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Archived Podcasts from:
Patient Engagement and Provider Collaborations Across the Healthcare Continuum to Improve Care Transitions
Posted: May 14, 2013
To rise to the challenge of non-compliant patients, providers should ask how they can work together to empower patients toward self-management rather than why patients are non-adherent in the first place, suggests Alicia Goroski, MPH, senior project director for care transitions for the Colorado Foundation for Medical Care (CFMC). CFMC coordinates the work of state-based Quality Improvement Organizations (QIOs), who have been working with hospitals and community providers to improve care transitions and reduce readmissions.
In this interview, Ms. Goroski describes some of the interventions focused on patients, providers or both groups that have not only lowered key Medicare readmission rates but also reduced participants' overall admission stats.
Ms. Goroski will share lessons learned from the 14 communities that participated in the CMS care transition demonstration project and details on program rollout to over 12 million Medicare beneficiaries in 400 communities during a May 22, 2013 webinar, Patient Engagement and Provider Collaborations Across the Healthcare Continuum to Improve Care Transitions.
Most Recent Podcasts:
Medicare Pioneer ACO: Case Study on Atrius Health's Focus on the Triple Aim
Posted: May 2, 2013
A core desire to create a single population-focused model of care for all Medicare beneficiaries, rather than multiple payor-driven approaches, drives Atrius Health’s participation in the CMS Pioneer ACO program, explains Emily Brower, executive director of accountable care programs at Atrius Health. The success of the Atrius ACO hinges on several preferred partnerships it has cultivated, including a collaboration with skilled nursing facilities, as well as outreach by population health managers, who guide patients in the management of chronic illness and prevention.
Ms. Brower shared the first year lessons from its experience as a Medicare Pioneer ACO and how the program is evolving in year two during a May 9, 2013 webinar, Medicare Pioneer ACO: Case Study on Atrius Health’s Focus on the Triple Aim, now available for replay.
Healthcare Social Business Strategy: Driving Adoption with Social, Mobile and Cloud Technologies
Posted: April 24, 2013
There are two key mistakes healthcare companies make when adopting social or mobile technologies, explains Andrew Dixon, senior vice president of marketing and operations, Igloo Software. Dixon describes what's driving the aggressive growth of interactive patient care communities and suggests how responsibility for social strategy which he defines as both an internal and external communications strategy should be assigned.
Dixon discussed the key elements of an effective social strategy, along with and best practice guidance from healthcare social strategies having a bottom line impact during a May 1, 2013 webinar, Healthcare Social Business Strategy: Driving Adoption with Social, Mobile and Cloud Technologies, a 45-minute program sponsored by The Healthcare Intelligence Network, now available for replay.
A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings
Posted: April 9, 2013
Low scores on patient outcomes measures within the CMS Star Quality ratings program metrics CMS weights most heavily in its assignment of stars can typically be traced to poor provider and member engagement, notes Joseph Johnson, vice president of L.E.K. Consulting. Johnson suggests ways to enlist support from these two stakeholder groups, and describes how MA plans should prepare for the possible display in 2014 of CAHPS care coordination ratings along with with its star scores (though the care coordination ratings will not be factored into star ratings).
Johnson shares tactics to improve quality ratings as well as insight into the future direction of the CMS Star Quality program during an April 16, 2013 webinar, now available for replay: A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings, a 45-minute program sponsored by The Healthcare Intelligence Network.
Care Transition Management: Strategies for Effective Patient Handoffs
Posted: March 27, 2013
The initial goal of Cullman Regional Medical Center's "Good to Go" program was to reduce readmissions. But CRMC didn't anticipate the effect that recording discharge instructions and sharing them with patients via phone and computer would have on the patient experience. Cheryl Bailey, CRMC's vice president of patient care services, talks about the unexpected benefit of the award-winning initiative, the minimal investment required to get "Good to Go" off the ground, and planned expansion for the initiative that is bridging the patient communication gap.
Ms. Bailey, along with Joshua Brewster, director of care management at Regions Hospital, a HealthPartners hospital, shared the key features of their care transition management programs during an April 24, 2013 webinar, Care Transition Management: Strategies for Effective Patient Handoffs, a one-hour program, now available for replay, sponsored by The Healthcare Intelligence Network.
Moving Forward with Payment Bundling
Posted: March 12, 2013
Since the idea of payment bundling was first introduced 10 years ago, justification for the episode-based reimbursement model has shifted from quality and innovation gains to its proven ability to reduce the total cost of healthcare, notes Jay Sultan, associate vice president and chief product portfolio architect for TriZetto®. Healthcare entities testing bundled payments should keep two key factors in mind when trying to engage physicians in the model, Sultan adds, describing the type of message most likely to foster provider support. And finally, Sultan also identifies the major decision primary care must make now that CMS has introduced bundled payments for care coordination tasks.
Sultan provided perspectives on the emerging bundled payment trend during a March 13, 2013 webinar, Moving Forward with Payment Bundling, a 45-minute program sponsored by The Healthcare Intelligence Network.
The Role of Case Managers in Emerging Care Delivery Models
Posted: February 14, 2013
With ACA reforms underway, the case manager is fast becoming a major player in the patient-centric, quality over volume healthcare mindset, taking on more standardized, collaborative approaches to care coordination and its changing delivery systems. But as crucial as case managers are to the evolving healthcare landscape, they also need to realize that they are, in many ways, the new kids on the block. Embedded case managers in particular need to understand that how they relate to their professional partners is one of the most important keys to their success, explains Teresa Treiger, president of Ascent Care Management. Here she shares her views on this and other aspects of the industry, including the opportunities for home-based care and how case managers can maximize the use of technology to manage patient care plans.
Teresa Treiger provides perspectives on the changing healthcare landscape for case management and care coordination during The Role of Case Managers in Emerging Care Delivery Models, a February 21, 2013 webinar, now available for replay.
Health and Wellness Incentives: Positioning for Outcome-Based Rewards
Posted: January 29, 2013
Outcomes-based rewards have a place in an overall incentives offering, notes John Riedel, president, Riedel & Associates Consultants, Inc., but despite the growth in these offerings, companies should keep their incentive options open. To maximize effectiveness, programs should include something for all: simple items like gift cards and tee shirts for sign-on, progress-based rewards to move individuals along, and outcomes-based incentives for individuals who take their health seriously. Reidel examines the staying power of extrinsic incentives and suggests eight questions companies should ask themselves to determine whether they've truly constructed a culture of health for the population they serve.
John Riedel shares the key strategies in sustaining a health and wellness incentive program and moving toward outcome-based results during Health and Wellness Incentives: Positioning for Outcome-Based Rewards, a February 4, 2013 webinar, now available for replay.
Physician Hospital Organizations: Developing a Collaborative Structure for Shared Savings Agreements
Posted: January 16, 2013
Physician-hospital organizations have been around before, but it's the emphasis on quality that sets today's PHO apart from the 80's version. In PHO 2.0, where healthcare value is favored over volume, clinical integration of participating physicians is a prerequisite, agree Greg Mertz, director of Healthcare Strategy Group, and Travis Ansel, its manager of strategic services. In this interview, they talk about the essential first steps of PHO creation and the perennial challenges of physician engagement and clinical leadership in this emerging collaborative model.
Greg Mertz and Travis Ansel explore the key contractual elements to consider when creating a PHO during a January 23, 2013 webinar, Physician Hospital Organizations: Developing a Collaborative Structure for Shared Savings Agreements, a 45-minute program sponsored by The Healthcare Intelligence Network.
Care Coordination for Dual Eligibles: A Results-Oriented Approach
Dr. Timothy Schwab
Posted: November 29, 2012
SCAN Health Plan's Interdisciplinary Care Team for dual eligibles is a diverse multiprofessional group encompassing many geriatric specialists, explains Dr. Timothy Schwab, chief medical officer of SCAN Health Plan. Dr. Schwab describes some of the challenges of risk stratification in a dual eligible population, and details case management support for the percentage of dual eligibles that require support for disabilities.
Dr. Schwab will share his organization's strategic approach to serving the dual eligible market during a December 6, 2012 webinar, Care Coordination for Dual Eligibles: A Results-Oriented Approach, a 45-minute webinar sponsored by The Healthcare Intelligence Network.
Healthcare Trends & Forecasts in 2013: A Strategic Planning Session
Posted: September 25, 2012
A presidential election, more post-ACA milestones and a remodeling of healthcare funding and delivery will no doubt make for an exciting year ahead in healthcare. In this preview of their October 17, 2012 strategic planning session for healthcare executives, Dennis Eder and Hank Osowski, managing directors of Strategic Health Group, and Steven Valentine, president of the Camden Group, predict the direction of physician reimbursement, trends in ACO administration, the technology to embrace in the year to come, and the industry's response to a softened demand for service.
Eder, Osowski, and Valentine presented during the Healthcare Intelligence Network's ninth annual Healthcare Trends & Forecasts in 2013: A Strategic Planning Session presentation, a 60-minute webinar on October 17, 2012, now available for replay.
Improving Population Health Management Through Effective, Efficient Data Analytics
Posted: September 20, 2012
Enhanced reporting and efficiency, significant reductions in readmissions in congestive heart failure patients and added leverage at contract negotiation are just a few advantages Bon Secours is deriving from its EHR-based data collection tools, explains Robert Fortini, vice president and chief clinical officer at Bon Secours. Fortini talks about the health system's shift from home-grown methodologies to the sophisticated IT knowledge base powering its population health management program, resulting in data that has a "compelling" effect at contract time.
Robert Fortini drills down on Bon Secours' tools and protocols for data analytics during an October 3, 2012 webinar, now available for replay, Improving Population Health Management Through Effective, Efficient Data Analytics, a 45-minute webinar sponsored by The Healthcare Intelligence Network.
Integrated Health Coaching: The Next Generation in Health Behavior Change Management
Dr. Dennis Richling
Posted: September 18, 2012
Integrated health coaching's person-centric approach to health behaviors across the entire health risk continuum aligns with many of the key principles of post-ACA care delivery models like the patient-centered medical home and the accountable care organization (ACO), explains Dr. Dennis Richling, HealthFitness chief medical and wellness officer. Dr. Richling and HealthFitness Vice President of Service Delivery Kelly Merriman describe the population presenting the greatest opportunities for integrated health coaching, the key to discerning participant values during the coaching intervention, and the art of 'appreciative inquiry' an essential coaching skill that helps to define an individual's 'exceptionality.'
Dr. Richling and Kelly Merriman presented during Integrated Health Coaching: The Next Generation in Health Behavior Change Management, a 45-minute webinar on September 20, 2012, now available for replay, during which they shared the key features of HealthFitness' integrated health coaching program, from how participants are assessed and assigned to coaches to the program's impact.
Population Health Management: Achieving Results in a Value-Based Healthcare System
Posted: September 12, 2012
Before shifting from a disease-focused to population health management (PHM) approach, healthcare organizations need to do their homework, advises Patricia Curran, principal in Buck Consultants' National Clinical Practice from researching the population's culture to examining its patterns of healthcare usage and cost trends. In this interview, Ms. Curran describes the four key research areas, as well as some of the barriers encountered along the road to population health management. She also predicts what the no- or low-health-risk populations can expect in a population health management world that spans the health risk continuum from incentives to provider and payor contact.
Patricia Curran presented during Population Health Management: Achieving Results in a Value-Based Healthcare System, a 45-minute webinar on September 26, 2012, now available for replay, during which she shared the types of population health management programs and how these programs can produce tangible results in terms of improved outcomes and costs savings.
Patient Engagement in the Patient-Centered Medical Home: A Continuum Approach
Posted: July 26, 2012
Although the healthcare industry is well-acquainted with the patient-centered medical home, the model is still quite new and novel to patients, notes, Jay Driggers, director of consumer engagement at Horizon Blue Cross Blue Shield of New Jersey. In this interview, Driggers describes what's at stake when moving from a reactive provider model to a proactive model.
