Remote

Circle

Humana's remote monitoring pilots go beyond traditional targets of heart failure, diabetes and COPD to observe functionally challenged members, explains Gail Miller. This novel approach uses a Personal Emergency Response System (PERS) with a built-in accelerometer to monitor members challenged by activities of daily living (ADL), says the VP of telephonic clinical operations in Humana's care management organization, Humana Cares/SeniorBridge. Another pilot, a collaboration with HealthSense, places sensors around the member's home to study algorithms of normal movement so Humana can detect changes and intervene before a member's crisis.  All Humana remote monitoring pilots engage the circle of care surrounding the member --- be it home health, a family member, or a spouse.  Gail Miller will share more details of Humana's telephonic care management and how remote monitoring pilots will enhance care coordination during a March 19, 2014 webinar, "Integrating Mobile Health Remote Patient Monitoring with Telephonic Care Management for Improved Care Coordination Results," a 45-minute program sponsored by The Healthcare Intelligence Network.

Humana Remote Monitoring Pilots Engage Circle of Care Surrounding Member

Relationships with community organizations that support mental health as well as recovery from addiction are essential to care coordination of Medicare-Medicaid beneficiaries, notes Julie Faulhaber, vice president of enterprise Medicaid at Health Care Service Corporation (HCSC). These collaborations enable HCSC to address the needs of duals as "a whole sick person, and not just as a diagnosis," she explains, noting that duals often suffer from depression along with some physical disability. HCSC also has its own integrated team with behavioral health expertise.  Julie Faulhaber will share her organization's approach to designing a care coordination model for dual eligibles and initial findings from these new programs during a March 12, 2014 webinar "Moving Beyond the Medical Care Coordination Model for Dual Eligibles," a 45-minute program sponsored by The Healthcare Intelligence Network.

HCSC's Community Behavioral Health Links Essential to Duals Care Coordination

Given changing reimbursement incentives and collaborative models for physicians and hospitals, Greg Mertz, managing director of Physician Strategies Group, LLC, discusses why the Congressional proposal "Better Care, Lower Cost Act" of 2014 is financially more attractive to providers than ACO models and whether he thinks it will be passed. He also deconstructs CMS' recently reported financial results for such health reform delivery initiatives as Medicare ACOs, Pioneer ACOs, and the Physician Group Practice demonstration, and weighs in on which, if any, model he considers the most sustainable.  Greg Mertz helped healthcare organizations assess which value-based healthcare delivery model is right for their organization during "Physician Alignment: Which Model Is Right for You?," a February 19th, 2014 workshop at 1:30 p.m. Eastern.

Deconstructing Health Reform: 3 Reasons Medicare and Pioneer ACOs May Not Survive

There are three key benefits to prudent sharing of performance data among physicians, notes Cynthia Kilroy, senior vice president of provider strategy and business development at Optum, who suggests a four-step systematic approach for data dissemination that moves companies away from simply creating "metrics in a box." Besides the electronic health record, she recommends three other data sources to mine for provider performance metrics.  Cynthia Kilroy explored the key structure, issues and challenges in these evolving reimbursement models during a January 29, 2014 webinar, "Accountable Care Reimbursement Models: Moving from Productivity to Population-Based Incentives," a 45-minute program sponsored by The Healthcare Intelligence Network.

3 Key Benefits to Prudent Sharing of Physician Performance Data

Adventist Health's successful use of incentives to engage employees in population health sets a high bar for the program's imminent rollout to patients at Adventist-owned White Memorial Medical Center, notes Elizabeth Miller, Adventist's vice president of care management. In this interview, Ms. Miller describes the program's target population as well as the incentive that engaged 95 percent of its employees in health management.  Elizabeth Miller will share the key features of the population health management program at White Memorial, the program's impact on Adventist's 27,000 employees and program rollout to its patient population during a January 22, 2014 webinar, "Managing Risk in Population Health Management," a 45-minute program sponsored by The Healthcare Intelligence Network.

