• 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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Leveraging Health IT to Strengthen Patient Engagement

Leveraging Health IT to Strengthen Patient Engagement

In the spirit of moving innovation forward, I found relevance in the following article about engendering trust using healthcare technology.  In the crossfire of my own struggles with technology, I can appreciate the very salient points outlined by the author.  Specifically, he asserts that healthcare IT can be the lever for improving the physician-patient relationship through the following means.

In the first instance, he points out that technology can help a physician provide SMARTER care.  With escalating numbers of insured patients attempting to be seen by a shrinking provider pool, new delivery methods must be sought to meet this demand.  While the article addresses wellness and preventative care, it is a natural extension to mention patient’s interest in mobile visits.  Incorporating SMS, video and email into the physician toolbox is tantamount; however, certain touch points require a face to face interaction…and the mobile visit solves this dilemma.  In fact, I would dare say that all mediums should be utilized to ensure that the patient’s particular learning mode is engaged and the provider’s message is reinforced.

Secondly, healthcare IT can optimize physician workflow and remove administrative shackles draining resources and diverting attention from the more complex tasks at hand – treating chronically ill patients.  As noted, “technology can take over for clinicians when it comes to some of the more benign data capture and aggregation roles.”  While this can cover items such as first time visit paperwork, it can also be employed for personal health records, population health management, as well as the patient”s & provider’s modification of the medical record.  And by lightening the physician’s load, they are free to pursue clinical partners and engage them in community health and prevention efforts.  At minimum, in celebration of National Public Health Week, there should be a focus on data exchange for immunization and prevention.

Thirdly, one of the core means of establishing trust occurs through the delivery of personalized messages in a format most conducive to each individual patient’s learning and retention style.  Using technology to engage patients and stay connected during their care demonstrates concern and establishes trust – an integral component to the healing process and a competitive edge for a practice seeking to maximize efficiency and minimize cost.

Last, but not least, the author stresses that technology must be implemented in a safe and secure manner in order to protect and preserve the relationships with one’s patients.  Specifically, “being aware of the security of the larger ecosystem of which an organization is part is a way to quell data loss and enhance the trust of patients.”  Perhaps one of the most difficult things to do today, but arguably should not be forgotten in the quest to do no harm.

 

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse PractitionerPhysician 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

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Embracing Change for Healthcare Transformation

Embracing Change for Health Care Transformation

With thousands flocking to Chicago for the annual ACHE Congress on Healthcare Leadership, many were interested in learning more about the strategic initiatives, aimed at delivering ‘high value’ healthcare, manifesting here, there…suddenly everywhere.  Speaking to the increased recognition and velocity for change, Sabrina Rodak highlights six key themes that were no doubt ubiquitous at this moment of metamorphosis for healthcare, and more to the point, the hospital industry.

Building on a recent article in Health Affairs, “Decline In Utilization Rates Signals A Change In The Inpatient Business Model”, Rodak notes that keeping patients healthy through preventive and primary care services, and out of acute care facilities whenever possible via population health management is the new mandate. By focusing on care delivery in the right place at the right time with the right quality, cost, and access, leaders in this new era will transform the health of the system, as well as the nation.

In order to succeed, six fundamental requirements have been defined:

1. Culture. Hospital leaders need to focus on delivering value rather than only acute-care services.  Proponents believe that happy, engaged providers and employees have a more positive impact on patient experience, versus those that do not.

2. Physicians and care delivery. Hospitals will need a strong physician platform to reduce utilization and cost and improve value. In concert with local, affiliated physicians and allied health providers, hospitals and health systems are moving closer to this goal through a variety of care coordination innovations.

3. Communication and HIT. Hospitals need to develop health IT systems to communicate with providers across the care continuum and analyze data to increase value. And with the onset of stage 2 meaningful use, having the tools to define and eradicate potential conflict between patient expectations and evidence-based medicine becomes tantamount.

4. Facilities. Hospital leaders should consider investing in outpatient settings instead of building costly hospital facilities.

5. Contracts. Hospital leaders need to encourage payors to participate in value-based initiatives to support providers who are delivering value. Nimble, forward thinking organizations are exploring a variety of collaborative measures in order to jointly address care delivery innovation.

6. Transformation. Hospitals need to start preparing for a value-based care model now by eliminating clinical variation, reorganizing services and reducing costs.  Checking out the ACHE Congress Management Innovations and Circle of Life winners gives you a small sample of the transformations en route and poised to come.

