Does Collaborative Continuous Quality Improvement + Technology Innovation = Improved Hospital Value-Based Purchasing Scores?

Poised at the nexus of Supreme Court oral arguments for health care reform constitutionality and the close of the Centers for Medicare and Medicaid Services (CMS) Hospital Value-Based Purchasing (HVBP) nine month performance period (July 2011-March 2012), hospitals eagerly anticipate news regarding their FY2013 Medicare reimbursement.  Beginning October 2012, CMS will reduce base operating diagnosis-related group (DRG) payment to all hospitals reimbursed under the inpatient prospective payment system (IPPS) model by 1 percent, with the amount gradually increasing to 2 percent by FY 2017.  Monies withheld will be used to create an incentive fund for future hospital performance based payment relative to identified domains of quality measures. Final determination of payment from the 1 percent withholding will be calculated as a linear function based on all participating entities, meaning that organizations must demonstrate continuous quality improvement in order not to fall behind their peers.

As outlined in the FY 2013HVBP final rule, an overall performance score will be calculated by assessing achievement and improvement for an institution’s Clinical Process of Care Measures and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient survey feedback.  In determining the final score, CMS will weigh the HCAHPS results at 30 percent and the Clinical Care Core Measures results at 70 percent.

For each of the 17 measures (12 identified for FY2013 shown below) included under the Clinical Process of Care Measures, CMS will use hospital data to calculate a performance score ranging from 0 to 10. A hospital earns an achievement score based on how well it did relative to a lower threshold and upper benchmark (generally 1.0 or 100%) calculated from all hospitals’ previous baseline scores, and an improvement score based on whether it beat its own performance during the baseline period. CMS uses the higher of these two scores for its official tally. In theory, a hospital could receive all 10 points if it beats the achievement benchmark, or 0 if it fails to meet the achievement threshold or better its own previous score.

Measure ID	Clinical Process of Care Measure Description	Threshold
AMI-7a	Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival	0.6548
AMI-8a	Primary PCI Received Within 90 Minutes of Hospital Arrival	0.9186
HF-1	Discharge Instructions	0.9077
PN-3b	Blood Cultures Performed in the Emergency Department Prior to Antibiotic Received in Hospital	0.9643
PN-6	Initial Antibiotic Selection for CAP in Immunocompetent Patient	0.9277
SCIP-Inf-1	Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision	0.9735
SCIP-Inf-2	Prophylactic Antibiotic Selection for Surgical Patients	0.9766
SCIP-Inf-3	Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time	0.9507
SCIP-Inf-4	Cardiac Surgery Patients with Controlled 6AM Postoperative Serum Glucose	0.9428
SCIP-VTE1	Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered	0.95
SCIP-VTE2	Surgery Patients Receiving VTP w/I 24Hours Prior to Surgery to 24 Hours After Surgery	0.9307
SCIP-Card-2	Surgery Patients on a Beta Blocker Prior to Arrival Receiving a BB During the Perioperative Period	0.9399

Scoring remains relatively the same for the eight measures based on the HCAHPS patient surveys. Hospitals, however, also can earn up to 20 consistency points based on how well their single lowest score stacks up to the competition. Hospitals will receive a percentage grade based on how many points they scored out of the possible total.  CMS will post all scores on its Hospital Compare site and use the final performance score to determine the value-based incentive payment.

Domain	Question	Min	50th %	Benchmk
Nursing	Nurse courtesy and respect	38.98	75.18	84.7
Communication	Nurse listens carefully
	Nurse explanations are clear
Doctor	Doctor courtesy and respect	51.51	79.42	88.95
Communication	Doctor listens carefully
	Doctor explanations are clear
Staff	Did you need help in getting to bathroom?	30.25	61.82	77.69
Responsiveness	Staff helped with bathroom needs
	Call button answered
Pain	Did you need medicine for pain?	34.76	68.75	77.9
Management	Pain well controlled
	Staff helped patient with pain
Medication	Were you given any new meds?	29.27	59.28	70.42
Instructions	Staff explained medicine
	Staff clearly described side effects
Discharge	Did you go to a home or another facility?	50.47	81.93	89.09
Information	Staff discussed help needed post discharge?
	Written symptom/health info provided
Cleanliness and Quietness	Area around room quiet at night	36.88	62.8	77.64
Hospital	Room and bathroom kept clean
Overall Rating	Hospital rating question	29.32	66.02	82.52

While CMS’ Hospital Value-Based Purchasing Final Rule refers to Medicare patients only, private payers are quickly advancing towards a quality based reimbursement model as well.  As the bar continues to be raised in pursuit of improved quality and better value, how will your organization prepare for this challenge?  With less time to address the much more speculative HCHAPHS scores, does this provide the greatest area for improvement?  Since many enterprising organizations are currently engaged in this process, will innovative technology coupled with collaborative continuous quality improvement keep your institution in the race?