Drigger presented during Patient Engagement in the Patient-Centered Medical Home: A Continuum Approach, a 45-minute webinar on August 22, 2012, during he described some of Horizon BCBS's novel consumer engagement tactics that involve everything from smartphone apps to telemonitoring.
Bending the Cost Curve with a Commercial Value-Based Payment Contract: A Case Study from Advocate Physician Partners
Dr. Carrie Nelson
Posted: July 24, 2012
A value-based contract between Advocate Physician Partners (APP) and Blue Cross Blue Shield of Illinois (BCBSIL) has reduced inpatient admissions and emergency room visits and has bent the cost curve after its first year. In this interview, Dr. Carrie Nelson, APP's medical director for special projects, describes how APP's eight-year clinical integration of 4,000 physicians and 10 hospitals has laid the groundwork for this value-based contract.
Dr. Carrie Nelson presented during Bending the Cost Curve with a Commercial Value-Based Payment Contract: A Case Study from Advocate Physician Partners, a 45-minute webinar on July 18, 2012, now available for replay, during which she shared lessons learned from the first year of implementing the value-based contract between APP and BCBSIL. APP's clinical integration program is described in detail in
Case Study in Clinical Integration: The Advocate Physician Partners Experience.
Healthcare Performance Benchmarks: Diabetes Management
Posted: July 11, 2012
The use of a disease-specific approach to improve health outcomes and
self-management for patients with diabetes is utilized by 77 percent of organizations, according to HIN's 2011 survey on diabetes management programs. In this podcast, Melanie Matthews shares key metrics from the survey, including the role of the case manager, the use of incentives, the staff member responsible for diabetes management and the greatest challenge associated with the control of diabetes.
Also, Kathy Brieger, Hudson River HealthCare chief operating officer, describes HRHC's four-pronged approach to weight management for the 3,400 adult patients it serves.
Need more information on this topic? Download an executive summary of the survey results.
Advanced Illness Care Coordination: A Case Study on Aetna's Compassionate Care Program
Dr. Joseph Agostini
Posted: June 13, 2012
Aetna's Compassionate Care Program is a case management initiative that specifically targets health plan members with advanced illness, focusing on improving the quality of care they receive. As a result, explains Dr. Joseph Agostini, senior medical director of Aetna Medicare, these patients get more of the type of care that they want and spend less time in the hospital. Patient satisfaction with the program is high, he says, which reflects the strong bond between Aetna members and nurse case managers. In this interview, Dr. Agostini explains the key elements of the Compassionate Care program as well as some of the challenges the case managers may face in the management of advanced illness.
Dr. Joseph Agostini presented during Advanced Illness Care Coordination: A Case Study on Aetna's Compassionate Care Program, a 45-minute webinar on June 13, 2012, now available for replay, during which he shared the key features of the Compassionate Care Program at Aetna, along with the impact the program has had on healthcare utilization and quality outcomes.
The Patient-Centered Medical Home: Lessons from a Statewide Rollout
Posted: May 2, 2012
Nurse educators provide essential support to physician practices in Florida Blue's rollout of a statewide patient-centered medical home, explains Barbara Haasis, RN, CCRN, senior clinical lead for Florida Blue's quality reward and recognition programs. They help practices meet key disease metrics within Florida Blue's performance scorecards, and can direct providers to both internal and external resources to help them resolve patient issues. Ms. Hassis also explains why providing after-hours access is a prerequisite for practices in the medical home program as well as the case manager's contribution to this program.
Barbara Haasis will present during The Patient-Centered Medical Home: Lessons from a Statewide Rollout, a 45-minute webinar on May 10, 2012, during which she will share how the health plan transitioned from the Recognizing Physician Excellence (RPE) program to a medical home model.
Reducing Avoidable Medicaid ER Visits With a Community Partnership Approach
Posted: April 24, 2012
Anxiety caused by the wait for a non-urgent appointment or lack of awareness that they are assigned a primary care physician are just two barriers to appropriate ER utilization by a diverse Medicaid population, explains Laura Linebach, director of quality improvement at L.A. Care Health Plan. As part of a health plan-hospital collaboration with a goal of reducing non-acute ER use by children ages 1 to 19, L.A. Care Health Plan has launched a Nurse Advice Line and developed a range of materials to educate parents about appropriate use of the ER. Ms. Linebach describes these tools as well as a metric in L.A. Care Health Plan's pay for performance program that measures group providers' appropriate resource use.
Laura Linebach will present during Reducing Avoidable Medicaid ER Visits With a Community Partnership Approach, a 45-minute webinar on May 9, 2012, during which she will share the inside details on how the health plan worked with the hospital to target avoidable ER use and results from the initiative.
Geisinger Reduces All-Cause 30-Day Readmission Rates Through Remote Monitoring Program
Dr. Maria Lopes
Posted: April 19, 2012
Geisinger Health Plan reduced the relative risk of all-cause 30-day readmissions by 44 percent compared to a matched control group using an interactive voice response (IVR) system developed by AMC Health. The IVR system targeted patients who were at high risk for readmissions following a hospital discharge. Care managers identified those complex patients that were at high risk for post-discharge complications that could lead to a readmission, explained Dr. Maria Lopes, chief medical officer at AMC Health.
The IVR system makes one call per week for four weeks, using branching logic to identify issues with medication adherence, PCP follow-up, and complications, as well as a risk and falls assessment. The program is integrated into the care management workflow to make this impact, she added.
Recruiting, Training and Case Load Management Strategies for Embedded Case Managers
Posted: April 10, 2012
When looking for new hires for its embedded case management program, Bon Secours Health System looks for critical thinking skills and previous roles that are transferable, such as work with chronic disease patients, explains Irene Zolotorofe, administrative director of clinical operations at Bon Secours. Zolotorofe also describes the importance of matching personalities when placing a case manager in a physician practice, how to build a trusting relationship between an embedded case manager and the physician and Bon Secour's embedded case manager training process.
Irene Zolotorofe will present during Recruiting, Training and Case Load Management Strategies for Embedded Case Managers, a 45-minute webinar on May 3, 2012, sharing the process that Bon Secours has established for recruiting, selecting and placing an embedded case manager in their practices, along with details on case load management, tools used by case managers, benchmarks for measuring effectiveness and much more.
Second Annual Benchmarks in Reducing Avoidable ER Use: Pain Management Driving 'Ultra Utilizers'
Posted: April 4, 2012
The use of nurse-only health advice lines to reduce avoidable ER visits is up 10 percent over 2010 levels, according to HIN's second annual survey on reducing avoidable emergency room use. In this podcast, Melanie Matthews shares key metrics from the 2011 survey, including program availability, health advice line use, new benchmarks on contributions from health coaches and health educators in this area and the biggest barrier to program launch.
Also, Dr. Mina Chang describes the methodology behind Ohio Medicaid's interventions to encourage appropriate ED utilization by this population.
Need more information on this topic? Download an executive summary of the survey results.
Health Coaching Trends for 2012
Posted: March 28, 2012
While telephonic sessions were the primary vehicle for health coaching in the last five years, Internet-based face-to-face coaching incorporating motivational interviewing techniques is one of the directions the industry will be taking going forward, says Melinda Huffman, partner in Miller and Huffman Outcome Architects, co-founder of the National Society of Health Coaches, and a cardiovascular clinical specialist, writer and author. Mobile applications will also become more widely used, enabling health professionals to quickly access their patients' personal records, and coach via internet-based in-person calls.
There will also be a move toward standardizing health coaching in terms of definition, education, and training and skill validation, Huffman says.
Leveraging Case Management Tools and Technology to Improve Outcomes
Posted: March 13, 2012
With more than 100 case managers working in seven regional offices, Arkansas Blue Cross Blue Shield (BCBS) embraces any tools that can elevate care delivery and efficiency and reduce paperwork. Karen Black, RN, HIPAAP, HIA, Arkansas BCBS quality improvement coordinator, describes how an early interest in computers helped to drive development of two Web-based tools supporting Arkansas BCBS case managers today, the potential for these tools to support other areas of the company, and how one tool from the centralized portal is helping to standardize transitions of care for Arkansas BCBS members.
Karen Black presented during Leveraging Case Management Tools and Technology to Improve Outcomes, a 45-minute webinar on April 11, 2012, during which Black shared how the Arkansas BCBS tools repository was developed, how it fits into the case manager's workflow and the key features that are directly attributed to improvements in patient care delivery.
Physician Pay for Performance: Refining the Bonus Structure to Meet Market Realities
Posted: March 6, 2012
In its 15-year existence, Highmark's Quality Blue physician pay for performance program has evolved from one strictly based on clinical measures to a payment model shaped by practices' needs, explains Julie Hobson, Highmark's manager of provider engagement, performance and partnership. Hobson describes how feedback from physicians resulted in its Best Practice quality improvement project, what CMS's recently announced stage 2 proposal for meaningful EHR use means for Quality Blue, and some lessons Highmark has learned about engaging physicians in pay for performance.
Julie Hobson presented during Physician Pay-for-Performance: Refining the Bonus Structure To Meet Market Realities, a 45-minute webinar on March 22, 2012, during which Hobson described how Highmark’s Quality Blue physician pay for performance program has evolved to meet today's healthcare market realities. Hobson will share new developments slated for 2012 to reflect meaningful use requirements; the bonus scoring algorithm currently in place that rewards physicians across the measure set and how this algorithm will change in 2012 to reflect market developments; and much more.
CMS Innovation Panel Looks to Medication Adherence as Potential Delivery Innovation
Dr. Janice Pringle
Posted: February 28, 2012
Medication adherence rates for patients enrolled in a collaborative program developed by the University of Pittsburgh School of Pharmacy, Highmark, RiteAid and CE City, a technology company, was significantly improved and continued to improve over time compared to a control group, according to Dr. Janice Pringle, director of the program evaluation research unit at the University of Pittsburgh School of Pharmacy.
Dr. Pringle describes the intervention, which takes a patient-centered approach to pharmacy visits combined with motivational interviewing by the community pharmacists to improve adherence rates. Dr. Pringle also shares how the collaborative has evolved following its first year results, as well as her recent appointment to CMS’ Innovation Advisors Program. As part of her focus on the Innovation Advisors Program, Dr. Pringle will be working with RTI to develop pay for performance models for the community pharmacist program.
Telephonic Case Management: Protocols for Behavioral Healthcare Patients
Posted: February 15, 2012
Though adult mental health patients, substance abusers and children and adolescents may face different behavioral health issues, there's a common reason behind their frequent hospital and ER visits, explains Jay Hale, LPC, CEAP, director of quality improvement and clinical operations at Carolina Behavioral Health Alliance. Hale's organization uses a set of telephonic case management protocols to reduce avoidable inpatient and ER use by these populations. He describes some of the barriers telephonic case managers might face during member outreach, red flags that indicate a physician visit is warranted, and the role of primary care providers in the member's care continuum.
Hale presented during a March 7, 2012 webinar, Telephonic Case Management: Protocols for Behavioral Healthcare Patients, during which he shared the case management protocol developed by his organization, including using scripts and surveys to assess patients' engagement in the treatment process and identify patients at-risk.
Diabetes Management in the Medical Home: A Diabetes Collaborative Takes Team-Based Approach
Posted: January 10, 2012
Hudson River HealthCare (HRHC) takes a team approach to disease management in the 3,400 adult patients with diabetes it serves, explains Kathy Brieger, RD, CDE, HRHC's chief operations officer. Ms. Brieger describes the multiple levels of care available to patients served by the HRHC Diabetes Collaborative, a four-point strategy for weight management that targets the most challenging aspect of managing diabetes, and HRHC's upcoming trial of telepsychiatry at selected FQHCs.
Ms. Brieger presented during Diabetes Management in the Medical Home, a 45-minute webinar on January 26, 2012, providing the inside details on HRHC's diabetes management program and the program's impact on its diabetic patients. Brieger shared how to: identify and assess patients for diabetes management, including an analysis of literacy and learning and social barriers that could impact outcomes for complex patients; train staff and report quality data to drive further performance improvement; and much more.