While measured steps are being taken for positive outcomes, critics of the Health Affairs article argue that this is meaningless activity for those lacking health insurance, mired in sub-optimal social health circumstances and facing a dangerous precipice with potential changes in Medicaid funding. Right, wrong or indifferent, there is one consistent theme – the time is ripe for change.  And as the outgoing ACHE Chairman, Gayle Capozzalo, points out – we, as healthcare leaders, are no strangers to change.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse PractitionerPhysician 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

Collaborating for Care Management Innovation

Collaborating for Care Management Innovation

With the onset of sequestration, Texas stands to lose funding for Head Start services, children’s vaccines and meals for seniors.  Add to this potential losses in law enforcement and education funding, one can see that programs, once aiding children, seniors and the homeless by keeping them out of the emergency room, might cease to address this critical need.  Compound these losses with the pressure being exerted by value based purchasing, and the dilemma becomes magnified tenfold.  As if accountable care organizations, medical homes, hospitals and healthcare systems did not have enough on their plate, one wonders where they will find the resources to supplement these activities?

One enterprising non-profit has tackled this challenge head-on.   Billed as a nine-year old strategic initiative with a mission to improve the quality, capacity, and accessibility of the healthcare system for vulnerable populations in the City of Camden, the Camden Coalition has analyzed local healthcare system claims data for the purpose of building a repository and sharing data with regards to this typically transient population.  In addition, they operate several health project initiatives that demonstrate a collaborative approach to improving care delivery and patient outcomes in their area.  And by building relationships with executive leadership of the hospitals, social service/public health agencies, state government agencies, leaders at the statewide Medicaid health plans, and policymakers, they have taken a discretely modern approach to healthcare delivery.

Current innovative initiatives garnering attention include the Coalition’s Care Management and Care Transitions programs, aimed at reducing hospital utilization by directing outreach to the ‘high flier’ population whom frequently lack appropriate access to primary and mental health care.  Designed to target high cost, complex patients for improved care transitions and care coordination, the Coalition is steadfastly working to move these patients into a medical home model.  Upon presenting at the emergency room, patients are divided into one of two groups:  a) those with no primary care access and significant mental/social issues and b) patients with more stable primary care and mental health status.

In the Care Management program, patients meeting specific criteria receive assistance from a social worker, a health outreach worker/medical assistant and a nurse practitioner with primary/specialty care coordination, applying for government assistance, finding temporary shelter and enrolling in medical day programs.  Through stabilization of their social environment and health conditions, the team’s ultimate goal of finding a primary care medical home for the patient can begin.

Patients participating in the Care Transitions program are enrolled in and receive assistance from embedded care management nurses and health coaches from one of two Camden Federally Qualified Health Centers (FQHC) – CAMcare and Project HOPE.  On the path to becoming patient-centered medical homes, these FQHCs are fostering better care transitions and coordination with their hospital and health system partners.

These bold programs have been facilitated by city-wide use of health information exchange and electronic health record use for this targeted population, thereby allowing providers to share information and analyze data for additional care coordination.  Data analysis also remains integral for the monthly Care Management Committee meeting, held at rotating hospitals, in order to review and refine current processes for these programs. And by bringing together emergency room physicians, hospitalists, specialists, social workers, and nurse discharge planners across the city, more efficient and effective discharge planning and care coordination can help decrease utilization and improve safety, experience and ultimately, quality of care.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse PractitionerPhysician 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

Seeing Red for Heart Health

Seeing Red for Heart Health

According to the caption, “heart disease still kills more women than all cancers combined”.  And in celebration of National Wear Red Day, the American Heart Association (AHA) wants to know how you will make a difference?   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.

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.

Partnering with local and national non-profit organizations has, and will continue, to offer avenues for awareness, education and prevention.  The American Heart Association’s Go Red For Women campaign- described as a passionate, emotional, social initiative designed to empower women to take charge of their heart health – reflects this opportunity.  Not only does it challenge women to know their risk for heart disease, but it also encourages women to utilize AHA tools to take action for personal risk reduction.

According to the AHA Go Red For Women website, the group turns science into materials and tools that healthcare providers and decision-makers can use to help women. Great idea, wouldn’t you agree?  Now, after seeing the article outlining Heritage Health’s interest in working with UCLA and Open mHealth, I am wondering if there isn’t an opportunity to collaborate on production of a chronic disease app?  At the very least, a Go Red For Women mobile app could deliver a personal heart health dashboard, as well as, messaging and alerts regarding symptoms, diet, exercise, lifestyle and AHA events.

With funds raised by Go Red For Women supporting educational programs, increasing women’s understanding about their risk for heart disease and supporting research to discover scientific knowledge about heart health, this seems perfectly APPropriate to me.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse PractitionerPhysician 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

Engaging Consumers for Improved Cost, Quality and Outcomes

Engaging Consumers for Improved Cost, Quality and Outcomes

Following closely on the heels of the mHealth Summit, the Bipartisan Policy Center (BPC) recently released the research report, “Improving Quality and Reducing Risk in Health Care:  Engaging Consumers Using Electronic Tools”.  Arriving in the shadows of the fiscal cliff discussion, the report notes that healthcare spending currently places a considerable burden on our economy.  And with a focus on cost reduction, implementing the right measures to improve quality and individual health remain tantamount as well.

