1.800.360.0603

GE Healthcare Camden Group Insights Blog

Today's Patient-Centered Medical Home Care Team

Posted by Matthew Smith on Aug 22, 2014 3:32:00 PM

Patient Centered Medical Home, PCMHThe Patient Centered Medical Home (PCMH) is a model of primary care delivery designed to strengthen the patient-clinician relationship by replacing episodic care with coordinated care and a long‐term healing relationship. It can lower costs of care through its focus on patient self-management and engagement, rather than only disease treatment.

PCMH encourages teamwork and coordination among clinicians and support staff to give patients' better access to care and to take a greater role in making care decisions. Key PCMH components include understanding patients’ preferences and culture, shared decision making between patient and clinician, and patients’ willingness to establish and work toward personal health goals. 

The following chart by Healthcare Intelligence Network spells out who is on today's Patient-Centered Medical Home care team.

Healthcare Intelligence Network - Who's on the Patient-Centered Medical Home Care Team?

Topics: patient centered medical homes, PCMH, Patient Centered Medical Home, Coordinated Care

Infographic: Accountable Care Organizations & How Patients Benefit

Posted by Matthew Smith on Jun 10, 2014 12:14:00 PM

Infographic, ACO, Accountable Care OrganizationsAs a HD Insights Blog reader, you are used to seeing us share helpful and engaging infographics on a regular basis. We share these infographics because we hope that they can help you better explain a multitude of topics to your patients, colleagues, and constituents. We hope that you find these infographics worthwhile. If there is an infographic that you would like to share with our blog readership, please email a link or .jpg, .png, or .tif file to msmith@healthdirections.com We will be happy to review the infographic and share it if we feel it is appropriate for the readership.

Today's featured infographic was created by the University of Southern California's Keck School of Medicine and provides a graphic overview of Accountable Care Organizations (ACOs) and provides information surrounding:

  • Goals of Coordinated Care
  • Types of ACOs
  • How ACOs Can Benefit Patients

**For a full-sized look at the infographic, please click here and then click on the image to enlarge.

Infographic, ACO, Accountable Care Organization

 

 

ACO, Accountable Care, Clinical Integration, Population Health

Topics: ACO, Infographic, Accountable Care Organizations, Coordinated Care

7 Steps to Achieving Clinical Integration Via Physician Engagement

Posted by Matthew Smith on Jun 2, 2014 11:18:00 AM

Clinical Integration, Physician EngagmentNew payment models are making it more important than ever for hospitals to collaborate with physicians. From readmission penalties to bundled payments to ACOs, providers have a growing economic incentive to pool resources, share information, coordinate care and services and cooperate on quality improvement. 

But while the incentives are strong, the obstacles to clinical integration are daunting. Hospital-physician collaboration is operationally complex. Although physician employment can smooth out some of the bumps, practice acquisition is expensive. While a handful of large health systems have devoted extensive resources to launching clinical integration initiatives, most smaller organizations are still sorting out their options.

How can hospitals integrate with physicians without creating political and financial problems? The solution is to focus on building mutually beneficial relationships and use existing resources wisely.

The following practical approach will help healthcare leaders achieve clinical integration by engaging physicians, strategizing collaborative programs and making targeted investments.

1. Understand Physician Motivation

Convincing physicians to collaborate more closely with a hospital can be challenging. Physicians are trained as autonomous decision makers. Perfectionism and the need for control can make it difficult to weave physicians into an integrated organization. But there is a positive side to the medical personality: No doctor wants to be an outlier.

Engage physicians by presenting data on their patient outcomes. Most physicians will discover at least a few areas in which their performance falls short of their peers.

Talk to doctors about their patients’ flu vaccination rates, medication reconciliation rates, performance on diabetes control measures, etc. This is easiest for hospitals that have access to physician claims data through a physician-hospital organization (PHO) or that offer physicians a subsidized electronic medical record (EMR) with built-in Clinical Quality Measure (CQM) templates that facilitate reporting.

Most physicians do not track and evaluate their own performance, let alone measure their performance against peers. Relevant patient statistics will earn physicians’ attention and generate interest in working more closely with hospital staff to improve outcomes.

It is also important to educate physicians on the evolving healthcare market. Explain how payers are creating incentives for clinical integration though bundled or global payments and per patient/per month care coordination fees. As physicians become more aware of these payment trends, many will embrace the opportunity to increase their salary by partnering with the hospital.

