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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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Transforming Medicaid via the Medical Home Model

Transforming Medicaid via the Medical Home Model

With the March 1st sequestration deadline looming, the budget battle continues. Facing potential cuts to public health and reduced federal relief, ignoring Medicaid expansion could be hazardous to a state’s health.  At least, some states have come to this conclusion.

Despite this, the state with the largest number of uninsured seeking medically necessary healthcare chooses to stand tall.  With emergency relief in mind, House Bill 10 was introduced in the Texas legislature this past week to address a shortfall in Medicaid and the Children’s Health Insurance Programs.

As one reporter for the Texas Tribune pointed out, “the federal government is offering to pay all of the costs of expanding the Medicaid program to some of the state’s uninsured population for three years, then to pay 90 percent of the costs for several years after that. Texas could, according to a report commissioned by Texas Impact, an interfaith public policy group, spend $15 billion over the next 10 years and pull down $100 billion in federal funds as a result. (So), here’s the business question: Why leave that kind of money on the table, especially if it’s going to be spent elsewhere if Texas opts out?”

While the article goes on to point out that federal monies would provide relief to local taxpayers currently subsidizing uncompensated care and potentially turbocharge the state’s medical economy, what I found most intriguing was the statement about running healthcare like a business.  Having just had a similar conversation with a colleague from the finance industry, I lamented that healthcare is a unique industry, dangerously siloed with imminent challenges to data access and ultimately, provider alignment – U.S. healthcare’s primary economic engine.

Now, some might argue that alignment becomes null and void in the absence of an adequate number of providers to address the incoming flux of under and uninsured persons.  Imagine instead, the opportunity to increase the number of providers by establishing advance practice nurse led clinics for participation in medical homes.  Equipped with patient registries, data analytics and health information exchange, physicians become liberated to focus on chronically ill patients and specialist provider coordination.  And perhaps the most galvanizing of all, instead of penalizing patients for visiting the emergency room, engage them in their care by developing a personal contract with specific achievable goals, provide a personal health record (PHR), mobile apps and texting to help monitor their health while keeping them incentivized via a loyalty program that offers redemption for health related items.

Not only is it the right thing to do, but by embracing this transformational change… perhaps savings similar to Chemung county’s Medicaid Medical Home could be achieved.

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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Empowering Healthcare Improvement with the Community Needs Assessment

Empowering Healthcare Improvement with the Community Needs Assessment

With President Obama’s second inaugural speech calling for a reduction in rising healthcare costs, the need for reassessment of health and social service delivery in the physician’s office, medical homes, accountable care organizations, urgent care/retail center, community clinics, hospital, health system and COMMUNITY ring louder.  For the good news, the Journal of American Medical Association recently published a study demonstrating that quality improvements within the community helped reduce hospitalizations and readmissions for the Medicare population.

With the help of CMS funded Quality Improvement Organizations (QIO), community wide interventions were coordinated between hospitals, nursing homes, home health agencies, physicians, hospice organizations and senior centers, resulting in roughly 5.7% reduction in hospitalizations and readmissions for fourteen diverse areas.

And while it is critically important to continue the investigation and sharing of best practices for hospitalization and readmission reduction, I was also intrigued by Ted Eytan’s recent post, Pioneering Idea: Your Patient’s Community Health Needs Assessment on the Desktop.  Reminiscing about his ‘community oriented primary care’ instruction in medical school, he introduces a new community health assessment platform available online at http://www.chna.org along with his thoughts about how to utilize it.  As a futurist, he suggests that information could be integrated into a patient’s medical record for analysis and discussion.

With ten Community Oriented Primary Care Centers currently administered by Parkland Health & Hospital System, I began to wonder if having this type of data available for patient discussion would be beneficial?  Already fluent in patient registries and predictive analytics for increased prevention and better outcomes, this sounds like the perfect storm for the Parkland Center for Clinical Innovation.

And for those remaining physician practices, accountable care organizations, medical homes, hospitals and healthcare networks delivering healthcare on a daily basis, could this information be made available to patient and provider alike on one’s website, app, iTriage – or better yet, a game created to crowdsource ideas for improving community status?

As Ted aptly puts it, morphing from a health advocate to a “health activist” requires innovative ideas like the one above in order to, one day, become part of a human development system, designed to help all people achieve their life goals through optimal health of the individual, family, community and society.

Physical Inactivity (Adult)

This indicator reports the percentage of adults aged 18 and older who self-report no leisure time for activity, based on the question: “During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?”. This indicator is relevant because current behaviors are determinants of future health and this indicator may illustrate a cause of significant health issues, such as obesity and poor cardiovascular health.