Managing Risk in Population Health Management

With hospital readmission rates under close scrutiny by CMS, Torrance Memorial Health System launched a readmission program in early 2013 that has been recognized as a program of excellence for its innovation and impact on the community. Navigators work with patients prior to discharge from the hospital to educate them on the hospital's Care Transitions program, which includes a network of Skilled Nursing Facilities, or SNF's and one home health agency. And once the patient is discharged, ambulatory case managers keep watch on the patients after the 30-day penalty phase is over.  Josh Luke, Ph.D., vice president of post acute services at Torrance Memorial Health System and founder of the California Readmission Prevention Collaborative and the National Readmission Prevention Collaborative, shared the key features of the program during "Award Winning Readmission Prevention Protocols: Navigating Care Transitions with Preferred SNF and Home Health Providers," a 45-minute webinar on January 8th, 2014, at 1:30 pm Eastern.

Award Winning Readmission Prevention Protocols: Navigating Care Transitions with Preferred SNF and Home Health Providers

Lauded for its care coordination service, Monarch had to overcome a few challenges when retrofitting the Naylor Transition of Care (TOC) model for the ACO --- among them insufficient patient access, patient skepticism and resource limitations. By focusing on readmissions reductions and four disease management conditions --- ESRD, COPD, CHF and diabetes --- and creating a care coordination team that included the newly created care navigator, case managers, and pharmacist, the organization has improved patient compliance, reduced negative drug interactions and hospital days and improved patients access to community services. During "Medicare Pioneer ACO Year One: Lessons from a Top-Performer," a September 18th webinar at 1:30 pm Eastern, Colin LeClair, executive director of ACO for Monarch HealthCare, shared first year lessons from its Medicare Pioneer ACO experience, how it evolved in year two and the impact on its organization's participation in other accountable care organizations.

Medicare Pioneer ACO Year One: Lessons from a Top-Performer

There's education, there's experience, and then there's the 'right stuff' --- the indefinable personality traits that earmark an individual as a change agent, collaborator and ambassador of case management, says Annette Watson, senior vice president of community transformation for Taconic IPA (TIPA), of TIPA's requirements for the RN case managers it hires for its advanced patient-centered medical homes.  Then there are the not insignificant contributions of the RN case manager to accountable and patient-centered care, which Ms. Watson describes in this interview.  While staff-buy-in and communication continue to challenge the embedded case manager model, the participant in CMS Innovation Center's Comprehensive Primary Care (CPC) initiative says reimbursement for embedded case management is less of an obstacle today than in the past, due to funding-friendly care models and pilots descending from healthcare reform. Ms. Watson shared how TIPA has successfully embedded case managers in an open, multi-payor community during an October 9, 2013 webinar, "Improving Population Health with Embedded Case Managers in an Open, Multi-Payor Community."

Improving Population Health with Embedded Case Managers in an Open, Multi-Payor Community

From partnering with non-traditional providers like retail clinics to targeting larger physician practices to achieve savings and boost health outcomes, watch for health plans to continue to reshape primary care delivery over the coming year, predicts Catherine Sreckovich, managing director, healthcare, Navigant. Ms. Sreckovich outlines seven ways in which payors will influence primary care, advocates for big data for both payors and providers, and comments on the longevity of the bundled or episodic payment trend in this HealthSounds interview.  Catherine Sreckovich and Steven Valentine, president of The Camden Group, provided a roadmap to the key issues, challenges and opportunities for healthcare providers and payors in 2014 during an October 30, 2013 webinar, "Healthcare Trends and Forecasts in 2014: A Strategic Planning Session."

Healthcare Trends and Forecasts in 2014: 7 Payor Strategies That Will Reshape Primary Care

Modifying a popular hospital admissions risk assessment tool for its own use helps Stanford Coordinated Care to prioritize home visits for its roster of high-risk patients, all of whom have complex chronic conditions, explains Samantha Valcourt, MS, RN, CNS, Stanford's clinical nurse specialist. Stanford's HARMS-11, based on Iowa Healthcare Collaborative's HARMS-8 hospital risk screening tool, looks at individuals' utilization, social support and medication issues, among other factors, to measure a patient's risk of readmission.  The resulting home visits, a critical component of Stanford's care transitions management program, help to uncover health challenges the complex chronic patient may still face, including four common medication adherence barriers Ms. Valcourt describes in this interview.  Samantha Valcourt shared how Stanford's Coordinated Care uses a home visit assessment to improve care transitions post-discharge during a December 19, 2013 webinar, "Home Visits: Assessing Complex Patients Post-Discharge To Reduce Readmissions."

