Medical Home Monitor
Medical Home Monitor
December 6, 2010
Vol. III, No. 15

Medical Home Monitor Archives

In This Issue:

  1. Q&A: Lean Healthcare, ACO Payments
  2. HIV/AIDS Medical Home
  3. New Chart: Depression Screening Tools
  4. Podcast: Nurse Advice Line
  5. Payor-Provider Commercial ACO
  6. E-Survey: Reducing Readmissions
  7. Benchmarks: Telehealth in 2010
  8. Editor's Pick

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Medical Home Q&A's:
Lean-ing Healthcare, ACO Payment Models

Medical Home Monitor

Lean-ing Healthcare

Q: Beyond length of stay and frequency, in what areas can health plans and providers look to reduce costs and create a lean organization?
A: Traditional operational areas are still ripe to be leaned. On the payor side, the claims, medical management and provider management functions still offer significant opportunities to identify where specific tests can be automated, where they can be virtualized via cloud-enabled processes as service entities or just outsourced. We’re experiencing increased demand for outsourced virtualized services that will ultimately improve efficiency but reduce operational costs.

William Shea, partner, health industry consulting, Cognizant Business Consulting.

For more healthcare trends for 2011, please visit:

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ACO Payment Models

Q: What payment modeling supports sustainable infrastructure for an accountable care organization (ACO)?

A: Part of the Dean System is a rural network that is paid fee-for-service (FFS), so they are not at risk and they are not capitated. We are piloting a performance model to reward the physicians on top of their production income — that is, additional income for quality, service and efficiency. I predict that future physician reimbursement is going to be a balanced scorecard of measures. It is not just going to be the volume of care. It is going to be an array of things. For example, we are looking at paying our rural physicians based upon a mock NCQA accreditation of their practice. We do random chart reviews on their patients as if we were NCQA-accrediting all of them — how are they doing, diabetes performance, post-MI beta-blocker — all of the things for which a medical group or health plan would be credentialed for by NCQA.

We have looked at rewarding patient satisfaction scores and gain-sharing. When we can suppress medical cost trend because we are practicing more efficiently, we can then gainshare with physicians who have helped achieve favorable medical cost trends.

Craig Samitt, M.D., M.B.A., president and CEO of Dean Health System.

For more basics on accountable care organizations, please visit:

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Study to Test Medical Home Model for Patients with HIV/AIDS
Over the next three years, five California provider organizations will study how the patient-centered medical home (PCMH) model might improve the quality of care and reduce costs for individuals with HIV/AIDS. The PCMH project is the first in the United States to focus on the HIV/AIDS population, and is funded by $6.4 million in grants from the California HIV/AIDS Research Program (CHRP) of the University of California.

The grantees will test a number of strategies through their PCMH models, including:

  • Improving health outcomes by establishing electronic information exchange within multidisciplinary care teams and among providers of specialty and support services.
  • Using innovative encounters (telephone, texting, and e-visits) to improve communication between patients and providers.
  • Testing new models of integrated HIV and aging care services to address the complex needs of persons 50 years and older living with HIV.
  • Creating a Web-based portal to give home health nurses mobile access to EHRs while working with homebound patients in the field.
  • Piloting a new messaging portal for local HIV testing sites to alert the HIV clinic when a new HIV-positive client has been identified and referred to the agency.
  • Piloting a computerized pharmacy electronic interface that allows the clinic to ascertain when a prescription has not been filled.
Collectively, these five organizations provide medical and social services for more than 8 percent of Californians reported to be living with HIV/AIDS. The percentages among African Americans, Latinos and women are 9.8, 9.9 and 11.7 percent, respectively. In addition, CHRP estimates that over 25 percent of people in California with HIV/AIDS age 50 and over are served by these five organizations.

The Obama administration has identified the PCMH as a key element in the 2010 National HIV/AIDS Strategy for the United States.

