Designing Healthcare 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 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

Engaging Specialty Practices in the Patient Centered Medical Neighborhood

Building on last week’s post about embracing change for healthcare transofrmation, it was intriguing to learn about the NCQA’s new patient centered medical home program for specialty practices.  Kicking off  March 25, the Patient Centered Specialty Practice (PCSP) recognition highlights specialty practices committed to access, communication and care coordination as “neighbors” that surround and inform the medical home and colleagues in primary care, according to NCQA.  And I regret to say that I missed the informational webinar, including an NCQA advisor and guest speaker from one of the local healthcare systems.

Had I attended the webinar, I would have been better prepared to query the CEO of a hospital within the same healthcare system at a recent American College of Healthcare Executives (ACHE) function.  Interestingly, we had a lengthy conversation regarding the system’s desire to exchange data within the area; however, the CEO noted that current system architecture made it challenging enough to simply share information amongst health system participants.  With one of the key tenets for the PCSP recognition being timely exchange of data, this is a bit of a conundrum.  While the Direct project offers a simple solution, the ultimate goal will be to facilitate and encourage physicians to search for records in efforts to keep all parties abreast of the care plan.  And while this is a tremendous step, we also noted that retail & urgent care clinics, solo primary care practices and free-standing care centers need to get in on the game too.

I also see a need for ancillary providers to be included as well.  Not only would individuals benefit from the opportunity to view x-rays but, more to the point, visualizations, similar to the one here.  While Physical Therapists do an excellent job engaging patients in discussion, they would have far greater impact with the ability to illustrate their points on an interactive tablet app.  And thinking out loud, wouldn’t it be great for individuals to be able to reference the same app at home – to review the information and implement “their’ steps in the care plan?

 

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

HIMSS 2013: Mayhem or Magic?

With the closing of the HIMSS13 annual conference, I am reminded of the question posed previously – can health ITs newest ideas reduce cost, improve quality and facilitate patient engagement?  In lieu of the recent sequestration events, continued emphasis on value-based purchasing and a still troubled economy, the battle will likely wage uphill.   On a positive note, providers continue to join the ranks of the digital world in terms of medical records and care coordination…but at an alarmingly slow pace.  And while patients are becoming more interested in accessing and sharing their healthcare data, numerous obstacles plague their efforts.

So, how do we find trifecta – where cost reduction, quality improvement and patient engagement peacefully co-exist?  After stumbling on a conversation with SETMA’s Larry Holly, I am reminded of a key overarching principle – perhaps the fulcrum – being the distinct need for both provider and patient behavior change.  As Dr. Holly shares, while healthcare data and technology have evolved at lightning speed, many of the processes associated with utilization have not.  In order to facilitate population management and patient engagement, systems must promote data exchange, add value to clinicians’ diagnostic/therapeutic processes and strengthen relationships with their patients.  Without these capabilities, even the highly customized EMR and mobile applications currently in existence will fail; instead igniting the angst and ire of their users.

Dr. Holly goes on to point out that organizations need to look internally to find the creativity and energy for change while continuing to leverage external experts in this field and others.  And according to Warner Thomas, Oschner Health System CEO, one such field to explore is the airline industry.  With costs spiraling out of control, the airline industry has been forced to automate and reengineer their processes in order to stay competitive – all in the midst of improving customer satisfaction.  A slippery slope, to say the least.  Healthcare, an inherently conservative and compassionate industry, has enabled  patients and providers seeking to maintain status quo.  And while there a select number of healthcare systems that have partnered with vendors to disrupt this mentality, it will be interesting to see how this theme carries over to the annual meeting of the American College of Healthcare Executives, premiering shortly at Chicago’s Palmer House Hilton.

Reading a quote by Arthur C. Clarke, “Technology, properly applied, is indistinguishable from magic.”, I am reminded that healthcare IT is one part art, one part science.  With the opportunity to realize Warner Thomas’ goals – better quality, lower cost and happier providers – the question is, do you believe in magic?

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

Transforming Medicaid via the Medical Home Model

With the March 1^st 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 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

Collaborating for Community Health Innovation

With the recent Super Bowl festivities and Fat Tuesday fast approaching, New Orleans conjures up images of pomp, circumstance and regalia.  While the ragin’ Cajuns will always welcome celebration, the reality of everyday circumstance pales in comparison to these high dollar, high revenue activities.  As noted in The 2013 Healthcare Informatics Innovator Awards: Co-Second Place Winner: The Louisiana Public Health Institute, New Orleans is beset by poverty and poor health status.  And with the onset of Hurricane Katrina in 2005, these difficult situations were magnified.

As noted in the article, one entity that has taken purposeful steps to improve the health of the people in this community is the Louisiana Public Health Institute (LPHI).  Established in 1997, the LPHI’s mission is “to promote and improve health and quality of life in Louisiana through diverse public-private partnerships with government, foundations, community groups, academia and private businesses at the community, parish and state levels.”  After applying for participation in the federal beacon communities project, the group was granted Beacon status and awarded a federal grant, under the auspice of the Crescent City Beacon Community (CCBC) initiative.  Armed with $13.5M, the group is working steadfastly towards the development of a metro area-wide patient centered medical home (PCMH) model.

Tackling dual goals of community quality improvement and long-term healthcare investment, the group is developing a foundation for a patient-centered, accountable, community-wide focus for care.  In order to achieve these goals, they are redesigning care management, employing the new role of care manager to facilitate communication between physicians, administrators and patients in the 20 federally qualified health centers (FQHCs) in the metro area.  And through the use of health information exchange (HIE) and electronic health records (EHR), these re-engineered teams aim to connect patient visits from the ED, hospital, primary care and specialty physician office.

Moving beyond the physical exchange, the group also remains intently focused on improving clinic processes for meaningful use of the shared data.  Instituting regular visits with community stakeholders has allowed for providers to share protocols and other tips for delivering safe, quality healthcare while maximizing workflow.  As a Healthcare Informatics Innovator winner, LPHI has successfully leveraged healthcare technology for community quality improvement.  And while my hat is off to Dr’s Anjum Khurshid, director of the LPHI’s Health Systems, Eboni Price-Haywood, co-ED/CMO for Tulane Community Health Centers and Maria Ludwick, associate director LPHI’s Health Systems, I would be curious to know how they are engaging other providers – pharmacists, schools, social services, long-term care, first responders, etc – and most importantly, patients, in the design process?  Sounds like a great opportunity for the pending 2013 HIMSS conference, coming soon to the Ernest N. Morial Convention Center, located smack dab in the heart of New Orleans.

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

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 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

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 21^st 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