently, less than 20 percent of respondents are pursuing some form of an ACO-like model today. However, 61 percent said they are likely to move toward this model within the next three years.

Other study findings show that a majority of hospital executives (71 percent) are allocating budgets to address operational priorities such as controlling costs, increasing efficiency and improving the profitability of their patient mix. Respondents reported that they are looking for medical device companies to help them address new healthcare insurance reform care and reporting mandates by clearly articulating product cost-benefit value propositions, providing clinical data, sharing risk and offering full solutions.

Posted in Accountable Care Organizations, Affordable Care Act, Health IT, Healthcare Administration, Healthcare Costs, Healthcare Trends, Physician Practices, e-Health | No Comments »

6 Features of CMS’s Redesigned Medicare Summary Notice

March 12th, 2012 by Cheryl Miller

In light of ongoing healthcare reform there is a push for clarity, as several of our stories illustrate this week. Medicare claims forms have been redesigned so that beneficiaries and their caregivers can better understand them, check for important facts and potential fraud. The subject of fraud is particularly timely given the story that has been circulating for the last week involving the arrest of a physician, the office manager of his medical practice, and five owners of home health agencies. They’ve been charged with allegedly participating in a nearly $375 million healthcare fraud scheme involving fraudulent claims for home health services.

When given the option of choosing a high or low cost health plan, consumers will most likely choose the higher cost plan because they associate it with better quality, says a new study funded by the AHRQ. But researchers caution that this isn’t necessarily true: higher costs could be attributed to unnecessary services or inefficiencies. A push is underway to simplify public physician and hospital report cards, and make them clearer for consumers to understand (not unlike the redesigned Medicare claim forms) so consumers can make better informed decisions about their health coverage.

The Robert Wood Johnson Foundation and Group Health Research Institute have launched a new national project intended to shed light on what makes a successful health practice tick. Designed in response to the burgeoning shortage of primary care practices, the project will identify successful practices that improve patient and practice outcomes, and share the information so they can be replicated.

And lastly, a study debunks the long held belief that HIT will improve cost savings by reducing the need for diagnostic testing; instead, the study shows that having computerized access to EHRs in the ambulatory setting could result in a 40 to 70 percent increase in testing.

Don’t forget to take our latest survey: Physician Reimbursement Models. Describe the physician reimbursement models in place at your organization by April 15th and you will receive a free summary of survey results once it is compiled.

These stories and more in this week’s Healthcare Business Weekly Update.

Posted in Affordable Care Act, Avoidable ER Use, Behavioral Health, Consumer-Driven Healthcare, Health IT, Uncategorized, e-Health | No Comments »

CMS to Release Stage 2 Meaningful Use proposals

February 27th, 2012 by Cheryl Miller

CMS and the Office of the National Coordinator for Health IT have just announced proposed regulations for Stage 2 Meaningful Use and Medicare and Medicaid EHR Incentive Programs.

Incorporating recommendations from the Health IT Policy Committee, they stress the need for hospitals and physicians to improve quality and efficiency through HIT. The rules focus on increasing the electronic capturing of health information in a structured format, and increasing the exchange of clinically relevant information between providers of care at so-called “care transitions.”

At this time of writing, some of the new Stage 2 recommendations will include the following: the percentage of orders entered via computerized physician order entry (CPOE) will rise from 30 percent to 60 percent and include medications, labs and radiology; E-prescribing in the emergency department will increase from 40 percent to 60 percent; and recording objectives, such as problem lists, vitals and smoking status will increase from 50 percent to 80 percent.

The proposed Stage 2 regulations will keep some Stage 1 criteria unchanged, revise others, and include new requirements. Once published in the Federal Register, there will be a 60 day comment period; these regulations are expected to be released this summer.

In related news, the use of HIT by hospitals and physicians has more than doubled in the last two years and CMS reports that nearly 2,000 hospitals and more than 41,000 doctors have received $3.1 billion in incentive payments for ensuring meaningful use of health IT, particularly certified EHRs. EHR incentive payments can total as much as $44,000 under the Medicare EHR Incentive Program and $63,750 under the Medicaid EHR Incentive Program.

Want to know the secrets to launching a successful ACO pilot program? Thomson Reuters has published a report showing four key metrics that can predict success; the first metric is the number of attributed members. The others are detailed in this issue.

And unfortunately, there is no secret formula to reducing avoidable hospitalizations; according to a new study from Delta Health Technologies, which was based on data from more than 1,000 homecare agencies across the U.S., while most agencies are taking steps to reduce avoidable hospitalizations, with patient care a strong concern, there was no one magic formula for success in this area. But there were a number of findings on successful hospitalization reduction strategies.

And don’t forget to participate in our latest e-survey: our third annual Healthcare Case Management survey. Participants receive a free, downloadable executive summary of the results once compiled.

Posted in Accountable Care Organizations, Avoidable ER Use, Case Management, Health IT, Healthcare Costs, Uncategorized, e-Health | No Comments »

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 »

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