March 1, 2010
Vol. II, No. 20
Year 1 of MetCare Medical Home:
Utilization Down, Prevention & Compliance Up
Readmissions running 6 percent below Medicare benchmarks, a 3 percent drop in hospital admissions and 4.5 percent decrease in length-of-stay per 1,000 customers as well as 94 percent of diabetic patients in compliance with A1C screening targets are some of the outcomes from the first year of the Metropolitan Health Networks, Inc. (MetCare) Patient-Centered Medical Home (PCMH) pilot program.
MetCare and Humana studied the impact of the PCMH model in a Medicare Advantage capitated group, establishing specific utilization, financial and quality metrics. This group represented Medicare Advantage HMO customers seen by primary care physicians within the same markets under a capitated risk arrangement but in a traditional medical practice model. Baseline measures were determined from medical claims for the period November 1, 2007 to October 31, 2008, and a matched control group was identified and tracked for similar measures. The pilot ran from November 1, 2008 to October 31, 2009.
Additional 12-month financial and quality results included the following:
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Methodist Health System, The Nebraska Medical Center and their affiliated physicians have formed the Accountable Care Alliance, a partnership to reduce costs to patients and to improve quality and efficiency of patient care across the two health systems.
The Accountable Care Alliance will be structured like an accountable care organization (ACO), one of the models being considered by the federal government under healthcare reform as a way to reduce healthcare costs. An ACO is an integrated healthcare delivery system that relies on a network of primary care physicians, specialists and hospitals that are held responsible for the quality and cost of healthcare to a defined patient population.
Patients with chronic conditions (diabetes, congestive heart failure, cystic fibrosis, etc.) and patients who are frequently readmitted to the hospital will especially benefit. The Accountable Care Alliance can help to increase communication between doctors and hospitals, reduce duplication of services, limit unnecessary tests, make sure transitions from hospital to home are better managed, and help patients maintain good health in their homes to reduce hospital utilization.
The Accountable Care Alliance is committed to improving the health of patients long after the doctor’s appointment or hospitalization has concluded. For a diabetes patient, this may mean a daily phone call or text after the patient is discharged from the hospital to make sure the patient is taking her medications and monitoring her blood sugar levels.
Closely monitoring a patient’s care could also include making sure the patient has a complete and accurate list of prescribed medications along with proper instructions as well as booking a follow-up appointment for a patient and making sure that the patient has transportation.
Finally, the Accountable Care Alliance will allow both health systems to share knowledge and performance criteria to ensure both health systems are performing at their best and providing the highest level of quality care. The Accountable Care Alliance will be operated by a 12-member board of directors (six representatives, mostly physicians, from each hospital system).
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Last day! 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. Join the more than 130 organizations that have already described how they use incentives to promote health and wellness by completing HIN's second annual Survey of the Month on this topic by March 1, 2010. You'll receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.
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Healthcare Benchmarks: Telehealth & Telemedicine - Wired for Access and Efficiency
How prevalent is remote monitoring, and which medical conditions are most often monitored? How has telehealth impacted levels of healthcare access, efficiency, cost and patient compliance? The Healthcare Intelligence Network set out to answer these questions and others during its 2009 Telehealth e-survey. This executive summary of responses from 134 healthcare organizations identifies emerging trends in the use of telehealth and telemedicine and offers a glimpse into a healthcare future where no patient is left behind because of a lack of access.
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