In its annual survey on electronic health record use, Xerox found many Americans are open to getting medical records online if given instruction on how to obtain access by their medical providers.

A new infographic by Xerox illustrates the survey results, including details on the factors that would make consumers more likely to use a patient portal, differences between millenial and baby boomer use of portals and patient engagement strategies.

Faith-based integrated delivery system Adventist Health is on a mission to improve population health status with a wellness-based approach it estimates will eventually net $49 million in savings.

Population Health Framework: 27 Strategies to Drive Engagement, Access & Risk Stratification walks through the elements of Adventist's population health management program that engages individuals to modify behaviors and prevent illness in the future.

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Ninety-two percent of eligible hospitals and 75 percent of eligible healthcare professionals have received an incentive payment for meaningful use, according to an infographic by CMS.

The infographic also examines the progress on other CMS' quality improvement programs, including: ACOs; physician quality reporting system; ICD-10; and electronic funds transfer.

Humana recently distributed $76.8 million in quality awards to approximately 4,700 physician practices through Humana's Provider Quality Reward programs. The program is designed to support providers where they are in their practices as they move through the continuum of care programs focused on the Triple Aim.

Physician Quality Rewards for Population Health Management a 45-minute webinar on December 16th, now available for replay, Chip Howard, Humana's vice president of payment innovation in the provider development center of excellence, shares how Humana's program supports physicians' transition from volume to value and helps them become successful population health managers.

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Use of telemonitoring equipment, electronic medical records (EMRs), a staff dedicated to monitoring home visits and engaged caregivers are just some of the protocols used to enhance home visits, according to 155 respondents to the Healthcare Intelligence Network’s most recent industry survey on home visits.

Following are 10 more protocols used to improve the home visit process:

• Inclusion of home visiting physician in hospital rounds; and the collaboration of home visit physician with primary care physician (PCP) and complex case managers.
• Using our medication management machines with skilled nursing follow-up to increase medication compliance.
• Proactive phone calls to determine if a patient's condition is worsening and in need of home visits.
• Daily workflow management algorithms with prioritization and mobile access to electronic case management records.
• Using teach-back to assure comprehension.
• Easy to use/wear multimodal, advanced diagnostics telemonitoring allowing patients total mobility and continuous real-time monitoring.
• Medication reconciliation is crucial in eliminating confusion for the patient, and our electronic medical record (EMR) accurately reflects what the patient is taking, including over-the-counter (OTC) and supplements.
• Hospital coach gathers information and prepares the patient for discharge, coordinates with home visit staff, home visit team (coach and mobile physician) and completes home visit.
• Portable EMR to document and review medical information on the spot.
• EHR-generated lists, community-based team, community Web-based tracking tool, telehome monitoring devices, preferred provider network with skilled nursing facility/long-term acute care (SNF/LTAC), home health and infusion therapy.

Source: 2013 Healthcare Benchmarks: Home Visits

2013 Healthcare Benchmarks: Home Visits examines the latest trends in home visits for medical purposes, from the populations visited to top health tasks performed in the home to results and ROI from home interventions.

Kevin Watson is CEO of Netsurion, a provider of cloud-managed IT solutions.

Unlike many recent data breaches, Anthem was quick to publicly announce the breach only days after discovering that personal information on as many as 80 million of its customers and employees had been stolen. In this case, it appears the hackers used rather sophisticated methods, managing to gather names, dates of birth, social security numbers, addresses and email addresses. Although it does not appear any medical information or financial records were exposed, the information that was taken is more than enough to steal the identities of the affected individuals.

For so long, the focus of data breaches has been on credit card data, as stolen credit card data can so readily be turned into cash or goods. However, with the increasing popularity of EMV or chip and pin enabled credit cards, the prevalence of data breaches involving personal information may again rise to the forefront. This is especially true when one realizes the value of a stolen identity can often be far greater over the long term than the value of a stolen credit card.

If access to insurance plan information were to have been stolen along with identity information, data thieves would have a good indicator as to which identities were of higher value based on the value of the insurance plan. If thieves focus on the individuals with the highest plan costs, these are likely the people who are more established in their lives, have families, higher incomes and better credit, meaning their identities are worth even more on the black market.

This breach highlights that data security is not an issue limited to those processing credit cards. Businesses of all types must think of the type of information stored in their systems and realize they are only as secure as their weakest system. The following checklist outlines simple methods can help protect businesses from electronic data theft:

1. Protect a Location’s Incoming Internet Traffic

The first step in stealing data is finding an avenue into the targeted business. All of a business’ data circuits and its Internet connections must be protected by a robust and adaptable firewall; protecting the business from unwanted incoming traffic.

2. Implement Secure Remote Access

When permitting remote access to a network, it is essential that this access is restricted and secure. At a minimum, access should only be granted to individual (not shared) user accounts using two-factor authentication and strong passwords. Remote access activities should also be logged so that an audit trail is available.

