Medical Home Monitor
Medical Home Monitor
January 17, 2011
Vol. III, No. 18

Medical Home Monitor Archives

In This Issue:

  1. Q&A: ER Discharge, Provider Partnerships
  2. 3 Ways to Manage Medication
  3. New Chart: 7 Critical Care Transitions
  4. Podcast: Physician-Owned ACOs
  5. Reducing Patient Wait Times
  6. E-Survey: Healthcare Case Management
  7. Benchmarks: Tobacco Cessation in 2010
  8. Editor's Pick

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Medical Home Q&A's:
ER Discharge ,
Provider Partnerships

Medical Home Monitor

ER Pre-Discharge Questions

Q: What interview questions are asked by nurses of patients prior to discharge from the ER?
A: Various models like the Coleman Care Transitions model talk about the gaps in care: Do you understand your condition? Do you have access to a PCP? Do you understand your medications? Some of the best engagement results have been with members that we interviewed in the hospital before discharge. The questions that we ask when we do the outreach calls to members with ER visits are a bit different: Why did you use the ER? What were the determining factors that made you use the ER? Do you have access to a PCP or an urgent care center? Are there any barriers for you to get to your PCP? Some of the questions overlap, but some might be more specific to ER utilization versus hospital utilization.

The most important intervention that we are trying to effect for a member that has a lower acuity admission as opposed to a higher acuity admission is to make sure they have primary care follow-up, ideally within seven days. That is the single most important intervention or behavior that we are trying to effect in the member.

Karen Amstutz, M.D., M.B.A.,is vice president and medical director of Medicaid and Senior Markets and Barsam Kasravi, M.D., M.P.H., is managing medical director for state-sponsored programs for WellPoint.

For more interventions to reduce avoidable ER use, please visit:

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Primary Care-Specialist Collaborations

Q: What are some successful collaborations between primary care physicians and specialists?

A: We are working with the support of the eHealth Initiative (eHI) on a project where a nurse care coordinator employed by the IPA is working at one of our private practices, and also working with a large cardiology group in our region on specific areas of care coordination. Developing a mutually agreeable care plan summary that summarizes both goals and laboratory, and other information that should flow back and forth, tries to at least define in some way who is going to do what. We are in the early stages, and we are working with our cardiology group to get feedback from the tool. The desire is to eventually have these flow electronically, and right now we’re doing the intellectual work on paper. It’s posing some interesting challenges because there are some areas of overlap for responsibility where cooperation is easier than others, but we are making good progress.

Paul Kaye, M.D., is medical director at Taconic IPA.

For more information on medical home reimbursement, please visit:

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Pharmacy Medical Home Could Improve Medication Management
A centralized pharmacy home — similar to the concept of a medical home — where a patient's pharmacy care is evaluated and renewals and refills are better synchronized and managed, may help individuals with chronic illness better manage their medications, suggest researchers from Harvard Medical School, Brigham and Women's Hospital and CVS Caremark.

The centralized pharmacy home could also provide financial incentives for patients to fill prescriptions at a single pharmacy, so that a single healthcare professional has a full view of the patient's needs and care, the researchers suggest.

Likely to benefit are patients with chronic heart disease, who usually have multiple doctors and take nearly a dozen medications that are filled in at least two different pharmacies. This results in many patients struggling to keep their medications straight, according to the new study published in January's Archives of Internal Medicine.

Other solutions proposed by the researchers include the following:

  • Encouraging 90-day prescriptions versus 30-day prescriptions and coordination through mail order pharmacies to reduce complexity of both filling and taking medications and streamlining the number of trips it takes to fill prescriptions.
  • Experimenting with programs and technologies that may make it easier for patients to better organize their medications.
The recommendations are based on a review of pharmacy claims from the CVS Caremark pharmacy benefit management (PBM) book of business for 1.83 million patients taking statins, and 1.48 million patients taking ACE inhibitors or ARBs between June 1, 2006 and May 30, 2007. The researchers selected these medicines for review because they are the most widely sold medications for the treatment of cardiovascular disease, which is the condition that imposes the greatest clinical and economic burden in the U.S. and abroad.

During a three-month period, patients filled prescriptions for an average of 11 medications representing an average of six different drug classes, the researchers said. "More striking, during this 90-day time frame, 10 percent of these patients filled prescriptions for 23 or more medications . . . and 11 or more different drug classes, had prescriptions written by four or more prescribers, filled these prescriptions at two pharmacies and made 11 or more visits to those pharmacies," they said.

For more information, please visit:

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New Chart: 7 Critical Care Transitions
Tighter management of transitions in care can help to close care gaps, avoid unnecessary hospitalizations, readmissions and ER visits, reduce medication errors and raise the bar on care quality. We wanted to see which care transitions are being addressed by healthcare organizations.

