• 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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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

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

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

Advance Practice Nurse Led Clinics – Coming to Your Medical Neighborhood Soon?

Advance Practice Nurse Led Clinics – Coming to Your Medical Neighborhood Soon?

In celebration of National Nurse Practitioner week, Drs. Norah Johnson and Kristin Haglund provide a glimpse into a developing trend between academic nursing institutions and nurse led clinics.  In their overview of Marquette Neighborhood Health Center (MNHC) in Wisconsin, they illustrate the symbiosis that can be found between a nursing school seeking resident NP training and the desire to improve the communities that they serve.  Through its affiliation with the Marquette University College of Nursing, MNHC delivers primary care, health promotion, physical exams and diagnosis and treatment of common illnesses in a federally designated primary care health professional shortage area, located in downtown Milwaukee.  Since 2007, this NP led clinic has treated local residents, Marquette University students and employees, clients of the Salvation Army, and clients of the Milwaukee Center for Independence.

Predominantly serving a Medicaid population, this nurse-managed health center now finds itself facing many issues regarding sustainability.  Not meeting the current requirements of a federally qualified health center (FQHC), no matching federal funding opportunities exist.  Rather, nurse led clinics often rely on the support of university funding via an academic partner, leaving it in competition for dwindling dollars.  And while Medicaid does reimburse for Nurse Practitioner services, it is generally at a rate one-third less (66%) of a standard primary care visit.  Medicaid reimbursement rates are projected to improve for 2013/14; however, only those delivered by a physician specializing in family medicine, internal medicine, pediatric medicine OR a nurse practitioner working and billing under the supervision of a qualifying physician. While this is a positive step for increasing the Medicaid provider panel, it will not generate additional revenue for MNHC since the NPs bill under their own Medicaid provider numbers.

Having recently written about the dwindling number of Medicaid providers in the state with the highest uninsured rate, I would be curious to know how the Centers for Medicare and Medicaid Services (CMS) would view the inclusion of nurse led clinics in the medical home?  By developing affiliations with accountable care organizations, nurse practitioners gain access to referral sources for higher acuity services and capital for infrastructure and improvements.  Additionally, drawing this vulnerable population into a continuum of care paves the way for reducing inappropriate utilization of more expensive outlets for primary care – namely the emergency department.  Thus, savvy hospitals, healthcare systems, physician groups and payers participating in or modeling new payment arrangements not only reap the benefit of prevention, wellness and subsequent reduced readmissions, they also have the opportunity to engender loyalty amongst an influential group of expanding primary care providers and expand their recruitment pool.  Most importantly, with a new entry point into these redesigned delivery mechanisms, increased numbers of un/underinsured persons have the potential to receive care; albeit not without the changes to the Medicaid reimbursement rate for the NP led clinic clinician in a medical home.

In addition to funding challenges, MNHC struggles with a high no-show rate.  In working with a medical home, MNHC would have the ability to employ an electronic medical record and participate in direct messaging or a health information exchange, services not typically found in a siloed NP led clinic.  Layer in population health management tool and these front-line providers begin to have the ability to improve their breadth and depth of services rendered.  Marry this with appropriate messaging for appointment reminders, medication maintenance and others identified in the webinar below and the potential exists to transform the manner in which this critical population accesses healthcare – a fundamental necessity for bending the cost curve and transforming the way healthcare is delivered today.

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

Driving Down the Real Cost of Healthcare: Pediatric and Teen Medical Homes

Driving Down the Real Cost of Health Care:  Pediatric and Teen Medical Homes

At last, the presidential race has concluded and, as a nation, we can prepare to move forward.  With President Obama’s election to a second term, implementation of the Accountable Care Act (ACA) moves full steam ahead.  In light of the fiscal cliff – perpetuated by the expiration of the Bush tax cuts, the 2009 Economic Stimulus provisions, the payroll tax holiday and 67 other tax provisions – the question still remains, how do we make a significant impact on cost reduction in healthcare?

While much has been written about the spiraling cost of chronic care, I found it surprising to learn that spending on healthcare for commercially insured children under age 18 grew faster than spending for adults from 2007 to 2010. After examining more than three billion insurance claims from three major carriers, the Healthcare Cost Institute reported that consumer spending on pediatric and teen healthcare increased 12% to nearly $88 billion dollars from 2007-2010, while spending on adults increased at a slower rate of 8%.  Even more intriguing, it seems that spending for children’s healthcare increased despite decreasing numbers of children covered and a utilization of expensive healthcare services, such as hospital stays and brand-name drugs.