3. Keep Anti-Malware Software Up-to-Date

It is critical to keep all anti-virus/anti-malware software up to date with the latest versions and definitions. The companies that make anti-malware software monitor threats constantly and regularly update their packages to include preventive measures and improvements to thwart malware seen in other attacks.

4. Update all Operating Systems as Security Patches are Released

Much like anti-virus/anti-malware updates, designers of operating systems are constantly improving their software to prevent hackers from stealing data, especially if a criminal manages to bypass the built-in security. It is essential that the latest security releases and patches be installed on all systems.

5. Limit Outbound Internet Traffic

In addition to blocking unwanted traffic from getting into a location, it is always a good practice to selectively block outgoing traffic as well. Many modern breaches involve software that becomes resident on a company network and then tries to send sensitive data to the hacker’s system via the Internet. No system can completely prevent unwanted malware or viruses, so a good last line of defense is making sure secure data doesn’t leave the network without prior knowledge. The same firewall used in Step One should be configured to monitor outgoing traffic as well as incoming.

Netsurion is a leading provider of cloud-managed IT security services that protect small- and medium-sized businesses' information, payment systems and on-premise public and private Wi-Fi networks from data breaches and other risks posed by hackers. Netsurion's patented remote installation technology and PCI compliant cloud-based solutions simplify the implementation process and ongoing support. Any sized branch or remote office, franchise or sole proprietor operation can use Netsurion without the costs of onsite support. The company serves the retail, hospitality, healthcare, legal and insurance sectors.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

With communication between care sites a top barrier to efficient transitions for one quarter of respondents, HIN's fourth comprehensive Care Transitions Management survey pinpointed information tools getting the message across during patient discharge and handoff.

Technology offers a leg up by way of telehealth and remote monitoring, respondents said; 75 percent of respondents transmit patient discharge or transition information via electronic medical records (EMR).

2015 Care Transition Survey Highlights

• Discharge summary templates are used by 45 percent of respondents.
• Beyond the EHR, information about discharged or transitioning patients is most often transmitted via phone or fax, say 38 percent of respondents.
• Twenty-seven percent of respondents record patient discharge instructions for patients' future access.
• After communication, inconsistent follow-up is the most frequently reported barrier to care transition management, say 21 percent of respondents.
• The hospital-to-home transition is the most critical transition to manage, say 50 percent of respondents.
• Home visits for recently discharged patients are offered by 49 percent of respondents.
• Heart failure is the top targeted health condition of care transition efforts for 81 percent of respondents.
• A history of recent hospitalizations is the most glaring indicator of a need for care transitions management, say 81 percent of respondents.
• Beyond the self-developed approach, the most-modeled program is CMS’ Community-Based Care Transitions Program, say 13 percent of respondents.
• Eighty percent of respondents engage patients post-discharge via telephonic follow-up.
• A majority of respondents—72 percent—assign responsibility for care transition management to a healthcare case manager.

Download an executive summary of the February 2015 Care Transitions Management survey.

More than half of U.S. physicians had adopted electronic health records (EHRs) by 2013, according to a new survey by The Commonwealth Fund.

An infographic on the study results breaks down the percentage of physicians who were early adopters, new adopters, partial implementers, planners (adopting in the next two years) and persistent non-adopters, as well as some demographic insight into these groups.

While widespread adoption of electronic health records has generated new streams of actionable patient data, John C. Lincoln has taken data mining to new levels to enhance performance of its accountable care organization (ACO).

Beyond the EMR: Mining Population Health Analytics to Elevate Accountable Care reviews the concentrated data dig undertaken by John C. Lincoln to prepare for participation in the CMS Medicare Shared Savings Program (MSSP).

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Physician champions and legislative advocates can spur remote patient monitoring success.

• Unclear ROI: There are always questions around ROI. We look at pre-implementation costs and pre-enrollment costs versus post-costs, including all project costs. What does that ROI mean for your organization?
• Limited Resources: With care transitions, we took remote patient monitoring and put it on top of the care transitions program. That added additional responsibilities to the already busy workflow process. Whether you’re looking at an E-Hub model or expanding these programs into other areas of your organization, it’s important to review that budget up front. What’s expected of your outcome goals? How will you do that from a day-to-day process and biweekly performance outcomes and measures so you meet that targeted overall outcome, whether it’s reducing length of stay, cost of care, or 30-day readmissions?

  You want all of that to match. Your resources have to be identified upfront. We have been very fortunate to have our providers as champions. They buy into it; they understand it. They didn’t buy into it initially because the nurse coach thought it necessary to make that patient home visit. Sometimes it is. But she has found, with these tools, that she can better do that from her office and manage more patients.

• Physician Skepticism: It is important to understand your champions, your available resources, backup, etc., when issues come up and you need those resources. We’re finding — and statistics state this — that physicians are still more comfortable doing face-to-face visits. Keeping those patients healthier and at home means we’re keeping them out of the facilities. The physicians and primary care providers may have some skepticism regarding that as well. They have less hands-on training with the equipment so perhaps don’t fully understand the opportunity for them to fill clinic days with patients that are truly in need of an appointment that day versus monitoring others who can be coached to wellness at home.

