Medical Home Monitor
Medical Home Monitor
April 19, 2010
Vol. III, No. 1

Medical Home Monitor Archives

In This Issue:

  1. Q&A: Bundled Payments
  2. Online Medical Home
  3. New Chart: Coach Case Loads
  4. Podcast: Hospital Discharge
  5. NPs: Bigger Roles, Bigger Risk
  6. E-Survey: Obesity Management
  7. Benchmarks: Reform Reaction
  8. Editor's Pick

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Medical Home Q&A's:
Bundled Payments,
Risk Assessment

Medical Home Monitor

Distributing Bundled Payments

Q: What is the best way to distribute bundled payments?

A: The best way to distribute the bundled payment is through the physician-hospital organization (PHO). Decisions about gainsharing are made at the PHO board level. The physicians didnít want everything coming through the hospital and the hospital being the bank. We didnít want that, either. We needed to develop a sense of shared governance; ultimately, the decision was to run the distribution through the PHO. We have a third-party administrator who handles the claims processing directly with the fiscal intermediary.

In other words, once that clean claim is received, the payments are transmitted electronically. We then adjudicate the claims within three days and turn around that payment to the physician. The physicians receive their payment from the PHO through our claims administrator.

(Michael Zucker, F.A.C.H.E., chief development officer of Baptist Health System.)

For more on the bundled payment model of reimbursement, please visit:

Medical vs.
Financial Risk

Q: How should an organization think of and handle medical risk as opposed to financial risk?

A: There isnít a fine line for me between medical risk and insurance risk. The implications of medical risk are things that are actionable and impactable by the medical system. Insurance risks are those that are not. Over time, we hope that due to this model, things that we have thought of as insurance risks actually become for medical providers something that they can take more of a part in. For example, our community clinics have done a very good job in getting diabetics under control. And in doing so, they have beat the numbers of some of those who pay for or have much larger private insurance products. It really has blown apart a little bit the myth that language and some other aspects of social complexity cannot be impacted by the healthcare system. An organization should look at medical risk. If I were a provider organization, Iíd try to negotiate along those lines and then I'd be looking at financial risk with my payors to see how they want to handle that going forward.

We have to be careful that we donít transfer more risk to provider groups than they can handle, such as the financial risks of a patient needing a transplant. You donít want to inappropriately put the providers at risk for insurance product. But on the other hand, you want to ask providers to do as much intervention as they can even on things that may not immediately be seen as medical risks.

(Dr. Jeff Schiff, medical director of Minnesota healthcare programs for the Minnesota Department of Human Services.)

For more on a risk-adjusted reimbursement strategy, please visit:

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Online Medical Home Delivers On-Demand Specialist Consults

Seeking to increase access to care in remote communities and decrease delays associated with traditional patient referrals, Blue Cross Blue Shield of Hawaii will become the first health plan to deploy American Well's Online Care Team Edition, whose Online Medical Home brings live, on-demand specialist care consults into primary care physicians' exam rooms.

The online tool provides health plans with two new capabilities:

  • Provider-to-Provider allows network primary care physicians (PCPs) to consult with specialists in real time during in-person patient office visits. Physicians can search for affiliated available specialists and initiate an Online Care consult immediately. During the consult, professionals can evaluate physical findings, lab and imaging results, eliminating redundant and time-consuming workups. The system automatically captures an electronic record of the consultations, supporting continuity and accountability of care.

  • In support of accountable care organizations (ACOs), the Online Medical Home further equips the PCP to coordinate complex care by allowing multiple specialists to actively engage around a given patient from their respective locations. Medical Home team members can review the patient's health information, including transcripts of previous consults, and collaborate via live audio/video or by posting notes and guidance onto the patient's collaborative chart.
A recent meta-analysis of 23 studies published in the February 26, 2010 Annals of Internal Medicine found that improved interactive communication between PCPs and specialists was associated with improved patient outcomes and delivered a "better return on investment than many clinical interventions."

