Healthcare Intelligence Network

Social and demographic factors such as chaos in the home or functional status can complicate care coordination for patients as much as clinical factors, explains Jeff Schiff, M.D., M.B.A., medical director of Minnesota Health Care Programs for the Minnesota Department of Human Services. He identifies two key social/demographic factors getting close attention in Minnesota's new primary care reimbursement model and explains how the engagement of patient and family at the clinical level is paying off in improved patient safety, satisfaction and health outcomes. Dr. Schiff examined the risk factors that need to be considered in a risk-adjusted medical home reimbursement strategy during the December 16, 2009 webinar, "Risk Adjustment in the Medical Home: Building an Effective Reimbursement Strategy."

Case managers and advanced practice nurses in Aetna's Transitional Care pilot have also successfully partnered to reduce readmissions. Dr. Randall Krakauer, national medical director, Medicare at Aetna, describes the key focus and the complementary roles that reduced 90-day readmissions by 25 percent. Dr. Krakauer also weighs in on the pros and cons of bundled payments, and why incentives alone will not significantly impact avoidable readmissions. Dr. Krakauer and Dianne Feeney, BSN, MS, associate director of quality initiatives for the Maryland Health Services Cost Review Commission (HSCRC), examined how to structure programs to reduce avoidable hospital readmissions, including the alignment of financial incentives, during the December 2, 2009 webinar, "Aligning Reimbursement To Reduce Avoidable Hospital Readmissions."

Maryland's Hospital Preventable Readmissions program rewards efforts that reduce hospital readmissions while improving care quality and decreasing cost. Dianne Feeney, associate director of quality initiatives for the Maryland Health Services Cost Review Commission (HSCRC), describes HSCRC's response to hospitals that claim they can't afford the empty beds that result from programs like these, as well as processes to help ensure that higher-risk patients are not refused admittance to hospitals. She also explains how partnerships with "siloed settings" --- nursing homes and home health providers --- can reduce common errors that occur during patient handoffs. Feeney and Dr. Randall Krakauer, national medical director, Medicare at Aetna, examined how to structure programs to reduce avoidable hospital readmissions, including the alignment of financial incentives, during the December 2, 2009 webinar, "Aligning Reimbursement To Reduce Avoidable Hospital Readmissions."

Priority Health members play an active role in keeping themselves out of the hospital, explains Mary Cooley, manager of case and disease management at Priority Health. She describes the four-point strategy that is reducing readmissions at Priority Health, the challenges that still exist and the essential tool that Priority supplies to help providers identify and close care gaps. Cooley provided more details on the strategies that Priority Health is using to reduce avoidable hospital readmissions during "Reducing Avoidable Hospital Readmissions: A Case Study from Priority Health," a 45-minute webinar.

Case managers are the backbone of the Geisinger Health Plan (GHP) Health Navigator(SM) program, a medical home partnership between primary care providers and GHP that has reduced 30-day hospital readmissions by 15 to 20 percent. Providing benchmarks for case manager caseloads and contact frequency, tools to support the case management effort, the key to smooth placement of case managers in the medical home and tips for better management of patients discharged to nursing facilities are Diane Littlewood, R.N., and Joann Sciandra, R.N., who are both regional managers of case management for health services at Geisinger Health Plan. Littlewood and Sciandra provided more detail on the key components of a winning case management program during "Effective Case Management in the Medical Home," a 45-minute webinar. The webinar is part of HIN's continuing "Medical Home Open House webinar series."

A forecast of 2010 healthcare trends would not be complete without some prognostication on the fate of healthcare reform. The Healthcare Intelligence Network asked William DeMarco, president and CEO of DeMarco and Associates, and Jim Knutson, risk manager and human resources director, Aircraft Gear Corporation, to predict the winners and losers from the controversial legislation, as well as the delivery date of the much-debated package. DeMarco and Knutson go beyond crystal-gazing to describe the implications for key healthcare stakeholders in the coming year with a special focus on payment reform in "Healthcare Trends and Forecasts in 2010: Performance Expectations for the Healthcare Industry," a new special report from the Healthcare Intelligence Network.

Medical home innovators Group Health Cooperative, Greenhouse Internists and Grand Valley Health Plan describe practice level transformations that improve care delivery and move them along the path to NCQA medical home recognition in Part 2 of Medical Home Open House Highlights.

Grand Valley Health Plan's (GVHP) workgroup approach helps the staff model HMO to successfully disseminate workflow changes resulting from its NCQA medical home recognition process, explains Barbara Luskin, GVHP quality manager, and also created location champions in the process. Luskin describes how GVHP demonstrates compliance with the most challenging NCQA "must-pass" elements and shares GVHP's early returns in patient satisfaction ratings, quality of care and healthcare utilization. Luskin, along with Dr. James Kerby, GVHP vice president of medical affairs, shared the basics of preparing for and achieving recognition from NCQA's Physician Practice Connections(R) - Patient-Centered Medical Home(TM) during Achieving NCQA's Patient-Centered Medical Home Recognition, a 45-minute webinar on October 21, 2009. The webinar is part of HIN's continuing Medical Home Open House webinar series.