  It’s about educating physicians, finding those champions and engaging them in the overall process and direction of our health system.

• Reimbursement Regulations: You need an advocate who can speak for you, represent what you’re doing, and prove the value both at a state and federal level. That should be an ongoing process and on your calendar monthly: identifying and calling your state or federal representative.
• Rising Technology Costs: This is a booming area; vendors can’t get their products out fast enough. When you set up a budget for a program like this and look to initiate a pilot or expansion, you must look at all technology costs—not only for hardware but for software, upgrades and required support. Do you go through a third party vendor, and do you lease or purchase your equipment? When do you purchase the equipment? Just from our original pilot in late 2012 to today, we’ve seen some changes in technology. If your kits are organized to fit that original technology, how will that change 18 months later, and what will be the cost of adjusting the kits (for example, Styrofoam, boxes, etc.)?

  All of that will change. Look at those technology costs and related issues as you move forward and have a plan to how best recycle that kit.

  
  Luke Webster, MD, is vice president and chief medical information officer of CHRISTUS Health. Dr. Webster has over 20 years of clinical and health informatics experience. He specializes in health informatics and physician leadership, clinician adoption and change leadership, clinical transformation, evidence-based medicine, clinical analytics and process improvement.
  

  Source: Remote Patient Monitoring for Chronic Condition Management

Data, connectivity and innovation are changing the healthcare landscape, according to a new infographic by Philips.

In the infographic, Philips examines the potential of wearable technologies, connected devices, electronic health records, telehealth, predictive analytics, population health management, mobile health apps, data security, partnerships and cloud-based technology in healthcare.

Real-time remote management of high-risk populations curbed hospitalizations, hospital readmissions and ER visits for more than 80 percent of respondents and boosted self-management levels for nearly all remotely monitored patients, according to 2014 market data from the Healthcare Intelligence Network (HIN).

Remote Monitoring of High-Risk Patients: Telehealth Protocols for Chronic Care Management profiles a successful eight-year initiative by New York City Health and Hospitals Corporation's (NYCHHC) House Calls Telehealth Program that significantly lowered patients' A1C blood glucose levels.

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Electronic Health Records (EHRs) grew out of the computer system that runs a hospital's inner workings. Physicians' needs were an afterthought, according to a new infographic by PatientKeeper. As a result, the typical hospital EHR frequently makes doctors who use it less efficient and productive.

The infographic depicts the way it is today for physician users of EHRs, compared to the way it should (and could) be.

While widespread adoption of electronic health records has generated new streams of actionable patient data, John C. Lincoln has taken data mining to new levels to enhance performance of its accountable care organization (ACO).

Beyond the EMR: Mining Population Health Analytics to Elevate Accountable Care reviews the concentrated data dig undertaken by John C. Lincoln to prepare for participation in the CMS Medicare Shared Savings Program (MSSP).

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The state of a healthcare organization's data center has a domino effect on all the infrastructures and networks that depend on its "health," according to a new infographic by CDW Healthcare.

The infographic examines infrastructure optimization, software-defined data centers, infrastructure for cloud enablement, power/cooling, backup/disaster recovery and networking requirements.

The increased role of IT in the healthcare sector has led to the coining of a new phrase "health informatics," which deals with the use of IT for better healthcare services. Health informatics applications often involve maintaining the health records of individuals, in digital form, which is referred to as an Electronic Health Record (EHR). Building and implementing an EHR infrastructure requires an understanding of healthcare standards, coding systems, and frameworks.

Electronic Health Record: Standards, Coding Systems, Frameworks, and Infrastructures provides an overview of different health informatics resources and artifacts that underlie the design and development of interoperable healthcare systems and applications.

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Steward's Medicare Pioneer ACO was a top performer in performance year two, with gross savings of $19.2 million.

"We can't prevent a readmission back to the hospital or redirect unnecessary emergency department visits if we don't know the patients were in the hospital to begin with," noted Kelly Clements, Pioneer program director at Steward Healthcare Network, during Medicare Pioneer ACO: Care Management, Quality Improvement and Data Integration Yields Substantial Performance Gains, a Healthcare Intelligence Network webinar now available for replay.

But Steward's Medicare Pioneer ACO meets this challenge head-on with two tools: a home-grown patient surveillance tracker, and the "Patient Ping" service that provides real-time patient admissions and discharge notifications to providers. Both tools help Steward to identify and coordinate care for Pioneer ACO beneficiaries who seek services from both Steward and non-Steward providers.

These innovations have helped Steward's Medicare Pioneer ACO, aptly named Promise ("For our promise to do the best we can to coordinate beneficiaries' care and increase quality of care," said Ms. Clements), to emerge as one of the top CMS Medicare Pioneer ACO performers in 2013, with gross savings of $19.2 million.

