Archive for the ‘Patient-Centered Medical Home’ Category

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Health Insurers Must Provide “Plain English” Summaries of Benefits, Coverage

February 13th, 2012 by Cheryl Miller

Transparency and clarity are the objectives in HHS’s “Plain English” ruling on health plan benefits and coverage. Under the rule, health insurers must provide consumers with simple, understandable summaries about their plans. Roughly 150 million Americans have private health insurance today, and should benefit from the ruling. More on this in our feature story.

Transparency is also a key objective in CMS’s new data for its Hospital Compare Web site consumers can now access hospital infection rates at the more than 4700 hospitals listed. According to the CMS, hospital-acquired infections result in thousands of deaths each year and nearly $700 million in added costs to the U.S. healthcare system.

Healthcare costs are key to a recent study from Virginia Commonwealth University, which finds that the managed care medical home for the uninsured will help curb costs and reduce ER visits for the uninsured. The study, which focused on nearly 27,000 uninsured adults over a seven-year period, found that when they had access to regular healthcare their ED visits and inpatient admissions declined, while their primary care visits increased. Researchers concluded that savings in healthcare costs were cut by nearly half.

And lastly, costs are also key to a recent Rand Corporation study on declining prescription drug costs. While costs on brand name drugs have decreased because of increased purchases of generic drugs, drug costs in general remain a hardship for many American families.

Posted in Accountable Care Organizations, Avoidable ER Use, Behavioral Health, Patient-Centered Medical Home, Prescription Drugs, Reducing Readmissions | No Comments »

Q&A: Lessons on Physician Payment Reform from CDPHP

February 9th, 2012 by Patricia Donovan

CDPHP’s medical home project aims to reform not only the practice of primary care in its network but also the payment to its physicians. We recently spoke with CDPHP’s Dr. Bruce Nash, senior VP of medical affairs and CMO, about motivating physicians for practice and payment reform, positioning for accountable care organizations, and replacing current productivity-only models.

HIN: Are the primary care physicians (PCP) becoming involved in practice reform because they know it is the right direction for healthcare or because of the mandates and the additional funding opportunities?

Response: (Dr. Bruce Nash) In our marketplace, our physicians are doing it because they view it as the only hope for primary care, not only for medical students who chose it as a career. The practice of primary care for many of them has become a drudgery in this hamster wheel of trying to see more and more patients faster and faster. The compensation simply doesn’t support them. We have a great deal of enthusiasm among our physicians.

One of the younger physicians came to me about halfway through the project and said she wanted to thank me. She had stopped taking medical students to precept them some years before because she didn’t know what she should tell them about why to go into primary care medicine. Now her hope is rejuvenated and she has resumed that activity.

HIN: In multi-specialty groups, how do you incorporate the PCMH and quality payments for PCPs into a current productivity-only base formula with specialists?

Response: (Dr. Bruce Nash) One of the real challenges you get with payment models, and one of the undoings of capitation in the ‘90’s, was that, although a global payment would be paid out within a large multi-specialty group, that global payment would be divided up by productivity measures. You never dealt with the overall driving factor of that. It would be important to maintain a form of global budgeting for the overall group.

Whether it is this model or something similar, the PCPs are operating under this, and it is a salary equivalent. A capitation is a fixed amount of money for one person. A salary is a fixed amount of money for a panel of patients. Allowing the physician and charging the physician with the responsibility of managing the patients effectively within that doesn’t mean face-to-face visits on a repeated basis. It means looking at it and saying, “What is the highest quality, most cost-effective approach for the care of that population?”

HIN: How is CDPHP positioning for ACOs?

Response: (Dr. Bruce Nash) The ACOs are conceptually entirely aligned with everything I’ve spoken about. We are discussing the word ‘accountable’ for a population of patients being paid on a global basis. The challenges are numerous, whereas on the West coast, there are delivery systems that are fairly well configured to function as the ACO. However, it is less common throughout most of the country.