Home Visits: Assessing Complex Patients Post-Discharge To Reduce Readmissions

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What constitutes healthcare quality improvement? CMS's definition of medical costs will likely coalesce around five key areas of quality improvement, say John Steele and Steve Young, managing directors for HealthScape Advisors. These CMS guidelines will impact health plans in January, when new medical loss ratio (MLR) regulations take effect. In this podcast, the advisors also describe the risk that insurers could incur on the rebate side if they don't adequately prepare for the January changes and the impact the regulations could have on consumers' medical care and choices.  Steele and Young will provide an in-depth analysis of what health plans must do now to comply with the January deadline for MLRs and how this might impact health plans operationally and financially during "Minimum Medical Loss Ratios: How Health Plans Should Prepare for the January Compliance Requirements," a 60-minute webinar on July 21, 2010.

Minimum Medical Loss Ratios: How Health Plans Should Prepare for the January Compliance Requirements                                      

Three key factors influence consumers' use of the hospital emergency room today, according to Dr. Barsam Kasravi, managing medical director for state-sponsored programs for WellPoint. In this podcast, Dr. Kasravi discusses how WellPoint is trying to close critical care gaps and encourage its members to utilize healthcare services more effectively.  Dr. Kasravi and Dr. Karen Amstutz, vice president and medical director of Medicaid and senior markets, will describe WellPoint's efforts to reduce avoidable emergency room visits during "Reducing Avoidable Emergency Room Visits: Approaches to Redirect Patients to Cost-Effective Care Settings," a 45-minute webinar on September 1, 2010.

Reducing Avoidable Emergency Room Visits: Approaches to Redirect Patients to Cost-Effective Care Settings                                         

In another excerpt from a conversation with Metcare of Florida chief executives on its continuing medical home pilot with Humana, COO Dr. Jose Guethon describes the mechanics of sharing utilization and financial data with its physicians, and the impact of this practice and friendly competition between physicians has had on workflow, patient access, customer service and other key metrics. Dr. Guethon and Metcare CEO Mike Earley described how Metcare practices have made the transformation to patient-centered medical homes, with an eye on maintaining the profitability of their practices, during "Patient-Centered Medical Home Transformation: 9 Key Hurdles for Physician Practices To Overcome," a 45-minute webinar on May 12, 2010.

Patient-Centered Medical Home Transformation: How Data Sharing Improves Physician and Business Performance                                      

Kerry Little, senior health coach with Duke University Medical Center, shares what strategies Duke uses for its health coaches to connect with participants. Bonnie Sechrist, director of clinical program development at HMC and Little, along with Maddy M. Rice, area vice president of education at CorSolutions, shared their companies' strategies for health coach training during Health Coach Training: Insider Tips for Effective Coaching, an October 26, 2005 audio conference now available on CD-ROM.

Health Coaching Strategies at Duke University Medical Center

Nurse practitioners constitute a workforce already grounded in patient-centered care, explains Linda Lindeke, Ph.D., an RN and a nurse practitioner herself since 1978. Lindeke, who is also associate professor for the School of Nursing and Department of Pediatrics and director of Graduate Studies for the School of Nursing at the University of Minnesota, describes the demographics where a nurse practitioner's contributions might need clarification, explains why there's not much mention of the medical home in nursing literature and assesses the impact of the Affordable Care Act's $15 million allocation to fund 10 nurse practitioner-led clinics that will provide primary care services to the medically underserved.  Lindeke will examine how nurse practitioners are being utilized in the physician practice, hospital and clinic settings to increase access to care and coordinate care for patients with chronic conditions during "The Emerging Role of Nurse Practitioners in Expanding Access, Enhancing Revenue," a 45-minute webinar on July 28, 2010.

The Emerging Role of Nurse Practitioners in Expanding Access, Enhancing Revenue                                     

To avoid missing other opportunities inherent in the ACO model, payors and providers shouldn't get hung up waiting for CMS's rule for Medicare accountable care organizations, advises Greg Mertz, senior project director with the Healthcare Strategy Group. In this podcast, Mertz has advice for both providers and payors on how to maximize participation in an ACO.  Mertz will provide a critical analysis of CMS's anticipated final rule on Medicare Shared Savings and how it will impact commercial ACOs during a 45-minute webinar on April 21, 2011, "Analyzing CMS's Medicare Shared Savings Final Rule: Implementation Advice for ACOs," sponsored by the Healthcare Intelligence Network.