Three Medicare Pioneer ACO Challenges

Care management, including the tracking of its 80,000 Promise beneficiaries, was one of three categories of Medicare Pioneer ACO challenges Ms. Clements touched on during the webinar, along with physician engagement and performance improvement.

Supporting care management, the internally developed patient surveillance tracker is Steward's in-network solution for real-time tracking of care received from Steward providers and facilities; the contracted Patient Ping service allows the Pioneer ACO to communicate with skilled nursing facilities (SNFs) outside their network that care for Steward Pioneer patients, providing the SNF is registered with Patient Ping.

"Through the Pioneer program, we've learned that a large portion of our opportunity to reduce cost and achieve savings as an ACO is in the post-acute care space, particularly in the SNFs," noted Ms. Clements.

To engage physicians in the delivery of accountable care, Steward has done everything from holding road shows for providers to creating performance improvement teams for each geographic "chapter" in the ACO to work with physician practices to improve efficiency and quality. Physician report cards measure stewardship (including attendance at chapter meetings) and other efficiency and quality indicators.

And finally, to drive performance improvement, Steward has worked aggressively on data integration, with a strong focus on the two most popular electronic health records (EHRs) its physician network, in order to feed its 'quality data warehouse.'

This focus, along with efforts by the physician practices, has generated results. Steward saw its Pioneer ACO raw quality scores rise significantly from performance year one to performance year two: a 39 percent jump in the preventive health domain, and a 42 percent improvement in the at-risk domain (care for chronic conditions such as diabetes and coronary artery disease (CAD).

There is one additional hurdle: Steward must decide which ACO program it will participate in next year: Pioneer ACO, Next Generation ACO or Medicare Shared Savings Program (MSSP), Track 3. "The more efficient we become, the harder it will be to achieve shared savings, because the benchmark will keep getting lower, so this is one of our big concerns," said Ms. Clements.

"Our leadership is fully committed to pursuing risk aggressively and it's been worthwhile being at the table with Medicare and advocating for programmatic changes that will benefit our providers and patients in a sustainable way."

As the healthcare industry moves increasingly toward a value-based system of healthcare delivery and reimbursement, a growing number of physician practices are delivering care in a more systemized way, according to a new infographic by Bain & Company.

The infographic illustrates this change—with 75 percent of physicians using electronic medical records, up from just 29 percent two years ago and 81 percent of practices using treatment protocols, up from 34 percent two years ago.

The infographic also examines the number of practices using metrics, participating in risk-based contracts and the change in management of physician practices.

CMS's ambitious agenda for moving Medicare into alternative payment models is driving the U.S. healthcare system toward greater value-based purchasing at a furious rate. Private payors also have pledged to continue to shift payments away from fee for service and into alternative payment models such as accountable care organizations (ACOs). Fortunately, many healthcare organizations are already exploring value-based payments—often a single innovation at a time—testing models that reward providers for meeting Triple Aim goals of improving patient experience and population health while reducing healthcare's per capita cost.

11 Profitable Value-Based Reimbursement Models: Lessons from Early Adopters encapsulates nearly a dozen such approaches, from Bon Secours' building of a business case for its multidisciplinary care team to the John C. Lincoln ACO's deep dive into data analytics to identify and manage the care of high-risk, high-cost 'VIP' patients to 'beat the benchmark' to WellPoint's engagement of specialists in care coordination.

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As physician practices gear up for Meaningful Use Stage 2, which requires physicians to promote and measure patient engagement, the role of the patient portal will become more important.

A new infographic by Nextech examines how practices can ensure their patient portal is set up for successful patient engagement.

Faith-based integrated delivery system Adventist Health is on a mission to improve population health status with a wellness-based approach it estimates will eventually net $49 million in savings.

Population Health Framework: 27 Strategies to Drive Engagement, Access & Risk Stratification walks through the elements of Adventist's population health management program that engages individuals to modify behaviors and prevent illness in the future.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you'd like featured on our site? Click here for submission guidelines.

Facing Center of Medicare and Medicaid Services' penalties, some 92 percent of eligible hospitals received a meaningful use reimbursement as of September 2014, according to a new infographic by Logicalis.

The infographic also examines physician readiness for meaningful use, the impact of data breaches on the healthcare industry and what's most important to healthcare organizations as they select EHR vendors.

While widespread adoption of electronic health records has generated new streams of actionable patient data, John C. Lincoln has taken data mining to new levels to enhance performance of its accountable care organization (ACO).

Beyond the EMR: Mining Population Health Analytics to Elevate Accountable Care reviews the concentrated data dig undertaken by John C. Lincoln to prepare for participation in the CMS Medicare Shared Savings Program (MSSP).