Dallas Cty

 

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 Population Health Management Strategy

Collaborating for Population Health Management Strategy

In response to value-based purchasing incentives and the proliferation of risk-sharing structures, the recent article, 5 Ways Population Health is Transforming Hospital Strategy, points out that hospitals that fail to align their strategies for growth and relevancy will quickly lose market share.  Specifically, Molly Gamble recommends the following tactics for tackling the issue head on:

  1.  While there should always be a place for the acutely and episodic ill, the new mantra should be keeping patients healthy (and out of the hospital).  Implementing disease registries and disease management programs coupled with virtual and urgent care will facilitate this goal.
  2. Design user friendly sites and services similar to retail and banking, giving patients the ability to access their data and schedule appointments in a safe and simple manner.
  3. Embrace mobile, telehealth and telemedicine in order to engage patients and improve the quality and safety of care delivered.  Successful execution of this tactic requires the ability to curate and share data in a seamless manner while protecting the privacy of the very individuals that you seek to help.
  4. Hospitals that deliver multidisciplinary care with providers matched to their competencies will improve access and population health.
  5. Look beyond the four walls of the hospital to collaborate with community, public health, government agency and payer organizations to improve the health of the people in the communities you serve.

Engaging in a near one hundred and eighty degree turn will prove challenging for the most agile health system; however, collaborating with entities, some former adversaries, outside the realm of standard organizational influence might be the most daunting feat yet. One community committed to this challenge is Tulsa, Oklahoma.  Together, the University of Oklahoma and the Kaiser Family Foundation have developed the OU School of Community Medicine – a first in the nation – for the distinct purpose of improving the health status of the underserved  in rural and urban Oklahoma communities.  Through this unique joint venture, the medical community is participating in one of seven national pilots  fostering the development of patient centered medical homes for the Medicare and Medicaid populations.

Additionally, the medical school operates MyHealth, a health information exchange with more than 150 participating healthcare organizations committed to improving care coordination and healthcare data exchange. While all may not be appropriate for size and scope of your entity, programs developed within this initiative that hold great potential for population health management include:

  • Outreach psychiatric and rehabilitation team care of those with most severe mental illnesses – current savings estimated at $15k
  •  Palliative Care teams – LOS reduced by 2 days
  • 75,000 secure web-based primary care/specialist consults – reduced face to face evaluations by 35%.
  • Acute Care Evening Clinic
  • Longitudinal Chronic Care Clinic – using Patient Centered Medical Home Model
  • FQHCs – Physician Assistant student Patient Centered Medical Home clinics (ACA – HRSA grant), Teaching Health Center (ACA – HRSA application)

Given their rural presence, it is encouraging to see the state ranking the highest on the primary care access challenge promoting mid-level providers in their healthcare service delivery strategy.  And with Kaiser’s commitment to mobile health, it will be interesting to learn more about this Beacon community’s utilization of such an important technology.

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

Deploying Health IT and Patient-Centered Process Improvement for Innovation

Deploying Health IT and Patient-Centered Process Improvement for Innovation

Many have gathered in Washington, DC this week to celebrate National Health IT week.  With the goal of raising awareness regarding healthcare information technology, numerous organizations are highlighting the increasingly essential role it plays in delivering high-quality, patient-centered healthcare.  While few would dispute its pivotal nature, health IT fans must also be quick to acknowledge that in silo it will not render results, but must be strategically utilized in thoughtful, pragmatic processes that drive evidence-based outcomes.  And according to Dr. Andrew Litt, the need for clinical transformation – fundamentally altering the way care is delivered versus simply automating current processes – will be key, if we, as a nation, are to succeed in revolutionizing healthcare.

For the good news, there are multiple examples of innovative programs leading this charge.  One such enterprising example is the congestive heart failure clinic at the Johnson City Medical Center in Tennessee.  Founded by Nurse Practitioner, Julia Bates, this free clinic was established to help patients with education, medication reconciliation, healthcare access issues and disease management.  Having previously extolled the virtues of the nurse led clinic, it would be intriguing to measure the impact of a disease registry combined with population health management tools, striving to engage the patient in a variety of mediums, in this venue.  And better yet, providing access to this website through a patient portal would facilitate the search for appropriate and available health coverage, thereby  minimizing healthcare access issues.  But even with the potential to reduce emergency department re/admissions and generate significant cost savings, this clinic will, no doubt, continue to face many challenges validating this assumption under the auspices of value-based purchasing.

Knowing that they are not alone in this endeavor, with access to Essentia Health System’s pioneering work in their advance practice nurse led heart failure clinic, will prove, however, to be helpful.  As noted in the Agency for Healthcare Research & Quality’s (AHRQ) service delivery innovation brief, Heart Failure Disease Management Improves Outcomes and Reduces Costs, Essentia Health restructured outpatient care for heart failure patients by incorporating a combination of chronic care and disease management principles with home telemonitoring for high-risk patients to decrease medication use, improve outcomes and functional status and reduce readmission rates, length of stay, and overall costs of care for the health system.  Tune in to find out how health information technology and patient-centered process improvement, in concert, enabled this healthcare innovation.