We have circumstances where hospitals are taking the lead in trying to develop ACOs, sometimes by buying up physician practices for as much as they did in the ‘90s, although for a different purpose. However, it is unclear how the hospital sector can lead that initiative given that is where the bulk of the savings need to come from to change the reimbursement incentives. We are in an active dialogue because of who we are, our close ties with the physician community and our physicians. In our markets, large would be 85 to 150 physician groups. If they want to enter into the ACO model as being put forward for FFS Medicare, they don’t have the infrastructure to manage it in the way it needs to be managed, because that is what the health plan does. We view ourselves as a Medicare Advantage Plan and an ACO with our providers.

We are having dialogue with our physicians and talking about how the health plan can partner with them to make them successful. Not only for our members, but for all their members.

Posted in Accountable Care Organizations, Affordable Care Act, Patient-Centered Medical Home, Physician Practices | No Comments »

3 Ways Proposed CMS Rule Could Cut Costs, Increase Transparency in Medicaid Prescription Drug Pricing

February 6th, 2012 by Cheryl Miller

In an attempt to pare down the nearly $16 billion Medicaid spent on prescription drugs in 2009, CMS is proposing three cost-cutting measures, one of which includes increasing rebates paid by drug manufacturers that participate in Medicaid. All of the measures are intended to increase transparency for states and taxpayers as well. The comment period for the proposed rule will close on April 2nd. CMS plans to issue a final rule in 2013.

Cutting healthcare costs is the NQF’s goal also; they are targeting diabetes, CV disease and primary care costs with four new resource use measures which have been approved for endorsement. This is the NQF’s first effort at endorsing measures that evaluate how resources are used in care delivery.

Aetna has launched a national PCMH program that will reward primary care physicians on a quarterly basis for selected care coordinated tasks, as long as the PCPs meet eligibility requirements. Connecticut and New Jersey are the first states to host this program. Aetna is the latest private payor to revamp the medical home funding model; you can read more about the others in our featured blog in this issue.

Hospitals are doing something right: according to the latest study from Press Ganey hospitals’ overall patient satisfaction scores have improved since July 2011, when the value-based purchasing period began. The new VBP criteria will affect hospitals’ performance-based Medicare payments.

P.S. By the time this newsletter publishes Monday, let’s hope the Giants did something right Sunday night and won the Super Bowl. Go Giants!

Posted in Accountable Care Organizations, Affordable Care Act, Disease Management, Patient-Centered Medical Home, Prescription Drugs | No Comments »

New Payor Medical Homes Put More Dollars in Physician Pockets

February 3rd, 2012 by Patricia Donovan

Revamped medical home programs from private payors offer participating physicians a range of financial incentives, including payment for some non-visit tasks like the preparation of care plans.

The enhanced earning opportunities are aimed at doctors who more actively coordinate and manage their patients’ care across the healthcare continuum.

In one new medical home funding model, eligible doctors can earn 30 percent to 50 percent than they do today.

Bolstered by improved health outcomes from pilot programs, expanded medical home offerings from Aetna, WellPoint, and others offer high-performing physicians the chance to earn additional revenue.

For example, primary care physicians (PCPs) in Aetna’s newly launched patient-centered medical home program earn a quarterly coordination of care payment for each commercial (non-Medicare) Aetna member in their care. The quarterly payment rewards PCPs who participate in Aetna’s networks, who have been recognized by the NCQA as a PCMH, and who are not participating in other quality incentive programs with Aetna.

The NCQA’s multi-tiered medical home recognition program acknowledges practices for providing a number of services, chiefly those that improve patients’ access to care and that foster a climate of prevention and proactive healthcare.

“Patient-centered care is something Aetna has always advocated. Our PCMH program rewards PCPs who focus on the patient’s entire health needs, not just a single condition,” said Elizabeth Curran, head of National Network Strategy and Program Development for Aetna in a press release on Aetna’s Web site. “As a result, members may experience better health, fewer hospitalizations, improvements in transitions of care, and greater engagement. The PCMH program is one more way we are moving from a system that rewards the quantity of procedures to a system that rewards quality outcomes.”

Aetna’s national medical home program will begin in Connecticut and New Jersey.

And buoyed by significant drops in ER and hospital utilization resulting from its medical home pilots, WellPoint last month launched a new patient-centered primary care program that amps up revenue opportunities for participating PCPs, enhances information sharing, and provides care management support from WellPoint clinical staff.