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Healthcare is in the middle of a revolution. Health systems continue to integrate and expand, acquiring private practices and hospitals. Insurance carriers still navigate the Affordable Care Act, and merge to build actuarial risk pools. Providers deal with changing payment models, transitioning from traditional fee-for-service to merit-based incentive payments, though the exact definition of pay-for-performance is not yet codified. And in the midst of these radical changes, doctors, hospitals, and health systems are implementing an array of electronic medical records (EMRs) to finally replace paper records.

Two things are clear with all of this upheaval in the medical world: providers are frustrated, and the patient is nowhere to be found.

Doctors, nurses, and healthcare administrators are all under financial and workload pressures; they are trying to comply with healthcare IT requirements for meaningful use, and everyone is uncertain about the future. Patients are exasperated with figuring out insurance plans and in-network versus out-of-network provider coverage; obtaining medical records from their doctors is a challenge; and they are left to their own devices to navigate the complexities of the healthcare system.

Technology is the answer for healthcare transformation, but the entire healthcare ecosystem is a decade behind the information technology boom that has transformed every other industry.

6 Barriers to Health IT Integration

Why has it been difficult to bring technology to healthcare? Based on two years of interviewing dozens of stakeholders across the healthcare continuum, we can point to several reasons:

• HIPAA, short for the Health Insurance Portability and Accountability Act passed in 1996 that legislates data privacy and security provisions designed to safeguard medical information.;
• Reimbursement: Only this year and last has CMS provided CPT codes for care coordination, Chronic Care Management 99490 and Transitional Care Management 99495 and 99496. Shared savings models provide inconsistent results and are still largely undefined;
• Limited investment: Providers already have invested heavily in EMRs, spending money and time on workflow management, and are therefore reluctant to add new workflows and software unless integrated with their current EMR systems, which are not built for patient-centric care coordination;
• Technology proficiency: Medical personnel, especially physicians, are not broadly trained in technology and software other than the specific EMR in the practice or hospital, and that training is lagging. Patients, especially senior citizens, have widely varying and often negligible technology access and knowledge;
• Data overload: There is so much unintegrated data from internal EMR and billing systems, claims forms, labs, and metabolic measures from myriad devices that no person can comprehend. Doctors and patients need clinically meaningful reports, not just data.
• Transformation: The medical system has been trained and operated as a treatment-focused, fee-for-service business; that is how healthcare professionals earn their living. Population health management and the primary care medical home (PCMH) models of healthcare require a realignment of the provider-patient relationship, transformation of business focus from in-office visits to out-of-the-office management, new staff and resource allocation—all without a defined financial model for future practice.

What's Needed for a Patient-Centric Collaboration?

So, how in the current tumultuous environment can we ever achieve the Triple Aim of better health and improved care delivery at lower costs? The answer is patient-centric collaboration—working together to achieve a common outcome. But in order to make collaborative care work, we need patients, nurses, and doctors to embrace technology for collaboration. To this end, a new role in healthcare, the care coordinator, is the lynchpin to connecting patients to the healthcare system. Plus, an array of new and emerging software platforms like GetRealHealth and C3HealthLink for population health management can foster the personal communication necessary to engage patients outside the office environment, with the system-driven performance to drive efficiency.

Fortunately, the care coordinator position is currently being championed in several areas. For example, in New Jersey, Horizon Blue Cross Blue Shield has promoted care coordination for many years by funding practices for on-site care coordinators. The PCMH movement embraces the care coordinator role and collaborative care, and The Patient Centered Primary Care Collaborative (PCPCC), a not-for-profit trade group, is dedicated to healthcare transformation through primary care.

Plus there is hope on the patient technology front. According to the Pew Research Center, 64 percent of Americans own a smartphone, and for those seniors who do own smartphones, 82 percent describe the phone as “freeing." Plus, broadband access is expanding through initiatives like the recently announced ConnectHome Pilot Program that will bring Internet access to underserved areas.

4 Ways Technology Will Optimize Healthcare Delivery

Through technology, we can optimize care delivery if we can provide care coordinators and patients with the tools they need to engage in health, and systems that provide interconnected data exchange through the patient’s health record, enabling the following:

• Patients to engage in health practices that promote adherence to medication schedules, self-monitoring, and care planning, together with HIPAA-compliant communications tools that foster responsibility and collaboration with a care team;
• Medical practices to manage patient populations inside and outside of the healthcare system to optimize care coordination (treatment, transition, communication, monitoring), while establishing workflows for the impending reimbursement changes to pay for performance;
• Health systems to establish new care coordination and data sharing models using cloud-based, HIPAA-compliant data exchange and communications channels that integrate clinically relevant data;
• Payors to evaluate and measure patient engagement in health and provider practices for care coordination and collaborative care in order to reimburse providers for performance.

The challenges in healthcare are many, but we can emerge from this healthcare revolution with a stronger healthcare system through collaboration: with patients taking responsibility, providers communicating and sharing data, health systems funding new delivery models, and payors enabling a sustainable financial model that provides benefits to all stakeholders.

