Healthcare Intelligence Network

Though adult mental health patients, substance abusers and children and adolescents may face different behavioral health issues, there's a common reason behind their frequent hospital and ER visits, explains Jay Hale, LPC, CEAP, director of quality improvement and clinical operations at Carolina Behavioral Health Alliance. Hale's organization uses a set of telephonic case management protocols to reduce avoidable inpatient and ER use by these populations. He describes some of the barriers telephonic case managers might face during member outreach, red flags that indicate a physician visit is warranted, and the role of primary care providers in the member's care continuum. Hale will present during a March 7, 2012 webinar, Telephonic Case Management: Protocols for Behavioral Healthcare Patients, during which he will share the case management protocol developed by his organization, including using scripts and surveys to assess patients' engagement in the treatment process and identify patients at-risk.

Hudson River HealthCare (HRHC) takes a team approach to disease management in the 3,400 adult patients with diabetes it serves, explains Kathy Brieger, RD, CDE, HRHC's chief operations officer. Ms. Brieger describes the multiple levels of care available to patients served by the HRHC Diabetes Collaborative, a four-point strategy for weight management that targets the most challenging aspect of managing diabetes, and HRHC's upcoming trial of telepsychiatry at selected FQHCs. Ms. Brieger presented during "Diabetes Management in the Medical Home," a 45-minute webinar on January 26, 2012, providing the inside details on HRHC's diabetes management program and the program's impact on its diabetic patients. Brieger shared how to: identify and assess patients for diabetes management, including an analysis of literacy and learning and social barriers that could impact outcomes for complex patients; train staff and report quality data to drive further performance improvement; and much more.

The mapping between ICD-9 and ICD-10 code sets will have two major impacts on healthcare, predicts Dennis Winkler, ICD-10 technical program director for Blue Cross Blue Shield of Michigan, which has created a roadmap for the transition that it is sharing with the industry. Winkler describes where health plans should be on the ICD-10 timeline at the start of 2012, and defines the two major challenges the health plan expects to face as it enters the testing phase of the transition. Dennis Winkler presented during, "Mapping the Way to ICD-10 Readiness: Blue Cross Blue Shield of Michigan's Approach," a 45-minute webinar, during which he shared BCBS of Michigan's mapping strategy along with other organizational readiness tactics for ICD-10. Winkler addressed: BCBSM's six dimensions of neutrality and how the BCBSM plan incorporates these aspects into ICD-10 readiness; working with external vendors and constituents; ICD-10 systems testing and training; and more.

When healthcare providers and health plan case managers join forces in the physician practice, the end result is "care completion," explains Dr. Randall Krakauer, medical director for Aetna Medicare. In his second HealthSounds interview, Dr. Krakauer describes how the meshing of complementary patient data and knowledge from payor and provider improves the "completion factor" of care that is ordered and provides feedback on the impact of this care. Dr. Krakauer will be presenting during the November 30, 2011 webinar, "Demonstrating the Value of the Embedded Case Manager for the Medicare Population," during which he will share the strategy supporting Aetna's embedded case management initiative, along with results from the program relating to healthcare utilization and member satisfaction.

HIN's fifth annual survey on the patient-centered medical home (PCMH) recorded the highest PCMH adoption levels to date, reports Melanie Matthews in this benchmarks podcast. A substantial number of medical homes expect to participate in an accountable care organization (ACO); Ms. Matthews also shares key metrics from the 2011 survey, including time required for medical home conversion and the PCMH effect on medication adherence and patient satisfaction. The survey also identified an impressive jump in the embedding of case managers in medical homes. Dr. Bruce Nash, senior VP of medical affairs and CMO for CDPHP, where embedded case managers are at the heart of CDPHP's clinical transformation, describes what sets his program apart from other medical home pilots.

While hospitals might find CMS's pure Medicare bundled payments initiative too restrictive, it won't prevent them from addressing their costs in a bundled payments fashion, predicts Steve Valentine, president of The Camden Group. In advance of HIN's eighth annual industry forecast, Valentine weighs in on the expected growth of bundled payments, a surprising new trend in case management, why the proposed ACO rule disappointed, and the industry segment where accountable care is thriving. Steve Valentine will be back to illuminate key trends and opportunities for healthcare in the coming year during a November 2, 2011 webinar, "Healthcare Trends in 2012: A Strategic Industry Forecast."

CMS learned a few things from its first foray into bundled payments, explains Jim Reilly, managing partner with TRG Health Care Solutions. Having worked with all five participants in the Acute Care Episode (ACE) pilot a few years back, Reilly is ideally positioned to identify the three key benefits of participation in the upcoming CMS bundled payment initiative. But in order for episodic payments, bundled pricing and other alternative payment methodologies to be implemented successfully a key organizational process must take place, Reilly notes. Reilly examined the key distinctions between each of CMS' four bundled payment models and the organizational criteria that is most effective in bundled payment programs during an October 19, 2011 webinar, "Evaluating CMS' Bundled Payment Initiative: Operational, Financial and Clinical Considerations."

Embedded case managers are the latest step in CDPHP's clinical transformation, which began in 2008 with a transition to the patient-centered medical home model and continued with the introduction of new payment models in 2009 and 2010. Lisa Sasko, CDPHP director of clinical transformation, and Charlene Schlude, the organization's director of case management, describes the embedded case manager's role in a new era of healthcare, targeted patients and disease states and some of the operational and cultural issues surrounding the co-location of case managers in physician practices. Ms. Sasko and Ms. Schlude shared the business case for embedded case managers as well as an inside look at the day-to-day interactions of embedded case managers with providers in practices during a September 20, 2011 webinar "The Role of Embedded Case Managers in Clinical Transformation," sponsored by The Healthcare Intelligence Network.