The new program from nation’s second largest insurer represents an investment in primary care of $1 billion or more, according to a January 27, 2012 article in the Wall Street Journal.

Over time, WellPoint estimates the program will substantially improve quality and member health, potentially reducing trend in overall medical costs by as much as 20 percent by 2015.

“Our medical home pilots have proven to make a meaningful difference in patient quality, outcomes and cost,” said Dr. Harlan Levine, WellPoint executive vice president, Comprehensive Health Solutions, in a WellPoint press release. Some of our pilots have experienced an 18 percent decrease in acute inpatient admissions and a 15 percent decrease in total ER visits while improving compliance with evidence-based treatment and preventative care guidelines,” said Levine, who is responsible for leading the company’s payment innovation strategies.

There are three ways WellPoint physicians can earn additional revenue:

  • General increase to the regular fees paid to physician practices for specific services.
  • Payment for “non-visit” services currently not reimbursed, with an initial focus on compensation for preparing care plans for patients with multiple and complex conditions.
  • Shared saving payments for quality outcomes and reduced medical costs.

To participate in WellPoint’s shared savings, practices must meet plan quality requirements, which include quality standards established by organizations such as the NCQA, the American Diabetes Association, the American Academy of Pediatrics and others. Primary care physicians who maintain or improve quality may earn 30 percent to 50 percent more than they earn today through the shared savings model.

The amped-up provider incentives come on the heels of a report from the Congressional Budget Office (CBO) that most disease management and care coordination programs have not reduced Medicare spending:

The disease management and care coordination demonstrations examined by the CBO comprised 34 programs that used nurses as care managers to educate Medicare beneficiaries about their chronic illnesses, encourage them to follow self-care regimens, monitor their health, and track whether they received recommended tests and treatments. Programs could earn fees to cover the costs of the interventions.

All of the programs sought to reduce hospital admissions by maintaining or improving beneficiaries’ health, and because hospitalizations are expensive, that reduction was expected to be the key mechanism for reducing Medicare spending. The CBO found that:

  • On average, the 34 programs had little or no effect on hospital admissions. There was considerable variation in the estimated effects among programs, however.
  • In nearly every program, spending was either unchanged or increased relative to the spending that would have occurred in the absence of the program, when the fees paid to the participating organizations were considered.
  • Programs in which care managers had substantial direct interaction with physicians and significant in-person interaction with patients were more likely to reduce Medicare spending than other programs. But, on average, even those programs did not achieve enough savings to offset their fees.

Posted in Healthcare Administration, Healthcare Costs, Patient-Centered Medical Home, Physician Practices | No Comments »

EHR No Substitute for Population View Provided by Registries

January 31st, 2012 by Patricia Donovan

The proliferation of EHRs is driving the format and functionality of patient registries today, according to new market research from the Healthcare Intelligence Network.

However, healthcare experts note that EHRs are no substitute for a registry.

“Registry functionality is not always the same as an EMR,” cautions Julie Schilz, manager, IPIP and PCMH for the Colorado Clinical Guidelines Collaborative. “Registry functionality is the ability to understand your patient population and their needs, whether they are being managed against evidence-based guidelines, being able to support outreach to patients who might be falling outside of the guidelines and understand per provider how their patients are being managed against evidence-based guidelines.”

The registry is used in a positive way for quality improvement, Schilz notes, not as a stick to suggest that providers and their care team are not managing effectively.

“The registry is utilized to help manage the patient population and understand how, in using the measures as a proxy, the systems that the practices put into place are having the desired impact on patient population for both health and healthcare delivery,” she concludes.

While more than two thirds of 2008 survey respondents favored freestanding database-centered registries, the trend in 2012 is toward registries as a component of an EHR, as reported by one-third of 2011 respondents, or Web-based registries, used by another 29 percent of this year’s respondents.

Registry use has remained constant at about 50 percent since HIN last surveyed the healthcare industry on this topic in 2008.