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

*Graphic courtesy of Triple Tree Research

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Are Collaborative Care Planning Teams and Technology the Key to Reducing Readmissions?

Are Collaborative Care Planning Teams and Technology the Key to Reducing Readmissions?

Tick tock goes the clock – in six short months the Centers for Medicare & Medicaid Services (CMS) will begin withholding 1% of Medicare inpatient payments for avoidable readmissions within 30 days.  Peaking at 3% in 2014, this penalty has the potential to be a major financial hit to some hospitals already facing lower reimbursements. According to PriceWaterhouse Coopers Health Research Institute’s, “The Price of Excess: Identifying Waste in Healthcare”, preventable hospital readmissions are a significant avoidable cost in the U.S. health care system, costing an estimated $25 billion annually. Further noted by authors Stephen Jenks, MD MPH, Mark Williams, MD and Eric Coleman, MD MPH, poor discharge procedures and inadequate follow-up care lead to nearly one in five Medicare discharged patients being readmitted within 30 days.  And across all insured patients, the preventable readmission rate is 11 percent, while the rate for Medicare patients is 13.3 percent.

While Jenks et al. noted that the highest rates of preventable readmission diagnoses are heart failure, COPD, psychoses, intestinal problems, and various types of surgery (cardiac, joint replacement, or bariatric procedures), the National Priorities Partnership estimates that total hospital readmissions could be reduced by up to 12% by improving proce­dures for admitting and dis­charging patients, providing better follow-up care and utilizing health information technology. With many readmissions costing between $6,000 and $10,000 each, a number of innovative solutions aimed at helping reduce avoidable incidents could be implemented:

During the Inpatient Stay

-          Collaborative Care Planning (CCP) – similar to morning management huddles, convene a multi-disciplinary discharge planning team to start working with the patient prior to transition to develop a care plan in laymen’s terms that effectively addresses appropriate care, medication instructions, future physician appointments, transportation and other psychosocial needs.

• Include health plan, home health, skilled and long-term providers in discussion via innovative technology or other means
• Request primary care physician acknowledgement of care plan before patient transition
  • Schedule first follow-up visit to occur within five days
• Clinical Pharmacist member of CCP team meets with patient to discuss medication, preventable errors and presents 30 day supply
• Require patient to ‘consent’ to care plan and sign-off prior to transition
  • Additional literature has highlighted the fact that most patients have one primary care giver – look for ways to integrate this individual into your discussions and follow-up
• Similar to the VA’s blue button, integrate the care plan with current EHR technology and make available online, in addition to paper format, via a patient portal

Following Discharge

-          CCP team member follows-up with patient within 48 hours

-          Schedule follow-up visit by CCP team member for high risk patients to review progress, monitor safety of home and manage medication adherence

• Akin to the Health Alliance Plan’s HealthTrack, enroll patient in disease management program
  • Assign Care Navigator/Coordinator/Health Coach
• Provide patient education materials in paper and online format, including interactive symptom checker driven by evidence based tool that delivers directives based on a decision tree
• Implement telehealth, IVR and/or wireless monitoring to remind patients to take meds, follow preventative measures, attend PCP visits and provide early warnings of worsening health conditions
• Educate patients regarding early warning signs and appropriate next steps

-          Explore means of sharing data with all participating parties in order to avoid duplicative visits, tests and other unnecessary resource consumption

-          Standardized discharge summary is sent to primary care physician, payer, clinicians, care givers

-          Post-mortem review of readmitted patients

If significant reductions in readmissions are to be achieved, a true system approach must be implemented with appropriate payment reform to bind payers, providers, physicians, pharma and specialty organizations to this important initiative.  Reengineering current processes to include collaborative care teams and progressive information technology could be the key for improving transitions, reducing readmissions and delivering safe, quality, patient-centered care.

 

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

Innovating Your Way to a Patient-Centric Emergency Department

As noted in a recent article by Hospital & Health Network’s Senior Editor, Haydn Bush, “When a patient with a sore throat, earache or other minor ailment heads to the emergency department for a cure, there are a raft of consequences every hospital is familiar with: longer waits for patients with more serious conditions, higher costs for the patient and the hospital, and the challenge of treating a patient in a less-than-ideal care setting.”  With the onset of National Patient Safety Awareness Week, it is an ideal time to review innovative strategies for implementing Be Aware for Safe Care (the 2012 NPSF theme), proper selection of care setting, reduction of wait time and expense and, ultimately, a more positive patient experience.