About the Author: Richard Purcell is president and chief executive officer of intelliSanté. He has played a lead role in founding the company, molding the corporate vision, and leading the commercial launch of C3HealthLink. Purcell has extensive experience in drug development, clinical data management, and business operations in a regulated environment. Previously, he was president of ClinPro, Inc., a mid-sized clinical research organization. In addition, he participated in the start-up of the medical Web site Medscape through sales and business development initiatives. Rich holds a B.S. in Biochemical Sciences from Princeton University, and attended Rutgers Graduate School of Management majoring in marketing and finance. He is an executive member of the Patient Centered Primary Care Collaborative (PCPCC), a member of the Licensing Executives Society, and an active member of the New Jersey Technology Council and HIMSS. (rich@intelliSanté.com)

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

Of all healthcare sectors, hospitals and health systems are the most engaged in ACO activity, with 72 percent belonging to an accountable care organization (ACO), versus 50 percent of overall respondents to the 2015 Accountable Care Organizations survey by the Healthcare Intelligence Network.

Hospitals and health systems made a strong showing in HIN's fourth annual ACO activity and trends snapshot.

And while not unanimous, hospital ACOs are almost twice as likely to be administered by a physician-hospital organization (60 percent, versus 28 percent overall); and to incorporate telehealth into their ACO framework (60 percent versus 34 percent overall).

This fourth comprehensive accountable care snapshot by the Healthcare Intelligence Network also found that ACOs within the hospital/health system sector, which comprised 11 percent of 2015 survey respondents, are twice as likely to employ 100 to 500 physicians (a metric reported by 60 percent of hospitals and health systems, versus 29 percent overall).

Also, hospitals have the largest number of pending ACOs, with half of those not already in an ACO expecting to be part of an ACO launch in the next twelve months, as compared to 25 percent overall.

Additionally, 40 percent of hospital-reported ACOs say they will participate in the Next Generation ACO Model, the latest Medicare Accountable Care Organization introduced by CMS, as compared to 21 percent of overall respondents, the survey found.

On the payment front, the hospital sector reports the highest use of a “fee for service + care coordination + shared savings” reimbursement model within their ACOs (60 percent versus 45 percent overall), the survey found.

Return on investment for hospital ACOs also tended to be healthier, with responding hospitals almost four times more likely to report ACO ROI between 3:1 and 4:1 (20 percent of hospitals versus 5 percent overall).

Finally, despite robust value-based activity, this sector expressed the most skepticism over CMS’s ability to shift half of Medicare payments to value-based models, with 71 percent doubting Medicare would meet this 2018 goal, versus 46 percent of responding healthcare organizations overall.

Source: 2015 Healthcare Benchmarks: Accountable Care Organizations

Just one-fifth of U.S. physician practices participate in CMS's Chronic Care Management Program.

The CCM care plan is all the clinical staff needs to have access to in order to count time toward the 20 minutes. In terms of the EHR itself, the practice is only required for certain specified services within the Chronic Care Management. For example, the practice has to create a structured recording of demographics, problems, medications and allergies within the EHR, and then that information must inform the care plan. The care plan will include that type of information but doesn’t have to include everything that is in the EHR.

The practice also must put into the EHR a structured clinical summary record, which is discussed at some length in the final rule. In addition, the EHR must document that there’s written consent for the CCM services and all the other things the practice explained to the patient when the patient gave consent.

In addition, the care plan must be provided to the patient. That could be a hard copy or an electronic copy. The communication to and from home with community-based providers regarding their psychosocial needs and functional deficits also must be in the EHR.

Essentially, the electronic care plan is a distilled version of the EHR containing the pertinent information clinical staff would need to provide CCM services.

However, in spite of this interpretation, one Medicare contractor recently suggested that in order to count time toward the 20 minutes, the clinical staff has to have access to the EHR. We believe that is an incorrect interpretation of the rule. We believe the practitioners only need access to the electronic care plan.

The last thing I would like to mention about the EHR is that use of the EHR to provide care plans and other information to all off-site clinical staff and to other practitioners could theoretically raise privacy concerns. These are not new privacy concerns, but any practice that is going to provide CCM services needs to be cognizant of potential HIPAA issues and make sure they are in compliance. One thing that can be done in this regard is to have the individuals with EHR access sign business associate agreements.

Source: Chronic Care Management Reimbursement Compliance: Physician Requirements for Value-Based Revenue

Chronic Care Management Reimbursement Compliance: Physician Requirements for Value-Based Revenue sets the record straight on CCM reimbursement compliance, offering strategies for navigating obstacles and meeting requirements. In this 25-page resource, attorneys Dr. Paul Rudolf, partner, Arnold & Porter LLP, and Nicole Liffrig, counsel, Arnold & Porter LLP, drill down into chronic care management requirements outlined in the 2015 Medicare Physician Fee Schedule.

In this guest post, RoundingWell CEO John Smithwick explains why all healthcare data should be structured and ready for interpretation and analysis, no matter how it is initially collected.