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

Healthcare Innovation: Moving from Stewardship to Leadership

Healthcare Innovation:  Moving from Stewardship to Leadership

With the close of the subdued Democratic National Convention this week, there was noticeably scant mention of healthcare reform.  In light of the Supreme Court’s landmark ruling in favor of the Patient Protection and Affordable Care Act (PPACA), perhaps President Obama has checked this off his list.  Given the compelling need to drive cost out of the current bloated system, one might argue, however, that now – more than ever – healthcare reform should be a topic for discussion.  And as Alan Zuckerman, President of Health Strategies and Solutions, states, “(in this new era with new imperatives).. like many other industries, the call to action is how do we do more, or even the same, with less? And with the artificial prop of 5 to 10 percent increases in rates and spending no longer guaranteed, how do we maintain the vitality of our organizations?”

Living in a prosperous economy with profitable reimbursement rates, Zuckerman argues, shields healthcare companies, in particular, non-profit entities, from innovation.   In addition, he points out that the traditional terminology reserved for healthcare leadership – administrator – connotates stewardship versus active management.  In order to tackle this challenge head on, Zuckerman suggests, “busting the status quo, challenging long-held assumptions, envisioning the possibilities when uncertainty is converted to action and forging a new path – that’s what true innovation in healthcare could look like.”  While this can be a daunting charge, “healthcare executives must recognize that their organizations’ cultures are at odds with this new posture and work to reshape the cultures to make them more adaptable, flexible, risk-bearing and (centrally focused on innovation).”  Check out this previous post for more examples.

For organizations having ‘played between the lines’ in the past, how do they adopt this new mindset?  According to Zuckerman, “Peter Drucker’s Harvard Business Review article, “The Discipline of Innovation,” identifies seven sources of innovation, four that are internal — unexpected occurrences, incongruities, process needs, and industry and market changes — and three sources that are external — demographic changes, changes in perception and new knowledge. He suggests that “an innovation has to be simple, and it has to be focused. It should only do one thing…Above all, innovation is work rather than genius.”

Furthermore, he lays out the following five actions to launch the innovation journey:

  • Rally senior leaders
  • Reexamine and begin to modify your organization’s culture to be more risk-bearing by encouraging experiments and pilots and create a non-punitive environment
  • Make innovation a theme of day-to-day operations
  • Consider structural changes in the form of a Chief Innovation Officer or committee to support innovation
  • Last but not least and my favorite – JUST DO IT!

A leader in the innovation movement, Kaiser Permanente has created a formal consultancy aimed at deploying design thinking to improve the care experience for both the patient and healthcare provider.  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

Healthcare’s New Imperative: Population Health Management

Health Care’s New Imperative:  Population Health Management

Now that the Patient Protection and Affordable Care Act (PPACA) has received the Supreme Court’s stamp of approval, healthcare providers must determine the best way to improve quality and safety while simultaneously reducing cost.  According to the Agency for Healthcare Research and Quality (AHRQ) Practice-Based Population Health:  Information Technology to Support Transformation to Proactive Primary Care Report, the proactive measurement and management of a panel of patients may be one means of transforming the current healthcare delivery approach.

As defined by the Health Research & Educational Trust, population health management provides a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:

  • The distribution of specific health statuses and outcomes within a population;
  • Factors that cause the present outcomes distribution; and
  • Interventions that may modify the factors to improve health outcomes

To succeed at population health management, effective strategies for increasing the prevalence of evidence-based preventive health services and preventive health behaviors, improving care quality and patient safety and advancing care coordination across the health care continuum must be implemented.

The Care Continuum’s report, Measuring Population Health: 2010 Outcomes Guidelines Report Volume 5, sets forth a framework for achieving healthcare quality improvement.  Utilizing health risk assessments, medical claims, lab and other data, individual’s health/emotional risk can be quantified and addresses accordingly.  Through face to face, mail, email, telephonic, social media, online education & coaching and other interventions, healthcare providers can work with patients to modify behavior and improve health status.  In order to cement long-lasting and continued success, care coordination and appropriate incentives must flank the framework.  Through improved health status, by-products of higher satisfaction and productivity with corresponding decreases in health service utilization and cost will occur.

In order to prepare for increasing numbers of aging, chronically ill and insured patients in the face of value-based purchasing, many organizations have already started down the path of population health management.  While population health management remains in its infancy, the Care Continuum has identified key issues for future success of this increasingly important strategy:

  • Accountable Care and Medicare Shared Savings Program – will these continue to be vehicles for healthcare reform?
  • Consumer Use of Mobile & eHealth Technologies – healthcare is moving to a patient-centered, consumer-empowered, pull-rather-than-push model
  • Reducing Medicare Hospital Readmissions – can this strategy effectively facilitate the Hospital Readmissions Reduction Program (HRRP)?
  • Quality Improvement- the need  to demonstrate improvement in wellness and chronic care measures will drive expanded opportunities
  • Improving Care Coordination for Dual Eligibles – can population health management drive efficiencies for the Federal Coordinated Health Care Office?
  • Federal  and state health insurance exchange support of prevention and wellness

Having recently hosted the Population Health Innovations Showcase in Washington, D.C., the Care Continuum Alliance continues to keep the country focused on healthcare’s new imperative:  population health management.

*graphic courtesy of SHPS

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