Since hospitals are required by the Emergency Medical Treatment and Active Labor Act (EMTALA) to take care of all patients that arrive in their ED, it is counter-intuitive to think that their best course of action might be to refer patients elsewhere.  It is in this vein that leaders at Presbyterian Healthcare Services of New Mexico have been piloting a program to screen patients for more serious problems prior to scheduling a primary care appointment for them.  Having met with the Centers for Medicaid & Medicare, local advocacy groups and ED physicians, this group’s initiative has led to decreased ED utilization and return visits from patients who had been navigated to primary care settings previously.

Additional tactics for preventing unnecessary ED visits include staffing and procedural changes within the ED department itself. Nurse Practitioner and Physician Assistants, along with a triage coordinator, have been successful at handling fast track patients with lower acuity.  Care coordination teams are also popping up at various facilities in order to ensure that patients presenting with chronic repeat problems receive care from a variety of disciplines – psychosocial, nursing, physical/occupational therapy, dietary and others.  Follow-up telephonic visits are conducted in efforts to confirm that patients are adhering to their care plan.  If one were to add a relationship management program that encompassed interactive voice response and mobile alerts, it would be intriguing to measure the enhanced outcomes.

According to Neighborhood Health Plans’ Multi-Dimensional Approach to Reducing Preventable Emergency Room Use, there are a number of additional steps that can be implemented post-visit to prevent future ones.  First, NHP distributes patient education materials in the form of the Healthwise Handbook to all members who have visited the ED for ambulatory-sensitive conditions in the past quarter.  In addition, members have access to the handbook online, which includes an interactive symptom checker.  By clicking on a body part and answering a series of questions generated by an evidence-based tool, patients can receive care recommendations such as seek urgent care, call a primary care physician or go to the emergency room.

NHP also sends quarterly reports to all physician groups in its network to indicate: (1) which of their patients have used emergency rooms; (2) which patients have used EDs frequently (i.e., more than five times in the past year); (3) the diagnoses of patients using emergency rooms and whether they used EDs for ambulatory-sensitive conditions;(4) times of day during which patients have used emergency rooms; and (5) health outcomes following ED visits. NHP sends reports to individual physicians and posts them on its secure Web portal so that physicians can sort and analyze the data.  Such impactful changes are to be lauded; however, just imagine the change that a multidisciplinary payer – provider team working in tandem with the chronic needs population could achieve.

While these examples are nothing less than noteworthy, the most potentially innovative change could be found in Intermountain Healthcare’s recent telehealth launch, which allows individuals to access primary care physicians or specialists from private computers at the hospital via a video chat feature located on the IHC website.  Individuals presenting at the ED, only to learn that their symptoms are more appropriate for primary care, now have the option to speak with a physician in a safe environment for a reasonable fee in an acceptable amount of time. Sounds like a win-win to me.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

Population Health Management: Revolutionizing Health Care Service Delivery

As noted in the recent HealthLeaders Media article, ACOs Population Health Management Share a Common Thread, “(as) the reimbursement environment transitions from volume-based to a value-based one focusing on quality care and efficiency, providers will be held accountable and could lose out financially if the health of their patients doesn’t improve.“  In an attempt to be ahead of the curve, one such group, Monarch HealthCare, is doing just that.  As a participant in the Brookings-Dartmouth ACO Pilot Program, this large physician-led independent practice association (IPA) felt well suited to pursue the concept of patients first.  And in the Commonwealth Fund’s January 2012 Case Study, Toward Accountable Care, the authors provide a comprehensive overview of the group’s journey towards this goal.

Located in the northern, southern and Orange county coastal California regions, this seventeen year old organization contracts with 2,200 independent private practice physicians to serve nearly 180,000 patients.  With a license to take global risk under its own Medicare Advantage plan, Monarch specializes in providing managed care to seniors.  Spurred by a perceived competitive threat from Kaiser Permanente’s move into Orange county, Monarch decided to leverage its extensive managed and preventive care experience in order to develop an accountable care organization.  Extolling their “I CARE” values, standing for “Innovation, Communication, Accountability, Respect, and Excellence.”, Monarch partnered with Anthem in order to provide care coordination and care navi­gation support for 25,000 Anthem preferred provider organization (PPO) members in Orange County.

In order to bear risk and successfully share in potential savings, Monarch had to develop sophisticated tools and infrastructure to manage both the quality and costs of care for this popula­tion of patients.  Specifically, they engaged in the following:

ACO Structure

• Governance & Leadership – two complementary governance structures are involved in overseeing and driving the progress of Monarch’s single payer/provider ACO model. These include an internal Executive Steering Committee, which meets weekly, and an external Monarch-Anthem Partners Joint ACO Steering Committee, which meets monthly. The Joint ACO steering committee is also supported by the Attribution, Clinical Operations, Contracting, Cost of Care, HIT/Sys Ops, Marketing/Sales/Comms, Medical Management, Performance Metrics and Product Development/Benefit Design subcommittees.  In addition, the SVP for Accountable Care position was created to execute ACO strategy.
• Payment – for the first year, the two groups have agreed on a care management fee and simple shared-savings model. They also have noted that for the ACO to be successful, they will eventually need to shift to a risk-bearing model and aim to phase in a global capitation model over the course of the five-year contract.

