Slowing Cost Growth, Employer Medical Home Trends
Medical Home Monitor
Medical Home Monitor
April 4, 2011
Vol. III, No. 23

Medical Home Monitor Archives

In This Issue:

  1. Q&A: SNF in ACO, Care Manager Trends
  2. CDPHP PCMH Slows Cost Growth
  3. New Chart: Co-Located Case Managers
  4. Podcast: Hospital-to-SNF Transitions
  5. Employers & Medical Home
  6. E-Survey: Fifth Annual Medical Homes Survey
  7. Benchmarks: Healthcare Trends for 2011
  8. Editor's Pick

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Medical Home Q&A's:
Embedded Care Managers

Medical Home Monitor

Long-Term Care's Role in ACO

Q: How do skilled nursing facilities (SNFs), home health agencies and hospice fit into an ACO?
A: Policy-makers see opportunity in transitions in care, in better coordination of care between settings and better management of people with chronic illnesses. If I were advising a hospital that wanted to set up an ACO with its physicians, I would suggest that they involve their SNFs, home health agencies and hospices to drive the clinical care process in a more effective and efficient way. They should be active participants in the ACO; whether or not those organizations share in savings is something that will be negotiated between whoever is initiating the ACO and those organizations.

John Harris, principal, DGA Partners.

For more benchmarks in accountable care organizations, please visit:

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Care Manager Trends

Q: Where are CareOregon's care management teams located?

A: The teams are at the health plan and are not embedded in the primary care practice. They are aligned with the primary care practices in the sense that they’re the case management team’s assignments, based on having a list of certain primary care practices that they connect with and that they are responsible for any patient that is assigned to any of those practices.

We have moved and embedded one of our case managers in a high-risk homeless clinic. We have been doing that pilot for about nine months. We are interested in moving more of our case managers into the primary care setting.

Right now we don’t have any in the ED, but we do have nurses from our utilization management department who are doing benefit administration activities in the hospital. They also help with discharge planning and will refer patients directly to the case management team.

Rebecca Ramsay, BSN, MPH, senior manager of care support and clinical programs at CareOregon.

For more contemporary trends in case management, please visit:

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Medical Home Reimbursement Model Slows Medical Cost Growth, Curbs Utilization
A novel patient-centered medical home pilot designed to increase physicians' annual earnings in return for reforming their practices has significantly slowed medical cost growth for participants, and may help to lure medical residents back to primary care.

The three physician practices involved in the Capital District Physicians' Health Plan (CDPHP®) medical home pilot reduced the rate of overall medical cost increases by 9 percent— a savings of $32 per member per month — as compared to other area physician practices, according to a Verisk Analytics™ independent analysis released by the Albany-based health plan. Data from the first year of the pilot also revealed significant reductions in advanced imaging utilization and ER visits. Total hospital admissions were 24 percent lower than otherwise expected among the population served by the practices participating in the pilot.

The three practices also demonstrated improvements in quality measures — most notably, the proper use of antibiotics and diabetic eye exams.

In September 2010, 21 additional practices began the transformation, bringing the total number of participants to 24 physician practices, approximately 150 local physicians and more than 50,000 CDPHP members. Encouraged by the results and the medical community’s continued interest in the program, CDPHP will begin recruiting for phase III of this initiative, now called the CDPHP Enhanced Primary Care program.

Phase III will include the embedding of CDPHP nurse case managers within the participating practices. These nurses work collaboratively with the practice staff to better facilitate medical, behavioral and pharmaceutical services for patients. This interaction will help CDPHP to realize additional future savings from reduced hospital, ER and imaging services.

Phase III will consist of primary care practices (family practice, internal medicine, and pediatrics) chosen by CDPHP by the end of May. Selected practices will display strong leadership and a stable practice culture and serve a significant number of CDPHP patients. The practice will need to demonstrate commitment to achieving NCQA Level III Medical Home status and enhancing access, as well as an overall willingness by leadership to collaborate with CDPHP. In addition, due to the significance of technology in the medical home model, practices utilizing EMR and e-prescribing are preferred.

For more information, please visit:

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New Chart: Who's Co-Locating Case Managers in Medical Homes?
The medical home care team provides patient-centered, coordinated and high-quality care for its members. A growing number of healthcare companies include case managers in their medical home staff. We wanted to see how many organizations have embedded a case manager in their physician practice.

View the chart at:

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HealthSounds Podcast: Improving Transitions of Care Between Hospital and SNF
Working with a network of 40 skilled nursing facilities to hone the hospital-to-SNF transfer of care has accomplished two goals for Summa Health System: readmissions and lengths of stay for patients released to SNFs have been reduced, and the experience has made hospitals and SNFs more accountable for both the quality and cost of care they provide. Carolyn Holder, manager of transitional care for Summa Health System, describes what had to happen before this critical care transition could improve and why physicians had to rethink their approach to hospital-to-SNF transfers.

To listen to this HIN podcast, please visit:

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More Arizona Employers Embrace Medical Home Program

More than 30 additional employers have opted to participate in UnitedHealthcare and IBM's Arizona-based patient-centered medical home (PCMH) program, which launched in 2009. The Arizona program currently includes seven medical practices and 25 physicians in Phoenix and Tucson, serving hundreds of adults and children. The program is considered among the earliest and most advanced PCMH offerings in the nation.

The Arizona PCMH program is open to UnitedHealthcare's employer-sponsored Medicare Advantage and Medicaid health plan participants in Arizona. UnitedHealthcare is also involved in medical home programs in other states including Colorado, New York, Ohio and Rhode Island.

The PCMH partnership offers each patient an ongoing relationship with a primary care physician who leads a team that takes collective responsibility for each patient's care. The result is a greater level of proactive and personalized care, helping coordinate visits to specialists, mental health professionals and health education.

"We know that having healthy employees will result in improved productivity, higher morale and a stronger organization, which is why we decided to join the medical home program," said Bob Beake, vice president of human resources at Shamrock Foods Company. "We are confident that our employees are benefitting from the improved care coordination."

For more information, please visit:

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HIN Survey of the Month: Fifth Annual Medical Home Survey
What is the shape of patient-centered care today? One year post-healthcare reform, we're taking our fifth annual look at adoption and support of the PCMH model. Describe your organization's progress and outcomes in this area by April 30 and you'll receive a free e-summary of the results — and be entered in a drawing to win our newest healthcare resource, Guide to Physician Performance-Based Reimbursement.

Complete the survey by visiting:

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New Benchmarks: Healthcare Trends for 2011
How are healthcare organizations preparing for healthcare reform implementation in 2011, and what other trends are impacting business for them? This white paper summarizes results of the Healthcare Intelligence Network’s sixth annual Healthcare Trends for the Year Ahead e-survey conducted in October 2010.

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 Benchmarks in Reducing Hospital Readmissions

All-new!This 40-page resource quantifies efforts by 90 healthcare organizations to reduce avoidable readmissions in their most vulnerable and high-utilization populations, as reflected by responses to HIN's second annual survey on Reducing Hospital Readmissions, conducted in December 2010.

New in the 2011 edition: Comparative 2010-over-2011 data on key activities, including the single area where efforts to reduce readmissions has doubled and the health professional to which overall responsibility for reducing readmissions has shifted. For the first time, review efforts to reduce readmissions on the part of long-term care providers. Respondents also describe how they're preparing for increased payor scrutiny of 30-day readmissions and PPACA-mandated posting of hospital readmission rates.

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

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

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