Mapping the Way to ICD-10 Readiness: Blue Cross Blue Shield of Michigan's Approach
Posted: December 20, 2011
The mapping between ICD-9 and ICD-10 code sets will have two major impacts on healthcare, predicts Dennis Winkler, ICD-10 technical program director for Blue Cross Blue Shield of Michigan, which has created a roadmap for the transition that it is sharing with the industry. Winkler describes where health plans should be on the ICD-10 timeline at the start of 2012, and defines the two major challenges the health plan expects to face as it enters the testing phase of the transition.
Dennis Winkler will be presenting during, Mapping the Way to ICD-10 Readiness: Blue Cross Blue Shield of Michigan's Approach, a 45-minute webinar, during which he will share BCBS of Michigan's mapping strategy along with other organizational readiness tactics for ICD-10. Winkler will address: BCBSM's six dimensions of neutrality and how the BCBSM plan incorporates these aspects into ICD-10 readiness; working with external vendors and constituents; ICD-10 systems testing and training; and more.
Demonstrating the Value of the Embedded Case Manager for the Medicare Population
Dr. Randall Krakauer
Posted: November 18, 2011
When healthcare providers and health plan case managers join forces in the physician practice, the end result is "care completion," explains Dr. Randall Krakauer, medical director for Aetna Medicare. In his second HealthSounds interview, Dr. Krakauer describes how the meshing of complementary patient data and knowledge from payor and provider improves the "completion factor" of care that is ordered and provides feedback on the impact of this care.
Dr. Krakauer will be presenting during the November 30, 2011 webinar, Demonstrating the Value of the Embedded Case Manager for the Medicare Population, during which he will share the strategy supporting Aetna's embedded case management initiative, along with results from the program relating to healthcare utilization and member satisfaction.
Fifth Annual Medical Home Benchmarks: PCMH Stepping Stone to ACO
Posted: November 8, 2011
HIN's fifth annual survey on the patient-centered medical home (PCMH) recorded the highest PCMH adoption levels to date, reports Melanie Matthews in this benchmarks podcast. A substantial number of medical homes expect to participate in an accountable care organization (ACO); Ms. Matthews also shares key metrics from the 2011 survey, including time required for medical home conversion and the PCMH effect on medication adherence and patient satisfaction.
The survey also identified an impressive jump in the embedding of case managers in medical homes. Dr. Bruce Nash, senior VP of medical affairs and CMO for CDPHP, where embedded case managers are at the heart of CDPHP's clinical transformation, describes what sets his program apart from other medical home pilots.
Need more information on this topic? Download an executive summary of the survey results.
Healthcare Trends in 2012: Eighth Annual Strategic Industry Forecast
Posted: October 11, 2011
While hospitals might find CMS's pure Medicare bundled payments initiative too restrictive, it won't prevent them from addressing their costs in a bundled payments fashion, predicts Steve Valentine, president of The Camden Group. In advance of HIN's eighth annual industry forecast, Valentine weighs in on the expected growth of bundled payments, a surprising new trend in case management, why the proposed ACO rule disappointed, and the industry segment where accountable care is thriving.
Steve Valentine will be back to illuminate key trends and opportunities for healthcare in the coming year during a November 2, 2011 webinar, Healthcare Trends in 2012: A Strategic Industry Forecast.
Evaluating CMS' Bundled Payment Initiative: Operational, Financial and Clinical Considerations
Posted: October 5, 2011
CMS learned a few things from its first foray into bundled payments, explains Jim Reilly, managing partner with TRG Health Care Solutions. Having worked with all five participants in the Acute Care Episode (ACE) pilot a few years back, Reilly is ideally positioned to identify the three key benefits of participation in the upcoming CMS bundled payment initiative. But in order for episodic payments, bundled pricing and other alternative payment methodologies to be implemented successfully a key organizational process must take place, Reilly notes.
Reilly will examine the key distinctions between each of CMS' four bundled payment models and the organizational criteria that is most effective in bundled payment programs during an October 19, 2011 webinar, Evaluating CMS' Bundled Payment Initiative: Operational, Financial and Clinical Considerations.
The Role of Embedded Case Managers in Clinical Transformation
Lisa Sasko and
Posted: September 8, 2011
Embedded case managers are the latest step in CDPHP's clinical transformation, which began in 2008 with a transition to the patient-centered medical home model and continued with the introduction of new payment models in 2009 and 2010. Lisa Sasko, CDPHP director of clinical transformation, and Charlene Schlude, the organization's director of case management, describes the embedded case manager's role in a new era of healthcare, targeted patients and disease states and some of the operational and cultural issues surrounding the co-location of case managers in physician practices.
Ms. Sasko and Ms. Schlude will share the business case for embedded case managers as well as an inside look at the day-to-day interactions of embedded case managers with providers in practices during a September 20, 2011 webinar The Role of Embedded Case Managers in Clinical Transformation, sponsored by The Healthcare Intelligence Network.
The Patient Experience: How to Keep the Healthcare Customer Satisfied
Posted: August 12, 2011
Spiritual support, in-room WIFI access, improved housekeeping and valet parking are just a few of the perks hospitals have added to boost patient satisfaction ratings. In this month's healthcare benchmarks podcast, Melanie Matthews from the Healthcare Intelligence Network describes how 146 healthcare organizations rank their own efforts to improve patient satisfaction. She also shares key metrics from the 2011 survey on Improving Patient Satisfaction and Experience, including the most important aspect of the care delivery experience and preferred formats for patient surveys.
Patient satisfaction is an important driver of core measurement scores. Dr. Steven Berkowitz, president of SMB Consulting, shares his formula for achieving 100 percent performance on core measures and describes an incentive program for drivers of the quality measures.
Need more data from this survey? Download a complimentary executive summary.
Embedded Case Management in the Primary Care Practice: Program Design and Results
Posted: July 19, 2011
Workflow rehearsals of key practice protocols ensure that the entire care team including the embedded case manager is prepared in advance, notes Robert Fortini, vice president and chief clinical officer at Bon Secours Health System. Fortini describes two workflows "rehearsed" by Bon Secours care teams, details the embedded case manager's contribution to medication compliance in the practice, and explains key steps that precede the case manager hiring process.
Robert Fortini will explain how Bon Secours has adapted the Geisinger Health System embedded case manager model to meet the needs of its own population during Embedded Case Management in the Primary Care Practice: Program Design and Results, a 45-minute webinar on August 10, 2011.
Healthcare Performance Improvement: Exceeding Core Measure Targets for Value-Based Reimbursement
Dr. Steve Berkowitz
Posted: June 24, 2011
The establishment of good core measure performance is good patient care, emphasizes Dr. Steve Berkowitz, president of SMB Consulting and former chief medical officer at St. David's HealthCare, which boasts a mortality index and CMS core measure ratings that are among the best in the nation. Dr. Berkowitz shares his formula for achieving 100 percent performance, describes an incentive program for drivers of the quality measures and weighs in on the need for an EHR to achieve core measure excellence.
Dr. Berkowitz shared practical strategies for improving core measures, as well as modeling techniques to illustrate the impact of a hospital's failure to meet the measures during Healthcare Performance Improvement: Exceeding Core Measure Targets for Value-Based Reimbursement, a 45-minute webinar on July 20, 2011, now available for replay, sponsored by The Healthcare Intelligence Network.
2011 Metrics in Healthcare Case Management
Posted: May 31, 2011
Has the practice of embedding case managers at the point of care grown since 2010? In this month's healthcare performance benchmarks podcast, Healthcare Intelligence Network's Melanie Matthews analyzes trends in contemporary case management and the evolving responsibilities of today's case manager derived from HIN's January 2011 survey results.
Toni Cesta, senior vice president of operational efficiency and capacity management at Lutheran Medical Center and Jan Van der Mei, the regional director of Sutter Health Sacramento Sierra Regions care management programs, supplement this data with commentary on the case manager's role in their organizations.
More actionable data on case management are contained in 2011 Benchmarks in Healthcare Case Management: Responsibilities, Results & ROI, a 40-page report packed with metrics and measures on current and planned initiatives, presented in more than 40 easy-to-follow graphs and tables. This data is derived from responses to the second annual Healthcare Intelligence Network Case Management Survey, which was conducted in January 2011.
Reducing Avoidable ER Visits by Medicaid Patients Through Quality-Based Interventions
Dr. Mina Chang
Posted: May 20, 2011
An Ohio collaborative of Medicaid plans is using a rapid cycle quality improvement approach to reduce avoidable ER visits by its Medicaid beneficiaries. One of the five regions targeted by the collaborative is Toledo, Ohio known for having the highest emergency department utilization in the nation. Mina Chang, Ph.D., of the Bureau of Health Services Research for the Ohio Department of Job & Family Services, outlines the framework of the collaborative. She explains its population-based and patient-centered approach and describes some of the priority populations targeted by the collaborative's interventions.
Dr. Chang will describe how the collaborative is developing actionable interventions to address the patient streams most likely to use the ED inappropriately during a June 23, 2011 webinar, Reducing Avoidable ER Visits by Medicaid Patients Through Quality-Based Interventions, sponsored by The Healthcare Intelligence Network.
Leveraging Population Health Management To Meet Accountable Care Organization Efficiency Metrics
Dr. Barbara Walters
Posted: May 17, 2011
As one of 10 participants in the CMS Physician Group Practice Demonstration, Dartmouth-Hitchcock has developed a competency in population health management that is being deployed in current and planned ACO pilots. Dr. Barbara Walters, Dartmouth-Hitchcock’s senior medical director, describes how the CMS demo experience provided the building blocks for an ACO, the impact of its pilots on Medicare utilization and costs, and the critical elements in managing population health in an ACO.
Dr. Walters will share how Dartmouth-Hitchcock pilots have demonstrated the value of an ACO by achieving efficiency, quality and cost targets during a June 1, 2011 webinar, Leveraging Population Health Management To Meet ACO Efficiency Metrics, sponsored by The Healthcare Intelligence Network.
Improving Medication Adherence Benchmarks Through Community Pharmacist Interventions
Posted: May 5, 2011
Training community pharmacists in the art of motivational interviewing can boost medication adherence levels in the patients who visit them, according to Janice Pringle, Ph.D, director of the program evaluation research unit at the University of Pittsburgh School of Medicine. In a unique intervention, the university is collaborating with Highmark Blue Cross Blue Shield and Rite-Aid pharmacies to deploy the training to 120 participating pharmacies to reduce medication non-adherence, a problem associated with an estimated $290 billion in avoidable medical spending every year, according to a recent New England Healthcare Institute estimate.
Dr Pringle describes the three primary reasons for medication non-adherence driving the intervention, the benefits of training the pharmacists in motivational interviewing and the pharmacy's role in the project.
Dr. Pringle will share how patients are identified for the intervention and the tools and strategies that pharmacists are using to improve adherence benchmark levels during, Improving Medication Adherence Benchmarks Through Community Pharmacist Interventions, a May 25, 2011 webinar from the Healthcare Intelligence Network.
Reducing Readmissions Through Multi-Disciplinary Post-Discharge Support
Dr. Stuart Levine
Posted: April 21, 2011
To achieve the lowest rates of readmissions in its history, HealthCare Partners Medical Group of California first identifies patients at high risk for readmission. HealthCare Partners corporate medical director Dr. Stuart Levine describes HCP's four key strategies to risk-rank patients and suggests proactive measures to limit the number of individuals who are rehospitalized.
Dr. Levine discussed HCP's approach to hospital readmissions during, Reducing Readmissions Through Multi-Disciplinary Post-Discharge Support, webinar on May 18, 2011 now available On-Demand via the Web or on DVD or CD from the Healthcare Intelligence Network.
Identifying Functional Decline in Chronic Care Patients To Reduce Preventable Healthcare Utilization
Posted: April 18, 2010
Functional decline in an elderly person can be the first indicator of a chronic condition ready to snowball out of control. Patricia Zinkus, director of case management at Fallon Community Health Plan, and Susan Legacy, FCHP’s senior manager of case management, describe how their collaborative multidisciplinary intervention monitors for these changes, and why the program's social component is just as critical as home visits and case management outreach.