Analyzing CMS's Medicare Shared Savings Final Rule: Implementation Advice for ACOs

Whether extracted from an EHR or compiled with a spreadsheet program, there's nothing magical about a registry, explains Dr. Gregory Spencer, chief medical officer for Crystal Run Healthcare. Dr. Spencer demystifies the registry, describes how to leverage registry data in multiple ways and underscores registries' growing value in emerging care delivery models like the accountable care organization. Dr. Spencer will share patient registry best practices during an April 28, 2011 webinar, "Patient Registries: A Cornerstone in Creating and Delivering Accountable Care," sponsored by The Healthcare Intelligence Network.

Patient Registries: A Cornerstone in Creating and Delivering Accountable Care

When health coaches employ motivational interviewing during patient encounters, expect upticks in medication adherence, weight loss, HbA1c levels and overall engagement, notes Alicia Vail, RN health coach for Ochsner Health System. Ochsner's eight health coaches focus on patients with diabetes, hypertension and obesity who have come to their attention by way of physician referrals, health screenings and pre-chart reviews.  In this podcast, Ms. Vail describes how Ochsner Health System incorporates health coaches in its clinic structure and describes the benefits that result from the coaching intervention.  Alicia Vail and Bill Appelgate, executive director of the Iowa Chronic Care Consortium, shared how an evidence-based health coaching focus drives returns in a value-based payment delivery system during a June 19, 2013 webinar, "Health Coaching's Value in Accountable Care and Medical Homes."

Motivational Interviewing by Ochsner Health Coaches Drives Results in 4 Key Areas

A patient might expect a reminder about a missed colonoscopy during a primary care visit, but during a trip to the dermatologist? Providing health plan members with "consistent and ubiquitous reminders" via multiple touchpoints in their healthcare journey is one of Kaiser Permanente's key population health management strategies, reports Jim Bellows, PhD, senior director of evaluation and analytics for Kaiser Permanente.  Another is the vigorous use of registries --- more than 50 in all, at last count --- even for relatively rare diseases. Dr. Bellows defines the criteria for registry creation, expands on the choice and availability of patient touchpoints and explains the evolution of other Web-based PHM tools in use by Kaiser Permanente.  Dr. Bellows shared his organization's approach to population care and population health management during a July 31, 2013 webinar, "Managing Population Health with Integrated Registries and Effective Patient Touchpoints."

Managing Population Health with Integrated Registries and Effective Patient Touchpoints

When tracked within its electronic medical record, key interventions like transitional care coaching and an expanded Patient Health Questionnaire not only improve the care provided to John C. Lincoln ACO's population but provide a clearer picture of the accountable care organization's performance, note Karen Furbush, business consultant, and Heather Jelonek, chief operating officer of the John C. Lincoln Network ACO.  Additionally, the ACO's Physician Advisory Network, made up of its leading physicians, tracks patterns and trends within the ACO and helps the care team to adhere to best practices in evidence-based medicine. Monthly webinars with the physician advisory network and its EMR specialists provide opportunities for evaluation and training in these best practices.  Karen Furbush and Heather Jelonek shared how the John C. Lincoln Network ACO has modified its reporting process, from workflow changes to customizations within its EMR to improve performance results during a July 17, 2013 webinar, "Performance Quality Measurement and Reporting for Accountable Care," a 45-minute program sponsored by The Healthcare Intelligence Network.

Performance Quality Measurement and Reporting for Accountable Care

In its quest to transform 70 to 80 percent of its physician practices to a patient-centered medical home (PCMH) over the next three years, WellPoint has adopted a "meet the practices where they are" philosophy, reports Julie Schilz, director of care delivery transformation for WellPoint. Each practice is at a different place in the transformation effort and requires specialized supports, she adds.  Smoothing the transformation rollout is the simultaneous participation of 500 WellPoint practices in CMS's Comprehensive Primary Care (CPC) program, whose goals dovetail with key PCMH principles --- as though WellPoint had another partner in its transformation initiative, Schilz notes. Just as important as practice support is transparency with health plan members, Schilz adds, especially when it comes to explaining the concept of the medical home neighborhood --- where care coordination is a collaboration between primary care and the specialist. Ms. Schilz shared the key features of WellPoint's transformation initiative, including results from its pilot program that have led to a system-wide rollout, during an October 24, 2013 webinar, "Aligning Value-Based Reimbursement with Physician Practice Transformation."

