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    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

Designing Healthcare Innovation

Designing Health Care Innovation

By now you know that I have a distinct interest in healthcare innovation, so it should come as no surprise that an article about the recent Healthcare Experience Design Conference caught my eye.   Kicking the day off with a battle cry from Dr. Jacob Reider, chief medical officer at the Office of the National Coordinator for Health IT, he challenged the crowd, “to help this industry do better”.  And by better, he is referring to development of user friendly processes for patients and providers alike.

Albeit, being a do-it-yourself techie hamstrung by programs on a regular basis, I was encouraged to hear that this conference stretched beyond the traditional confines of user-centered design to include workflows, patient engagement and population health.  Having designed a website myself, I can appreciate the tips outlined for engaging individuals in the digital realm; however, what I found most intriguing was Nir Eyal’s discussion about how people choose to engage with habit-forming technology.  According to Eyal, “the key to developing habit-forming technology is to understand end-users’ “internal triggers” – the emotional drives that motivate them – and develop technology that begins as “vitamin” and then “turns into a painkiller.”

Cassie McDaniel, of the Centre for Global eHealth Innovation at Toronto’s University Health Network also pointed out that examining research, usage patterns and prototyping are key elements for user-centered design.  And similar to the role that technology has played in the modernization of healthcare service delivery, McDaniel suggests that user-centered design bears the potential to catalyze the healthcare innovation movement.

One company, breaking down barriers to patient engagement and collaboration, is currently employing user-centered design. Iora Health, an accountable care organization (ACO), maintains its own team of designers and developers that routinely visit member practices to work with clinicians and staff to rethink the relationships between people, processes, IT and health reform. As a result, physicians now project the EHR onto a screen for patients to view/query and provide access to OpenNotes, thereby allowing individuals to access and update their charts.  With the onset of meaningful use stage 2 and the voices of the impatient growing louder, will this impetus be enough?  While I suspect that they have merely scratched the surface, time will only tell how far these right brain thinkers push the needle for transformation.

 

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

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

Innovating Medicaid with the Medical Home Model

Innovating Medicaid with the Medical Home Model

After reading Cheryl Clark’s interview with Dr. Bruce Siegel, President & CEO of the National Association of Public Hospitals and Health Systems, she points out that if the entities existing in one of the 30 states now threatening to refuse to expand their Medicaid eligibility rules to 138% of the federal poverty leveldon’t receive assistance, they’ll continue to provide uncompensated care for many of their sickest patients.  For organizations already stretching to deliver care to the most vulnerable populations, it was encouraging to learn that seven more states have joined the Medicaid ACO project, which targets low-income populations for care improvements and cost reduction via the medical home.

Will a move away from managed care to care coordination payments provide enough incentive for chronically ill Medicaid patients to obtain necessary primary care versus waiting for an urgent or emergent situation to send them to the emergency department?  Dr. Lisa Letourneau, executive director of Maine Quality Counts, a regional healthcare improvement collaborative and  physician champion for the Maine Patient-Centered Medical Home pilot, thinks so.  In order for the 108 practices that have applied for the Medicaid health home pilot, they must have NCQA medical home recognition or have applied for it, maintain an EHR and commit to 10 core expectations of medical home that go beyond National Committee for Quality Assurance (NCQA) conditions.

Although there are already more than 100 ACOs that serve Medicare populations, the Medicaid population is notably sicker, poorer and requires more resources – a complex and challenging equation to say the least.  In efforts to utilize the most efficient resources, advanced nurse led medical homes with patient engagement technology provide an alternative worth considering for those rural locations struggling to meet budgetary requirements. With the brightest minds recently convening at the World Congress 2nd Annual Leadership Summit on Medicaid, one can only hope that they were discussing medical homes similar to Piedmont Health, North Carolina’s first community health center focused on delivering comprehensive primary care services and health education to its members.

With millions of dollars at stake and community health on the line, innovating Medicaid with the medical home model should be a priority today, and not tomorrow.

Innovating with Patient-Centered Medical Homes and Accountable Care Organizations to Improve Healthcare

Innovating with Patient-Centered Medical Homes and Accountable Care Organizations to Improve Health Care

With the close of the third National Accountable Care Organization (ACO) Summit in Washington, DC last week, it got me thinking about the Patient Centered Medical Home (PCMH) and ACO models.  Specifically, what are the differences and which is more appropriate for the future delivery of healthcare?

As defined by the four primary care societies (AAFP, AAP, ACP, AOA), the Patient-Centered Medical Home is as an approach to providing comprehensive primary care as a health setting that facilitates a continuous relationship between patients, the patient’s family when appropriate, and the patient’s personal primary care physician.  The joint principles supporting this model include:

  • Personal physician – serves as the primary contact and coordinator of care for a patient.
  • Physician directed medical practice – is led by the personal physician who directs the practice team to ensure continuous, comprehensive patient care.
  • Whole person orientation – in which the personal physician arranges and oversees care throughout patients’ various stages of life.
  • Care is coordinated and/or integrated – by the personal physician in connection with specialists and across settings facilitated by information technology and other appropriate tools.
  • Quality and safety – serve as primary guideposts for all aspects of a patient’s medical care.
  • Enhanced access – using tools such as open scheduling, extended hours, and various modes of communication between patients and providers.
  • Payment – is value driven and reflective of case mix, enhanced technologies, quality improvements, and shared savings achieved by successful patient management.

In keeping with these principles, the medical home goal is to deliver coordinated care in a seamless and efficient manner, thereby improving quality and reducing cost.

MedPAC has defined accountable care organizations (ACOs) as a set of providers associated with a defined population of patients, accountable for the quality and cost of care delivered to that population.  While the population is larger and generally involves multiple practices, similar intent remains for the ACO to reduce cost through enhanced preventative care, disease management and improved quality through coordination of care.  In order to manage a population effectively, ACO governance models often include not only physician members, but also, hospital or physician hospital organization (PHO) and/or payer representatives.  Structured purposefully in opposition to fee-for -service (FFS), ACO members are rewarded for efficiency in the form of a shared bonus.  If, on the other hand, an ACO underestimates the cost of operation, the providers will earn less, thereby becoming ‘accountable’.

Healthcare is, and likely will continue to be, a local service.  Determining whether a PCMH or ACO is more appropriate will be fueled by the local physician community’s appetite for and ability to change. Establishing clear goals with corresponding metrics, creating a path for process improvement and developing appropriate financial incentives will be integral  to driving this process forward.  In the absence of interoperable data, both organizational models must also find creative solutions for their health technology constraints.

As we prepare to learn the fate of the Patient Protection and Affordable Care Act, we find ourselves with the potential to transform care delivery through healthcare information technology, innovative team approaches and other new models of care.  With more than 500 physician practices in the United States, the metamorphosis to medical homes or ACOs will be a monumental undertaking.  Will it fundamentally improve care?  Listen in to find out more….

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

Population Health Management:  Revolutionizing Healthcare 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