Medical Home Monitor
Medical Home Monitor
August 2, 2010
Vol. III, No. 7

Medical Home Monitor Archives

In This Issue:

  1. Q&A: ROI & Case Management
  2. Barriers to Integrated and Accountable Care
  3. New Chart: Case Management ROI
  4. Podcast: Emerging Role of Nurse Practitioners
  5. Improving Heart Failure Care
  6. E-Survey: Health Coaching in 2010
  7. Benchmarks: Case Management
  8. Editor's Pick

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Medical Home Q&A's:
Medical Home ROI, Reducing Readmissions

Medical Home Monitor


Q: Have practices that are participating in PCMH seen revenue boosts in terms of efficiency from the changes that have been made thus far?

A: No, but they have seen incentive payments, which is beneficial. On the other hand, they have not seen any revenue drops. That’s remarkable because they are adding a lot of work in terms of patient contact, patient follow-up, a commitment to return phone calls in a certain time period and a commitment to follow up on referrals. These are extra expenses that haven't been done in traditional practices. Some of the practices added more staff; most did not and simply found a way to shift work around to do this while keeping their bottom line up by what still remains a visit-driven reimbursement system.

Dr. Paul Kaye, Medical Director at Taconic IPA.

For more Taconic IPA strategies to improve physician performance, please visit:

Telephonic Case Management

Q: How can a telephone case manager effectively assist hospital discharge planners and social workers with reducing repeat hospitalizations?

A: The first thing is having good communication between hospital discharge planners and the telephone case manager. It is important to let them know that the patient is being discharged, when their appointments are, what their medications are, why they were in the hospital and for which symptoms. This way, the case manager can make sure the patient is getting the services they need and understands what needs to be done. Communication is critical. If you are involving your system in that cross-communication, you don't even need to have a transition coach.

Susan Shepard, director of patient safety education at the Doctors Management Company

For more on telephonic case management, please visit:

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Lack of Financial Incentives Hinders Integrated and Accountable Care

The lack of incentives and current financial interests of providers and other stakeholders are barriers to moving healthcare toward more integrated and accountable delivery models, according to nearly nine of 10 leaders in healthcare and healthcare policy.

Healthcare leaders discussed obstacles to the growth of accountable care organizations (ACOs), but also identified potential solutions. Large majorities support providing special payment arrangement to ACOs (65 percent) and giving providers financial incentives to practice in ACOs (65 percent) — similar to provisions in the Patient Protection and Affordable Care Act.

Majorities of leaders support the growth of more integrated models of care delivery, like ACOs and integrated delivery systems, but also voiced concerns. Nearly three-quarters (74 percent) of opinion leaders said they were concerned or very concerned with providers acquiring excessive market power and dominance. To safeguard against such undue market share, a majority of healthcare leaders (56 percent) support regulation of ACO payment rates in regions with insufficient market competition — similar to the way a public utility is regulated. To alleviate concerns that accountable models of care would encourage providers to withhold appropriate care, more than eight of 10 leaders support the development of performance metrics for ACOs, as well as increased transparency and public reporting on quality of care, resource use and costs.

The Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey also found that 63 percent of opinion leaders support or strongly support development of a national accreditation system for ACOs. Also, nearly eight of 10 leaders (77 percent) support or strongly support establishing standards for primary care capacity as a condition of qualifying for payment as an ACO. In addition, most healthcare opinion leaders (62 percent) support exempting ACOs from antitrust and other legal barriers to coordinating care and sharing cost information in exchange for meeting performance, disclosure and accreditation standards, with support particularly high among leaders in healthcare delivery (80 percent).

For more details, please visit:

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New Chart: Case Management ROI
An increase in healthcare case management programs is significantly influencing medication compliance levels, hospital readmission rates and healthcare costs. We wanted to see what ROI has been generated by healthcare case management programs.