Aligning Value-Based Reimbursement with Physician Practice Transformation

If payment inequities can be addressed, communication and technology tools in place in large physician multispecialty groups make them ideal candidates for a medical neighborhood, suggests Terry McGeeney, MD, MBA, director of BDC Advisors. Dr. McGeeney, who spent 13 years of his practice career in a large multispecialty group, has also seen some FQHCs and managed Medicaid programs that do a good job of linking community and social supports required in medical neighborhoods.  As for engaging patients in this emerging integrated care delivery system, try explaining the medical neighborhood's value proposition for them, he suggests. Patients already get why the integrated approach is good for physicians and insurance companies but need to hear why they should buy in to team care, patient portals and other aspects of centralized care coordination.  Dr. McGeeney shared his expertise in developing medical home neighborhoods during a November 20, 2013 webinar, "Medical Home Neighborhoods: Uplinking Specialists To Create Integrated Systems of Care."

Medical Home Neighborhoods: Uplinking Specialists To Create Integrated Systems of Care

Primary care and the patient-centered medical home offer a great opportunity for health coaches to become allies with patients in improvement of their health, notes William Appelgate, executive director of the Iowa Chronic Care Consortium. Individuals with the highest health risks should be given priority, but those on the cusp of a serious health event also merit coaching assistance, he says. For providers new to the coaching conversation, Appelgate shares three benefits of incorporating health coaches in the care process --- including the upping of their 'outcomes game.'  Bill Appelgate and Alicia Vail, RN health coach for Ochsner Health System, shared how an evidence-based health coaching focus drives returns in a value-based payment delivery system during a June 19, 2013 webinar, "Health Coaching's Value in Accountable Care and Medical Homes."

Health Coaching's Value in Accountable Care and Medical Homes

A core desire to create a single population-focused model of care for all Medicare beneficiaries, rather than multiple payor-driven approaches, drives Atrius Health's participation in the CMS Pioneer ACO program, explains Emily Brower, executive director of accountable care programs at Atrius Health. The success of the Atrius ACO hinges on several preferred partnerships it has cultivated, including a collaboration with skilled nursing facilities, as well as outreach by population health managers, who guide patients in the management of chronic illness and prevention. Ms. Brower shared the first year lessons from its experience as a Medicare Pioneer ACO and how the program is evolving in year two during a May 9, 2013 webinar, "Medicare Pioneer ACO: Case Study on Atrius Health's Focus on the Triple Aim," now available for replay.

Medicare Pioneer ACO: Case Study on Atrius Health's Focus on the Triple Aim

There are two key mistakes healthcare companies make when adopting social or mobile technologies, explains Andrew Dixon, senior vice president of marketing and operations, Igloo Software. Dixon describes what's driving the aggressive growth of interactive patient care communities and suggests how responsibility for social strategy --- which he defines as both an internal and external communications strategy --- should be assigned. Dixon discussed the key elements of an effective social strategy, along with and best practice guidance from healthcare social strategies having a bottom line impact during a May 1 2013 webinar, "Healthcare Social Business Strategy: Driving Adoption with Social, Mobile and Cloud Technologies," a 45-minute program sponsored by The Healthcare Intelligence Network.

Healthcare Social Business Strategy: Driving Adoption with Social, Mobile and Cloud Technologies

Low scores on patient outcomes measures within the CMS Star Quality ratings program --- metrics CMS weights most heavily in its assignment of stars --- can typically be traced to poor provider and member engagement, notes Joseph Johnson, vice president of L.E.K. Consulting. Johnson suggests ways to enlist support from these two stakeholder groups, and describes how MA plans should prepare for the possible display in 2014 of CAHPS care coordination ratings along with with its star scores (though the care coordination ratings will not be factored into star ratings). Johnson shared tactics to improve quality ratings as well as insight into the future direction of the CMS Star Quality program during an April 16, 2013 webinar, "A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings," a 45-minute program sponsored by The Healthcare Intelligence Network.

A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings

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