• Principle Healthcare Associates


    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

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Innovating Medicaid for Healthcare Reform

Innovating Medicaid for Health Care Reform

With two short weeks to go before an unprecedented presidential election, healthcare continues to remain on the forefront.  And while most of the focus has been on healthcare delivery for the Medicare population, there is reason to be very concerned about the future of the Medicaid program.  According to the Kaiser Commission on Medicaid and the Uninsured, “Medicaid is the nation’s public health insurance program for low-income Americans.  Currently, to qualify for coverage a person must not only be low-income but also must fit into specific eligibility categories.  The Children’s Health Insurance Plan (CHIP) complements Medicaid by covering uninsured low-income children with family incomes above Medicaid thresholds. Many low income children, families, and people with disabilities would be uninsured without these programs.”

In an interesting development, the commission’s recent report noted that Medicaid enrollment and expense dropped in the year 2011.  While on the surface, this appears to be a positive trend, additional probing might be warranted.  Are the decreases in enrollment truly due to an improved economy stimulating job opportunities that now offer health insurance or have these individuals grown tired of being placed on a waiting list for one of the few available slots due to the diminishing number of participating physicians? And while select market leaders are experimenting with new and innovative delivery models, is this enough to account for the expense reduction?  One remains hopeful that these efforts are not in vain, but could it simply be that fewer participants require less care?  Or, have the hassles of being dropped from the program and repeating enrollment convinced recipients that it is much easier to access the emergency room for their healthcare needs?

Faced with the option of significantly reducing the number of uninsured through Medicaid expansion, a requirement of the Affordable Care Act (ACA), or maintaining the previous untenable expense for this population, states with the highest uninsured rates should be paying close attention.  At the top of the list (33%) with a mere 30% of physicians accepting Medicaid, Texas, in particular, has a cross to bear.  Factor in the fact that Governor Perry staunchly supports Medicaid expense reduction and has refused additional monies for expansion, one begins to wonder where will these people go to obtain care?  In a vicious cycle, likely right back to the place they started, and often, the most expensive site of care.   Given that safety net hospitals typically serve this patient population, these hospitals, in an unforeseen turn of events, are now positioned to lose millions in reimbursement.

So, how do we avoid this calamity?  For the good news, recent Texas Medicaid policy actions have been driven the approval of a section 1115 waiver that expanded managed care, ended the former Upper Payment Limit payment methodology, and created two funding pools to help offset uncompensated care costs and encourage delivery system reform.  Specifically, the Delivery System Reform Incentive Payment (DSRIP) program will be used to make incentive payments to encourage delivery system reform in four broad areas – infrastructure development, program innovation and redesign, quality improvements and population-focused improvement. Reform activities will be conducted by Regional Healthcare Partnerships (RHPs) that are financially anchored by a public hospital or local governmental entity; RHPs will collaborate with a variety of healthcare providers to evaluate current challenges in the delivery system and propose a course of action to address those challenges.

Not to sound like a broken record, but the DSRIP appears to be the perfect vehicle to test the advance practice nurse led medical home for children and low risk pregnant women.  With more than one-half of Texas’ 1.2 million uninsured children eligible for enrollment in a public program, engaging them in a medical home would help to eliminate future lapse in coverage and unnecessary healthcare expense.  Treating the total uninsured at a cost of $9.2B (in 2005 dollars), Texas also has the opportunity to reduce the unfortunate ramifications of passing this burden on to taxpayers in the form of higher hospital cost and insurance premiums.  Irrespective of physician or NP direction, the “coordinated care organizations” model is currently being utilized to improve quality and remove cost for the Oregon Medicaid program – to the tune of $11B in projected savings by the end of the decade.  In this model, hospitals, physicians, counties and community organizations will operate under a risk bearing model to integrate services, coordinate care and produce better outcomes at a lower cost.  Not to be taken lightly, what appears to be a plain ol’ vanilla version of the medical home could prove truly revolutionary in its ability to broker public-private partnerships, leverage technology and galvanize the community for a truly collaborative experience.