View the chart at:

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HealthSounds Podcast: Legal, Regulatory and Compliance Challenges of Physician-Owned ACOs
Even though the specifics of Medicare's Shared Savings Program have yet to be defined, physician organizations can still position themselves to achieve cost savings through an independent accountable care organization (ACO), notes attorney Jeffrey R. Ruggiero, a partner in the law firm of Arnold & Porter LLP, who is advising the Queens County Medical Society on the launch of one of New York State's largest physician ACOs. Ruggiero describes the advantages of a physician-run ACO as well as some of the regulatory, compliance and operational factors to consider prior to ACO launch.

To listen to this HIN podcast, please visit:

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Advanced or Open Access Scheduling Dramatically Reduces Patient Wait Times

Use of advanced or open access scheduling dramatically reduced patient wait times for physician appointments, according to the Connecticut 2009 Primary Care Survey. Advanced or open access scheduling refers to the practice of reserving regular appointment times daily in a physician’s schedule to accommodate patients with acute needs. Physicians reported wait times were 35 percent shorter for patients in offices using open access scheduling. This translates to average wait times of 9.9 days rather than 15.3 days for patients in need of medical care.

The findings were part of the Connecticut State Medical Society's second and final report from the Connecticut 2009 Primary Care Survey, which examined the adoption of the medical home model of care in physician offices throughout the state. The research, published in the current issue of the peer-reviewed journal Connecticut Medicine, indicates that while some elements of the patient-centered, coordinated-care model are found in a majority of family medicine, internal medicine and pediatric practices, the adoption of the entire medical home model is in its infancy in Connecticut.

The report also found that costs related to electronic medical record (EMR) implementation and reimbursement levels for care coordination tasks are hindering medical home adoption in the state.

“Small practices have a harder time implementing the medical home. Some elements, like EMRs, come down to dollars and cents. The capital outlay can be as high as $15,000 to $20,000 per physician and today there are few guarantees that the system you choose will be able to talk to the rest of the other systems, much less be in business next year,” said report co-author and CSMS Executive Vice President Matthew C. Katz. “Health insurers don’t pay physicians for the additional staff work and coordination required by the medical home model, and some of their other practices actually discourage it.”

The findings related to medical home adoption are not too surprising in the context of how medical care is delivered in Connecticut,” said David S. Katz, MD, CSMS president. “The majority of physicians in our state are in small or solo practices; and the kind of coordinated care that is the hallmark of the medical home approach can require more administrative support than these practices can provide.”

The Connecticut findings regarding medical home adoption were in keeping with the national picture, where primary care practices that meet the definition of medical home remain very limited.

The research was conducted in partnership with the Connecticut chapters of the American Academy of Pediatrics, the American Academy of Family Physicians and the American College of Physicians. It was funded by a grant from the Universal Health Care Foundation of Connecticut.

For more information, please visit:

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HIN Survey of the Month: Healthcare Case Management in 2011
Targeted case management interventions across the health continuum are resulting in more efficient and appropriate care delivery and utilization of healthcare resources. Complete HIN's second annual Survey of the Month on Healthcare Case Management by January 31, 2011 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

Complete the survey by visiting:

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Tobacco Cessation Efforts in 2010
How are 84 healthcare organizations working to curb and prevent smoking in their populations, and what are the results of their efforts? This white paper summarizes results of the Healthcare Intelligence Network’s second annual Tobacco Cessaton & Prevention e-survey conducted in November 2010, including program availability, program components, ROI and reimbursement trends

To download this complimentary white paper, please visit:

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EDITOR'S PICK: Save 10% on This Week's Medical Home Resource

2011 Healthcare Benchmarks Yearbook

The 425-page 2011 Healthcare Benchmarks Yearbook: Metrics, Measurements and Innovations delivers more than 23,000 data points from 1,000 healthcare organizations in an easy-to-use binder format or Instant PDF download. This second annual yearbook contains more than 400 graphs and tables documenting adoption, activity and ROI in nine key healthcare areas, frequently drilling down to the perspectives of hospitals, health plans and employers.

The 2011 Healthcare Benchmarks Yearbook includes comprehensive data on the following activities:

  • Healthcare Trends for 2011*
  • Healthcare Case Management
  • Medication Adherence
  • Care Transitions Management*
  • Health Risk Assessment & Stratification
  • Reducing Avoidable ER Use
  • Health & Wellness Incentives*
  • Patient-Centered Medical Home*
  • Telehealth & Telemedicine* *Includes comparative 2009-over-2010 performance metrics.

    Use ordering code MHMP to save 10 percent on this special report by visiting:

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