Ms. Zinkus and Ms. Legacy shared details from FCHP's risk-sharing model during Identifying Functional Decline in Chronic Care Patients To Reduce Preventable Healthcare Utilization, 45-minute webinar on April 27, 2011.
Patient Registries: A Cornerstone in Creating and Delivering Accountable Care
Dr. Gregory Spencer
Posted: April 11, 2011
Whether extracted from an EHR or compiled with a spreadsheet program, there's nothing magical about a registry, explains Dr. Gregory Spencer, chief medical officer for Crystal Run Healthcare. Dr. Spencer demystifies the registry, describes how to leverage registry data in multiple ways and underscores registries' growing value in emerging care delivery models like the accountable care organization.
Dr. Spencer shared patient registry best practices during an April 28, 2011 webinar, Patient Registries: A Cornerstone in Creating and Delivering Accountable Care, sponsored by The Healthcare Intelligence Network.
Assessing ACO Business Opportunities in the Medicare and Commercial Markets
Posted: March 28, 2011
To avoid missing other opportunities inherent in the ACO model, payors and providers shouldn't get hung up waiting for CMS's rule for Medicare accountable care organizations, advises Greg Mertz, senior project director with the Healthcare Strategy Group. In this podcast, Mertz has advice for both providers and payors on how to maximize participation in an ACO.
Mertz provided a critical analysis of CMS's anticipated final rule on Medicare Shared Savings and how it will impact commercial ACOs during a 45-minute webinar on April 21, 2011, Assessing ACO Business Opportunities in the Medicare and Commercial Markets, sponsored by the Healthcare Intelligence Network.
Improving Transitions of Care Between Hospital and SNF: A Collaboration Supporting the Accountable Care Vision
Posted: March 22, 2011
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.
Holder and Michael Demagall, administrator of Bath Manor and Windsong Care Center, an SNF participating in the network, described their collaboration during Improving Transitions of Care Between Hospital and SNF: A Collaboration Supporting the Accountable Care Vision, a 60-minute webinar on April 6, 2011.
2011 Metrics in Accountable Care Organizations
Posted: March 8, 2011
Are accountable care organizations (ACOs) the new wave of healthcare delivery?
In this month's healthcare performance benchmarks podcast, Healthcare Intelligence Network's Melanie Matthews analyzes the industry's acceptance of and participation in accountable care organizations derived from HIN's February 2011 survey results.
Jeffrey Ruggiero, Esq., advises ACO participants to prepare for the legal and regulatory hurdles.
More actionable data on accountable care organizations are contained in 2011 Benchmarks in Accountable Care Organizations: Metrics from Early ACO Adopters, a 40-page report that provides new market research on current and planned ACOs as well as the ACO metrics and measures used by ACO early adopters to evaluate success, quality, efficiency and satisfaction.
Aligning Physician Incentives for Shared Risk and Reward Across the Healthcare Continuum
Posted: February 28, 2011
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.
Apland will share how HealthPartners is aligning physician incentives and shared savings with PFP programs and a total cost of care initiative
during Aligning Physician Incentives for Shared Risk and Reward Across the Healthcare Continuum, a 45-minute webinar on March 2, 2011.
Evaluating Health and Wellness Incentive Programs for Behavior Change
Posted: February 22, 2011
Getting people to think about dying is not the first health behavior that comes to mind when employing incentives. However, incentives can be used anywhere in the healthcare continuum including end of life to influence behaviors, notes Neal Sofian, MSPH, director of member engagement at Premera Blue Cross. Sofian describes the barriers individuals face at this time in their lives and how the use of incentives can result in exactly the kind of care these patients want and need.
Sofian shared the latest strategies to increase engagement and the results from these efforts during Evaluating Health and Wellness Incentive Programs for Behavior Change, a 45-minute webinar on February 10, 2011.
Rewarding Primary Care Practice Reform with Physician Payment Reform: A Medical Home's Experience
Dr. Bruce Nash
Posted: February 10, 2011
Capital District Physicians' Health Plan’s (CDPHP) medical home pilot began in 2008, with the dual goals of reforming both the practice of primary care in the CDPHP network and payments to these physicians. Dr. Bruce Nash, CDPHP's senior vice president of medical affairs and chief medical officer, explains what sets the two-phase CDPHP program apart from other medical home pilots, how participants met the challenge of practice transformation, and why preliminary pilot results mirror what's going on in the industry today.
Dr. Nash described how CDPHP met the challenge of developing a novel risk adjustment methodology that would drive a global payment combined with a significant bonus structure to attract physician participation and encourage future growth by medical students to enter primary care during Rewarding Primary Care Practice Reform with Physician Payment Reform: A Medical Home's Experience, 45-minute webinar on February 23, 2011.
Avoidable ER Visits: Reduction and Prevention Benchmarks
Avoidable ER Visits
Posted: February 10, 2011
How are healthcare organizations encouraging appropriate use of the emergency room in their populations?
In this month's healthcare benchmarks podcast, Healthcare Intelligence Network executive VP and COO Melanie Matthews shares metrics from HIN's July 2010 survey on reducing avoidable ER visits, with relevant commentary from Dr. Barsam Kasravi, managing medical director for state-sponsored programs at WellPoint; and Sara Tracy, senior manager of emergency services at Kaiser Foundation Health Plan of Colorado.
More actionable data on reducing avoidable ER use is contained in 2010 Performance Benchmarks in Reducing Avoidable ER Visits, a 50-page report derived from responses from 90 healthcare organizations. Presenting this data in more than 30 easy-to-follow graphs and tables, this resource documents trends and metrics from emergency departments across the country that are successfully managing ER utilization.
Physician-Owned ACOs: Overcoming the Legal and Regulatory Compliance Challenges
Jeffrey R. Ruggiero
Posted: January 11, 2011
Even though the specifics of Medicare's Shared Savings Program have yet to be defined, physician organizations can still position themselves to achieve cost savings through an independent accountable care organization (ACO), notes Jeffrey R. Ruggiero, Esq., a partner in the law firm of Arnold & Porter LLP, who is advising the Queens County Medical Society on the launch of one of New York State's largest physician ACOs. Ruggiero describes the advantages of a physician-run ACO as well as some of the regulatory, compliance and operational factors to consider prior to ACO launch.
Ruggiero described the Queens County Medical Society’s ACO development approach during Physician-Owned ACOs: Overcoming the Legal and Regulatory Compliance Challenges, a 45-minute webinar on January 19, 2011.
Healthcare Performance Update: Healthcare Trends for 2011
Healthcare Trends for 2011
Posted: January 4, 2011
Was 2010 a better year for healthcare than 2009, and what were the best and worst business ideas in healthcare over the last 12 months?
In this month's healthcare performance benchmarks podcast, Healthcare Intelligence Network's Melanie Matthews reviews the top healthcare trends and concerns for 2011 derived from HIN's October 2010 survey results.
More actionable data on healthcare trends as well as 2011 industry forecasts from healthcare thought leaders William Shea of Cognizant Business Consulting and Steven T. Valentine from The Camden Group are contained in Healthcare Trends & Forecasts in 2011: Performance Expectations for the Healthcare Industry, a 35-page report that reviews the industry landscape for 2011 and suggests how healthcare organizations can best position themselves for the 12 months to come.
Co-Locating Case Managers in the Care Continuum
Jan Van der Mei
Posted: December 16, 2010
Co-locating healthcare case managers in care settings can improve communication with patients as they move through the continuum of care, says Jan Van der Mei, regional director of continuum case management for Sutter Health Sacramento Sierra Region. Ms. Van der Mei describes the major issues that case managers face while helping patients navigate the Sutter system, as well as the key role of case managers in reducing hospital readmissions.
Ms. Van der Mei is one of five contributors to the "Guide to Patient-Centered Case Management," a 110-page resource of best practices in identifying, stratifying and monitoring individuals for case management. It documents the returns generated by targeted case management interventions in place at Geisinger Health System and other organizations, and the Q&A chapter answers more than 50 questions on patient-centered case management.
The Essentials of an Accountable Care Organization: Preparing for the ACO Model
Posted: December 8, 2010
The accountable care organization (ACO) is a staple of healthcare reform. CMS will launch its Shared Savings Program an ACO for Medicare patients in January 2012. John Harris, principal with the consulting firm of DGA Partners, advises potential participants in an ACO to lay the groundwork now. In this interview, he recommends eight elements of an ACO infrastructure and weighs in on the patient-centered medical home's role in an ACO.
Harris is one of five contributors to Essential Guide to Accountable Care Organizations: Challenges, Risks and Opportunities of the ACO Model, a 60-page resource that answers key questions surrounding ACOs so that hospitals, PHOs, IPAs and other physician organizations, networks or group practices can weigh the merits now of creating or joining an ACO before CMS's ACO launches next year.
Maximizing the Nurse Advice Line To Ensure Appropriate Healthcare Utilization
Posted: November 29, 2010
More than a third of healthcare organizations have launched nurse advice lines to reduce avoidable emergency room use and direct patients to the most appropriate care venue, according to a July 2010 survey by the Healthcare Intelligence Network. The staffing and operation of Optima Health's nurse advice line is influenced by many factors, explains Patricia Curtis, director of operations, clinical care services for Optima Health. Curtis describes the distinct responsibilities of the LPNs and RNs who staff the advice line as well as the diverse needs of the member populations who call the advice line.
Curtis shared how Optima’s nurse advice line has evolved from a call center that supported a staff model HMO to a critical component of the organization’s effort to improve the efficiency of healthcare utilization during Maximizing the Nurse Advice Line To Ensure Appropriate Healthcare Utilization, a 45-minute webinar on January 6, 2011.
How To Create an ACO Framework Through Clinical Integration with Independent Physicians
Dr. Mark Shields
Posted: November 23, 2010
Thinking about creating an accountable care organization? The clinical integration of healthcare providers can be the first step, facilitating the coordination of services required for shared accountability and reward. Dr. Mark Shields, senior medical director with Advocate Physician Partners, describes the logistics of training 3,400 providers on clinical integration, the importance of the physician peer group in this effort, and the business case for the devotion of three of Advocate's 41 performance measures to smoking cessation and prevention.
Dr. Shields shared Advocate's clinical integration strategy during How To Create an ACO Framework Through Clinical Integration with Independent Physicians, a 45-minute webinar on December 1, 2010.
Redesigning the Physician Practice for Improved Efficiency and Increased Revenue
Dr. David Eitrheim
Posted: November 17, 2010
In the face of healthcare reform and new models of care delivery such as the patient-centered medical home, primary care physicians don't have to fly solo anymore, advises Dr. David Eitrheim, a family physician with the Mayo Clinic Health System in Wisconsin. Dr. Eitrheim described how his practice's team-based approach has changed the nature of the patient visit as well as the nurses' workload, and provides the secret to a productive patient visit.
Dr Eitrheim shared how his practice made the transformation from a traditional practice to a team-based approach during Redesigning the Physician Practice for Improved Efficiency and Increased Revenue, a 45-minute webinar on December 15, 2010.
Health Risk Assessments: Administration, Delivery and Completion Benchmarks
Health Risk Assessments
Posted: November 12, 2010
Who's using health risk assessments (HRAs), and how are they administered? What are the top incentives driving HRA completion, and what are the top three uses for HRA data? What completion rates can be expected?
In this month's healthcare benchmarks podcast, Healthcare Intelligence Network executive VP and COO Melanie Matthews shares the latest market research on HRA use. This month's metrics are derived from HIN's June 2010 survey on HRAs, with commentary from Dr. Marcia Wade, Aetna Medicare’s senior medical director.
More actionable data on ways that 116 healthcare organizations are using HRAs is contained in 2010 Performance Benchmarks in Health Risk Assessment Use, a 60-page resource providing metrics and measures on current and planned HRA initiatives as well as lessons learned and results from successful health assessment programs.