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

Delivering Collaborative Breast Cancer Care in the Oncology Medical Home

Delivering Collaborative Breast Cancer Care in the Oncology Medical Home

October is National Breast Cancer month and many supporters will be indulging in pink and racing for the cure.  According to the Department of Health and Human Services (HHS), breast cancer is the second leading cause of cancer death in women and the most common cancer among women in the U.S.  For Hispanic women, it is the most common cause of death, while it remains the second leading cause of death for Asian, American Indian, African American and Anglo women.  With early detection and treatment, breast cancer can be beat.  In an alarming trend, however, it appears that the number of individuals seeking mammograms has tapered off since 2001.  And with limited access, knowledge and resources, many women have been putting this critical preventive measure off.

While it remains imperative to continue the campaign to increase awareness and prevention, I have to wonder if a vital piece of the puzzle is missing?   With millions being spent on marketing campaigns, is there no better substitute than your primary care provider being the first line of defense in this rigorous battle?  And with the mounting evidence pointing to the success of medical homes and accountable care organizations, would there not be value in shoring up communication between primary care providers and oncologists in order to catch symptoms in the earliest stage possible?  Better yet, what if oncology providers formed medical homes for the purpose of promoting evidence based care and enhanced communication?  As noted here, the National Committee on Quality Assurance is taking a stance, having developed the Specialty Practice Recognition (SPR) 2013, scheduled to be piloted in 14+ practices next year.  Through this new mandate, NCQA is hoping to invigorate specialist referral response, care coordination and evidence based practice alignment.

And with the new standard, quality reporting measurements will be developed in efforts to improve the standard of care while simultaneously reducing the amount of variation and unnecessary cost.  How will this be done?  Similar to current medical homes, developing patient registries and cancer specific evidence based pathways, allows for best practices to be utilized and generic drug recommendations to be made when appropriate.  Furthermore, in keeping with patient specific treatment plans, advanced technology also offers the opportunity for more meaningful dialogue with the patient by delivering key information in a variety of formats.

Will this be enough to close the loop?  Though the jury remains out, there is promising news from the ASCO Breast Cancer Registry Pilot Program, funded by Susan G. Komen for the Cure.  During this study, 20 practices implemented a web based registry for newly diagnosed patients and generated one of two patient specific treatment plans for future assessment of care quality/research initiatives and patient and practices’ perceived burden, value, usefulness, and effectiveness of discussions regarding treatment and survivorship using the treatment plan and summary reports.  Participants were surveyed via electronic and telephonic means and a majority felt that the process improved communication between patient/providers and physician to physician and, ultimately, provided greater piece of mind.

While not affiliated with the ASCO program, Oncology Physician Resources’ Lesli Lord illustrates below how evidence based pathways will facilitate the future delivery of quality oncology care in a collaborative and cost-efficient manner.

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

Partnering Patients and Providers for Healthcare Technology Innovation

Partnering Patients and Providers for Health Care Technology Innovation

With the conclusion of the first vice presidential debate, the Los Angeles Times noted that discussions regarding healthcare turned prickly and personal.  Such heated rancor suggests that healthcare should become much more personal in the near future.  And speaking of making healthcare personal, the fall Health 2.0 conference commenced this week, debuting and highlighting new technology designed to improve cost transparency, patient engagement and provider workflow.  Having introduced more than 500 companies since its inception in 2007, Health 2.0 co-founders Indu Subaiya and Mathew Holt have helped to galvanize the revolution in healthcare delivery. Sufficiently impressed by several presentations, I will be watching a number of companies; however, my inner skeptic also wonders how many of these start-ups will successfully transcend the o-gap (operationalization), a term coined by Boston Children’s Hospital Chief Innovation Officer, Naomi Fried?

And by ‘operationalization’, I am referring to igniting both the attention and utilization of providers and patients alike.  Building on CryerHealth CEO, Donna Cryer’s definition, “patient engagement in action looks like shared responsibility between patients (and their families if applicable), health care practitioners (the entire team: surgeons, physicians, nurses) and healthcare administrators (providers of the infrastructure and payment models) to co-develop pathways to optimal individual, community and population health.  In order to succeed at this task, Paul Cerrato points out that tech tools alone, are not a magic bullet for patient engagement. Rather, an engaged, consumer driven provider, must also be part of the successful equation.  So, the better question becomes, what steps can be taken to foster this symbiotic relationship?