HIT Infrastructure

• Health Information Exchange (HIE) – when it is launched, this Web-based platform will pro­vide internal connectivity between systems that are already in place at Monarch and between Monarch’s electronic systems and those of other institutions.
• NextGen – includes an EHR system, prac­tice management system, internal HIE system and patient portal. The EHR is linked with laboratories, pharmacies, imaging services, and appointment reminder tools.  And the patient portal will provide patients with secure access to phy­sicians via e-mail and enable them to request appointments or medication refills and see test results.
• PracticeConnect – a web-based tool that deploys information to all independent practice providers and enables clinical information-sharing, patient status inquiry and messaging.  With chronic care registries and claims submission/authorization/referral features, a variety of important metrics can also be monitored and reported.

Population Management Strategies

• Case Management – Monarch keeps a tight rein on care transitions for their elderly population by using the following “five pillars” as guidelines: 1) reconcile medications, 2) set a follow-up appointment, 3) educate patients about warning signs, 4) use effective patient–physician communica­tion, and 5) use a personal health record.  Key players in providing case management include inpatient case managers, ambulatory case managers in a centralized office, employed hospitalists and nurse practitioners on site at hospitals and skilled nursing facilities, social workers, patients’ primary and specialty care physicians,  inpatient medical directors and ambulatory care medical directors .
• Disease Management and Registries – primary care providers and disease man­agement coaches help asthmatic and diabetic patients write self-care man­agement plans, with a case manager being assigned to each patient. The plans include recommendations for patients on routine care, sick-day planning, symptom recognition, and early intervention to prevent unneces­sary emergency department visits.
• “Touch Teams” – an advanced nurse practitioner, case manager, social worker, and pharmacist—coordinate patients’ transition from hospital to home and make home visits. Monarch also hired two full-time social workers to integrate behavioral health clinical services and other community-based services into the overall plan of care for each high-risk patient.
• Personal Health Records and Advance Directives – these two paper-based tools are used to improve care transitions. The personal health record includes sections on medi­cal history, medications, recent hospitalizations, emergency or urgent care visits and preventive maintenance.  The Physicians Orders for Life Sustaining Treatment is recorded on paper, as well as online, for future reference.
• Urgent Care and ‘Alternative’ Providers – in order to reduce hospital re-admissions and emergency department visits, Monarch has employed hospitalists, skilled nursing physicians and nurse practitioners for better care transitions and, if appropriate, encouraged members to utilize urgent care facilities.

Performance Improvement

• Readmission Rounds – medical director or assistant medical director, hospitalists, and case managers con­duct a root cause analysis of every readmission that occurs within 30 days of discharge to determine where the system broke down and how to improve care pro­cesses.
• Integrated Care Teams – a new initiative aimed at bringing together all of the people involved in managing a population of patients. These teams will focus on patients aligned with spe­cific physician practices, according to geography.  With local integration, Monarch hopes to facilitate more effective communication and alignment across specialties, geographic locations, and episodes of care.
• Reducing Waste – by pulling relevant data from the network using nearly 20 complementary data systems, as well as actu­arial services to compare utilization with peer organiza­tions, Monarch identified system-wide inefficiencies in duplicative or otherwise unnecessary tests, inadequate communication of information, excessive inpatient bed days, unnecessary utilization of specialists and over­-utilization of emergency services.
• Quality Gate and Efficiency Scorecard – the qual­ity gate is the minimum performance threshold that must be achieved by participating providers in order to receive a bonus. The draft efficiency scorecard iden­tifies aggregate utilization and costs associated with efficiency measures. Once the ACO passes the quality gate, the efficiency scorecard will be used to determine the savings that will be shared between Monarch and Anthem.

Through strong executive leadership, trust and transparency in partnerships, use of care navigators, physician champions and economies of scale, Monarch HealthCare has the potential to revolutionize healthcare service delivery with its population management strategies.  In light of Monarch’s recent acquisition by OptumHealth, a subsidiary of UnitedHealth Group, it will be intriguing to see if they remain the course.  The proof, no doubt, will be in the pudding.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

*image courtesy of the Public Health Agency of Canada

Can Health IT’s Newest Ideas Reduce Cost, Improve Quality and Facilitate Patient Engagement?

