Medical Home Monitor
Medical Home Monitor
March 7, 2011
Vol. III, No. 21

Medical Home Monitor Archives

In This Issue:

  1. Q&A: ED Case Managers, Concierge Primary Care
  2. Online Patient Rosters, Records & Risk
  3. New Chart: Case Manager Caseloads
  4. Podcast: Aligning Physician Incentives
  5. 7 ER-PCP Communication Gaps
  6. E-Survey: Health & Wellness Incentives
  7. Benchmarks: Accountable Care Organizations in 2011
  8. Editor's Pick

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Medical Home Q&A's:
ED Case Managers,
Concierge Care

Medical Home Monitor

ED Case Manager Skill Sets

Q: What skill sets are essential for an ED case manager?
A: When I am recruiting for an ED case manager, I am looking for somebody who has worked in an ED. That increases their credibility with the ED physicians in particular, and they understand how EDs operate. They understand the ins and outs of the operations. I have minimum requirements for the case manager, regardless of what unit their work is on. We look for a minimum of five years of clinical experience and relevant clinical experience. My first preference is somebody who has worked in an ED. For the social workers, we love to have masters-prepared social workers in all of our positions. I like to select social workers that have a working knowledge of EDs, have worked in EDs, because they tend to fare a little bit better. You have to have people who like a fast-paced hectic environment. We look for people that are going to enjoy that kind of environment.

Toni Cesta, senior vice president of operational efficiency and capacity management at Lutheran Medical Center.

For more best practices in case management, please visit:

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Membership-Based Primary Care Models

Q: What is your opinion of membership-based models of direct primary care?

A: I assume that terminology means that in some markets, physicians are actually having patients enrolled to them to provide an enhanced level of access.

In essence, I think that this is a concierge practice. It’s a reflection of the marketplace filling a void because of the current flaws in the healthcare delivery system. There’s a need for concierge medicine because the rest of the delivery system isn’t meeting the needs of the public. So physicians are charging membership fees, for example, to allow patients to get enhanced access to the doctor by e-mail. If we move to more of a global model, this willset up the financial alignment to say to the doctor, ‘Listen, it's in your best interest and the patient's best interest to allow access to you in the most efficient/effective way." For some that’s going to be e-mail, for some that’s going to be face to face, and for others this will mean group visits. It needs to be determined individually.

Dr. Bruce Nash, senior vice president of medical affairs and chief Mmedical officer for Capital District Physicians Health Plan Inc.

For more details on clinical integration of physicians, please visit:

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CareFirst Medical Home Portal to Offer Patient Rosters, Records and Risk Rankings to Participating Physicians
A unique online portal in CareFirst BlueCross BlueShield’s (CareFirst) network-wide Primary Care Medical Home (PCMH) program will enable 2,200 providers to more effectively coordinate patient care by providing a complete roster of their CareFirst patients. The portal will provide a health risk ranking for each patient and tools that enable collaboration with other providers around personalized care plans.

The portal will be enhanced later this year when patients’ claims-based health records will be added – allowing providers to get a more complete picture of their patient’s health status.

The CareFirst PCMH increases payments to primary care providers (PCPs) who provide comprehensive care coordination to help patients with chronic illnesses better manage their diseases and improve their overall health.

Initial provider participation in the CareFirst PCMH represents nearly 40 percent of the more than 5,000 primary care providers in CareFirst networks. Further recruitment efforts are expected to bring in many more physicians before the end of 2011, notes Chet Burrell, CareFirst president and CEO. "This program is the largest of its type in the nation. We believe that by compensating physicians for placing an increased emphasis on helping their sickest patients, particularly those with multiple chronic diseases or at greatest risk for these diseases, measurable improvements in care quality and cost savings can be achieved.”

Physicians participating in CareFirst’s PCMH program must form panels of five to 15 PCPs. Panels can be formed by existing practices, and smaller practices can participate by combining to form virtual medical panels – ensuring that primary care practices of any size can join the program. Among other things, the panels are intended to help assure backup and coverage and enhanced member access to primary care services. To date, 184 medical panels have been formed including 99 virtual medical panels. PCMH is voluntary, and physicians are not required to purchase electronic health record systems or hire additional staff to participate.

For more information, please visit:

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New Chart: Case Manager Monthly Caseloads
Healthcare case managers are playing a larger role in the coordination of all phases of patient care — from management of the chronically ill in primary care to monitoring hospitalized patients to overseeing care of residents in long-term care facilities. We wanted to identify the average monthly case load of a case manager.