Originally identified in the 2001 report, “Crossing the Quality Chasm: A New Health System for the 21st Century”, the Institute of Medicine (IOM) promoted patient-centeredness as one of six key aims for the nation’s health care system, thereby making it well-established and widely embraced today.  And building on the January 2012 report, Transforming Health Care: The Role of Health IT, the BPC identified six attributes that emphasize patient engagement’s role in supporting high performance organizations:

1. Organization-wide focus on the needs of the patient

2.  Strong organizational and clinical leadership

  • Bring the patient’s perspective to the design, delivery, and management of care.
  • Patients are involved in governance and advisory boards to provide input.
  • Create organizational culture that focuses on the needs of the patient and encourages continuous learning and improvement

3.  Access to information to support efficient, coordinated care

  • Successfully coordinate care across providers, settings, conditions, and time
  • Care teams and patients have access to an individual patient’s records across settings in which care and services are delivered.
  • Patient preferences and status are included in the record to inform clinical decision-making
  • Reminders and alerts for both clinicians and patients help eliminate medical errors as well as gaps and duplications in care
  • Privacy and security are carefully managed

4.  Timely access to care

  • High-performing organizations provide multiple avenues for patients to receive timely care.
  • Care teams are available when needed, whether by phone, by mail, online, or in person, including nights and weekends.

5.  Emphasis on prevention, wellness, and healthy behaviors

  • Recognize that providing educational resources and self-management tools to promote prevention and wellness, as well as management of chronic conditions can lead to better health outcomes

6.  Accountability, alignment of incentives and payment reform

  • High-performing organizations continuously measure and take actions to continually improve performance on the cost and quality of care, including patient experience of care and health outcomes.
  • Clinical, administrative, and patient-generated data inform goal-setting, the identification of areas needing improvement, and the effectiveness of interventions.
  • Financial incentives are aligned with better outcomes in cost, quality, and patient experience.

In efforts to support cost and quality goals, there have been a number of new models being tested by the Centers for Medicare and Medicaid Innovation (CMSI), including the Medicare Shared Savings, Advanced Payment and Pioneer ACO models, as well as the, Comprehensive Primary Care Initiative Demonstration.  Together with the Partnership for Patients:  Community Based Transition Care program, these arrangements are helping demonstrate that patient engagement, activation and communication are all associated with lower cost and better outcomes.

Despite the forward movement, significant challenges continue to exist for patient-centered care and patient engagement.  Such challenges include the need to expand patient engagement in medical education, post-graduate training and continuing medical education.  Making a fundamental shift in practice and reimbursement will not only improve physician-patient interaction, but also help to align participant goals with health, wellness and prevention.  And as Susannah Fox, Associate Director, Digital Strategy, Pew Internet & American Life Project, outlines below – organizational culture should embrace the “e” in e-Patient, since engagement is an instrumental step towards achieving the IOM goals.

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

Innovating Healthcare System Strategy: Creating the Commercial ACO

Innovating Health Care System Strategy:  Creating the Commercial ACO

Tick tock goes the clock….October 2012 will soon arrive and value-based payment will commence.  In order to prepare for this change, hospitals and healthcare systems are simultaneously improving quality and patient experience, reducing expense and crafting new strategies for growth.  While strategic planning efforts have traditionally focused on modifying or developing new service lines or delivery sites, one healthcare system has forged a different path, forming a commercial accountable care organization via a new payer partnership.

Though the concept of commercial ACOs is not new, the novel approach being taken by Aurora Healthcare, Aetna and Wellpoint subsidiary, Anthem Blue Cross and Blue Shield Wisconsin, is to offer a price guarantee – defined as a potential 10% reduction in cost – to small and mid-size businesses, which typically, are not target markets for insurers seeking large, self-insured groups.  Through the Accountable Care Network, Aurora Healthcare’s 1400+ providers will be poised to deliver care through its 15 hospitals and more than 160 clinics.  Not for the faint at heart, Aurora Healthcare’s new business model is supported by its 15+ years experience as one of the largest employers, with 48,000 covered lives, in the Wisconsin and surrounding area.

With extensive use of care managers for appointment scheduling, assistance connecting with physicians and follow-up for patients who have chronic or complex conditions, this group succeeded in reducing their per-member-per-month cost by 2.4% in 2010, while the national average rose more than 10%.  Coupling personalized care with its use of electronic medical records, claims reviews and advanced analytics, the Accountable Care Network is now confident that they can lower future members cost of care per diagnosis.  Bold statement, indeed.

Bold enough, in fact, to make me wonder…could this price guarantee be replicated for the Medicaid population?  With skyrocketing cost and rampant chronic illness, there exists no better petri dish for testing this hypothesis.  And, as Dr. Nick Turkal, Aurora Healthcare’s President & CEO mentions below, as a national quality and healthcare reform leader, they (and others) are beholden to share their knowledge regarding tools and processes developed to address these critical issues along the way.

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