Health Plan Rate Setting: Balancing Premium Increases Against Regulatory Oversight
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Posted: November 2, 2010
In an atmosphere of increased state and federal oversight of health plan rates, healthcare organizations need a sound strategy for determining premium rate increases that meet regulatory approval. HealthScape Advisors managing directors Steve Young and John Steele describe the challenges of setting rates in this environment and the essential experience that can best prepare health plans for dealing with commercial plans.
Young and Steele shared how health plans can develop a sound policy for premium rate increases that will meet with regulatory approval during Health Plan Rate Setting: Balancing Premium Increases Against Regulatory Oversight, a 45-minute webinar on December 8, 2010.
Integrated Case Management for Medicaid's High-Cost, High-Need Members
Dr. Sam Toney
Posted: October 20, 2010
Medicaid managed care organizations can turn the tide on the rising cost of care management for their high-need, high-cost members by implementing integrated programs that simultaneously address medical and behavioral health conditions, says Dr. Sam Toney, Health Integrated's chief medical officer.
In this podcast, Dr. Toney describes how integrated case management and integrated chronic condition management are especially beneficial to Medicaid's mostly vulnerable members as they navigate acute health crises as well as longer-term, sustainable efforts to improve their health status. For more information on Health Integrated, please visit: http://www.healthintegrated.com or call 800-323-0286.
Embedded Case Managers in the Emergency Department
Posted: October 12, 2010
Organizations should advocate for a case manager in the emergency room, says Toni Cesta, senior vice president of operational efficiency and capacity management at Lutheran Medical Center. Making the business case for an ED-embedded case manager, Cesta shares key targets for case management intervention in the ED and describes how the ER case manager is positioned to improve patients' transitions in care.
Cesta explored how to effectively structure an ED-based case management program and the potential impacts of an embedded case manager in the ED during Embedded Case Managers in the Emergency Department, a 60-minute webinar on November 3, 2010.
Healthcare Trends in 2011: A Strategic Industry Forecast
Posted: October 20, 2009
Healthcare reform offers two major opportunities for healthcare to bend the spend curve and improve profitability, says Steven Valentine, president of The Camden Group. Valentine also weighs in on the current state of healthcare, and why organizations can't think about healthcare reform without considering the current economy.
While the healthcare winds blew more favorably this year than they did in 2009, healthcare organizations will need key expertise to succeed in the year ahead, advises William Shea, a partner in health industry consulting for Cognizant Business Consulting. With the remix of healthcare delivery models brought on by healthcare reform, Shea identifies two challenges inherent in the trend toward patient-centered care that spans the entire continuum of care.
Valentine and Shea provided strategic advice healthcare companies can use to position themselves for success in the coming year during Healthcare Trends in 2011: A Strategic Industry Forecast, a 60-minute webinar on October 20, 2010.
Healthcare Performance Metrics: How to Reduce Avoidable ER Visits
Reducing Avoidable ER Visits
Posted: September 22, 2010
In a new monthly podcast, Healthcare Intelligence Network executive VP and COO Melanie Matthews shares the latest market research on key healthcare topics. This month's metrics are derived from HIN's July 2010 survey on Reducing Avoidable ER Visits, with commentary from Dr. Barsam Kasravi, managing medical director for state-sponsored programs for WellPoint and Sara Tracy, senior manager of emergency services at Kaiser Foundation Health Plan of Colorado.
More actionable data from 90 healthcare organizations on their efforts to reduce inappropriate use of the ED is contained in 2010 Performance Benchmarks in Reducing Avoidable ER Visits, a 50-page resource documenting trends and metrics from EDs across the country that are successfully managing ER utilization.
The Colorado Accountable Care Collaborative: Practical Lessons from an ACO
Posted: September 2, 2010
To provide immediate feedback to participants in Colorado's accountable care organization (ACO) for Medicaid beneficiaries, program developers have chosen a handful of performance measures that will focus on program quality and cost containment, explains Laurel Karabatsos, deputy Medicaid director. The ACO is rapidly approaching its January 2011 launch date, and the development team has worked hard to garner support for an ACO that will provide health services for 60,000 Medicaid lives in the state.
Karabatsos and Jerry Smallwood, Medicaid reform unit manager, walked through Colorado's ACO development process during The Colorado Accountable Care Collaborative: Practical Lessons from an ACO, a 45-minute webinar on September 29, 2010.
Coordinating a Virtual Medical Home in Your Community: Lessons from the Iowa Collaborative Provider Network
Sarah Dixon Gale
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Posted: August 27, 2010
To create a virtual medical home also called a virtual healthcare home primary care providers partner with community organizations to deliver a full continuum of healthcare services in a manner that is transparent to patients and health plan members. Sarah Dixon-Gale, lead contract manager for the Iowa/Nebraska Primary Care Association, explains how Iowa's virtual medical home program has improved access at Siouxland Community Health Center. Also in this podcast, Siouxland CEO Michelle Stephan describes a major challenge faced by the virtual medical home. Learn how this unique community partnership helps to position these organizations for federal Medicaid expansion in 2014.
Dixon-Gale and Stephan shared more lessons learned from the virtual medical home during Coordinating a Virtual Medical Home in Your Community: Lessons from the Iowa Collaborative Safety Net Provider Network, a 45-minute webinar on September 23, 2010.
Reducing Avoidable Emergency Room Visits: Approaches to Redirect Patients to Cost-Effective Care Settings
Dr. Barsam Kasravi
Posted: August 24, 2010
Three key factors influence consumers' use of the hospital emergency room today, according to Dr. Barsam Kasravi, managing medical director for state-sponsored programs for WellPoint. In this podcast, Dr. Kasravi discusses how WellPoint is trying to close critical care gaps and encourage its members to utilize healthcare services more effectively.
Dr. Kasravi and Dr. Karen Amstutz, vice president and medical director of Medicaid and senior markets, described WellPoint's efforts to reduce avoidable emergency room visits during Reducing Avoidable Emergency Room Visits: Approaches to Redirect Patients to Cost-Effective Care Settings, a 45-minute webinar on September 1, 2010.
Case Management: Identifying, Monitoring and Managing Target Populations
Posted: August 10, 2010
As part of CareOregon's initiative to create a more robust care management program, the organization has found new ways of stratifying members and identifying high-risk members, explains Rebecca Ramsay, B.S.N., M.P.H., CareOregon's 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.
Ms. Ramsay shared the strategies that CareOregon is using to segment patients by complexity to ensure that case management resources are allocated effectively during Case Management: Identifying, Monitoring and Managing Target Populations, a 60-minute webinar on September 16, 2010.
Best Practices in Case Management Patient Contact, Monitoring and Follow-up
Jan Van der Mei
Posted: July 19, 2010
One of the advantages of co-locating healthcare case managers in various care settings is the improved level of communication for a patient as they move through the continuum of care, says Jan Van der Mei, regional director of continuum case management for Sutter Health Sacramento Sierra Region. Ms. Van der Mei describes the major issues, such as medication reconciliation and patient and family education, that case managers face while helping patients to understand their health conditions and goals of care as they navigate the Sutter system. She also discusses how case managers can educate patients to avoid hospital readmissions through interventions and symptom management.
Ms. Van der Mei shared details on Sutter Health's case management initiatives during Best Practices in Case Management Patient Contact, Monitoring and Follow-up, a 45-minute webinar on August 25, 2010.
Patient-Centered Medical Home Transformation: How Data Sharing Improves Physician and Business Performance
Dr. Jose Guethon
Posted: July 13, 2010
In another excerpt from a conversation with Metcare of Florida chief executives on its continuing medical home pilot with Humana, COO Dr. Jose Guethon describes the mechanics of sharing utilization and financial data with its physicians, and the impact of this practice and friendly competition between physicians has had on workflow, patient access, customer service and other key metrics.
Dr. Guethon and Metcare CEO Mike Earley described how Metcare practices have made the transformation to patient-centered medical homes, with an eye on maintaining the profitability of their practices, during Patient-Centered Medical Home Transformation: 9 Key Hurdles for Physician Practices To Overcome, a 45-minute webinar on May 12, 2010.
Minimum Medical Loss Ratios: How Health Plans Should Prepare for the January Compliance Requirements
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Posted: July 7, 2010
What constitutes healthcare quality improvement? CMS's definition of medical costs will likely coalesce around five key areas of quality improvement, say John Steele and Steve Young, managing directors for HealthScape Advisors. These CMS guidelines will impact health plans in January, when new medical loss ratio (MLR) regulations take effect. In this podcast, the advisors also describe the risk that insurers could incur on the rebate side if they don't adequately prepare for the January changes and the impact the regulations could have on consumers' medical care and choices.
Steele and Young provided an in-depth analysis of what health plans must do now to comply with the January deadline for MLRs and how this might impact health plans operationally and financially during Minimum Medical Loss Ratios: How Health Plans Should Prepare for the January Compliance Requirements, a 60-minute webinar on July 21, 2010.
The Emerging Role of Nurse Practitioners in Expanding Access, Enhancing Revenue
Posted: June 30, 2010
Nurse practitioners constitute a workforce already grounded in patient-centered care, explains Linda Lindeke, Ph.D., an RN and a nurse practitioner herself since 1978. Lindeke, who is also 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, describes the demographics where a nurse practitioner's contributions might need clarification, explains why there's not much mention of the medical home in nursing literature and assesses the impact of the Affordable Care Act's $15 million allocation to fund 10 nurse practitioner-led clinics that will provide primary care services to the medically underserved.
Lindeke examined how nurse practitioners are being utilized in the physician practice, hospital and clinic settings to increase access to care and coordinate care for patients with chronic conditions during The Emerging Role of Nurse Practitioners in Expanding Access, Enhancing Revenue, a 45-minute webinar on July 28, 2010.
Improving Physician Performance and Value-Based Reimbursement Levels Through Meaningful Data Sharing
Dr. Paul Kaye
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Posted: June 16, 2010
Along with the transformation to a patient-centered medical home came an acceptance of a model that coordinates care for an entire population, not just the patients showing up each day, notes Dr. Paul Kaye, medical director at Taconic IPA. And even though the 238 Taconic physicians at 11 sites have received Level III PPC®-PCMH™ recognition from the NCQA, Susan Stuard, executive director of THINC, explains that practice transformation doesn't stop there.
Dr. Kaye and Ms. Stuard described how the sharing of data across its organization is improving physician performance and value-based reimbursement levels during Improving Physician Performance and Value-Based Reimbursement Levels Through Meaningful Data Sharing, a 45-minute webinar on June 23, 2010.
Reducing Unnecessary Emergency Room Visits: Strategies To Discourage Inappropriate Use and Reduce Preventable Visits
Posted: June 2, 2010
When primary care isn't available, several proxy healthcare services can sometimes fill the bill for certain conditions, helping to reduce the number of avoidable emergency room visits, explains Sara Gray, senior manager of emergency services at Kaiser Foundation Health Plan of Colorado. Ms. Gray describes two important steps hospitals can take when discharging patients to keep those patients from seeking post-discharge care in the ER, and suggests a hospital-SNF partnership to reduce preventable ER visits by SNF patients.
Ms. Gray shared Kaiser's three-pronged approach to reducing inappropriate and avoidable ED use during Reducing Unnecessary Emergency Room Visits: Strategies To Discourage Inappropriate Use and Reduce Preventable Visits, a 45-minute webinar on June 9, 2010.
Recruiting Physician Practices for a Medical Home Pilot
Dr. Marjie Harbrecht
Posted: May 24, 2010
As more payors test the patient-centered medical home model of care, what are the pros and cons of participation for physician practices? Dr. Marjie Harbrecht, medical and executive director of Health TeamWorks, describes the financial middle ground that is likely to satisfy payors and providers who sign on for medical home pilots and offers some additional selection criteria her organization (formerly the Colorado Clinical Guidelines Collaborative) may use in the future.
