Medical Home Monitor
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November 2, 2009
Vol. II, No. 13

Medical Home Monitor Archives


Medical Home Q&A's:

ACO's Effect on Quality, Salaries;
Patient Self-Management Tips

Medical Home Monitor

ACO's Effect on
Quality, Provider Salaries

Q: What impact has Dean Health System's accountable care organization (ACO) had on quality outcomes and payments to providers?

A: We have actually seen our quality performance progressively rise. In the Wisconsin Collaborative for Healthcare Quality, where all major institutions compare their quality performance through a common measurement methodology of 18 measures, Dean has progressively moved up the ranking. We attribute this to a lot of things, but much of it has to do with technology. Achieving quality performance improvement has a great deal to do with just prompting staff and physicians about the types of preventive measures that are needed. Physician compensation continues to rise at Dean Health System, and our philosophy is that we want our physicians to be paid at market. Delivering on our vision of better care at a lower cost has enabled us to share the efficiencies that we can capture with our doctors in the form of added pay. (Dr. Craig Samitt, president and CEO of Dean Health System)

For more on Dean's ACO experience and other medical home funding solutions, please visit:
http://store.hin.com/product.asp?itemid=3952



Best Practices for
Patient Self-Management


Q: What are some best practices and tools that medical home physicians can implement to help patients better manage their wellness and chronic diseases?

A: We have several approaches to enhance our patients' capabilities. For those with chronic illnesses, we offer shared appointments, during which a practitioner, a health coach and often a nurse meet with eight to 10 individuals. This provides education and support in a group setting to help patients develop individual plans for their disease management.

We also give report cards to certain patients, such as those with diabetes, following their visit. The report cards rate where they stand on established goals, such as hemoglobin H1C level or completion of an annual retinopathy eye exam. Also, for wellness support, we use health risk assessments to interact with our well individuals and try to enhance their health maintenance activities. (Dr. James Kerby, vice president of medical affairs for Grand Valley Health Plan)

For more advice on achieving NCQA recognition for the patient-centered medical home (PCMH), please visit:
http://store.hin.com/product.asp?itemid=3953


CMS Shelves Plans for Medicare Medical Home Demo in Favor of Multi-Payor Pilots

Citing pending legislation that would repeal its planned Medicare Medical Home demo and replace it with a similar pilot, CMS last week said it would not pursue clearance of the demo from its Office of Management and Budget. Instead, CMS said it will move forward with a demo announced in September by the HHS in which Medicare would partner with existing multi-payor medical home pilots to improve the delivery of care. That Multi-Payor Advanced Primary Care Practice Demonstration will be launched in 2010.

CMS was referring to the pending House Bill 3200, which contains a provision to repeal the CMS demo and replace it with an independent practitioner-based medical home pilot described further in the bill. In addition, the House bill includes a second medical home pilot to evaluate community-based medical home models.

For more details, please visit:
http://www.cms.hhs.gov/

HealthSounds Podcast: New Staffing Models and Roles for the Care Team

New primary care staffing models and increased use of telehealth are improving the connections of Group Health Cooperative patients with their caregivers, says Michael Erikson, Group Health's vice president of primary care services. In this podcast, Erikson discusses Group Health's staff expansion and the many benefits of contacting patients via phone and e-mail.

To listen to this HIN podcast, please visit:
http://www.hin.com/podcasts...


New Report Estimates Cost of 'Medical Homeness'

With the exception of health IT costs, a Commonwealth Fund analysis of cost estimates for the medical home model did not find evidence of additional costs associated with higher levels of "medical homeness." The new analysis uses data from 35 practices to analyze the relationship, if any, between costs and medical home activities.

Based on data from the 35 practices in the final analysis sample, researchers found no evidence of additional costs associated with higher levels of medical home activity; estimates suggested that there was less than a $1-per-month difference in patient costs between the third of study practices with the highest PPC®-PCMH™ scores (NCQA rating that measures medical home intensity) and those in the middle and lower thirds. The average total cost per full-time-equivalent (FTE) physician was $517,000 for all 35 practices. Although the mean total cost per FTE physician increased slightly across the three score categories, the low and high means were within one standard error of one another, meaning that the differences were not statistically significant. Support staff costs exhibited a similar pattern.

The report noted that IT costs show a modest but statistically significant increase with medical home intensity and acknowledged that the general lack of an association between costs and medical home intensity may be due to limitations of the data or to the definition of medical home.

The cost data came from the Medical Group Management Association (MGMA) Cost Survey and the American College of Physicians (ACP) Practice Management Check-up Tool for 2006; the medical home data were from NCQA’s PPC-PCMH recognition tool.

For more on the study, please visit:
http://www.commonwealthfund.org...

HIN Survey of the Month: Reducing Hospital Readmissions

Primary care plays a pivotal role in the reduction of hospital readmissions, especially for older patients with chronic conditions. The posting of hospital readmission rates for Medicare patients with heart attack, heart failure and pneumonia on the CMS Hospital Compare site and the tying of these rates to reimbursement are making healthcare organizations work harder to keep patients from returning to the hospital. Describe your strategies by taking the HIN 2009 Hospital Readmissions Benchmark Survey and receive an e-summary of the results once the survey is completed.

Complete the survey by visiting
http://www.surveymonkey.com/...

Healthcare Trends Update: 2009 Telehealth & Telemedicine Benchmarks

While rising healthcare costs fuel much of the healthcare reform debate, many health organizations have tuned in to telehealth to deliver care more efficiently while expanding access to services — especially for patients in rural areas. Download this complimentary summary of the 2009 Telehealth & Telemedicine Benchmarks e-survey, which identifies emerging trends and metrics in telehealth use and its effect on care delivery, healthcare access and healthcare spend through an analysis of responses from 139 healthcare organizations.

To download this complimentary white paper, please visit:
http://www.hin.com/library/registertandt.html

Effective Case Management in the Medical Home — Save 10% on Registration

The role of the case manager in the healthcare system has been steadily increasing as the need to manage healthcare expenditures and utilization grows. Whether by phone, in the home, in the ER, on the medical home team or at the time of discharge, case managers are charged with helping patients gain access to needed medical, social, educational and other services for chronic conditions.

During Effective Case Management in the Medical Home, two regional managers of case management for health services at Geisinger Health Plan will examine the key components of an effective case management program — from the background of the case manager to their responsibilities and training. They will share strategies for training case managers, managing case loads, case management tools, techniques, principles and practices and case management stratification.

Use ordering code MHMP to reserve your specially priced participation in this webinar by visiting:
http://store.hin.com/product.asp?itemid=3917




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Publisher: Melanie Matthews, mmatthews@hin.com;

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