This year’s analysis also found that registries are used more than three times as often today to generate health alerts and reminders for appointments and preventive services. Only a quarter of 2008 respondents were using registries in this proactive manner. Whether as simple as an Excel® spreadsheet or a module in an EHR, healthcare organizations have warmed to the patient-tracking features and the population-eye view that registries deliver.

“To move primary care forward, you want the care team to begin preparation for visits well in advance of the patient arriving,” adds Michael Erikson, vice president of primary care services for Group Health Cooperative, an organization touted by CMS for its advanced and comprehensive primary care services. “With our EMR, which has registry-like functions within it, we know the care gaps of the patients who are coming for a visit; we see all their HEDIS measures. The team begins, one to three days before visits occur, to look for any of those care gaps, so that when a patient arrives for a visit, not only are we responding to their acute need, but we are also responding comprehensively to address any care gaps, whether that be a chronic illness, a preventive need or an acute need.”

Posted in Accountable Care Organizations, Affordable Care Act, Customer Service, Healthcare Costs, Patient-Centered Medical Home | 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: How Aetna Redefines Case Management for Medicare Population

January 12th, 2012 by Jessica Papay

The purpose of case management is care completion, states Dr. Randall Krakauer, Aetna’s Medicare medical director. Prior to his presentation on Demonstrating the Value of the Embedded Case Manager for the Medicare Population, Dr Krakauer discussed in detail the purpose of case management, the act of combining the capabilities of the physician and the health plan to create something new, and the enhanced patient experience that results from the medical home partnership between Aetna and Emory Healthcare.

HIN: What is the purpose of case management?

(Dr. Randall Krakauer): The purpose of case management is to assist members in the management of their own health. Case managers provide advice and assistance to make sure that patients understand what they need to do and that their questions are answered to engage their own risk factors and manage them better. Case managers help members to engage their own chronic conditions and to manage them more properly, and to better navigate the healthcare system to their own benefit.

HIN: What is care management at the provider level?

(Dr. Randall Krakauer): Better care management would involve the provision of additional resources at the provider level. This includes data (which may not be available to a provider) and longitudinal contact. Providers generally assume and accept responsibility for management of their own patients’ illnesses. They don’t always have all the data, however, and they sometimes don’t have the outreach for longitudinal follow-up case ability. For example, they don’t always know what other physicians are doing. They don’t always know what other medications are being prescribed. Patients get lost in follow-up. Patients don’t always follow instructions or fill their own prescriptions. They leave a physician’s office and don’t necessarily understand the instructions as well as they should. The purpose of case management is care completion. When a physician sees a patient in the hospital and writes a set of orders, he has a very high level of confidence that this will all get done. That’s not the case with outpatients seen in the office. The purpose of case management is to improve the ability to manage the cases in that milieu.

HIN: How can the capabilities and skill sets of the health plan be combined with those of the provider to create something greater than the sum of its parts?

(Dr. Randall Krakauer): The health plans generally engage in case management and disease management for a population that they identify through their own means or algorithms. They try to coordinate and collaborate with physicians’ offices to whatever extent is possible, frequently by telephone. Physicians are likewise trying to manage their own patients and this includes incoming calls and occasionally outgoing calls, plus other types of contact. They each have information and data that the other may lack. The physician has knowledge of the case, the family and the milieu that the health plan lacks. The health plan has claims information, its own process and transaction data for the individual case, and also global information on outcomes for the provider’s patients in general. We also have an expertise in longitudinal case management and the ability to provide people who will, with experience, outreach to members in between office visits.

Combining the capabilities of the physician and the health plan can create something greater than the sum of its parts; that is, the physicians can identify cases better that could be in need of case management. Physicians, in collaborating with case managers, can give case managers instructions on types of follow-ups that are necessary. Case managers can provide physicians with information, transactions, etc. For example, “This patient left your office. What has happened that you should know about that requires your attention?” Or, “Your heart failure patient has put on a kilogram and a half of weight in one week.” “This prescription was not filled.” It is this interchange, exchange and collaboration that has the potential for creating something that is better.

HIN: Aetna recently announced a partnership with Emory Healthcare and a patient-centered primary care program that will use embedded case managers. You were quoted as saying that this medical home partnership would improve the patient experience. Can you describe how this will happen?