Dr. Harbrecht examined how practices are recruited, selected and supported in medical home programs during Physician Practices in the Medical Home: Recruiting, Evaluating, Supporting and Measuring the Patient-Centered Team, a 45-minute webinar on May 19, 2010.
Home Visits in the Patient-Centered Medical Home
Dr. Larry Greenblatt
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Posted: May 13, 2010
Medicaid patients present their own unique set of needs during home visits, explain Dr. Larry Greenblatt, medical director, Chronic Care Program, Durham Community Health Network, Duke University Medical Center, and Jessica Simo, program manager, Durham Community Health Network for the Duke Division of Community Health. The duo explains the two types of patients that benefit most from home visits, the priorities of the home visit and the most common problems identified during home visits.
Dr. Greenblatt and Ms. Simo examined the features of a successful home visit initiative during Home Visits in the Patient-Centered Medical Home, a 45-minute webinar on May 20, 2010.
Patient-Centered Medical Home Transformation: 9 Key Hurdles for Physician Practices To Overcome
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Dr. Jose Guethon
Posted: April 27, 2010
In the first of several conversations with Metcare of Florida chief executives on its continuing medical home pilot with Humana, CEO Mike Earley and President and COO Dr. Jose Guethon describe Metcare's longstanding commitment to the management of care transitions for its Medicare patients, how its 10 medical home practices keep a handle on patient care in hospital settings, and the clinical and business returns that result from these efforts.
Earley and Dr. Guethon described how Metcare practices have made the transformation to patient-centered medical homes, with an eye on maintaining the profitability of their practices, during Patient-Centered Medical Home Transformation: 9 Key Hurdles for Physician Practices To Overcome, a 45-minute webinar on May 12, 2010.
A Coordinated Discharge Planning Approach to Reduce Avoidable Hospital Readmissions
Posted: April 13, 2010
Sharing the latest literature on the causes and prevention of hospital readmissions is Susan Shepard, the director of patient safety education for The Doctors Management Company. Ms. Shepard described the type of patient most at risk for readmission, some of the risks inherent in transitioning patients from one care site to another, and the contribution of the patient's primary physician to a successful discharge.
Shepard identified key aspects of the hospital admission, stay and discharge that can reduce the likelihood of readmission during A Coordinated Discharge Planning Approach to Reduce Avoidable Hospital Readmissions, a 45-minute webinar on April 28, 2010.
Shared Savings in the Medical Home
Dr. David West
Posted: April 2, 2010
The patient-centered medical home is at the heart of Mesa County, Colorado's shared savings model, explains David West, M.D., a hospitalist, family physician and healthcare consultant from Grand Junction, Colorado. Dr. West describes how the shared savings model can be adapted across markets, including the conditions and factors that must be present for this approach to be feasible. He also shares a unique provider incentive that is keeping hospital stays of Medicare patients at less than one-third the national average, one of the factors that has the nation touting this area as a model for efficient healthcare delivery.
Dr. West examined how to structure a shared savings agreement during Shared Savings in the Medical Home, a 45-minute webinar on March 31, 2010.
Embedded Case Managers: Navigating Care Transitions, Gaps in Care and Patient Compliance
Posted: March 11, 2010
The contributions of an embedded case manager to the practice quickly become evident, explains Diane Littlewood, R.N., regional manager of case management for health services, Geisinger Health Plan, which in turn bolsters physician buy-in for the program. She describes the upfront basics that help to ensure that health plan and provider expectations for embedded case management are met.
Ms. Littlewood examined an embedded case manager program, from the factors that will help determine if a program is right for an organization and deciding on the placement to defining roles and responsibilities for the program, during Embedded Case Managers: Navigating Care Transitions, Gaps in Care and Patient Compliance, a 45-minute webinar on March 10, 2010.
Achieving Medication and Care Plan Adherence Through an Integrated Care Team
Dr. Jan Berger
Posted: March 4, 2010
While neither colocation of team members nor an electronic health record is a prerequisite for a successful integrated care team, explains Dr. Jan Berger, chief medical officer of Silverlink Communications Inc., there are four essential factors that contribute to the confidence and comfort levels of both patients and team members.
Dr. Berger shared practical examples on how the integrated care team can work together to support patients in adhering to care plans, including a model of care that places the pharmacist on the care team and another that incorporates technology, during Achieving Medication and Care Plan Adherence Through an Integrated Care Team, a 45-minute webinar on March 17, 2010.
Assessing and Predicting Health Risk in the Elderly
Dr. Marcia Wade
Posted: January 26, 2010
Even though more than a third of the elderly are online, they're not necessarily using the Internet to seek health assistance, explains Marcia Wade, M.D., F.C.C.P., M.M.M., senior medical director at Aetna Medicare. That's why Aetna delivers its health risk assessment for the elderly in an alternate format while making available other Web-based tools to web-savvy boomer beneficiaries. Dr. Wade also describes Aetna's user-friendly strategy for heading off high-risk complications among its elderly and how this contributes to an overall reduction in hospital readmissions.
Dr. Wade will explain what to assess in the elderly population, how to match interventions based on risk score and the impact of this type of initiative during Assessing and Predicting Health Risk in the Elderly, a 45-minute webinar on February 10, 2010.
Multi-Payor Medical Home Programs: Addressing Funding and Organizational Challenges
Posted: January 14, 2010
A year into the Colorado multi-payor medical home pilot whose practices provide care to 30,000 patients, Julie Schilz, B.S.N., M.B.A., prescribes a single tool that can help transform practices, improve quality and deliver evidence-based care. It's NOT an EHR, says the manager of the Improving Performance in Practice and Patient-Centered Medical Home (PCMH) initiatives for the Colorado Clinical Guidelines Collaborative, who lists this tool's four key functionalities. Also in this interview, Schilz describes the influence of other reimbursement models on the Colorado pilot and identifies two opportunities for NCQA to enhance its PCMH recognition process.
Schilz shared Colorado's experience to date in creating this multi-payor initiative from the development of the program to the challenges of working with multiple payors during the January 20, 2010 webinar, Multi-Payor Medical Home Programs: Addressing Funding and Organizational Challenges.
Health Coaching Evaluation: Measuring the ROI on Healthcare Utilization and Costs
Dr. Jim Reynolds
Posted: December 29, 2009
The dismal economy of 2009 has been a bright spot for health coaching and other health improvement programs, notes Dr. Jim Reynolds, chief medical officer for Health Fitness Corporation. Dr. Reynolds also compares early results from a Massachusetts' smoking cessation program for Medicaid beneficiaries with outcomes in commercial populations, and describes what Year 1 of a coaching program for improved medication adherence might yield in the way of behavior change and cost impacts.
Dr. Reynolds and Dr. Elizabeth Rula, clinical research manager at the Center for Health Research at Healthways Inc., shared how their organizations respond to the challenges of evaluating and reporting on health coaching ROI during the January 13, 2010 webinar, Health Coaching Evaluation: Measuring the ROI on Healthcare Utilization and Costs.
Medication Therapy Management in the Patient-Centered Medical Home
Posted: December 21, 2009
The pharmacist has a natural and important role in patient medication reconciliation and review, explains Dr. Beth Chester, senior director of clinical pharmacy services and quality, Kaiser Permanente Colorado. She describes the dramatic impact that a pilot pharmacist intervention had on emergency department visits and mortality rates among patients just discharged from skilled nursing facilities (SNFs) once the health plan's pharmacists stepped in to monitor medication therapy in this population.
Dr. Chester detailed the roles of the physician practice’s staff and the pharmacist in medication management, the use of technology and how financial incentives and reimbursement can play a role in improving medication compliance during the January 6, 2010 webinar, Medication Therapy Management in the Patient-Centered Medical Home.
Risk Adjustment in the Medical Home: Building an Effective Reimbursement Strategy
Posted: December 11, 2009
Social and demographic factors such as chaos in the home or functional status can complicate care coordination for patients as much as clinical factors, explains Jeff Schiff, M.D., M.B.A., medical director of Minnesota Health Care Programs for the Minnesota Department of Human Services. He identifies two key social/demographic factors getting close attention in Minnesota's new primary care reimbursement model and explains how the engagement of patient and family at the clinical level is paying off in improved patient safety, satisfaction and health outcomes.
Dr. Schiff examined the risk factors that need to be considered in a risk-adjusted medical home reimbursement strategy during the December 16, 2009 webinar, Risk Adjustment in the Medical Home: Building an Effective Reimbursement Strategy.
Aligning Reimbursement To Reduce Avoidable Hospital Readmissions
Dr. Randall Krakauer
Posted: November 30, 2009
Maryland's Hospital Preventable Readmissions program rewards efforts that reduce hospital readmissions while improving care quality and decreasing cost. Dianne Feeney, associate director of quality initiatives for the Maryland Health Services Cost Review Commission (HSCRC), describes HSCRC's response to hospitals that claim they can't afford the empty beds that result from programs like these, as well as processes to help ensure that higher-risk patients are not refused admittance to hospitals. She also explains how partnerships with "siloed settings" nursing homes and home health providers can reduce common errors that occur during patient handoffs.
Case managers and advanced practice nurses in Aetna's Transitional Care pilot have also successfully partnered to reduce readmissions. Dr. Randall Krakauer, national medical director, Medicare at Aetna, describes the key focus and the complementary roles that reduced 90-day readmissions by 25 percent. Dr. Krakauer also weighs in on the pros and cons of bundled payments, and why incentives alone will not significantly impact avoidable readmissions.
Feeney and Dr. Krakauer examined how to structure programs to reduce avoidable hospital readmissions, including the alignment of financial incentives, during the December 2, 2009 webinar, Aligning Reimbursement To Reduce Avoidable Hospital Readmissions.
Reducing Avoidable Hospital Readmissions: A Case Study from Priority Health
Posted: November 17, 2009
Priority Health members play an active role in keeping themselves out of the hospital, explains Mary Cooley, manager of case and disease management at Priority Health. She describes the four-point strategy that is reducing readmissions at Priority Health, the challenges that still exist and the essential tool that Priority supplies to help providers identify and close care gaps.
Cooley provided more details on the strategies that Priority Health is using to reduce avoidable hospital readmissions during Reducing Avoidable Hospital Readmissions: A Case Study from Priority Health, a 45-minute webinar on November 18, 2009.
Effective Case Management in the Medical Home
Geisinger Health Plan
Posted: November 5, 2009
Case managers are the backbone of the Geisinger Health Plan (GHP) Health NavigatorSM program, a medical home partnership between primary care providers and GHP that has reduced 30-day hospital readmissions by 15 to 20 percent. Providing benchmarks for case manager caseloads and contact frequency, tools to support the case management effort, the key to smooth placement of case managers in the medical home and tips for better management of patients discharged to nursing facilities are Diane Littlewood, R.N., and Joann Sciandra, R.N., who are both regional managers of case management for health services at Geisinger Health Plan.
Littlewood and Sciandra provided more detail on the key components of a winning case management program during Effective Case Management in the Medical Home, a 45-minute webinar on November 11, 2009. The webinar is part of HIN's continuing Medical Home Open House webinar series.
Predicting Healthcare Reform's Biggest Losers and Winners
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Posted: November 4, 2009
A forecast of 2010 healthcare trends would not be complete without some prognostication on the fate of healthcare reform. The Healthcare Intelligence Network asked William DeMarco, president and CEO of DeMarco and Associates, and Jim Knutson, risk manager and human resources director, Aircraft Gear Corporation, to predict the winners and losers from the controversial legislation as well as the delivery date of the much-debated package.
DeMarco and Knutson go beyond crystal-gazing to describe the implications for key healthcare stakeholders in the coming year with a special focus on payment reform in Healthcare Trends & Forecasts in 2010: Performance Expectations for the Healthcare Industry, a new special report from the Healthcare Intelligence Network.
Medical Home Open House Highlights Part 2: Physician Practice Innovations To Improve Care Delivery
Posted: October 27, 2009
Medical home innovators Group Health Cooperative, Greenhouse Internists and Grand Valley Health Plan describe practice level transformations that improve care delivery and move them along the path to NCQA medical home recognition in Part 2 of Medical Home Open House Highlights.
