Healthcare Intelligence Network

Thinking about creating an accountable care organization? The clinical integration of healthcare providers can be the first step, facilitating the coordination of services required for shared accountability and reward. Dr. Mark Shields, senior medical director with Advocate Physician Partners, describes the logistics of training 3,400 providers on clinical integration, the importance of the physician peer group in this effort, and the business case for the devotion of three of Advocate's 41 performance measures to smoking cessation and prevention. Dr. Shields will share Advocate's clinical integration strategy during "How To Create an ACO Framework Through Clinical Integration with Independent Physicians," a 45-minute webinar on December 1, 2010.

In the face of healthcare reform and new models of care delivery such as the patient-centered medical home, primary care physicians don't have to fly solo anymore, advises Dr. David Eitrheim, a family physician with the Mayo Clinic Health System in Wisconsin. Dr. Eitrheim describes how his practice's team-based approach has changed the nature of the patient visit as well as the nurses' workload, and provides the secret to a productive patient visit. Dr Eitrheim will share how his practice made the transformation from a traditional practice to a team-based approach during "Redesigning the Physician Practice for Improved Efficiency and Increased Revenue," a 45-minute webinar on December 15, 2010.

Who's using health risk assessments (HRAs), and how are they administered? What are the top incentives driving HRA completion, and what are the top three uses for HRA data? What completion rates can be expected? In this month's healthcare benchmarks podcast, Healthcare Intelligence Network executive VP and COO Melanie Matthews shares the latest market research on HRA use. This month's metrics are derived from HIN's June 2010 survey on HRAs, with commentary from Dr. Marcia Wade, Aetna Medicare's senior medical director. More actionable data on ways that 116 healthcare organizations are using HRAs is contained in "2010 Performance Benchmarks in Health Risk Assessment Use," a 60-page resource providing metrics and measures on current and planned HRA initiatives as well as lessons learned and results from successful health assessment programs.

In an atmosphere of increased state and federal oversight of health plan rates, healthcare organizations need a sound strategy for determining premium rate increases that meet regulatory approval. HealthScape Advisors managing directors Steve Young and John Steele describe the challenges of setting rates in this environment and the essential experience that can best prepare health plans for dealing with commercial plans. Young and Steele will share how health plans can develop a sound policy for premium rate increases that will meet with regulatory approval during "Health Plan Rate Setting: Balancing Premium Increases Against Regulatory Oversight," a 45-minute webinar on December 8, 2010.

Medicaid managed care organizations can turn the tide on the rising cost of care management for their high-need, high-cost members by implementing integrated programs that simultaneously address medical and behavioral health conditions, says Dr. Sam Toney, Health Integrated's chief medical officer. In this podcast, Dr. Toney describes how integrated case management and integrated chronic condition management are especially beneficial to Medicaid's mostly vulnerable members as they navigate acute health crises as well as longer-term, sustainable efforts to improve their health status. For more information on Health Integrated, please visit: http://www.healthintegrated.com or call 800-323-0286.

While the healthcare winds blew more favorably this year than they did in 2009, healthcare organizations will need key expertise to succeed in the year ahead, advises William Shea, a partner in health industry consulting for Cognizant Business Consulting. With the remix of healthcare delivery models brought on by healthcare reform, Shea identifies two challenges inherent in the trend toward patient-centered care that spans the entire continuum of care. Shea and Steven Valentine, president of The Camden Group, provided strategic advice healthcare companies can use to position themselves for success in the coming year during "Healthcare Trends in 2011: A Strategic Industry Forecast," a 60-minute webinar on October 20, 2010.

Organizations should advocate for a case manager in the emergency room, says Toni Cesta, senior vice president of operational efficiency and capacity management at Lutheran Medical Center. Making the business case for an ED-embedded case manager, Cesta shares key targets for case management intervention in the ED and describes how the ER case manager is positioned to improve patients' transitions in care. Cesta will explore how to effectively structure an ED-based case management program and the potential impacts of an embedded case manager in the ED during "Embedded Case Managers in the Emergency Department," a 60-minute webinar on November 3, 2010.