View the chart at:

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HealthSounds Podcast: Aligning Physician Incentives for Shared Risk and Reward
Money may talk, but after 14 years of administering pay for performance (PFP) programs for its providers and specialists, HealthPartners has figured out what motivates physicians even more than financial incentives. Babette Apland, HealthPartners senior vice president of health and care management, shares this insight, as well as the measures by which HealthPartners evaluates pharmacies and specialists in its PFP program.

To listen to this HIN podcast, please visit:

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7 Communication Gaps Between Emergency Rooms and Primary Care

Haphazard communication, poor coordination between emergency room and primary care physicians and insufficient time and reimbursement can undermine effective care, according to a new study by the Center for Studying Health System Change (HSC).

Researchers conducted 42 telephone interviews between April and October 2010 with 21 pairs of ED and primary care physicians. Emergency department and primary care physicians were case-matched to hospitals so the perspectives of both specialties working with the same hospital could be represented.

The study identified seven areas where ER-PCP communication could be improved:

  • Real-time communication: Communicating via telephone was particularly time-consuming. Both ER and primary care physicians reported successful completion of each telephone call often required multiple pages and lengthy waits for callbacks.
  • Asynchronous communication: Asynchronous modes of communication, such as faxes, did not require breaks in task but had significant limitations as well. Faxed records can be reviewed at providers’ convenience but do not provide an opportunity to converse in real time and ask questions. Physicians had little confidence that faxes were carefully reviewed by their intended recipient and often reported that faxed records were poorly organized and difficult to decipher.
  • Shared electronic medical records (EMRs): Sharing information through a fully interoperable EMR can address some barriers. However, while EMRs are valuable tools for billing and liability documentation, they are not yet designed to offer a rapid overview of a patient’s case that is relevant to a particular problem with the level of detail that could help an emergency provider direct care.
  • Lack of time and reimbursement: Emergency and primary care physicians most commonly cited insufficient time and lack of reimbursement as significant barriers to communication. While care coordination activities might seem straightforward and quick, providers noted that each small action multiplied across dozens of patients can become a daunting burden, with little immediate reward.
  • Limited role of cross-covering providers: The rise of larger groups and more elaborate cross-coverage systems means that ER physicians are less likely to speak with a physician who has direct knowledge of the patient. Respondents agreed that time invested in care coordination through a cross-covering PCP yielded much less value because cross-covering physicians rarely knew the patient and were less likely to offer data that would change an ER physician’s plan of care.
  • Changing interpersonal relationships: While rising hospitalist use and the growth of larger primary care groups help PCPs decrease their call responsibilities and maintain a more balanced lifestyle, they inevitably decrease interactions between office-based and hospital-based physicians. Many ER physicians reported that they had no venues for ongoing collaboration with PCPs in their community.
  • Risk and malpractice liability concerns: Liability concerns may keep providers from participating fully in care coordination. Many respondents noted that ER and primary care physicians are bound by different constraints and have fundamentally different assumptions regarding patients’ reliability and resilience.

The study was conducted for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR). Findings are detailed in a new NIHCR Research Brief that is available online at .

For more information, please visit:

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HIN Survey of the Month: Third Annual Health Incentives Survey
Healthcare companies have grown increasingly creative in their use of incentives to drive engagement and participation in health and wellness programs. Please share your experiences with incentives by completing HIN's third annual survey on this topic by March 31, 2011. You'll receive a free executive summary of the compiled results, and your responses will be kept strictly confidential.

Complete the survey by visiting:

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Accountable Care Organizations in 2011
A significant segment of the healthcare industry is reframing its care delivery structure as an accountable care organization (ACO) or will do so in the near future, according to new market research by the Healthcare Intelligence Network. This white paper summarizes awareness of and readiness for ACOs at 228 healthcare organizations, based on their responses to a February 2011 ACO Readiness Assessment. This research was conducted before CMS released its proposed rule governing ACOs.

To download this complimentary white paper, please visit:

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

Home Visit Handbook: Structure, Assessments and Protocols for Medically Complex Patients

This resource delivers actionable data from 228 healthcare companies that responded to HIN's February 2011 ACO readiness assessment. The result? A comprehensive snapshot of ACO awareness, participation, administration, targeted populations, payment models and much more from healthcare companies already immersed in the ACO architecture.

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

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Editor: Patricia Donovan,;
Publisher: Melanie Matthews,;

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