2. Create True Physician Governance

To gain the most under new payment models, physicians and hospitals have to play nice in the sandbox. The key is establishing a governance body that allows physicians to guide the development of care strategies and clinical protocols. Physician-led governance will create physician awareness and support for clinical integration initiatives and make a positive impact on the overall success of the program. Make sure the clinical integration governance committee includes physicians from solo practices and small partnerships as well as large groups. Include representatives from a range of specialties.

Most important, the governance body should include physicians who are critical or even negative about the clinical integration initiative. Often these “difficult” physicians simply want to be heard and provide their input. Making these physicians feel included will go a long way toward smoothing the transition to integration.

3. Focus on Quality, Not Finances

Physicians are concerned about productivity and payment, but concentrating exclusively on financial metrics will disenchant many providers. Focus instead on clinical quality and performance improvement. After all, this is the main reason physicians entered medicine — to provide quality care to the patients they serve.

The clinical integration committee should establish quality benchmarks and treatment protocols that define performance standards. Benchmarks can be based on evidence-based standards and care plans developed by national quality organizations and disease associations. Micromanaging clinical decisions will be unpopular, so care protocols should be broad guidelines that allow room for individual judgment.

To choose initial improvement goals, review admission and inpatient reports to identify areas of low quality and high cost. For which conditions does the hospital see the greatest number of admissions? Which conditions have the longest length of stay? Physicians using an EMR may be able to report on certain quality measures. For example, what is the percentage of hypertensive patients with adequate blood pressure control? How many heart disease patients have an up-to-date lipid profile?

Begin the clinical integration outreach with physicians in specialties linked to poorer outcomes and higher costs. Another logical starting point is primary care. Family practice physicians and internists often have the greatest impact on chronic disease management.

4. Concentrate on Care Coordination

One of the biggest opportunities in clinical integration is better coordination of care. Focus on high- and medium-risk patients who are responsible for the highest costs or who will likely increase costs in the near future. Target care transitions between the hospital and admitting specialists or primary care physicians. Involve physical therapy, home health providers and long-term care facilities in clinical coordination planning.

Physicians need to ensure that discharged patients complete follow-up visits. The hospital can assist by sponsoring a care coordination team for the entire organization to help manage follow-up appointments, referrals and home health services. To help guide care coordination, stratify hospital discharges by risk of readmission, complication or care plan non-compliance.

5. Use Technology to Get Providers Talking

Clinical integration is nearly impossible without an EMR system, but many medical practices are not far along in EMR adoption. Most practices cite expense as the main obstacle.

To overcome the cost hurdle, consider subsidizing EMR systems for practices that agree to join the integrated organization. Relaxation of the Stark laws allows hospitals to subsidize as much as 85 percent of the purchase and support costs of an EMR system. Subsidy agreements can require physicians to report quality measures and meet quality performance thresholds.

However, do not expect physicians to acquire the same EMR system as the hospital. Many small practices can do very well with free and low-cost alternative systems. The hospital should build interfaces for exchanging information with the EMR systems used by the majority of integrated physicians.

Many physicians who have implemented EMRs have participated in the Medicare and Medicaid EHR Incentive Program. As part of demonstrating Meaningful Use under the program, these physicians have already begun tracking clinical quality measures. Clinically integrated organizations should use the EMR to create aggregated quality reports and share them with physicians. Weekly or monthly reports can track disease management data such as HbA1c levels, cholesterol, blood pressure and preventive screenings. Giving physicians the chance to view quality performance metrics will engage both their competitive personalities and their collaborative spirit.

6. Build Financial Incentives

Clinical integration will require physicians to invest time and money into patient education, technology and additional staff. The problem is that methods of compensating providers for care coordination are still being developed and tested by payers. Given the costs being shouldered by physicians, financial incentives are critical.

Regardless of how incentives are distributed, hospital leaders should reward physicians either for controlling costs, achieving quality benchmarks or both. Focus on achieving care management quality metrics early on, since reduced costs tend to follow well-managed patients. Establish and re-assess these performance targets annually.

One important note: Make sure primary care physicians get a piece of the pie. Although surgical specialists might be responsible for most of the hospital’s costs and revenue, primary care doctors have the most frequent patient contact and are also responsible for most of the work of chronic disease management.

7. Invest Early for Healthy Returns

Even hospitals without the resources of a large medical system can achieve clinical integration by focusing on strategic investment and engaging community physicians through quality improvement. Hospital leaders need to allow physicians to establish the quality benchmarks and evidence-based protocols for the organization’s costliest conditions. Leaders can then concentrate on linking doctors through technology, assisting with care coordination, and negotiating with payers on bundled payments or pay-for-performance incentives.