Billed as ‘the most comprehensive and authoritative knowledge event in healthcare IT today’, the HIMSS12 Annual Conference commenced this week.  Borrowing from the success of the TED conferences, the event was kicked-off by Twitter cofounder and innovator, Biz Stone.  Careful to point out that his purpose was not to deliver healthcare social media strategy, he instead left the audience with the notion that the health care industry could expand its reach by embracing entrepreneurial humanitarianism. In keeping with this sentiment, Intel’s Global Director of Innovation, Eric Dishman and Innosight Institute’s Executive Director, Jason Hwang MD, noted that healthcare IT is the conduit for improved access, heightened collaboration and faster decision-making.  And while technology can bring physicians, patients, payers and other necessary healthcare organizations together, IT alone will not lead to better patient care.

Last but not least, in a MedCity News interview from the conference, Lisa Suennen of the Psilos Group, reiterated the need for healthcare start-ups to, “(not only) find technologies that engage the consumer, provider and payer altogether in a system in order to make a difference, (but also) be able to demonstrate concrete measures of cost savings and return on investment.”  Most telling, she also mentions, “there is a lot of (technology) to collect and preview data…but not much in terms of taking it from a pragmatic standpoint to make an operational difference”. Aha, score one for process improvement AND technological advancement.

Based on Information Week’s Marianne Kolbasuk McGee HIMSS12 preview, it will be intriguing to determine which of the following newest health IT ideas will successfully reduce cost, improve quality and facilitate patient engagement.  Here are my favorites.  With many more available for review at the conference, what were yours?

• MyHospital24/7 Telemedicine Platform – MyHospital24/7, from Consult A Doctor, is a turn-key suite of telemedicine services configurable for hospitals and health systems. The telemedicine platform, which will debut at HIMSS, allows hospitals to offer their patients telemedicine access via phone, email, or video to their employed and affiliated physicians, or to Consult A Doctor’s national network of certified physicians. The platform includes an integrated physician and patient dashboard that enables adaptable workflow and business logic.

• Shareable Ink – helps healthcare organizations transition from paper documentation to electronic records using an enterprise cloud-based platform that incorporates “natural input tools,” including iPads and digital pen and paper technology. Using a specialized ballpoint digital pen, clinicians can continue to fill out forms and other documents manually. The pen records every stroke and transmits the data to Shareable Ink’s data center, where it is processed, converted to digital data and transferred to the healthcare provider’s e-health record system. Built-in analytics give hospitals and physician practices insight into their operations–from a clinical, quality, and efficiency standpoint.

• Capsule Technology’s Neuron – a medical device integration platform to capture vital signs, Neuron has an intelligent touch screen designed to manage bedside connectivity and workflow for higher and lower acuity, and fixed and mobile environments. Capsule Neuron also has a field upgradeable design for flexibility and scalability. It can be used with RIFD to manage a healthcare enterprise’s future connectivity needs, including smart pump connectivity and encounter reporting.

• PatientSafe Solutions’ PatientTouch – a mobile care product that enables healthcare providers to coordinate people, processes, and data in real time. PatientTouch delivers Positive Patient Identification (PPID) workflows, clinically contextual communications,and configurable care interventions via a single, easy-to-use device running on the Apple iPod touch. The product is configurable to hospital policies and procedures for medication administration, nursing intervention, clinical documentation, and communication.

• Summit Express Connect 9 – the latest iteration of Summit Healthcare’s interface engine, an interface consolidation tool for healthcare organizations. The new version emphasizes ease-of-use with a new feature called Summit APEX Mapper, which allows general IT staff to design, filter, and map complex interfaces. Healthcare organizations can leverage EC 9 to support a range of interoperability initiatives, including connecting their hospital information systems to third-party ancillary systems; integrating with physician offices; connecting to health information exchanges and regional health information organizations; and laying the integration foundation required in order to achieve Meaningful Use.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

Kick-starting Healthcare Innovation with TEDMED2012

Having just written about crowdsourcing for healthcare innovation, I was intrigued by a recent tweet for the TEDMED2012 Conference.  Landing on the TED home page, I found myself selecting a link for Lucien Engelen’s presentation, “Crowdsourcing for Your Health”. As the former Dutch Health 2.0 Ambassador, Engelen is also the founder of REshape, a program of Radboud University Nijmegen Medical Centre dedicated to creating the decade of the self-empowered patient.  Inspirational stuff, indeed.

Originated by Richard Saul Wurman, the first TED Conference was launched in 1984. Building on a fascination with people he met working in the fields of technology, entertainment and design, he seized the opportunity to explore these connections further in conference format.  Independently owned and operated, TEDMED remains true to the TED spirit by gathering a community of passionate leaders and doers from a variety of disciplines to “think out loud” about the challenges and opportunities facing health and medicine today.

In his thought provoking TEDMED2011 delivery, the tech publisher, Ted Reilly, discusses what healthcare can borrow from Silicon Valley titans, from better product development to crowdsourcing implementation, wearable tech and even advantageous hacking.

