February 1, 2010
Vol. II, No. 19
New CMS Demos Test Medical Home for Dually Eligible, Multi-Payor Health Information Exchange
CMS has launched two new demonstrations — a community-wide health information exchange in Indiana and a consortium of community care physician networks in North Carolina — to improve the delivery of quality care to an estimated 130,000 beneficiaries in those states. Both demos allow the organizations to share in a portion of Medicare savings achieved once quality of care and cost objectives are met.
The Indiana Health Information Exchange (IHIE) demo is the first large-scale Medicare study to examine the impact of a multi-payor, quality reporting and improvement, and pay-for-performance (PFP) program. Medicare data will be used by the IHIE along with outside clinical and administrative data to provide participating physicians with better information on the patients they are treating and to use common quality measures to create incentives to improve the quality and cost of care for patients covered by private insurers, employer-sponsored group health plans, Medicare and Medicaid. IHIE’s program will test whether quality improvement and PFP initiatives are more effective in a multi-payor environment.
The North Carolina Community Care Networks (NC-CCN) demo will extend the medical home concept to the dually eligible — low-income beneficiaries eligible for both Medicaid and Medicare. Consisting of eight regional healthcare networks in several North Carolina counties, the NC-CCN combines community-based care coordination and health IT to support more effective care management for a population whose care can sometimes be fragmented.
The demos are part of the national five-year Medicare Health Care Quality (MHCQ) demo mandated by Congress in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). The Indiana and North Carolina demos will make more effective use of best practice guidelines, encouraging shared decision-making between providers and patients, and altering incentives for care delivery.
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Chronically ill older adults closely supported by a nurse-physician primary care team are twice as likely to rate their healthcare as high-quality than those who receive usual care, according to a study by researchers at the Johns Hopkins Bloomberg School of Public Health. The study found that after 18 months of a randomized controlled trial, Guided Care recipients rated their primary care significantly higher than usual care recipients with regard to coordination with specialists, support for self-management, and help with setting goals, making decisions and solving health-related problems.
Guided Care is a model of proactive, comprehensive healthcare provided by physician-nurse teams for patients with several chronic health conditions — a type of “medical home” for this rapidly growing population.
Guided Care patients were also 70 percent more likely to rate the time they had to wait for an appointment when sick as “excellent” or “good,” and 50 percent more likely to rate the ability to get phone advice as “excellent” or “good,” according to the study. The multi-site trial of Guided Care included 49 physicians, 904 older patients and 308 family members in eight locations in the Baltimore-Washington, D.C. area.
This model is designed to improve complex patients’ quality of life and quality of care while improving efficiency of treatment. The care teams include a registered nurse, two to five primary care physicians, and other members of the office staff who work together for the benefit of each patient. Following a comprehensive assessment and planning process, the Guided Care nurse educates and empowers patients and families, monitors their conditions monthly, and coordinates the efforts of healthcare professionals, hospitals and community agencies.
Previously published data suggested that, compared to usual care patients, Guided Care patients tended to spend less time in hospitals and skilled nursing facilities and had fewer ER visits and home health episodes, producing an annual net savings for healthcare insurers (after accounting for the costs of Guided Care) of $1,365 (11 percent) per patient, or $75,000 per nurse.
Source: Johns Hopkins Bloomberg School of Public Health, January 19, 2010
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The use of economic incentives to drive engagement and results from wellness and prevention programs continues to proliferate, both as a response to escalating healthcare costs and a shift of more health ownership to consumers. Please share how your organization uses incentives to promote health and wellness by completing HIN's second annual Survey of the Month on this topic by February 28, 2010. You'll receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.
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Healthcare Trends Update: Patient Education and Engagement in 2009
How prevalent are patient and member education programs, and which health areas are addressed by these efforts? How are healthcare organizations delivering health education, and who is the primary health educator? What is the chief impact of patient education programs, and how do organizations measure ROI from patient education efforts? The Healthcare Intelligence Network set out to answer these questions and others during its 2009 Patient Education and Outreach Benchmarks e-survey. This executive summary of responses from 134 healthcare organizations offers lessons in the value of educating patients and members about disease management and self-care.
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