Healthcare Intelligence Network

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.

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.

Along with the transformation to a patient-centered medical home came an acceptance of a model that coordinates care for an entire population, not just the patients showing up each day, notes Dr. Paul Kaye, medical director at Taconic IPA. And even though the 238 Taconic physicians at 11 sites have received Level III PPC(R)-PCMH(TM) recognition from the NCQA, Susan Stuard, executive director of THINC, explains that practice transformation doesn't stop there. Dr. Kaye and Ms. Stuard described how the sharing of data across its organization is improving physician performance and value-based reimbursement levels during "Improving Physician Performance and Value-Based Reimbursement Levels Through Meaningful Data Sharing," a 45-minute webinar on June 23, 2010.

When primary care isn't available, several proxy healthcare services can sometimes fill the bill for certain conditions, helping to reduce the number of avoidable emergency room visits, explains Sara Gray, senior manager of emergency services at Kaiser Foundation Health Plan of Colorado. Ms. Gray describes two important steps hospitals can take when discharging patients to keep those patients from seeking post-discharge care in the ER, and suggests a hospital-SNF partnership to reduce preventable ER visits by SNF patients. Ms. Gray shared Kaiser's three-pronged approach to reducing inappropriate and avoidable ED use during "Reducing Unnecessary Emergency Room Visits: Strategies To Discourage Inappropriate Use and Reduce Preventable Visits," a 45-minute webinar on June 9, 2010.

As more payors test the patient-centered medical home model of care, what are the pros and cons of participation for physician practices? Dr. Marjie Harbrecht, medical and executive director of Health TeamWorks, describes the financial middle ground that is likely to satisfy payors and providers who sign on for medical home pilots and offers some additional selection criteria her organization (formerly the Colorado Clinical Guidelines Collaborative) may use in the future. Dr. Harbrecht examined how practices are recruited, selected and supported in medical home programs during "Physician Practices in the Medical Home: Recruiting, Evaluating, Supporting and Measuring the Patient-Centered Team," a 45-minute webinar on May 19, 2010.

Medicaid patients present their own unique set of needs during home visits, explain Dr. Larry Greenblatt, medical director, Chronic Care Program, Durham Community Health Network, Duke University Medical Center, and Jessica Simo, program manager, Durham Community Health Network for the Duke Division of Community Health. The duo explains the two types of patients that benefit most from home visits, the priorities of the home visit and the most common problems identified during home visits. Dr. Greenblatt and Ms. Simo will examine the features of a successful home visit initiative during "Home Visits in the Patient-Centered Medical Home," a 45-minute webinar on May 20, 2010.

In the first of several conversations with Metcare of Florida chief executives on its continuing medical home pilot with Humana, CEO Mike Earley and President and COO Dr. Jose Guethon describe Metcare's longstanding commitment to the management of care transitions for its Medicare patients, how its 10 medical home practices keep a handle on patient care in hospital settings, and the clinical and business returns that result from these efforts. Earley and Dr. Guethon will describe 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.

Sharing the latest literature on the causes and prevention of hospital readmissions is Susan Shepard, the director of patient safety education for The Doctors Management Company. Ms. Shepard described the type of patient most at risk for readmission, some of the risks inherent in transitioning patients from one care site to another, and the contribution of the patient's primary physician to a successful discharge. Shepard identified key aspects of the hospital admission, stay and discharge that can reduce the likelihood of readmission during "A Coordinated Discharge Planning Approach to Reduce Avoidable Hospital Readmissions," a 45-minute webinar on April 28, 2010.

The patient-centered medical home is at the heart of Mesa County, Colorado's shared savings model, explains David West, M.D., a hospitalist, family physician and healthcare consultant from Grand Junction, Colorado. Dr. West describes how the shared savings model can be adapted across markets, including the conditions and factors that must be present for this approach to be feasible. He also shares a unique provider incentive that is keeping hospital stays of Medicare patients at less than one-third the national average, one of the factors that has the nation touting this area as a model for efficient healthcare delivery. Dr. West examined how to structure a shared savings agreement during "Shared Savings in the Medical Home," a 45-minute webinar on March 31, 2010.

