Medical Home Monitor
Medical Home Monitor
August 16, 2010
Vol. III, No. 8

Medical Home Monitor Archives

In This Issue:

  1. Q&A: NPs, Home Visits
  2. Guided Care Improves MD Satisfaction
  3. New Chart: Top Coaching Tech Tools
  4. Podcast: Stratifying High-Risk Patients
  5. Humana Subsidizes EHRs
  6. E-Survey: Health Coaching in 2010
  7. Benchmarks: Medication Adherence
  8. Editor's Pick

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Medical Home Q&A's:
Overseeing NPs, Home Visit Training

Medical Home Monitor

Overseeing an NP

Q: What provision and oversight is required for a nurse practitioner in a practice?

A: We are liable for our own professional actions. Nurse practitioners (NPs) are an independent profession; we are not physician assistants but work under the professional parameters of nursing. We collaborate with physicians. In some states, that collaboration has been put into a legal framework, but in most states the collaboration is part of professional behavior. Rather than supervision, I use the term "collaboration." We are responsible for maintaining malpractice and doing safe standards of care that are defined for us and for other providers.

We also will want to know who we can refer patients to and with whom we can co-manage a patient, should the patient require a level of skill and knowledge and management that is greater than the comfort level and knowledge level of that particular NP. That would be the same for a physician whose background is orthopedics and is treating a patient who has had a heart attack. We talk in terms of educating our NPs in the full set of professional behavior.

Linda Lindeke, Ph.D., R.N., and C.N.P., 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.

For more on the benefits of adding a nurse practitioner to a physician practice, please visit:

Training Staff to Conduct Home Health Visits

Q: How do you prepare and train staff to conduct home visits?

A: The best way to prepare someone to do home visits is to have them shadow a more experienced staff person. There are too many independent variables at play when you go into somebody’s home and you just don’t have control over that environment, nor should you. It’s impossible to anticipate every possible scenario. Therefore, we do a lot of shadowing for at least a month before somebody does a home visit on their own.

Jessica Simo, program manager with Durham Community Health Network for the Duke Division of Community Health.

For more reasons to conduct home health visits for medically complex patients, please visit:

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Guided Care Improves Physician Satisfaction with Communications, Knowledge of Patient Conditions

Physicians who provided Guided Care, a primary care enhancement program for patients with multiple chronic conditions, reported higher levels of satisfaction with their patient/family communications and their knowledge of their patients’ clinical characteristics, according to a study by researchers at the Johns Hopkins Bloomberg School of Public Health.

The research, published in the July/August edition of Annals of Family Medicine, found that after one year of a multi-site randomized controlled trial, Guided Care physicians were significantly more satisfied with patient/family communications than physicians who provide usual care. Guided Care physicians were also significantly more satisfied with their knowledge of their patients’ clinical characteristics.

Previously published data suggest that compared to patients who receive “usual care,” Guided Care patients tend to spend less time in hospitals and skilled nursing facilities and have fewer ER visits and home health episodes, producing an annual net savings for health insurers (after accounting for the costs of Guided Care) of $1,365 (11 percent) per patient or $75,000 per nurse. Other studies have shown that Guided Care improves patients’ ratings of the quality of their care and reduces family caregiver strain.

Guided Care is a model of comprehensive healthcare provided by physician-nurse teams for people with several chronic health conditions. It is a type of “medical home” for the growing number of older adults with multiple chronic conditions. The model is designed to improve the quality of life and the quality of healthcare, while improving the efficiency of treating the sickest and most complex patients.

Guided Care teams include a registered nurse, two to five physicians, and other members of the office staff, all of whom work together for the benefit of each patient. In partnership with the primary care physician, the Guided Care nurse conducts in-home comprehensive assessments, facilitates care planning, educates and empowers patients and families, monitors their conditions monthly, and coordinates the efforts of healthcare professionals, hospitals, and community agencies to ensure that no important health-related need slips through the cracks.

A multi-site, randomized controlled trial of Guided Care involving 49 physicians, 904 older patients and 319 family members recently concluded in eight locations in the Baltimore-Washington, D.C. area.

For more details, please visit:

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New Chart: Top Health Coaching Tech Tools
With so much technology available to wellness and health promotion programs, we wanted to see which IT tools are supporting organizations' health coaching programs.

View the chart at:

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HealthSounds Podcast: Case Management Stratification of High-Risk Members
CareOregon's robust care management program has found new ways of stratifying members and identifying high-risk members, explains Rebecca Ramsay, B.S.N., M.P.H., senior manager of care support and clinical programs. Ms. Ramsay also explains how daily data from CareOregon's emergency departments is informing their member outreach strategy.

To listen to this HIN podcast, please visit:

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Humana to Subsidize EHRs for Eligible Physicians
Humana will subsidize the implementation cost of athenahealth’s EHR service, athenaClinicals(SM), for eligible physicians, a program that could generate an additional 20 percent of revenue beyond physicians' current fee-for-service base collections from Humana. Humana and athenahealth will jointly promote the program to approximately 20,000 family and internal medicine physicians inHumana’s national provider network, with Humana subsidizing implementation for 100 physician practices representing 1,000 physicians, ranging from small practices to large multi-specialty groups that include primary care physicians.

The newly announced alliance connects Humana’s Primary Care Rewards Program with athenahealth’s EHR service. Under the alliance, physician encounters will be measured against nationally recognized HEDIS quality measures designed to improve the overall efficiency of the healthcare delivery system, such as hospital readmission rate, generic drug dispensing rate, mail order usage and health risk assessment completion.

Humana will also make care coordination payments to practices in recognition of their transformation to a more patient-centered approach to care delivery. Physician practices will be provided with individualized goals and measured regularly to provide performance feedback. Physician practices may also be eligible to receive additional financial benefits through a shared savings program, but only after the practices meet or exceed certain quality benchmarks.

Also, athenahealth will offer a service package to participants that will include the company’s full, integrated suite of services and is designed to make medical home compliance easier on physician practices while enabling them to optimize their performance in the program.

To learn more, please visit:

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HIN Survey of the Month: Health Coaching in 2010
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 Improving Medication Adherence
This white paper captures the efforts of 107 healthcare companies to improve medication adherence in their populations, from targeted populations and conditions of medication adherence programs to the components of a successful medication adherence program in response to the Healthcare Intelligence Network January 2010 Medication Adherence 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

Hospital Discharge Improvement Guide: How to Close Six Key Care Gaps and Reduce Readmissions

This 25-page guide delivers dozens of tactics to tighten the six major gaps in the hospital discharge process and suggests skills and interventions that health plans, hospitals and physician practices can use to improve critical areas of the hospital discharge process.

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

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

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