Click here to listen to Part 1: Focus on Care Continuity, Quality and Access.
Achieving NCQA's Patient-Centered Medical Home Recognition
Posted: October 12, 2009
Grand Valley Health Plan's (GVHP) workgroup approach helps the staff model HMO to successfully disseminate workflow changes resulting from its NCQA medical home recognition process, explains Barbara Luskin, GVHP quality manager, and also created location champions in the process. Luskin describes how GVHP demonstrates compliance with the most challenging NCQA "must-pass" elements and shares GVHP's early returns in patient satisfaction ratings, quality of care and healthcare utilization.
Luskin and Dr. James Kerby, GVHP vice president of medical affairs, shared the basics of preparing for and achieving recognition from NCQA's Physician Practice Connections® - Patient-Centered Medical Home™ during Achieving NCQA's Patient-Centered Medical Home Recognition, a 45-minute webinar on October 21, 2009. The webinar is part of HIN's continuing Medical Home Open House webinar series.
Applying Evidence-Based Guidelines in the Medical Home
Dr. Richard J. Baron
Posted: September 24, 2009
Despite the challenges, cost and uncertain return of EHRs, practices should move quickly to adopt this tool, recommends Dr. Richard J. Baron, president and CEO of Greenhouse Internists, where the EHR is the backbone that supports the implementation of evidence-based practices.
Dr. Baron shared his practice’s evidence-based guidelines experience from working with physicians on documentation, staff training and work flow redesign to using the data to improve practice performance during the October 6, 2009 webinar, Adopting and Implementing Evidence-Based Guidelines in the Medical Home. The 45-minute session is part of HIN's continuing Medical Home Open House webinar series.
Tackling Healthcare Fragmentation with Innovative Health Management Solutions
Posted: September 23, 2009
Through the implementation of innovative health management programs, we can improve the performance of our healthcare system, says Steve Wigginton, president of Health Integrated, a leading health management solutions company. This podcast discusses how Health plans that make investments in wellness, chronic condition management and technology can enjoy a healthy return on investment with improved health outcomes for their members. To download a case study of one health plan's successful use of health management solutions that improved outcomes and reduced costs, and for more information on Health Integrated, please visit: www.healthintegrated.com/HIN909A or call 800-323-0286.
Successful Models of Care for the Medical Home: Staffing and Roles of the Care Team
Posted: September 1, 2009
Although Group Health Cooperative's increased their primary care staff, patients are still successful in connecting with their caregivers, says Michael Erikson, vice president of primary care services for Group Health Cooperative. In fact, the key to a patient's understanding of his care team lies in the physician's hands. In this podcast, Erikson discusses the effect Group Health's staff expansion has had on its patients, as well as the many benefits of contacting patients via phone and e-mail in lieu of in-person office visits.
Erikson described the staffing strategies it implemented to reduce downstream utilization costs from the skill sets required by the staff to the workflow changes needed to accommodate this model of care during a September 9, 2009 webinar, Successful Models of Care for the Medical Home: Staffing and Roles of the Care Team. The 45-minute session is part of HIN's continuing Medical Home Open House webinar series.
Medical Home Reimbursement: Exploring Bundled Payment Options
Posted: August 19, 2009
Healthcare reform partially fueled Baptist Health System's desire to participate in the CMS Acute Care Episode (ACE) pilot that is testing bundled or episodic payments for selected orthopedic and cardiac procedures, explains Michael Zucker, Baptist's chief development officer. He describes some early returns from the experience, highlights the provider's role in Baptist's multi-pronged awareness campaign for Medicare beneficiaries and explains the committee-based approach to quality change and cost savings that has already improved communications among participating providers.
Zucker shared Baptist Health System's experience thus far in the CMS bundled payment pilot and early feedback during a September 16, 2009 webinar, Medical Home Reimbursement: Exploring Bundled Payment Options. The 45-minute session is part of HIN's continuing Medical Home Open House webinar series.
Closing Gaps in Care for Chronic Conditions
Posted: August 12, 2009
The fragmentation in the U.S. healthcare system for the care of chronic conditions, like diabetes, asthma, heart disease, and depression, causes the health of individuals with these chronic conditions to deteriorate while driving up expenses in emergency room visits and inpatient stays, says Steve Wigginton, president of Health Integrated, a health management solutions company. In this podcast, Wigginton describes how by closing gaps in care, addressing the interplay between medical and psychosocial health and providing day-to-day support for these patients, organizations can avoid costly emergency room visits and inpatient stays.
Medical Home Open House Highlights Part 1: Focus on Care Continuity, Quality and Access
Posted: July 31, 2009
The opening sessions of the Medical Home Open House webinar series delivered tips for improving care continuity, quality and access for patients assigned to a medical home.
Click here to listen to Part 2: Physician Practice Innovations To Improve Care Delivery.
Constructing Care Transitions to Reduce Hospital Admissions
Posted: July 23, 2009
Geisinger Health Plan's successful Transitions of Care program is the health plan's response to rising rehospitalization rates among Medicare patients, a major concern of both CMS and private payors. Geisinger Health Plan's Doreen Salek defines the transition teams' key area of focus when providing a "clean and clear handoff" of a patient from one care site to another, with the goal of avoiding readmission to the hospital. The health plan's director of business operations of health services also defines the plan's ideal home health partner, its blueprint for a universal plan of care to improve care coordination and expectations for patients and their families and caregivers.
Salek, along with Janet Tomcavage, R.N., M.S.N., vice president of health services for Geisinger Health Plan, explained how a focus on transitions of care across the continuum can enhance care quality and reduce readmissions during the August 26, 2009 webinar, Constructing Care Transitions to Reduce Hospital Admissions. The 45-minute session is part of HIN's continuing Medical Home Open House webinar series.
Patient Engagement and Education in the Medical Home: Perspectives from Several Pilots
Posted: July 16, 2009
Looking to jump-start patient outreach in the medical home? The appointment calendar is a great place to start, recommends Barbara Wall, a healthcare consultant who advises organizations on adoption of the patient-centered model of care. She describes the simple steps that medical home staff can follow to turn the appointment calendar into a patient teaching, recall and outreach tool.
A featured presenter during HIN's Medical Home Open House webinar series, Wall explained the essential process changes that improve patient outreach and keep the patient at the center of the medical home during the August 5, 2009 webinar, Patient Engagement and Education in the Medical Home: Perspectives from Several Pilots.
Meet the Medical Home Neighbor: Accountable Care Organizations
Dr. Craig Samitt
Posted: July 14, 2009
The accountable care organization (ACO) — a network of primary care physicians, one or more hospitals, and subspecialists that provide patient-centered care — is receiving increasing attention as healthcare reform unfolds. Not only do ACOs complement the medical home model, but they are inextricably linked, says Dr. Craig Samitt, M.B.A., president and CEO of Dean Health System. Dr. Samitt discusses how ACOs complement the medical home model, the pros and cons of mandatory and voluntary ACOs and creating reimbursement strategies for ACOs.
Dr. Samitt shared how Dean Health System uses its best practices to create an accountable care organization that provides a high-value patient-centered care experience during the July 29, 2009 webinar, Meet the Medical Home Neighbor: Accountable Care Organizations, part of the Medical Home Open House webinar series.
Reducing Uncompensated Care Costs for the Chronically Ill Through a Medical Home Approach: A Health System Case Study
Dr. Ricardo Guggenheim
Posted: July 9, 2009
Increasingly, uninsured patients are seeking chronic care via the ER, where they are stabilized, possibly admitted and eventually discharged. However, this cycle is not conducive to managing chronic diseases, and, in the end, will result in high costs and poor quality of care for these individuals, says Dr. Ricardo Guggenheim, vice president of care management services at McKesson Health Solutions. Dr. Guggenheim discusses what areas stand to see improvements as a result of managed uncompensated care, why it is essential to invest in managing uninsured care costs and future plans for McKesson's Care Advisor program.
Baptist's Health's referral of patients to its family medicine residency program has given residents a greater understanding of the fiscal impact of the uninsured on the healthcare system, and the benefits don't end there. Robin Barca discusses the residents' experience with the medical home model, details of patient contracts and just how much of Baptist's uncompensated care falls into charity care.
Dr. Guggenheim and Barca described how, with a small up-front investment, Baptist was able to manage its health system costs more effectively and provide care for chronic diseases in more appropriate settings during the July 16, 2009 webinar, Reducing Uncompensated Care Costs for the Chronically Ill Through a Medical Home Approach: A Health System Case Study.
Medical Home Contracting: Building a Solid Framework
Dr. Barbara Walters
Posted: July 7, 2009
There are several ways a healthcare organization can bring clinical credibility to the medical home contract negotiating table, explains Dr. Barbara Walters, senior medical director for Dartmouth-Hitchcock Medical Center. She describes the ways in which the medical home contracting process differs from the standard payor contracting experience and highlights some typical performance guarantees to include in a medical home contract.
In a July 8, 2009 webinar, Medical Home Contracting: Building a Solid Framework, Dr. Walters shared how to effectively prepare, negotiate and contract with payors for the medical home model of care to better prepare organizations for a seat at the negotiating table. The 45-minute session is part of HIN's continuing Medical Home Open House webinar series.
Finding Success in Health Behavior Change
Posted: June 29, 2009
A move backward in readiness to change should not be perceived as a failure on the client's part but rather as an opportunity to readjust behavior goals, observes Kate Larsen, president of Winning LifeStyles, Inc., an ICF-certified professional coach and a WellCoaches® faculty member and mentor coach. There's value in reminding clients that health coaching is a journey and in checking coaching egos at the door to improve listening skills and allow clients to own their behavior change goals, notes the author of "Progress, Not Perfection."
Larsen and Claudine Reilly, wellness manager at CVS Caremark, a Certified Intrinsic Coach, and a Certified Health Education Specialist, provided different scenarios that coaches might encounter with patients and examples of how coaches can and should respond to assist clients in achieving the health behavior change they need during the July 15, 2009 webinar, Finding Success in Health Behavior Change.
Healthcare Trends in 2009: A Mid-Year Financial and Legislative Update
Posted: June 23, 2009
Early and costly proposals for healthcare reform are creating clouds of uncertainty on the healthcare horizon, providing scant relief for organizations stymied by the economy, patient safety issues and internal budget restraints, observes Paul Keckley, Ph.D., executive director of the Deloitte Center for Health Solutions. As he prepares a mid-year review of financial and legislative trends shaping the healthcare industry, Keckley anticipates a slow and bumpy road to EHR adoption and defines the three key elements of the platform for a new generation of care-giving and care consumption at a community level.
Keckley examined how the industry is faring in 2009, including the impact of stimulus funding on the industry, the potential and expected shape for reform and other industry trends during the June 25, 2009 webinar, Healthcare Trends in 2009: A Mid-Year Financial and Legislative Update.
Under One Roof: Integrating Primary Care and Behavioral Healthcare in the Medical Home
Posted: June 17, 2009
Individuals with severe and persistent mental illnesses are likely to die 20 years earlier than people without such conditions, says Liz Reardon, president of Reardon Consulting and a member of the National Council for Community Behavioral Healthcare (NCCBH) Integration Consulting Team. Putting the right medical home services in place for adults with chronic mental illness can help to reduce this disparity, suggests Reardon, explaining why the earliest medical homes for children with complex health needs are great models for behavioral healthcare organizations.
Reardon and Laura Galbreath, NCCBH Director of Policy and Advocacy, kicked off HIN's Medical Home Open House webinar series when they presented current developments in the patient-centered medical home model with evidence-based approaches to integration of primary care and behavioral health during the July 1, 2009 webinar, Under One Roof: Integrating Primary Care & Behavioral Health in the Medical Home.