Spiritual support, in-room WIFI access, improved housekeeping and valet parking are just a few of the perks hospitals have added to boost patient satisfaction ratings. In this month's healthcare benchmarks podcast, Melanie Matthews from the Healthcare Intelligence Network describes how 146 healthcare organizations rank their own efforts to improve patient satisfaction. She also shares key metrics from the 2011 survey on Improving Patient Satisfaction and Experience, including the most important aspect of the care delivery experience and preferred formats for patient surveys. Patient satisfaction is an important driver of core measurement scores. Dr. Steven Berkowitz, president of SMB Consulting, shares his formula for achieving 100 percent performance on core measures and describes an incentive program for drivers of the quality measures. Need more data from this survey? Download a complimentary executive summary at: http://www.hin.com/library/register_satisfaction2011.html.

Workflow rehearsals of key practice protocols ensure that the entire care team --- including the embedded case manager --- is prepared in advance, notes Robert Fortini, vice president and chief clinical officer at Bon Secours Health System. Fortini describes two workflows "rehearsed" by Bon Secours care teams, details the embedded case manager's contribution to medication compliance in the practice, and explains key steps that precede the case manager hiring process. Robert Fortini explained how Bon Secours has adapted the Geisinger Health System embedded case manager model to meet the needs of its own population during "Embedded Case Management in the Primary Care Practice: Program Design and Results," a 45-minute webinar on August 10, 2011.

The establishment of good core measure performance is good patient care, emphasizes Dr. Steve Berkowitz, president of SMB Consulting and former chief medical officer at St. David's HealthCare, which boasts a mortality index and CMS core measure ratings that are among the best in the nation. Dr. Berkowitz shares his formula for achieving 100 percent performance, describes an incentive program for drivers of the quality measures and weighs in on the need for an EHR to achieve core measure excellence. Dr. Berkowitz shared practical strategies for improving core measures, as well as modeling techniques to illustrate the impact of a hospital's failure to meet the measures during "Healthcare Performance Improvement: Exceeding Core Measure Targets for Value-Based Reimbursement," a 45-minute webinar on July 20, 2011 sponsored by The Healthcare Intelligence Network.

Has the practice of embedding case managers at the point of care grown since 2010? In this month's healthcare performance benchmarks podcast, Healthcare Intelligence Network's Melanie Matthews analyzes trends in contemporary case management and the evolving responsibilities of today's case manager derived from HIN's January 2011 survey results. Toni Cesta, senior vice president of operational efficiency and capacity management at Lutheran Medical Center and Jan Van der Mei, the regional director of Sutter Health Sacramento Sierra Regions care management programs, supplement this data with commentary on the case manager's role in their organizations. More actionable data on case management are contained in "2011 Benchmarks in Healthcare Case Management: Responsibilities, Results and ROI," a 40-page report packed with metrics and measures on current and planned initiatives, presented in more than 40 easy-to-follow graphs and tables. This data is derived from responses to the second annual Healthcare Intelligence Network Case Management Survey, which was conducted in January 2011.

An Ohio collaborative of Medicaid plans is using a rapid cycle quality improvement approach to reduce avoidable ER visits by its Medicaid beneficiaries. One of the five regions targeted by the collaborative is Toledo, Ohio --- known for having the highest emergency department utilization in the nation. Mina Chang, Ph.D., of the Bureau of Health Services Research for the Ohio Department of Job and Family Services, outlines the framework of the collaborative. She explains its population-based and patient-centered approach and describes some of the priority populations targeted by the collaborative's interventions. Dr. Chang described how the collaborative is developing actionable interventions to address the patient streams most likely to use the ED inappropriately during a June 23, 2011 webinar, "Reducing Avoidable ER Visits by Medicaid Patients Through Quality-Based Interventions," sponsored by The Healthcare Intelligence Network.

As one of 10 participants in the CMS Physician Group Practice Demonstration, Dartmouth-Hitchcock has developed a competency in population health management that is being deployed in current and planned ACO pilots. Dr. Barbara Walters, Dartmouth-Hitchcock's senior medical director, describes how the CMS demo experience provided the building blocks for an ACO, the impact of its pilots on Medicare utilization and costs, and the critical elements in managing population health in an ACO. Dr. Walters will share how Dartmouth-Hitchcock pilots have demonstrated the value of an ACO by achieving efficiency, quality and cost targets during a June 1, 2011 webinar, "Leveraging Population Health Management To Meet ACO Efficiency Metrics," sponsored by The Healthcare Intelligence Network.

Training community pharmacists in the art of motivational interviewing can boost medication adherence levels in the patients who visit them, according to Janice Pringle, Ph.D, director of the program evaluation research unit at the University of Pittsburgh School of Medicine. In a unique intervention, the university is collaborating with Highmark Blue Cross Blue Shield and Rite-Aid pharmacies to deploy the training to 120 participating pharmacies to reduce medication non-adherence, a problem associated with an estimated $290 billion in avoidable medical spending every year, according to a recent New England Healthcare Institute estimate. Dr Pringle describes the three primary reasons for medication non-adherence driving the intervention, the benefits of training the pharmacists in motivational interviewing and the pharmacy's role in the project. Dr. Pringle will share how patients are identified for the intervention and the tools and strategies that pharmacists are using to improve adherence benchmark levels during, "Improving Medication Adherence Benchmarks Through Community Pharmacist Interventions," a May 25, 2011 webinar from the Healthcare Intelligence Network.