Healthcare Intelligence Network

To achieve the lowest rates of readmissions in its history, HealthCare Partners Medical Group of California first identifies patients at high risk for readmission. HealthCare Partners corporate medical director Dr. Stuart Levine describes HCP's four key strategies to risk-rank patients and suggests proactive measures to limit the number of individuals who are rehospitalized. Dr. Levine will discuss HCP's approach to hospital readmissions during, "Reducing Readmissions Through Multi-Disciplinary Post-Discharge Support," a May 18, 2011 webinar from the Healthcare Intelligence Network.

Functional decline in an elderly person can be the first indicator of a chronic condition ready to snowball out of control. Patricia Zinkus, director of case management at Fallon Community Health Plan, and Susan Legacy, FCHP's senior manager of case management, describe how their collaborative multidisciplinary intervention monitors for these changes, and why the program's social component is just as critical as home visits and case management outreach. Ms. Zinkus and Ms. Legacy will share details from FCHP's risk-sharing model during "Identifying Functional Decline in Chronic Care Patients To Reduce Preventable Healthcare Utilization," 45-minute webinar on April 27, 2011.

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.

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.

Working with a network of 40 skilled nursing facilities to hone the hospital-to-SNF transfer of care has accomplished two goals for Summa Health System: readmissions and lengths of stay for patients released to SNFs have been reduced, and the experience has made hospitals and SNFs more accountable for both the quality and cost of care they provide. Carolyn Holder, manager of transitional care for Summa Health System, describes what had to happen before this critical care transition could improve and why physicians had to rethink their approach to hospital-to-SNF transfers. Holder and Michael Demagall, administrator of Bath Manor and Windsong Care Center, an SNF participating in the network, will describe their collaboration during "Improving Transitions of Care Between Hospital and SNF: A Collaboration Supporting the Accountable Care Vision," a 60-minute webinar on April 6, 2011.

Are accountable care organizations (ACOs) the new wave of healthcare delivery? In this month's healthcare performance benchmarks podcast, Healthcare Intelligence Network's Melanie Matthews analyzes the industry's acceptance of and participation in accountable care organizations derived from HIN's February 2011 survey results. Jeffrey Ruggiero, Esq., advises ACO participants to prepare for the legal and regulatory hurdles. More actionable data on accountable care organizations are contained in "2011 Benchmarks in Accountable Care Organizations: Metrics from Early ACO Adopters," a 40-page report that provides new market research on current and planned ACOs as well as the ACO metrics and measures used by ACO early adopters to evaluate success, quality, efficiency and satisfaction.

Money may talk, but after 14 years of administering pay for performance (PFP) programs for its providers and specialists, HealthPartners has figured out what motivates physicians even more than financial incentives. Babette Apland, HealthPartners senior vice president of health and care management, shares this insight, as well as the measures by which HealthPartners evaluates pharmacies and specialists in its PFP program. Apland shared how HealthPartners is aligning physician incentives and shared savings with PFP programs and a total cost of care initiative during "Aligning Physician Incentives for Shared Risk and Reward Across the Healthcare Continuum," a 45-minute webinar on March 2, 2011.

Getting people to think about dying is not the first health behavior that comes to mind when employing incentives. However, incentives can be used anywhere in the healthcare continuum --- including end of life --- to influence behaviors, notes Neal Sofian, MSPH, director of member engagement at Premera Blue Cross. Sofian describes the barriers individuals face at this time in their lives and how the use of incentives can result in exactly the kind of care these patients want and need. Sofian shared the latest strategies to increase engagement and the results from these efforts during "Evaluating Health and Wellness Incentive Programs for Behavior Change," a 45-minute webinar on February 10, 2011.

Capital District Physicians' Health Plan's (CDPHP) medical home pilot began in 2008, with the dual goals of reforming both the practice of primary care in the CDPHP network and payments to these physicians. Dr. Bruce Nash, CDPHP's senior vice president of medical affairs and chief medical officer, explains what sets the two-phase CDPHP program apart from other medical home pilots, how participants met the challenge of practice transformation, and why preliminary pilot results mirror what's going on in the industry today. Dr. Nash described how CDPHP met the challenge of developing a novel risk adjustment methodology that would drive a global payment combined with a significant bonus structure to attract physician participation and encourage future growth by medical students to enter primary care during "Rewarding Primary Care Practice Reform with Physician Payment Reform: A Medical Home's Experience," 45-minute webinar on February 23, 2011.