With a plethora of healthcare IT on the forefront, Rock Health, the first seed accelerator for digital health start-ups, has identified an immediate need for healthcare providers to partner with start-ups in order to verify clinical product efficacy and validity. Given President Obama’s recent legislation calling on HHS to report to Congress on an “appropriate, risk-based regulatory framework pertaining to health information technology, including mobile medical applications” and Rock Health’s interest in developing a formal collaboration process similar to the biotech industry’s clinical trial practice, it would be forward thinking to see academic, as well as, other healthcare providers with an Institutional Review Board (IRB) presence, engage in this activity.  Witnessing the extraordinary outcomes achieved by interdisciplinary teams of researchers, technology experts, clinicians and patients participating in the Robert Wood Johnson Foundation’s Project Health Design project for development of tools to be used by real people to improve their health, better engage in their care, and enhance communication with their providers, why can’t we accelerate this innovation two or three-fold?

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

Implementing Innovative Value-Based Purchasing and Readmission Reduction Strategies

Implementing Innovative Value-Based Purchasing and Readmission Reduction Strategies

No longer is the clock ticking; rather the alarm has sounded and value-based purchasing has commenced.  As this aptly titled article, “Medicare Rolls Out Carrots and Sticks for Hospital Quality”, the author points out that the Centers for Medicare & Medicaid Services (CMS) is now withholding 1 percent of its regular hospital payments and putting that money into a fund to reward hospitals that score well on 20 different quality measures.  Breaking that number down further reveals that seventy percent of a hospital’s score will be based on 12 measures that show how frequently hospitals performed recommended protocols, while the remaining 30 percent of a hospital’s value-based purchasing payment will be based on how it scored on patient surveys taken after they were discharged.

And as if that isn’t enough to contend with, CMS has also enacted the Readmissions Reduction Program, aimed at curtailing the number of patients that are sent back to the hospital.  With one in five Medicare patients typically being readmitted within one month, bringing this number down will help hospitals and healthcare systems avoid the 1% penalty looming in their future.  Some view the penalties as counterproductive since a patient’s behavior beyond the four walls of the hospital is simply beyond their control. And while medication adherence, diet, insurance and mental health status help drive many of these readmissions, CMS believes that hospital can significantly improve transitions and coordination of care.

In the face of two landmark program launches, what will your hospital’s valued-based purchasing and reductions readmission approach be?  According to Evolent Health, a joint venture between the University of Pittsburgh Medical Center system’s Insurance Division and the Advisory Board Company, a variety of paths can be taken based on a provider’s appetite for risk.  Ranging from individual programmatic efforts, to patient centered medical homes or accountable care organizations, providers must first review complex case management, condition management, and pharmacy utilization management to determine the right mix.

Specifically, Evolent Health believes that the following five key ingredients must exist in order to succeed at value-based purchasing:

  • Creating a Coherent View –organizations must integrate multiple sources of information, provide real-time alerts for ED admissions, and be able to transmit care manager notes to the appropriate providers
  • Prioritizing High-Risk Patients – entities must be able toassess patients over a discrete period of time by collecting data and processing it through a rules engine to create predictive models for readmission risks and risk scores
  • Providing the Right Intervention by Building a Targeted and Tiered Intervention Portfolio  – organizations must stratify patients into buckets and create menus of interventions and care management operations to address particular patients
  • Engaging at the Appropriate Intensity Level – depending on intensity, patients must be engaged in the appropriate format and/or forum

Given the current trend in healthcare spend, one would be hard pressed to argue the need for population health management, care coordination and home monitoring technology and processes.  And while large and medium size urban healthcare institutions have the ability to address these mandates head on, the question becomes – how will smaller entities in less well developed communities fare?  A first step in the innovation for value-based purchasing, according to Dr. Gregory Spencer, chief medical officer of Crystal Run Healthcare, is to develop internal processes and a registry for purposes of gaining a better understanding of your patient populations and identifying gaps in 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