(Dr. Randall Krakauer): In collaborating with the Emory physicians and their staff, we will be able to keep in contact with our members, and/or their patients, when they leave the office to answer questions, to follow up on health issues, to follow up on prevention issues, to follow up on management issues, to bring issues that arise to the attention of the physicians, etc. Once again, we cannot create the milieu of an inpatient patient experience for someone who has gone home. We can try to improve the completion factor, the ability to complete the care that is ordered and provide feedback and information on the results of this care.

Posted in Case Management, Disease Management, Healthcare Administration, Healthcare Trends, Patient-Centered Medical Home, Physician Practices, Transitions in Care | No Comments »

Two Medical Home Approaches Behind $1 Billion in N.C. Medicaid Savings

January 9th, 2012 by Patricia Donovan

Aggressive care management and preventive care saved North Carolina Medicaid nearly $1 billion over four years, according to a new analysis by Milliman Inc., a national healthcare consulting firm.

This latest report of savings in the Tar Heel State from patient-centered medical homes (PCMH) links the cost reductions to reduced hospital admissions, readmissions and emergency room visits, many of which are avoided when patient care is managed more efficiently.

The savings update was announced in a press release this week by the office of the state’s office governor, Bev. Perdue.

To provide medical homes, the state continues to partner with the Community Care of North Carolina (CCNC), a nonprofit group of local healthcare provider networks that provide and coordinate care for Medicaid recipients. The 14 regional CCNC networks since 1998 have pooled their resources for technological and administrative purposes, which not only saves operational costs but also provides opportunities for cooperation and collaboration throughout the networks.

With financial support from The Commonwealth Fund, CCNC has created a 16-module toolkit on constructing a medical home approach for vulnerable and high-cost populations.

The modules span everything from program development and rollout to IT support and informatics to establishing a network pharmacist program. There are also modules dedicated to a pregnancy medical home, integration of behavioral health and other populations.

CCNC has also created a workbook and resources for organizations pursuing recognition as a patient-centered medical home.

The Milliman report found that the key to the success of medical homes approach is a strong emphasis on preventative care, and aggressive care management. Although the cost of frequent office visits and treatment of newly diagnosed conditions adds to program costs initially, the reduction of emergency room visits and hospital admissions, as well as capturing of efficiencies and improving quality of care, results in significant savings and better health for the recipient.

The report by the San Diego-based accounting firm examined the impact of the state’s support for primary care medical homes – a system to coordinate healthcare for Medicaid recipients. Milliman’s report, which was required by the General Assembly, found that recipients with a medical home get better care and consumed fewer Medicaid resources than those who lack a medical home. From fiscal year 2007-2010, N.C. Medicaid avoided spending $984 million by having 1.1 million of its members enrolled into medical homes. In just the last two fiscal years of the study – 2009 and 2010 – $677 million was saved.

As N.C. Medicaid enrolled higher numbers of its members into a CCNC medical home, Milliman found annual savings increased—$103 million in fiscal year 2007 (July 1, 2006-June 30, 2007); $204 million in FY 2008; $295 million in FY 2009; and $382 million in FY 2010.

Milliman also reported that N.C. Medicaid is on a successful path to decrease cost by enrolling aged, blind or disabled (ABD) members into a medical home. Those Medicaid populations are generally the least healthy overall and costliest to treat. Enrollment into medical homes initially would add to the cost of caring for them but pays off in the long term. Indeed, Milliman found that in FY 2006, medical home enrollment of ABD populations cost the state an additional $82 million. But by FY 2010, enrollment of ABD Medicaid recipients into medical homes had paid off with the state avoiding $53 million in costs.

Posted in Accountable Care Organizations, Avoidable ER Use, Case Management, Disease Management, Healthcare Costs, Patient-Centered Medical Home | No Comments »

3 Key Influencers in Improving Medication Adherence

January 4th, 2012 by Patricia Donovan

The big three players in programs to improve medication adherence are the primary care doctor, the pharmacist and the case manager, according to 2011 market research by the Healthcare Intelligence Network. The pharmacist is also being recruited in a big way to assist with these programs, both at the health plan and primary practice levels, according to 162 healthcare organizations that took the survey. Often it is the pharmacist in the patient’s local drugstore that is making the primary contact, frequently with the help of motivational interviewing, and the patients like this.