How are healthcare organizations encouraging appropriate use of the emergency room in their populations? In this month's healthcare benchmarks podcast, Healthcare Intelligence Network executive VP and COO Melanie Matthews shares metrics from HIN's July 2010 survey on reducing avoidable ER visits, with relevant commentary from Dr. Barsam Kasravi, managing medical director for state-sponsored programs at WellPoint; and Sara Tracy, senior manager of emergency services at Kaiser Foundation Health Plan of Colorado. More actionable data on reducing avoidable ER use is contained in "2010 Performance Benchmarks in Reducing Avoidable ER Visits," a 50-page report derived from responses from 90 healthcare organizations. Presenting this data in more than 30 easy-to-follow graphs and tables, this resource documents trends and metrics from emergency departments across the country that are successfully managing ER utilization.

Even though the specifics of Medicare's Shared Savings Program have yet to be defined, physician organizations can still position themselves to achieve cost savings through an independent accountable care organization (ACO), notes Jeffrey R. Ruggiero, Esq., a partner in the law firm of Arnold and Porter LLP, who is advising the Queens County Medical Society on its ACO approach. The advisor to one of New York State's largest physician ACOs describes the advantages of a physician-run ACO as well as some of the regulatory, compliance and operational factors to consider prior to ACO launch. Ruggiero described the Queens County Medical Society's ACO development approach during "Physician-Owned ACOs: Overcoming the Legal and Regulatory Compliance Challenges," a 45-minute webinar on January 19, 2011.

Was 2010 a better year for healthcare than 2009, and what were the best and worst business ideas in healthcare over the last 12 months? In this month's healthcare performance benchmarks podcast, Healthcare Intelligence Network's Melanie Matthews reviews the top healthcare trends and concerns for 2011 derived from HIN's October 2010 survey results. More actionable data on healthcare trends as well as 2011 industry forecasts from healthcare thought leaders William Shea of Cognizant Business Consulting and Steven T. Valentine from The Camden Group are contained in "Healthcare Trends and Forecasts in 2011: Performance Expectations for the Healthcare Industry," a 35-page report that reviews the industry landscape for 2011 and suggests how healthcare organizations can best position themselves for the 12 months to come.

Co-locating healthcare case managers in care settings can improve communication with patients as they move through the continuum of care, says Jan Van der Mei, regional director of continuum case management for Sutter Health Sacramento Sierra Region. Ms. Van der Mei describes the major issues that case managers face while helping patients navigate the Sutter system, as well as the key role of case managers in reducing hospital readmissions. Ms. Van der Mei is one of five contributors to the "Guide to Patient-Centered Case Management," a 110-page resource of best practices in identifying, stratifying and monitoring individuals for case management. It documents the returns generated by targeted case management interventions in place at Geisinger Health System and other organizations, and the Q and A chapter answers more than 50 questions on patient-centered case management.

The accountable care organization (ACO) is a staple of healthcare reform. CMS will launch its Shared Savings Program --- an ACO for Medicare patients --- in January 2012. John Harris, principal with the consulting firm of DGA Partners, advises potential participants in an ACO to lay the groundwork now. In this interview, he recommends eight elements of an ACO infrastructure and weighs in on the patient-centered medical home's role in an ACO. Harris is one of five contributors to "Essential Guide to Accountable Care Organizations: Challenges, Risks and Opportunities of the ACO Model," a 60-page resource that answers key questions surrounding ACOs so that hospitals, PHOs, IPAs and other physician organizations, networks or group practices can weigh the merits now of creating or joining an ACO before CMS's ACO launches next year.

More than a third of healthcare organizations have launched nurse advice lines to reduce avoidable emergency room use and direct patients to the most appropriate care venue, according to a July 2010 survey by the Healthcare Intelligence Network. The staffing and operation of Optima Health's nurse advice line is influenced by many factors, explains Patricia Curtis, director of operations, clinical care services for Optima Health. Curtis describes the distinct responsibilities of the LPNs and RNs who staff the advice line as well as the diverse needs of the member populations who call the advice line. Curtis will share how Optima's nurse advice line has evolved from a call center that supported a staff model HMO to a critical component of the organization's effort to improve the efficiency of healthcare utilization during "Maximizing the Nurse Advice Line To Ensure Appropriate Healthcare Utilization," a 45-minute webinar on January 6, 2011.