Clinical Integration, Physician Engagement, Health Directions

Topics: EHR, EMR, Clinical Integration, Clinically Integrated Care, Physician Engagement, Coordinated Care

Medical Homes Set to Help Patients with Chronic Conditions Under ACA

Posted by Matthew Smith on May 13, 2013 9:56:00 AM
PCMH

One of the persistent questions about the Affordable Care Act is how are so many people, new to insurance, going to get quality health care when the system seems so strapped already. The law does have an answer to that: the medical home. But it is not a concept that is widely understood yet.

St. Francis Family Medicine near Richmond, Virginia is, like many medical practices in America, evolving into a medical home, where health care services are coordinated to manage each patient's care. 

That means patients come or call the practice first when they have a problem, and it means a team of physicians, nurses and other professionals take care of patients and keep tabs on their conditions over time. The team makes sure patients are taking medicines properly, getting timely preventive care and that no unnecessary tests are done. 

Dr. Rupen Amin say that frees him up to do his job. "You have more time to build a relationship with your patient and make those decisions that you need to, without having to worry about the small things," Amin says.

Medical homes use computerized record-keeping to track patients and to watch for trends that might signal the need for new treatments. All of this sounds expensive, and at first it may be, but two large scale programs suggest medical homes may save a great deal of money over time.

The first of these demonstration projects began seven years ago in Richmond. It’s called the Virginia Coordinated Care for the Uninsured Program or VCC. Linda Ford enrolled after coming down with a miserable case of shingles.

“I was in a tremendous amount of pain, and did not know what was going on with me,” Ford says. 

Ford wanted to see a doctor, but she had no insurance. By law, hospital emergency rooms must provide care for the uninsured, so Linda ended up at Virginia Commonwealth University’s medical center – home base for VCC. Through the program, she was able to see a primary care doctor at no charge. He prescribed medication to help prevent a recurrence of shingles and began treating her for high blood pressure – something she knows is important.

"Because if you don’t treat high blood pressure, you sometimes have a heart attack and die," says Ford.

Virginia Commonwealth says it eventually enrolled more than 26,000 people in the program that helped Ford.

"Our patients had lower utilization of the emergency room, fewer in-patient admissions, and the overall cost of care went down,” says VCU Health System Vice President Sheryl Garland.

At first, it cost about $8,000 a year on average to care for a patient, but for those who stayed in the program at least three years costs dropped by 50 percent.

In California, statisticians saw a similar trend in the Healthy San Francisco program. It started six years ago, funded by the city, county, local employers and donors. Thirty-seven clinics and medical practices provided care at little or no cost to about 49,000 people who were allowed to choose the "medical home" that appealed to them.

“That’s so important, because we really want to ensure continuity of care and relationship building with a particular medical home, and providers in that medical home,” says Healthy San Francisco Program Director Tangerine Brigham.

Brigham says costs dropped an average of $540 per patient per year. Many of the patients have chronic conditions – diabetes, high blood pressure, congestive heart failure or asthma. But Brigham says seeing a medical professional on a regular basis keeps them out of the hospital and emergency room – expensive places for care.

"When you get individuals with chronic conditions into stable care, where they really are able to maintain their medication regimen, their visit regimen, we can do group visits with them, all of those things really do ultimately contribute to improved health,” Brigham says.

And the program gets good reviews. A 2009 survey by the Kaiser Family Foundation showed 94 percent of Healthy San Francisco’s patients were satisfied with their care (KHN is an editorially independent program of the foundation). VCC’s Sheryl Garland hopes to collaborate with Healthy San Francisco on future studies and to release updated statistics on Virginia Coordinated Care this summer.

Clinical Integration, 4-Pillar Approach
Article used with permission of Kaiser Health News.

Topics: Accountable Care, ACA, PCMH, Coordinated Care, Medical Homes

Boston Children’s Hospital Creates ‘Living’ Practice Guidelines

Posted by Matthew Smith on May 6, 2013 3:58:00 PM
Childrens Hospital Boston, Coordinated Care

Overuse of some medical treatments – and underuse of others, when patients fail to get recommended care — are two factors linked to high medical spending in the United States.

But efforts to set “best practice guidelines” have often drawn criticism from physicians and patients as “cookbook medicine” that could limit doctors’ autonomy or restrict care for patients whose conditions fall outside the norm.

Now, though, Boston Children’s Hospital says it has found a way to create guidelines that have reduced costs and variation in care while improving patient outcomes – all without angering doctors.

Called SCAMPS, the program aims to standardize care for a variety of medical conditions – all while allowing its guidelines to evolve as new information is collected and analyzed, according to a paper published Monday in the journal Health Affairs.

“We’re creating living guidelines in a way that we can gather information and learn from every encounter,” said Dr. Michael Farias, a resident in pediatrics at the hospital and one of the program’s developers.