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HealthSounds Podcast: Nurse Practitioners Grounded in Patient-Centered Care
Nurse practitioners constitute a workforce already grounded in patient-centered care, explains Linda Lindeke, Ph.D., an RN and nurse practitioner since 1978. The associate professor for the School of Nursing and Department of Pediatrics and director of Graduate Studies for the School of Nursing at the University of Minnesota also describes the demographics in which nurse practitioners might encounter resistance and reacts to $15 million in federal funds for 10 nurse practitioner-led clinics to provide primary care services to the medically underserved.

To listen to this HIN podcast, please visit:

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Evidence-Based Toolkit Improves Heart Failure Care, Compliance in Outpatient Settings
A UCLA-led study has found that a new performance-intervention program significantly improved adherence to national guideline–recommended therapies for heart failure patients in outpatient settings.

Reported in the July 26 online edition of Circulation, the new program provided key interventions including clinical decision support tools, structured improvement strategies, and medical chart audits with feedback to help clinicians better provide heart failure therapies that have been proven to improve patient survival and other clinical outcomes.

For the study, researchers utilized a new program called the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) at 167 cardiology practice clinics in the United States. Participants included 34,810 patients diagnosed with a previous heart attack, weakening left heart ventricle function, or chronic heart failure.

The program applied interventions to help ensure that heart failure patients received seven national standard of care level treatments as recommended in heart failure guidelines developed by the American College of Cardiology and the American Heart Association.

The IMPROVE HF program employed a toolkit to help clinicians make patient care decisions which included educational outreach, performance profiling, reminder systems, practice-specific data, quality of care reports, guideline-based best practice algorithms, standardized encounter forms, checklists, pocket cards and patient chart stickers.

Medical chart reviews performed at baseline before adopting the program and at several points in time up to two years after initiation of the IMPROVE HF program revealed significant improvement in use of five of the seven evidence-based, national guideline-recommended heart failure treatments targeted in the study. Key findings include:

  • Heart failure patient education also rose 12.6 percent, from 59.5 to 72.1 percent.
  • Beta blocker medication use increased 6.2 percent, up from 86 percent at baseline to 92.2 percent after the interventions.
  • Aldosterone antagonist medication use rose 25.1 percent, increasing from 34. 5 to 60.3 percent.
  • Cardiac resynchronization therapy, a device to help coordinate the heart's contractions, had a reported increased use of 29.9 percent, up from 37.2 percent at baseline to 66.3 percent.
  • Use of implantable cardioverter-defibrillator devices, which help regularly pace abnormal heartbeats, increased 27.4 percent, from 50.1 to 77.5 percent.

Researchers say these findings are significant, especially given the wide range of cardiology practices across the country included in the study, the majority of which were community-based.

To learn more, please visit:

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HIN Survey of the Month: Health Coaching in 2010
Health coaching's domain has moved beyond traditional disease management to encompass care transitions coaching, medication adherence and more. Take HIN's third annual Health Coaching survey to find out how healthcare organizations are implementing health coaching as well as the financial and clinical outcomes that result. Complete the survey by August 31 and receive a free executive summary of compiled results. Your responses will be kept strictly confidential.

Complete the survey by visiting:

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Benchmarks in Healthcare Case Management
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 from pre-admission through post-discharge to overseeing care of residents in long-term care facilities. This white paper captures key information regarding the role of case managers from 187 healthcare organizations in response to the Healthcare Intelligence Network December 2009 Healthcare Case Management e-survey.

To download this complimentary white paper, please visit:

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

Guide to Medical Home Reimbursement

With data accumulating from dozens of pilots of the patient-centered medical home (PCMH) and federal legislation in place that will reward the PCMH and other team-based care delivery models in the months and years to come, healthcare organizations must be well-versed on reimbursement and physician incentive models that are driving results around the country. The Guide to Medical Home Reimbursement analyzes emerging payment models for patient-centered care from early adopters that are working overtime to put a fair price on care coordination tasks and adequately reward providers for medical home adoption.

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

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Guest Editor: Jackie Lyons,;
Publisher: Melanie Matthews,;

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