For more information and the list of grantees, please visit:

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New Chart: Top Depression Screening Tools
Patients with major depression are three times more likely to disregard treatment recommendations. We wanted to find out which screening tools were used most often by 261 healthcare organizations to identify individuals suffering from depression.

View the chart at:

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HealthSounds Podcast: Maximizing the Nurse Advice Line To Ensure Appropriate Healthcare Utilization
More than a third of healthcare organizations have launched nurse advice lines to reduce avoidable ER use and direct patients to the most appropriate care venue, according to a July 2010 survey by the Healthcare Intelligence Network. The staffing and operation of Optima Health's nurse advice line is influenced by many factors, explains Patricia Curtis, director of operations, clinical care services for Optima Health. Curtis describes the distinct responsibilities of the LPNs and RNs who staff the advice line as well as the diverse needs of the member populations who call the advice line.

To listen to this HIN podcast, please visit:

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Norton Healthcare, Humana Piloting Region's First Commercial ACO

Humana Inc. and Norton Healthcare, both based in Louisville, Ky., have launched the region’s first commercial Accountable Care Organization (ACO), a model endorsed by healthcare reform that establishes incentives for health systems to increase quality and efficiency, better coordinate patient care, eliminate waste and reduce the overuse and misuse of care.

The newly launched Norton-Humana ACO pilot has identified several initial areas of emphasis, such as improvements in the use of preventive screenings and tests (such as mammograms) and vaccinations, better coordination in management of chronic illnesses such as heart failure, more effective treatment of common problems like back pain, appropriate utilization of generic drugs to lower costs, and improved access to the appropriate level of care (such as primary care rather than emergency department treatment).

The Norton-Humana partnership, which began in early 2010, is one of five pilot sites selected by the Engelberg Center for Health Care Reform at the Brookings Institution and The Dartmouth Institute for Health Policy and Clinical Practice to implement the ACO model through the Brookings-Dartmouth ACO Pilot Project.

The Brookings-Dartmouth team is working closely with Humana and Norton Healthcare to support implementation of the ACO model. Each ACO site defines the patient population it serves and establishes a spending target that reflects the predicted costs for their patients. The goals of ACOs are to improve efficiency and effectiveness of care and slow spending growth. ACO providers who can demonstrate that they meet these goals will receive a portion of the savings achieved.

The Brookings-Dartmouth team will also evaluate the pilots to see how ACOs can impact the future of payment reform. The goal is to develop a model that can be replicated across the nation, building on health reform legislation which will likely make ACOs a voluntary option with Medicare participation in 2012.

For more information, please visit:

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HIN Survey of the Month: Reducing Hospital Readmissions in 2010
Spurred on by incentives from public and private payors, healthcare organizations are working hard to reduce avoidable rehospitalizations, especially among Medicare patients. Describe your organization's efforts to reduce hospital readmissions by taking HIN's second annual Reducing Hospital Readmissions Benchmark Survey. Respond by December 31 and receive an e-summary of the results once the survey is completed.

Complete the survey by visiting:

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2010 Benchmarks in Telehealth & Telemedicine
This white paper captures the nuts and bolts of telehealth services offered by 111 healthcare organizations who responded to HIN's September 2010 Telehealth and Telemedicine survey, including top technologies, targeted populations and prevalence of remote monitoring.

To download this complimentary white paper, please visit:

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

Healthcare Trends & Forecasts in 2011: Performance Expectations for the Healthcare Industry

In HIN's seventh annual healthcare industry forecast, which has become an essential planning tool for healthcare executives, William Shea, partner, health industry consulting for Cognizant Business Consulting, and Steven T. Valentine, president, The Camden Group, review the industry landscape for the coming year and suggest how healthcare organizations can best position themselves for the 12 months to come.

In the 35-page Healthcare Trends & Forecasts in 2011: Performance Expectations for the Healthcare Industry Shea and Valentine craft a healthcare reform strategy checklist, putting the smart money on models of consolidation and clinical integration that will not only increase throughput and market share for healthcare payors and providers but also reduce unnecessary utilization and thereby costs.

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

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