“The patient feedback is our secret weapon, because it does provide the patients with the opportunity to be able to say, ‘I felt I was heard and understood, my needs were met,’ explains Dr. Janice Pringle of the University of Pittsburgh School of Pharmacy. The university is a collaborator in a pilot that teaches retail pharmacists the principles of motivational interviewing, which they in turn use to screen customers for adherence issues. Other pilot participants are Rite Aid and CECity. “It’s not satisfaction,” she stresses. “A lot of people call it that. Satisfaction is more of a passive, evaluation of the process, where feedback is actually saying how they felt that their needs were met.

The University of Pittsburgh pilot participants are evaluating some of the interim results, she notes. “As a researcher, I’m very, very careful. However, I can say that there is an indication that there are statistically significant changes in adherence for the participating [pharmacy] sites. This will be borne out by our more thorough evaluation in mid-2012. We’ll be comparing not only changes over time amongst the intervention pharmacies, but also comparing to a group of pharmacies that we consider control pharmacies for the same time period and the same metrics.”

Pharmacist motivation and satisfaction with the effort is high, as well. Dr. Pringle shares a comment from one of the pharmacists in the pilot: “We have to do this project. All of us have been trained to work with patients and we have not been able to do that. This is the chance we’ve been looking for to have more contact with our patients and to make a difference in their lives.”

The prevalence of programs to monitor and improve medication adherence has remained steady from 2010 to 2011; this year’s survey identified just a slight uptick in adherence-related interventions. While the big five chronic conditions — ischemic heart disease, diabetes, COPD, asthma and heart failure — are still primary targets for these programs, there is also a move toward targeting individuals with dementia, stroke and osteoporosis.

The value of case managers in improving medication adherence levels is underscored by health plan respondents: 56 percent have given primary responsibility for these programs to case managers. Several future programs will embed case managers in physician practices for this purpose and/or step up case management of patients with chronic illness.

Posted in Case Management, Hospital Readmissions, Medication Management, Patient-Centered Medical Home, Reducing Readmissions, Uncategorized | No Comments »

5 Key Trends for Physicians in 2012

December 12th, 2011 by Cheryl Miller

More than half of today’s physicians believe that healthcare reform will not improve patient care, according to a new trends report from the Physicians Foundation. The changing healthcare landscape is also pushing the majority of physicians to leave primary care practices for hospitals and group practices. These and other trends detailed in this issue.

Children with special healthcare needs are less likely to receive care that meets the criteria for having a medical home, according to a new national report from the Health Resources and Services Administration (HRSA), the first such report on this segment of the population and its counterparts: children without special needs. These children are also being exposed to less than ideal conditions at home; secondhand smoke and poor nutrition are just two situations cited in the report, which based their data on a national survey of more than 90,000 children in the United States.

Depression and diabetes can trigger dementia within three to five years of diagnosis, say researchers from the University of Washington and Kaiser Permanente. Contributors to the study, among the first and largest to date to examine dementia in diabetes patients with and without depression, hope these findings will ultimately slow the advent of dementia.

The CMS has issued a final rule that will give qualified organizations access to health claims data that can help them identify high quality healthcare providers, or create online tools to help consumers make educated healthcare choices. The final rule makes a number of important changes from the original proposed rule, one of them being that data is less costly than previously thought for qualified entities.

And we wanted to make you aware of our new complimentary e-book on the use of embedded case managers in healthcare, a trend embraced by Geisinger, Aetna, CDPHP, Advocate Physician Partners, Marshfield Clinic, Bon Secours and others. This downloadable e-book provides some early metrics on the emerging trend of placing case managers alongside care teams in physician practices and describes some of the benefits that can result.

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

Posted in Accountable Care Organizations, Affordable Care Act, Avoidable ER Use, Behavioral Health, Healthcare Trends, Patient-Centered Medical Home | No Comments »

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