The contributions of an embedded case manager to the practice quickly become evident, explains Diane Littlewood, R.N., regional manager of case management for health services, Geisinger Health Plan, which in turn bolsters physician buy-in for the program. She describes the upfront basics that help to ensure that health plan and provider expectations for embedded case management are met. Ms. Littlewood examined an embedded case manager program, from the factors that will help determine if a program is right for an organization and deciding on the placement to defining roles and responsibilities for the program, during "Embedded Case Managers: Navigating Care Transitions, Gaps in Care and Patient Compliance," a 45-minute webinar on March 10, 2010.

While neither colocation of team members nor an electronic health record is a prerequisite for a successful integrated care team, explains Dr. Jan Berger, chief medical officer of Silverlink Communications Inc., there are four essential factors that contribute to the confidence and comfort levels of both patients and team members. Dr. Berger will share practical examples on how the integrated care team can work together to support patients in adhering to care plans, including a model of care that places the pharmacist on the care team and another that incorporates technology, during "Achieving Medication and Care Plan Adherence Through an Integrated Care Team," a 45-minute webinar on March 17, 2010.

Even though more than a third of the elderly are online, they're not necessarily using the Internet to seek health assistance, explains Marcia Wade, M.D., F.C.C.P., M.M.M., senior medical director at Aetna Medicare. That's why Aetna delivers its health risk assessment for the elderly in an alternate format while making available other Web-based tools to web-savvy boomer beneficiaries. Dr. Wade also describes Aetna's user-friendly strategy for heading off high-risk complications among its elderly and how this contributes to an overall reduction in hospital readmissions. Dr. Wade explained what to assess in the elderly population, how to match interventions based on risk score and the impact of this type of initiative during "Assessing and Predicting Health Risk in the Elderly," a 45-minute webinar on February 10, 2010.

A year into the Colorado multi-payor medical home pilot whose practices provide care to 30,000 patients, Julie Schilz, B.S.N., M.B.A., prescribes a single tool that can help transform practices, improve quality and deliver evidence-based care. It's NOT an EHR, says the manager of the Improving Performance in Practice and Patient-Centered Medical Home (PCMH) initiatives for the Colorado Clinical Guidelines Collaborative, who lists this tool's four key functionalities. Also in this interview, Schilz describes the influence of other reimbursement models on the Colorado pilot and identifies two opportunities for NCQA to enhance its PCMH recognition process. Schilz shared Colorado's experience to date in creating this multi-payor initiative --- from the development of the program to the challenges of working with multiple payors --- during the January 20, 2010 webinar, "Multi-Payor Medical Home Programs: Addressing Funding and Organizational Challenges."

The dismal economy of 2009 has been a bright spot for health coaching and other health improvement programs, notes Dr. Jim Reynolds, chief medical officer for Health Fitness Corporation. Dr. Reynolds also compares early results from a Massachusetts' smoking cessation program for Medicaid beneficiaries with outcomes in commercial populations, and describes what Year 1 of a coaching program for improved medication adherence might yield in the way of behavior change and cost impacts. Dr. Reynolds and Dr. Elizabeth Rula, clinical research manager at the Center for Health Research at Healthways Inc., shared how their organizations respond to the challenges of evaluating and reporting on health coaching ROI during the January 13, 2010 webinar, "Health Coaching Evaluation: Measuring the ROI on Healthcare Utilization and Costs."

The pharmacist has a natural and important role in patient medication reconciliation and review, explains Dr. Beth Chester, senior director of clinical pharmacy services and quality, Kaiser Permanente Colorado. She describes the dramatic impact that a pilot pharmacist intervention had on emergency department visits and mortality rates among patients just discharged from skilled nursing facilities (SNFs) once the health plan's pharmacists stepped in to monitor medication therapy in this population. Dr. Chester detailed the roles of the physician practice's staff and the pharmacist in medication management, the use of technology and how financial incentives and reimbursement can play a role in improving medication compliance during the January 6, 2010 webinar, "Medication Therapy Management in the Patient-Centered Medical Home."