Despite the challenges, cost and uncertain return of EHRs, practices should move quickly to adopt this tool, recommends Dr. Richard J. Baron, president and CEO of Greenhouse Internists, where the EHR is the backbone that supports the implementation of evidence-based practices. Dr. Baron shared his practice's evidence-based guidelines experience --- from working with physicians on documentation, staff training and work flow redesign to using the data to improve practice performance --- during an October 6, 2009 webinar, Adopting and Implementing Evidence-Based Guidelines in the Medical Home. The 45-minute session is part of HIN's continuing Medical Home Open House webinar series.

Through the implementation of innovative health management programs, we can improve the performance of our healthcare system, says Steve Wigginton, president of Health Integrated, a leading health management solutions company. This podcast discusses how Health plans that make investments in wellness, chronic condition management and technology can enjoy a healthy return on investment with improved health outcomes for their members. To download a case study of one health plan's successful use of health management solutions that improved outcomes and reduced costs, and for more information on Health Integrated, please visit: www.healthintegrated.com/HIN909A or call 800-323-0286.

Although Group Health Cooperative's increased their primary care staff, patients are still successful in connecting with their caregivers, says Michael Erikson, vice president of primary care services for Group Health Cooperative. In fact, the key to a patient's understanding of his care team lies in the physician's hands. In this podcast, Erikson discusses the effect Group Health's staff expansion has had on its patients, as well as the many benefits of contacting patients via phone and e-mail in lieu of in-person office visits. Erikson described the staffing strategies it implemented to reduce downstream utilization costs --- from the skill sets required by the staff to the workflow changes needed to accommodate this model of care during a September 9, 2009 webinar, Successful Models of Care for the Medical Home: Staffing and Roles of the Care Team. The 45-minute session is part of HIN's continuing Medical Home Open House webinar series.

Healthcare reform partially fueled Baptist Health System's desire to participate in the CMS Acute Care Episode (ACE) pilot that is testing bundled or episodic payments for selected orthopedic and cardiac procedures, explains Michael Zucker, Baptist's chief development officer. He describes some early returns from the experience, highlights the provider's role in Baptist's multi-pronged awareness campaign for Medicare beneficiaries and explains the committee-based approach to quality change and cost savings that has already improved communications among participating providers. Zucker shared Baptist Health System's experience thus far in the CMS bundled payment pilot and early feedback during a September 16, 2009 webinar, Medical Home Reimbursement: Exploring Bundled Payment Options. The 45-minute session is part of HIN's continuing Medical Home Open House webinar series.

The opening sessions of the Medical Home Open House webinar series delivered tips for improving care continuity, quality and access for patients assigned to a medical home. Healthcare thought leaders Barbara Wall, Doreen Salek and Liz Reardon describe how the medical home offers opportunities to improve patient education, transitions in care and the integration of behavioral and primary health. The remaining 45-minute sessions of the Medical Home Open House Series will explore strategies for staffing, reimbursement and attaining NCQA certification from early medical home adopters Group Health Cooperative, Baptist Health System and Taconic IPA.

The fragmentation in the U.S. healthcare system for the care of chronic conditions, like diabetes, asthma, heart disease, and depression, causes the health of individuals with these chronic conditions to deteriorate while driving up expenses in emergency room visits and inpatient stays, says Steve Wigginton, president of Health Integrated, a health management solutions company. In this podcast, Wigginton describes how by closing gaps in care, addressing the interplay between medical and psychosocial health and providing day-to-day support for these patients, organizations can avoid costly emergency room visits and inpatient stays.

Geisinger Health Plan's successful Transitions of Care program is the health plan's response to rising rehospitalization rates among Medicare patients, a major concern of both CMS and private payors. Geisinger Health Plan's Doreen Salek defines the transition teams' key area of focus when providing a "clean and clear handoff" of a patient from one care site to another, with the goal of avoiding readmission to the hospital. The health plan's director of business operations of health services also defines the plan's ideal home health partner, its blueprint for a universal plan of care to improve care coordination and its expectations of patients and their families and caregivers. Salek, along with Janet Tomcavage, R.N., M.S.N., vice president of health services for Geisinger Health Plan, explained how a focus on transitions of care across the continuum can enhance care quality and reduce readmissions during an August 26, 2009 webinar, Constructing Care Transitions to Reduce Hospital Admissions. The 45-minute session is part of HIN's continuing Medical Home Open House webinar series.