TEDMED2012 will be convening at the legendary Opera House, located in the John. F. Kennedy Center for the Performing Arts in Washington, DC on April 10-13th.  Exciting to note, each of the 11 Main Hall sessions can be live-streamed FREE to qualified healthcare organization auditoriums in HD from professionally produced, multi-camera, high definition feeds. With the opportunity for your institution’s physicians, medical staff leaders, residents, nursing, allied health and administrative staff to send questions electronically to speakers in real-time, what better way to spark innovation in your own organization?  Extend the invitation to providers across the street, payers around the corner, specialty organizations over the hill etc. and we may very well have the impetus for collaboration at the local level.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

Crowdsourcing for Healthcare Innovation

Crowdsourcing for Healthcare Innovation

In Robert Berenson, MD and Nicole Cafarella’s article, Is the CMS Innovation Center Innovating Too Fast?, the authors note that, “One of the few health policy issues that receives bipartisan support is the need to dramatically alter the way providers are paid, shifting from “paying for volume” to “paying for value” to alter the trajectory of health care spending while improving health care quality.”  One of the cost-cutting and quality enhancing tools created to facilitate this activity is the Center for Medicare and Medicaid Innovation.  While previously focused primarily on policy matters, the Innovation Center has added a new tactic to its strategy: crowdsourcing.  Originally coined by Jeff Howe, crowdsourcing’s open call technique helps solve complex problems by leveraging individuals most fit to perform identified tasks, thereby encouraging development of the most relevant and fresh ideas.

The CMS Innovation Center is deploying this tactic by issuing a number of innovation challenges with the intent to award up to $1 billion in grants to applicants who will implement the most compelling new ideas to deliver better health, improved care and lower costs to people enrolled in Medicare, Medicaid and CHIP, particularly those with the highest health care needs.  As further stipulated in Berenson and Cafarella’s artice, “Despite relatively broad agreement in the policy community on the Innovation Center’s objectives, some are skeptical about the role of government, as centralized in the Innovation Center, in promoting and adopting true innovation.   Another criticism is that the speed and approach it is using―rolling out over a dozen initiatives in rapid succession―are leaving behind potential innovators that have not been ready to respond to the quick pace of new funding opportunities.”

While proponents will likely fall on both sides of the coin, it is interesting to note that:  a) bipartisan support underscores the fact that the majority grasp the need to develop better care delivery systems and processes and b) the crowdsourcing technique has generated mass response and appeal. Inherent to the crowdsourcing definition, physicians, nurses, allied health and support professionals are conceivably the most fit to address healthcare delivery issues.  And if it is working at the federal and state level, why aren’t healthcare organizations adopting this model at their own institutions?  Penn Medicine is.

Launched on February 7^th, “Your Big Idea: Penn Medicine Innovation Tournament” offers faculty and staff the opportunity to submit patient experience innovations for evaluation and potential funding.  A well defined process will help define the top 10 submissions, followed by contestants pitching their ideas to Penn Medicine’s leadership in a town hall setting. The winning ideas will receive funding and resources for implementation.  While politics and budget concerns will likely determine the fate of federal care delivery improvements, perhaps crowdsourcing can prove to be the stimulant for healthcare innovation at the grassroots level.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

Collaborative Care for Living Well with Chronic Disease

In observance of National Wear Red Day, Americans will wear red to show their support for women’s heart health.  Poor heart health can lead to congestive heart failure, one of the leading chronic illnesses estimated to represent 75 percent of the $2 trillion in U.S. annual health care spending.  Also noted in the Institute of Medicine Report, Living Well with Chronic Illness, “chronic illnesses are slow in progression and long in duration, and they require medical treatment. All chronic illnesses have the potential to limit the functional status, productivity, and quality of life of people who live with them.”

In order to improve individual quality of life for chronic illness sufferers while simultaneously reducing healthcare spending, radical re-engineering of the healthcare delivery system must occur.  One such innovative design can be found in British Columbia’s Expanded Chronic Care Model.  According to this model, healthcare organizations must support chronic disease management (CDM) strategy at all levels.  Attempts at improvement must be aimed at global change and include a defined process for addressing quality issues.  Furthermore, agreements to facilitate care coordination must extend within/across organizations in the continuum of care and incent providers to improve quality of care.

The model further stipulates that health care service delivery should be tailored to assist practitioners in implementing planned interactions to support evidence-based care. Providing culturally sensitive clinical case management services for patients with complex health issues in combination with regular follow-up moves the needle in the right direction.  In order to carry out these tasks, healthcare organizations should harness the potential of their clinical information systems through the use of business intelligence software to identify and target sub-populations that would merit additional focus for care planning, targeted messaging and intervention.