Patient Activation Measure™: Assessing the Engaged Healthcare Consumer for Self-Efficacy
Dr. Judith Hibbard
Posted: May 27, 2009
There are many ways to administer the Patient Activation Measure™ (PAM) and many socioeconomic factors that influence its outcomes, explains Dr. Judith Hibbard, developer of the PAM and professor of health policy at the University of Oregon. Dr. Hibbard identifies the PAM scores that signal a behavior change and the value of adding patient activation assessment to a health improvement initiative.
American Health Holding relies on the Patient Activation Measure™ to assess a patient’s level of engagement in their own overall disease management (DM), but it does more than just that. PAM scores are also used to gauge the success of the DM program and its coaches. Director of DM and wellness services Diane Bellard discusses PAM — who is using it, how to deal with a decrease in PAM levels, how it fits with a patient's readiness to change and PAM's role in an organization's overall quality improvement.
Dr. Hibbard and Bellard shared the research behind the development of the PAM, its potential for improving a patient's healthcare self-efficacy and examples of its use in a DM setting during the June 18, 2009 webinar, Patient Activation Measure™: Assessing the Engaged Healthcare Consumer for Self-Efficacy.
Wiring the Medical Home: Healthcare IT to Power a Patient-Centered Model
Dr. James Crawford
Posted: May 20, 2009
Dr. James Crawford, senior vice president for laboratory services and chair of the department of pathology and laboratory medicine at North Shore-Long Island Jewish Health System, discusses the key process change that must accompany the adoption of health IT by a medical home as well as health IT's impacts on care coordination and findings from the PCPCC's survey of physician practices on their use of health IT in support of the medical home model.
Health IT is extremely important in improving an organization's communication and prevention strategies, says Ewa Matuszewski, CEO of Medical Network One. In this podcast, Matuszewski also comments on how health IT supports the joint principles of the PCMH and describes how her health IT tool of choice can be a stepping stone to further implement IT within an organization.
Dr. Crawford and Matuszewski presented case studies on the use of health IT in the medical home and its impact on care access, quality and cost in a May 28, 2009 webinar, Wiring the Medical Home: Healthcare IT to Power a Patient-Centered Model.
Reducing Acute and Chronic Care Costs Through an Effective Health Risk Stratification Model
Dr. William Vennart
Posted: April 29, 2009
Predictive modeling and health risk stratification can help providers identify members for case management and disease management interventions, says Dr. William Vennart, vice president of medical management and national medical director with CareAdvantage Inc. These methods ensure that patients receive treatment for their chronic conditions early on and, in turn, reduce unnecessary utilization and lower acute and chronic care costs.
Health claims are still scrutinized during risk stratification, but today's analysts examine these data points through a slightly different lens, explains John Harris, chief wellness officer and senior vice president for Healthways. Harris explains why the focus has shifted from ICD-9 coding patterns to the financial trends evident in the claims, and what accelerating or decelerating costs reveal about an individual's health status.
Dr. Vennart and Harris described how their organizations have approached health risk stratification, from how individuals are identified for stratification purposes to the effectiveness of risk stratification programs during a May 6, 2009 webinar, Reducing Acute and Chronic Care Costs Through an Effective Health Risk Stratification Model.
The Strategic Ongoing Role of Disease Management in the Healthcare Continuum: Achieving the ROI
Dr. Dexter Shurney
Posted: April 13, 2009
Nightly data mining has helped Vanderbilt University and Medical Center identify and make contact with high-risk high-volume patients, explains Dr. Dexter Shurney, which has vastly improved patient outcomes and closed care gaps. But the medical director of Vanderbilt's Employee Health and Care Plan would like to see even more data put in front of physicians at the point of care — especially regarding certain patients with no claims history. Dr. Shurney describes these "bombs waiting to explode," as well as the impact of the patient-centered medical home (PCMH) model of care on disease management and why wellness and prevention services may be the best responses to individuals with comorbidities.
Dr. Shurney, along with Dr. Ariel Linden, Dr.P.H., M.S., president of Linden Consulting Group, examined how disease management programs can continue to prove their worth and new developments in disease management that are netting results during The Strategic Ongoing Role of Disease Management in the Healthcare Continuum: Achieving the ROI.
Medical Home Metrics and Measurements for Achieving ROI
Dr. Don Liss
Posted: March 24, 2009
IBM spends about $2 billion a year on healthcare for its 500,000 employees but doesn't believe it's getting its money's worth from the current system, explains George Chedraoui, healthcare leader with IBM and immediate past president of Bridges to Excellence. Chedraoui explains why IBM is banking on the patient-centered medical home (PCMH) — with its focus on disease prevention and wellness — to deliver this value, what impact $19 billion in health IT incentives will have on physician practices, and why it will take more than technology to transform a physician practice into a medical home.
Aetna's practice of sending its providers periodic "care considerations" — detailed clinical data that identify opportunities to improve care — has been formalized in its patient-centered medical home (PCMH) pilot with Partners in Care (PIC), explains Dr. Don Liss, the regional medical director of Aetna's mid-Atlantic region. PIC providers' engagement with the care considerations is now a factor in the pay for performance aspect of the pilot. Dr. Liss shares some short-term indicators that demonstrate that the PCMH is working as well as the long-term view for medical home ROI, which can vary greatly for payors and providers.
Chedraoui and Dr. Liss shared different viewpoints — the healthcare payor and purchaser — and their strategies for achieving an ROI from the medical home during, Medical Home Metrics and Measurements for Achieving ROI.
Calculating the Health Coaching ROI: Models and Results
Posted: March 18, 2009
According to Paul Terry, Ph.D., president and CEO of StayWell Health Management, when evaluating health coaching and population health programs, it is rare to see a return on investment in a program's first year, but generally by the second and third years, ROI begins to build. In addition to discussing ROI trends, Terry evaluates the value of self-reported data and the impact health coaching can have on an organization's productivity, presenteeism and absenteeism, and also gives some benchmarks for ROI in health coaching.
Terry, along with Dr. Craig Nelson, director of health services research for American Specialty Health, described the measures to look at when evaluating health coaching and population health programs and provided case studies of how they are actually using these measures to demonstrate a health management ROI during a March 25, 2009 webinar, Calculating the Health Coaching ROI: Models and Results.
Physician Quality Reporting Initiative in 2009: How To Avoid Submission Errors and Improve Reimbursement
Dr. Bruce Bagley
Posted: February 27, 2009
According to Dr. Bruce Bagley, the cornerstone of PQRI is quality improvement, and any bonus payments physicians receive for reporting efforts are just that — by-products of the process. Dr. Bagley, medical director of quality improvement for the American Academy of Family Physicians, also shares his views on the value of patient registries and other healthcare IT for PQRI, and advises physicians who may be frustrated by their PQRI experiences.
Dr. Bagley, along with Betsy Nicoletti, consultant, Medical Practice Consulting, LLC, described how PQRI can provide physician practices with a great start on registries and measurement and reporting and provided practical hands-on PQRI coding and auditing strategies during a March 18, 2009 webinar, Physician Quality Reporting Initiative in 2009: How To Avoid Submission Errors and Improve Reimbursement.
New Approach to Chronic Pain: Focus on Patient, Not Condition
Dr. Agostino Villani
Part 1: 14:04
Part 2: 13:49
Posted: February 26, 2009
Too often, pain management tends to focus on the conditions rather than the people experiencing the pain, says Dr. Agostino Villani, internationally recognized expert on chronic pain, CEO of Triad Healthcare, Inc., and author of Pain Is Not A Disease. According to Dr. Villani, this way of thinking depersonalizes the experience of pain and treats it as a disease instead of the complex, personal event that it really is. In Part 1 of this interview with Dr. Villani, he discusses his new book as well as pain management programs, pain level reduction strategies and side effects of pain medications. In Part 2, Dr. Villani discusses the importance of the physician-patient relationship, measuring the outcomes of pain management and med school curricula surrounding the topic of pain management.
Reducing Heart Failure Admissions through Remote Health Monitoring
Dr. Randall Williams
Updated: September 16, 2009
Remote monitoring of heart failure patients by Henry Ford Health System reduced expected all-cause hospital admissions for enrollees by 36 percent after six months of enrollment and a return of 2.3:1 vs. program costs, according to a September 2009 study. Dr. Randall Williams, CEO of Pharos Innovations, the developer of the Tel-Assurance® remote patient monitoring platform used in Henry Ford's medical home pilot, describes how the daily engagement of Medicaid beneficiaries in self-care health monitoring programs can help healthcare organizations avoid many of the challenges inherent in working with this frequently underserved population. Once participants are identified, they are very receptive to the daily contact, which has resulted in extremely high program engagement rates.
Dr. Williams, along with Dr. Thomas Kline, medical director, Iowa Medicaid Enterprise, and Katherine Scher, R.N., C.C.M., program manager for the Center for Clinical Care Design at Henry Ford Health System, describe the factors that can impact engagement in telephonic health management programs and present strategies to improve engagement rates in Health IT in Care Management to Improve Health and Effect Behavior Change.
Patient Assignment into the Medical Home: Building a Collaborative Patient-Centric Approach
Dr. Anita Murcko
Dr. Charles DeShazer
Posted: February 4, 2009
According to Dr. Anita Murcko, medical director of clinical informatics and provider adoption with the Arizona Health Care Cost Containment System (AHCCCS), patient involvement and collaboration with providers are the keys to any successful medical home assignment — not only understanding what a medical home can provide patients but also how this model of care can empower them.
There are so many benefits to implementing the medical home model, that they more than justify the initial investment needed, says Dr. Charles DeShazer, market medical officer at Humana. These benefits range from a decrease in fragmentation of care to an increase in quality care processes to even allowing physicians to manage their time more efficiently. DeShazer also discusses the importance of patient involvement, overcoming patient resistance and measuring the success of your medical home.
Dr. Murcko and Dr. DeShazer examined the various approaches to medical home assignment and the factors that can impact effective assignment in a February 12, 2009 webinar, Patient Assignment into the Medical Home: Building a Collaborative Patient-Centric Approach.
Improving Patient Collections in an Unhealthy Economy: Technologies and Processes to Speed Payments
Kevin Burchill, Sean McDonagh and Ben Tobin
Posted: January 19, 2009
With a revenue cycle that is measured by claims denials, collaborative data mining by billing and IT can identify origins of financial "bleeding" and turn these problems into actionable items, explain Beacon Partner experts Kevin Burchill, director; Sean McDonagh, practice director; and Ben Tobin, management consultant. Patient-friendly IT can also improve the patient experience on the front end while obtaining data to improve collections on the back end. This is a practice frequently employed by more financially robust providers. The three experts also debate the merits of offering patient discounts for prompt payment and placing patient credit reports in providers' hands.
Burchill, McDonagh and Tobin, along with Beacon senior consultant Greg Adams and principal Phil Villacci, provided practical strategies, techniques and tools to improve patient collections without alienating patients during Improving Patient Collections in an Unhealthy Economy: Technologies and Processes to Speed Payments.
Emergency Room Utilization: Developing a Team Approach to Address Overcrowding Factors That Increase Wait Time
Posted: January 6, 2009
Delaying of healthcare for economic reasons is causing volatility in hospital emergency room volumes that is expected to intensify. To handle staffing, equipment and treatment challenges posed by these census variations, hospital EDs must rethink processes and protocols. At Edward Hospital in Naperville, Il., a "culture of certification" that includes cash bonuses for certification and peer support during exam preparation helps to raise the caliber of the ER staff and maintain patient satisfaction levels. Cindy Rentsch, Edward Hospital's clinical director of emergency services, describes the culture of certification that has raised the caliber of Edward's ER staff, a marketing campaign to divert mental health patients from the ER and protocols for treatment of pediatric ER patients.
Rentsch will be joined by Joan Heater, director of nursing emergency services, Banner Gateway Medical Center and Kevin Roche, director of the management engineering program at Banner Health Corporation, during Emergency Room Utilization: Developing a Team Approach to Address Overcrowding Factors That Increase Wait Time, a January 14, 2009 webinar. The three presenters shared organizational strategies that improve throughput in the ER as well as increase efficiencies, reduce costs and improve patient outcomes and satisfaction.