Healthcare reform offers two major opportunities for healthcare to bend the spend curve and improve profitability, says Steven Valentine, president of The Camden Group. Valentine also weighs in on the current state of healthcare, and why organizations can't think about healthcare reform without considering the current economy. Valentine and William Shea, a partner in health industry consulting for Cognizant Business Consulting, will provide strategic advice healthcare companies can use to position themselves for success in the coming year during "Healthcare Trends in 2011: A Strategic Industry Forecast," a 60-minute webinar on October 20, 2010.

In a new monthly podcast, Healthcare Intelligence Network executive VP and COO Melanie Matthews shares the latest market research on key healthcare topics. This month's metrics are derived from HIN's July 2010 survey on Reducing Avoidable ER Visits, with commentary from Dr. Barsam Kasravi, managing medical director for state-sponsored programs for WellPoint and Sara Tracy, senior manager of emergency services at Kaiser Foundation Health Plan of Colorado. More actionable data from 90 healthcare organizations on their efforts to reduce inappropriate use of the ED is contained in "2010 Performance Benchmarks in Reducing Avoidable ER Visits," a 50-page resource documenting trends and metrics from EDs across the country that are successfully managing ER utilization.

To provide immediate feedback to participants in Colorado's accountable care organization (ACO) for Medicaid beneficiaries, program developers have chosen a handful of performance measures that will focus on program quality and cost containment, explains Laurel Karabatsos, deputy Medicaid director. The ACO is rapidly approaching its January 2011 launch date, and the development team has worked hard to garner support for an ACO that will provide health services for 60,000 Medicaid lives in the state. Karabatsos and Jerry Smallwood, Medicaid reform unit manager, will walk through Colorado's ACO development process during "The Colorado Accountable Care Collaborative: Practical Lessons from an ACO," a 45-minute webinar on September 29, 2010.

To create a virtual medical home --- also called a virtual healthcare home --- primary care providers partner with community organizations to deliver a full continuum of healthcare services in a manner that is transparent to patients and health plan members. Sarah Dixon-Gale, lead contract manager for the Iowa/Nebraska Primary Care Association, explains how Iowa's virtual medical home program has improved access at Siouxland Community Health Center. Also in this podcast, Siouxland CEO Michelle Stephan describes a major challenge faced by the virtual medical home. Learn how this unique community partnership helps to position these organizations for federal Medicaid expansion in 2014. Dixon-Gale and Stephan will share more lessons learned from the virtual medical home during "Coordinating a Virtual Medical Home in Your Community: Lessons from the Iowa Collaborative Safety Net Provider Network," a 45-minute webinar on September 23, 2010.

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.

As part of CareOregon's initiative to create a more robust care management program, the organization has found new ways of stratifying members and identifying high-risk members, explains Rebecca Ramsay, B.S.N., M.P.H., CareOregon's senior manager of care support and clinical programs. Ms. Ramsay also explains how daily data from CareOregon's emergency departments is informing their member outreach strategy. Ms. Ramsay will share the strategies that CareOregon is using to segment patients by complexity to ensure that case management resources are allocated effectively during "Case Management: Identifying, Monitoring and Managing Target Populations," a 60-minute webinar on September 16, 2010.

One of the advantages of co-locating healthcare case managers in various care settings is the improved level of communication for a patient 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, such as medication reconciliation and patient and family education, that case managers face while helping patients to understand their health conditions and goals of care as they navigate the Sutter system. She also discusses how case managers can educate patients to avoid hospital readmissions through interventions and symptom management. Ms. Van der Mei will share details on Sutter Health's case management initiatives during "Best Practices in Case Management Patient Contact, Monitoring and Follow-up," a 45-minute webinar on August 25, 2010.

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.