Structured data is that which is quantifiable and measureable, such as signs like lab results, blood sugar levels and cholesterol. This type of data is objective and can be entered discretely into EMRs via predefined fields. Since the data is structured, software systems are able to understand the meaning of the data, interpret the data and report on it. Structured data can be put to use by clinicians at the point of care to aid their decision-making.

On the other hand qualitative data, such as symptoms like pain, discomfort and fatigue, is considered unstructured data. This type of data is subjective to the patient and is often gathered through conversations based on what the clinician asks and what the patient discloses. While it might seem like a simple exchange of niceties between clinician and patient, these communications provide a lot of information to the clinician, such as whether a patient is experiencing depression, or notices shortness of breath upon standing.

Correct diagnoses and appropriate treatments are dependent on managing both structured and unstructured data. Managing each type of data appropriately also greatly influences the outcomes a healthcare organization is able to deliver. As the amount of reimbursements tied to outcomes increases, delivering quality outcomes becomes all the more important.

Problems with Unstructured Data

Managing structured data is usually handled well. It’s in the management of unstructured data where problems arise. There are two primary problems with unstructured data:

• The first problem is technical. Unstructured data is most often recorded in EMRs in free text fields or note fields. Data stored this way makes it very difficult for software systems to interpret, understand and analyze.
• The second problem is process-related. Unstructured data is not gathered consistently or systematically. A clinician only knows about symptoms if he or she asks the patient, which doesn't always happen, or if the patient discloses the information, which, again, doesn't always happen. When symptoms are overlooked or patients withhold information, clinicians can’t make the right diagnosis or give the best treatment.

The ballooning amount of data available is its own issue. In 2012, worldwide digital healthcare data was estimated to be equal to 500 petabytes, and that number is only growing: the data is expected to reach 25,000 petabytes in 2020. It can be a daunting challenge for healthcare organizations to gain value from this mountain of data. To add to this, industry consensus is that approximately 80 percent of all healthcare data is unstructured data.

What the Future Holds for Unstructured Data

So, what if technology could not only ensure patients were being diagnosed correctly, but also automate the process? Cloud-based care management and patient engagement software are providing new ways for healthcare organizations to unlock the value of unstructured data. In essence, by creating “structured symptoms”—gathering patient-reported symptoms and discretely capturing them in a way the data could be analyzed.

These platforms systematically assess patients for symptoms (and signs) that they might not get asked about directly by a provider, and that they might not self-disclose because they don't think it's important (or because they simply forget). Care management software then stores patient symptom information in a structured way, allowing this previously unstructured data to be analyzed and made actionable.

The bottom line? Whether gathered via care management software, EHR or patient-specific physician insights, all data should be structured and be ready for interpretation and analysis. This is especially critical in value-based models: for any risk-bearing entity, getting this complete picture is absolutely critical in order to give patients the right treatment at the right time, to improve outcomes and prevent adverse health events.

About the Author: John Smithwick is the CEO of RoundingWell. He co-founded RoundingWell in 2011 following four years at Nashville's Healthways, where he led the design effort for its Web-based disease and lifestyle management product offerings. Prior to his work at Healthways, he worked in product management at Microsoft in Redmond, Wash. and in technology strategy consulting with Accenture in Boston, Mass. A graduate of the University of Richmond, he holds a master's of business administration from the University of Pennsylvania’s Wharton School of Business.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

One-fifth of healthcare companies experience annual savings of $100,000 to $500,000 from value-based payment models, finds a new Healthcare Intelligence Network Savings survey.

Seventy-one percent of survey respondents employ a value-based reimbursement or alternative payment model, according to the October 2015 survey. The study also determined that of those respondents not yet exploring a fee-for-value approach, 26 percent plan to do so in the coming year.

In assessing value-based payment formulas, 56 percent of respondents favor a pay-for-performance model, with 71 percent employing these models in contracts for commercial populations.

Despite healthy adoption of alternative payment approaches, one quarter of respondents say the infrastructure required to sustain value-based payment models is the reimbursement trend's most significant hurdle—greater even than the challenge of data integration or patient engagement, the survey determined.

In evaluating healthcare providers for value-based rewards, respondents most often review markers tied to quality (82 percent), hospital readmissions (56 percent) and patient satisfaction (56 percent) to determine payment, the survey found. The use of physician report cards to track provider performance was reported by 63 percent of respondents.

The shift toward fee-for-value has had the greatest impact on the area of prevention, respondents said, with 69 percent attributing a rise in preventive care to value-based reimbursement models.

Other survey findings included the following:

• Twenty-one percent of respondents reported savings from value-based payment models as ranging from $100,000 to $500,000 annually.
• Value-based payment contracts most often were executed for populations having more than 100,000 beneficiaries.
• Fifty-six percent said the market lacks sufficient technological support for value-based payment models.

Download an executive summary of results from the Value-Based Reimbursement survey.