The patient’s role is also crucial to maintaining good health and this model demands that individuals play a central role in managing his or her health. Self-management support strategies include assessment, goal-setting, action planning, problem-solving, follow-up and establishing contact with community resources that provide support.  Mobilization of community resources to support or expand healthcare for chronically ill patients remains additionally critical. The key focus here is to encourage: (a) patient participation in community programs (exercise, seniors and self-help groups) and, (b) partnerships with community organizations to support and develop interventions to bridge gaps in needed services.

Current healthcare delivery systems developed around acute visits and crisis management have not been successful in meeting chronic disease care needs. Based on brief and infrequent patient-provider interactions, these models do not provide the sustained support necessary to maintain the healthy lifestyle changes critical to prevention and management of chronic diseases. To better meet the needs of these individuals, care systems must explore new ways to define collaborative care for living well with chronic disease.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

* Graphic:   Wagner, E.H.  Chronic Disease Management:  What Will It Take to Improve Care for Chronic Illness?  Effective Clinical Practice 1998; 1:2-4.   Permission to reproduce model image granted from American College of Physicians (ACP), July 7, 2006.

Healthcare Innovation for an Economy Built to Last

According to President Obama’s recent State of the Union speech, “An economy built to last is one where we encourage the talent and ingenuity of every person in this country.  It means we should support everyone who’s willing to work, and every risk-taker and entrepreneur who aspires to become the next Steve Jobs.” Overwhelmed by the increasingly complex, disorganized and costly system of care, healthcare organizations are creating entities to explore non-traditional solutions to a wide variety of healthcare delivery issues.  Taking a cue from private industry, these organizations are embracing innovation as a means for overcoming a number of previously insurmountable obstacles.  According to the California Healthcare Foundation’s brief, Reinventing Health Care Delivery:  Innovation and Improvement Behind the Scenes, the following is a short list of formal programs that currently exist:

• Kaiser Permanente’s Sidney Garfield Healthcare Innovation Center serves as a test bed for workflow improvements, floor design plans and new technologies. In addition, they host comparative analyses and live demonstrations of competing technologies and equipment for consideration.  Two innovative processes emanating from this concept include the Nurse Knowledge Exchange, a comprehensive bedside protocol that facilitates information sharing at the time of shift change and KP MedRite, a systematic process for safe medication administration.

• With three hospitals and 40+ physician practices in predominantly rural Pennsylvania, Geisinger Health System was an early adopter of the patient centered medical home concept.  Rebranded ProvenHealth, this forward thinking entity is focusing on personal care coordination by shifting from episodic acute care to a continuous, comprehensive team-centered approach.

• Massachusetts General Hospital’s John D. Stoeckle Center for Primary Care Innovation develops, tests and implements improvements for their 22+ primary care practices care delivery process.  Included in their arsenal is a patient decision support tool that involves viewing short videos explaining the pros and cons of various treatments.  Additional efforts to increase the utility of the patient-provider interaction include development of the Ambulatory Practice of the Future which relies heavily on virtual doctor-patient visits.

• Northwestern Memorial Hospital’s Szollosi Healthcare Innovation Fund – borne out of a discussion between patient, Peter Szollosi, and Dr. Lyle Berkowitz, contributions to this entity are being used to improve the overall patient experience.  More specifically, this small group is focused on junctures in the care continuum where significant events transpire but friction or inefficiency often undermine the process.

• Vanderbilt University Medical Center for Better Health provides a range of tools and capabilities for developing, testing and implementing new healthcare methodologies, systems and strategies.  While fifty percent of the work is performed for the medical center and medical school, the remaining time is spent consulting for external clients.

• Mayo Clinic Center for Innovation is using a patient-centered focus to transform the experience and delivery of health care for patients everywhere. Laser focused on three platforms, each one is centered on human needs, has a multidisciplinary team, internal and external collaborators and a diverse portfolio of projects supported by a solid business model.  Specifically, they have their sights set on practice redesign, community health transformation and care at a distance.

• Ascension Health Transformational Development Team – as the largest nonprofit health system with 67 hospitals and more than 500 total health care facilities, this group spends a great deal of time scanning a variety of business and industrial sectors to identify ideas, solutions and techniques that may be applicable in extending care beyond the hospital of physician’s office.  Borrowing from the world of high-tech start-ups, Ascension’s “funnel” approach requires a project to progress through a specific set of development, validation and testing stages prior to approval.  In a radical departure from traditional healthcare delivery, this group is also piloting immersion studies aimed at uncovering unique social and cultural barriers to care.

• John Hopkins Center for Innovative Medicine has been creating new models of health care delivery that improve patient safety, quality and efficiency.  Through the development of tools and training programs that engage health care workers—from frontline staff to top leadership—to realize radical, measurable advances in care delivery.  Leveraging these experiences, the center has also helped hundreds of hospitals in the United States and around the world to develop or expand their quality and safety programs.