If utilization is not driving this increase in healthcare cost, then what is?  According to the report, a number of activities are contributing to this trend, including increased use of consults, procedures and testing facilities. Digging deeper into the data, the study also revealed that two groups are incurring the highest cost:  infants, three years and younger and teenagers, aged 14-18.  While the increasing expense associated with pre/peri/post-natal births and associated outcomes is comprehensible for the infant cohort, what makes les sense is the skyrocketing expense for prescription drugs for central nervous disorders, such as anti-depressants, anti-anxiety disorders and drugs used to treat ADD or ADHD in the teenage population.

By and large, families were spending the greatest amount on primary care visits, immunizations, and preventive medicines (40.3%), followed in short order by outpatient procedures (24%), inpatient procedures (22%) and prescription drugs (14%).  Sufficed to say, this study did not include children participating in the Medicaid or CHIP programs, so it is difficult to discern if similar trends occurred in this population.  As the author points out, regardless of payer, children with exponential healthcare costs grow into adults with unsustainable expense.  Recognizing the benefit of medical homes for low risk pregnant women and children, it would be a fascinating case study to enroll willing participants currently attending a MindUp program that were committed to learning how to cook healthy food options using locally grown fruits and vegetables and engage in healthy exercise regimens.  Last but not least, reaching this critical and vulnerable population will be key.  Incorporating text messaging, voice, email, video and animation in efforts to successfully communicate important healthcare messages, similar to the program below, will ensure that mothers, infants and teens seek wellness and prevention, in efforts to reverse this frightening trend.

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

Changing Behavior to Conquer Obesity

Changing Behavior to Conquer Obesity

According to a recent Bipartisan Policy Center report, Lots to Lose: How America’s Health and Obesity Crisis Threatens our Economic Future, two-thirds of Americans are overweight or obese.  In addition, one in three children meet this definition, putting them at risk for chronic diseases such as diabetes, hypertension, asthma, heart disease and cancer.  With escalating health care costs now acting as the main driver of our spiraling national debt, obesity has become a preeminent public health issue.  Recognizing this plight, the Bipartisan Policy Center (BPC) launched its Nutrition and Physical Activity Initiative based in large part on concern about the national debt and the clear role that escalating healthcare costs play in our nation’s looming fiscal emergency.  As noted in the report, a number of recommendations must be implemented across individual, family and organizations in order for, “success (to be) possible if all these entities work together and bring creativity, innovation and focused commitment to the effort.”

In response to the report, Kaid Baifield highlighted a number of recommendations regarding how cities can help fight obesity.  Specifically, the author outlines ways in which the community can help prevent the situation:

  1. Train health care professionals in nutrition and physical activity
  2. Expand a “prevention-workforce” by providing training also to non-clinical, community health workers
  3. Provide incentives for community health services such as diabetes or weight loss education
  4. Improve menu options at large institutions, shifting food supply chains towards healthier options and better prices
  5. Promote positive nutrition and fitness examples at public institutions
  6. Use existing infrastructure assets to promote more local opportunities for physical activity
  7. Make creative use of technology, such as games, pedometers, or apps locating walking and recreation spots
  8. Incorporate physical activity and healthy transportation guidelines into construction codes and planning policies

As a wise mentor once taught me, our mission, as healthcare leaders, is to improve the health of the people in the communities we serve.  In reviewing the list above, there are a number of recommendations for interventions with health professionals and services that serve this purpose.  And while it is commendable to note these general statements about improving health, perhaps the real crux of the problem is how we influence individuals to change the way they think, and more importantly, act, about their health?  Further complicating the debate, researchers at the University of Florida have also noted that forty percent of rural residents, versus thirty percent of their urban counterparts, remain obese, underscoring the lack of access to health professionals and services continuing to fuel this potential epidemic.

Noting my previous interest in healthcare providers engaging their patients, I continue to believe this strategy offers a potential key to the solution.  First and foremost, providers must be given tools and reimbursed appropriately in order to succeed at this endeavor.  And by incorporating tools – concisely written ‘cue’ cards, texts, videos, apps (games, weight loss programs), pedometers, e-health visits, follow-up phone calls with traditional office visits, providers are able to reinforce their message via a variety of formats that are most relevant to the patient.  And it is through these channels – incorporating the use of ubiquitous technology, theory-informed, but user-relevant interventions, high degree of tailoring, and continuous interventions –  that Dr. Karen Calfas believes that healthcare providers can drive successful maintenance of behavior change.

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