The agreement between the BCBS-Hawaii and American Well was announced at last week's World Health Care Congress, where the new product was unveiled.

For more information, please visit:

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New Chart: What's An Average Health Coach Case Load?
With health coaching frequently prescribed to alleviate chronic disease attributed to lifestyle factors like smoking, poor eating habits and physical inactivity, we wanted to see how many cases per month the average health coach is asked to manage.

View the chart at:

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HealthSounds Podcast: Hospital Discharge Planning to Reduce Avoidable Hospital Readmissions
Susan Shepard, director of patient safety education for The Doctors Management Company, shares the latest literature on the causes and prevention of hospital readmissions, including the type of patient most at risk for readmission, risks inherent in certain care transitions, and the contribution of the patient's primary physician to a successful discharge.

To listen to this HIN podcast, please visit:

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For Nurse Practitioners, Increased Role Means More Liability

During the last decade, as the nurse practitioner (NP) has taken on increased responsibility for the coordination and delivery of healthcare, NP liability claims have also grown at a rate of 2.3 percent per year over that time span, according to data from professional liability insurer CNA HealthPro.

A collaborative review of CNA HealthPro claims data and results from a Nurses Service Organization (NSO) survey of NPs found that:

  • Ultimate average indemnity and expense payments have increased over the past 10 years; the average appears to be increasing at a rate of 2.3 percent per year;
  • The medical care office is the location with the highest number of claims;
  • Adult/geriatric, family and pediatric/neonatal medicine specialties continue to have the most claims;
  • Pediatric/neonatal specialty has the highest average severity; and
  • Several closed claims that settled at the policy limit (i.e., $1 million) resulted from allegations of failure to diagnose or failure to properly assess.

Through its collaboration with the NSO, CNA HealthPro currently insures approximately 25,000 nurse practitioners nationwide.

The full report, Understanding Nurse Practitioner Liability: CNA HealthPro Nurse Practitioner Claims Analysis 1998-2008, Risk Management Strategies and Highlights of the 2009 NSO Survey has been published by CNA HealthPro and NSO and is available online at Printed copies can be requested by calling 888-600-4776. The report is designed to help NPs recognize medical malpractice risks, understand the current legal and regulatory environment and implement risk management strategies to prevent patient injuries.

To learn more, please visit:

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HIN Survey of the Month: Obesity and Weight Management
Despite early indicators of success on the management front, obesity is tied to an estimated $117 billion in healthcare costs. Join the nearly 80 healthcare organizations that have already taken this month's e-survey on Obesity and Weight Management and describe how your organization is working to reduce and prevent obesity and obesity-related conditions and costs. You'll receive a free e-summary of the results and your responses will be kept strictly confidential.

Complete the survey by visiting:

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Healthcare Benchmarks: Reaction to Reform
Did you vote yay or nay on the Patient Protection and Affordable Care Act? Read reactions from 124 healthcare organizations to the landmark healthcare reform captured in the days immediately following its passage, and see the steps they'll take to prepare for its proscribed changes.

To download this complimentary white paper, please visit:

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Save 10% on new medical home resource:
Principles of a Patient-Centered Practice: Medical Home Guidelines for Staffing, Recognition and Evidence-Based Care

This 70-page report delivers essential lessons in a practice-wide redesign from organizations that have already completed the transformation ó including two of the top 10 commercial health plans for 2009-2010 as ranked by the National Committee for Quality Assurance (NCQA) and the US News Media Group and a Level III NCQA-recognized medical home. Learn how to redefine care team roles, redesign workflow, address provider and staff expectations, strengthen the practice's technology backbone and improve the patient experience.

Use ordering code MHMP to save 10 percent on this new resource by visiting:

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

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ReadmissionsRx monthly e-newsletter delivers strategies to reduce hospital readmissions that encompass care plan development, case management, care transitions, pre- and post discharge planning, medication reconciliation and much more ó with a special focus on reducing rehospitalizations among the Medicare population.

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