• Stanford’s Clinical Excellence Research Center organizes research teams from multiple Stanford Schools to design and test new methods of health care delivery that substantially reduce population-wide disability and annual per capita health spending in the near term. Research is led by teams of post-doctoral research fellows and mentored by faculty from multiple Stanford Schools with initial emphasis on Business, Engineering and Medicine.

• Founded in 1995 by Harvard Medical School teaching hospitals, the Center for Connected Health develops new strategies to move health care from the hospital and doctor’s office into the day-to-day lives of patients. Leveraging information technology — cell phones, computers, networked devices and simple remote monitoring tools — the Center helps providers and patients manage chronic conditions, maintain health and wellness, and improve adherence, engagement and clinical outcomes.

• A relative new entrant, Boise, Idaho’s St. Luke’s Center for Healthcare Innovation, has culled expertise from the payer and venture capital industry and will be focused on employing venture philanthropy models for the purpose of accelerating cutting-edge projects.  By employing an approach that leads with the community and individuals, rather than an institution, the goal is to offer an opportunity for technology companies to test their wares in the real world.

• Last but not least, philanthropic pioneers Gary and Mary West launched the West Health Policy Center in Washington D.C. this week.  While heavily weighted towards health policy and reimbursement, two of the five focus areas do include promoting infrastructure independent care and appropriate care utilization. Hoping to act as a fellowship program, the Center intends to:  1) fund research to identify more than $100 billion in cumulative health care cost savings within ten years, 2) serve as a neutral convener between the public and private sectors, and 3) conduct educational activities with government, industry, academia and nonprofit stakeholders.

With relatively differing approaches, several common themes do remain.  Innovating and evaluating effectively requires substantial investment.  In addition, unnecessary duplication of efforts and inability to define/document value can derail any program.  And it is only through structure and metrics that the most tenacious programs will prevail – and prosper – the goal of an economy built to last.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

*Graphic courtesy of the Kaiser Permanente’s Sidney Garfield Healthcare Innovation Center

Healthcare Collaboration: A Dream for All

With the recent celebration of Martin Luther King, Jr.’s birthday, we are reminded about his passion for the dignity of life and justice for all Americans.  He would have turned 83 this year; and if this had occurred, it would have defied the average life expectancy of 69.7 years for an African American male.  Revisiting Dr. John Eisenberg’s, former Director for the Agency for Healthcare Research and Quality’s 2000 post, I too wonder what Dr. King would think about parity, but also the manner in which healthcare is delivered today?

While there remains significant work to be done regarding access for the under and uninsured, do we not have a wealth of opportunity to level the playing field by inviting all Americans to engage in their healthcare experience?  By encouraging patients to express their preferences for the type/intensity of health care services they receive and the settings in which they receive them, perhaps we would see more people taking an active role in preventative health and not just responding to an acute episode.

Poised on the cusp of a digital health revolution, there have been significant advances in electronic and personal health records,  mobile phones and wireless technologies, text messaging, tracking sensors and social media.  Despite this gain, a recent hypertension study published by the Journal of American Medical Informatics Association, noted that a mere 26% of patients used personal health records (PHR) frequently.   And it was only the most frequent users of the PHRs that saw reductions in their blood pressure.  So, how do we change this?

In the recent Congressional Budget Office economic and issue brief, Lessons from Medicare’s Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment, one of the recommendations for delivering high quality low cost services is to apply team-based care that includes face-to-face, as well as, telephonic visits by care managers.  While these individuals by and large have been working with chronic frequent flyers, imagine having a care manager assigned by your insurance company who becomes your point of contact upon entry into the system?  They review your insurance coverage with you to verify that it is appropriate for your needs, aid in your selection of a primary care provider and establish expectations for your role in maintaining your health.  Maintaining your health could very well be the most important job of your life.  Similar to a performance review, the payer care manager would contact you on an annual basis to confirm that you are liaising with your medical home care manager, discussing your care plan and acting on recommendations.  In essence, they become your macro patient relationship manager.

Payer care managers will also be instrumental in maintaining open lines of communication with the care manager, also known as the micro patient relationship manager, assigned to you within your medical home.  The success of such a model would be perpetuated by the secure exchange of vital data via a health information exchange (HIE), thereby allowing both parties to remain up-to-date regarding your current status.  Medical home care managers will work with providers, practitioners and individuals to develop a comprehensive plan of care.  And by ‘working’, these individuals become responsible for educating patients about their outcomes and reinforcing the role that they play in determining them.  With a firm baseline and predictive modeling, patients will receive preventative health reminders, episodic management and transitional follow-up.  Removing the burden of information exchange with pharmacy and lab providers, specialty providers, ambulatory sites and long-term care providers will also facilitate this critical planning process.

A system that provides connected care to patients no doubt can lead to improved care – and therefore improved health –  which is nothing less than a dream for all.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website