The healthcare industry has long been characterized by change and evolution. Yet, new requirements introduced by the Affordable Care Act (ACA), as well as changing demands and expectations among patients, have created new pressures for today’s healthcare organizations. Healthcare providers that fail to address this new reality and meet the call for more value-based healthcare that focuses on the patient will struggle to remain sustainable in this changing world.

So, what can healthcare management do to prepare their organizations to deliver more customer-centric care? Although a recent study found that the vast majority of healthcare CEOs plan to improve their ability to innovate, change technology investments and better manage data, very few have made significant headway in these areas. As with any large-scale change, the move to customer-centric healthcare needs to start at the top. To ensure an effective transition, C-level executives, whether the CEO or chief medical officer (CMO), must take the lead to get their teams on board and ensure they can create a sustainable model for the future.

A New Approach to Patient Care

Today’s patients have greater choice in the care they receive, meaning that organizations that don’t provide a positive experience for their patients will struggle to compete. The onus to improve falls on the CEO and CMO, who must revamp the typical patient experience of waiting a long time, only to spend five to seven minutes with the physician. Healthcare leaders can improve the process by making the operation more like a concierge service—scheduling appointments at literal points in time to minimize waiting, enabling patients to enter their information only once and treating patients as valued customers. They should also strive to offer more flexibility by way of extended hours, home visits and telehealth programs that enable patients to have a remote, video-based conversation with their physician.

In addition to optimizing the patient experience, healthcare leaders must also change their cost structures. Rather than the typical process of determining prices behind closed doors and putting a margin on it, costs need to come down, be determined by performance and quality of service and be delivered with greater transparency. More and more, the industry is shifting to a value-based operating model. One such example is the accountable care organization (ACO) model, whereby healthcare providers join together to deliver a payment and care delivery approach that ties provider reimbursements to quality metrics, while driving down costs for an assigned patient population.

The ACO approach links payment to quality improvements that can reduce costs for patients; data from the U.S. Centers for Medicare & Medicaid Services found that the ACO model has led to savings of $417 million since the program began in 2012. As the model continues to evolve, healthcare organizations will be managing a particular portion of the population whom they see regularly. When patients are part of a healthcare organization and receive frequent care, fewer patients will need emergency room service, resulting in lower costs. The industry is increasingly moving towards value-based operating models, but as with any change, implementing the associated customer-centric practices may be easier said than done.

Best Practices to Deliver Customer-Centric Care

To ensure their organizations remain competitive and sustainable in the face of unprecedented change across the healthcare industry, the CEO and CMO must implement the strategies that can lead to positive transformation. Though large-scale changes don’t happen overnight and inevitably will be met with some resistance, healthcare leaders should consider the following best practices to deliver a customer-centric approach:

1. Meet patients where they are: Today’s healthcare consumers increasingly expect the same level of service from their healthcare providers that they receive in other areas of life and business. Healthcare leaders must spearhead the process changes that meet this demand, by providing greater flexibility, extended hours, home visits and telehealth.
2. Set the tone for employees: To implement effective change management and overcome employee resistance, CEOs and CMOs must provide strong guidance throughout. Working with other C-suite executives to identify transformation needs, communicate these changes, introduce tools that can facilitate the transition and explain how each employee can contribute to delivering customer-centric care is essential.
3. Revamp cost structures: To be successful, CEOs and CMOs must deliver on two key priorities: keeping patients healthy and providing service at reasonable costs. This entails designing a fundamentally different operating model and driving down costs for activities that do not provide value – all while offering higher-quality care to their target population.
4. Seek outside help when needed: Healthcare leaders might not always have the internal senior-level capacity and capability needed to accelerate change. Leveraging the help of an executive talent provider to ensure the organizations have the support and expertise to deliver a more customer-centric patient experience can make all the difference.

Meeting Demand for a New Level of Care

As the ACA has given more people greater access to healthcare—and more options in how they receive that care—healthcare leaders must rethink their current processes to deliver high quality care. If patients are unhappy, they can always switch to another provider. In this age of empowered patients and increased competition between providers, the CEO and CMO must communicate a transformative vision throughout their organizations. This starts with having qualified leadership at the top to guide these changes, the right technology to facilitate the processes and the best team to deliver on this goal. With these factors in place, healthcare organizations can deliver the customer-centric care necessary for success in today’s healthcare climate.

About the Author: Nick Christiano is responsible for the overall execution of the National Healthcare Practice for Tatum, a Randstad company. The Healthcare Practice provides executive leadership solutions to healthcare provider organizations, heath plans, private-equity backed bio-tech firms and affiliated organizations where subject matter expertise is critical to a successful client engagement. Christiano is recognized as a leader in the pursuit of optimum patient care, productivity, efficiencies, cost management and navigating new challenges in the healthcare field. He has an M.B.A. in MIS/Finance from the John Hagan School of Business – Iona College and a B.S. with a dual major in Computer Science/Electrical Engineering from N.Y.I.T.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.