Results have included:

  • A 27% drop in the cost of caring for children with six different kinds of cardiovascular problems.
  • A rise in the rate of “ideal” outcomes for children with a congenital narrowing of the aortic valve from 40% to 69% during a one-year period, while “inadequate” outcomes for those patients dropped from 30% to 9%. Ideal was defined as a low likelihood of needing a valve replacement.
  • An increase in the rate of doctors who complied with recommended specialist referrals, from 20% to 75%.

Instead of setting rigid guidelines for doctors based mainly on reviews of existing medical studies, the program is more flexible. Physicians and nurses develop the guidelines, which are voluntary. Data is collected for each patient who goes through the program, which now covers 49 different conditions. That allows the hospital to make changes as new information becomes available and include patient experiences and reactions that might otherwise fall outside the average.

Standardized Clinical Assessment and Management Plans (SCAMPS) can be applied to almost any medical condition, the paper said. About 20 hospitals, including those treating adults, are also starting to use the protocol.

Sometimes, the guidelines result in fewer medical interventions.  Researchers found, for example, that doing cardiac imaging exams routinely at age 12 on every child who had one particular type of surgery was unnecessary. Instead, a review of cases found that it was the high-risk patients who benefited from the imaging, so the guidelines were changed to reflect that.

Conversely, children complaining of chest pain while exercising are now routinely recommended to have an echocardiogram picture of the heart because that type of pain is more likely associated with a cardiac problem than pain that occurs when a child is at rest.

“It’s not all about reducing resource use, it’s about optimizing it,” Farias said.

Courtesy of Kaiser Health News
Clinical Integration, CI, Physician Alignment

Topics: Clinical Integration, Boston Children's Hospital, Guidelines, Coordinated Care

10 Reasons Your Organization Needs a Clinical Integration Strategy

Posted by Matthew Smith on Apr 29, 2013 1:08:00 PM

Clinical IntegrationIn today's healthcare landscape, there are a wide-range of approaches and strategies employed to achieve successful clinical integration (“CI”). Regardless of the strategy, when designed and implemented correctly, CI offers tremendous potentials for efficiencies and improvements in healthcare quality and patient satisfaction.

Here are 10 identified benefits of CI to consider when exploring your CI options and feasability:

1. Increased Collaboration: The use of care teams to implement a CI program addresses gaps in the care continuum while reducing ineffective or unneeded process steps. This approach allows hospitals and healthcare providers to learn to operate as a team to better align, or realign, their efforts to improve quality, patient safety, and patient and family satisfaction.

2. Improved Efficiency: CI eliminates healthcare waste and redundancy, making it possible for hospital systems to provide patients focused seamless systems of care across and between healthcare providers.

3. Integrated Systems: CI programs provide hospital systems with many more monitoring and enforcement tools than through a typical medical staff organization, including the payment of financial incentives for physicians who actively participate in the program and penalties for those who do not.

4. Payer Partnerships: As CI improves the quality of patient care and clinical processes and reduces costs, hospitals are able to achieve market differentiation. This type of differentiation is attractive to health plans and can serve as the catalyst for payer partnerships.

5. Improved Care Management: Organizations that are successfully clinically integrated benefit from improved care management. Patients who see multiple doctors are well aware of the fragmented and redundant services and care they receive. Case management serves as the foundation to accomplish coordination of care across traditional health settings. Its goal is to achieve the best clinical and cost outcomes for both patient and provider and is most successful when case managers are able to work within and outside organized health systems.

6. Integrated Continuum of Care: At the center of CI is teamwork among healthcare providers working to ensure patients get the right care at the right time in the right setting. CI care management teams collaborate with adult day care, independent living, assisted living, and skilled nursing facility partners. Together, with infrastructure focused on supporting caregivers and patients to efficiently assess, document, communicate, and meet patient needs enables hospital systems and healthcare networks to achieve this core objective.

7. Clinical Data Systems: An integrated technology (“IT”) platform that supports continuity of care and enables access to medical history and critical patient data for all stakeholders is imperative in CI, easing communications across the care continuum and providing information that measures service, performance, quality, and outcomes on an individual provider and network-wide basis.

8. Patient-centered Communication: In many networks, communication skills training is provided to physicians and healthcare providers with the goal of establishing clear channels of communication as a vital part of the CI program. The Joint Commission has cited communication breakdown as the single greatest contributing factor to sentinel events and delays in care in U.S. hospitals. The CI emphasis on timely and clear communication is key to influencing patient behavior, resulting in cost/quality benefits.

9. Improved Pharmaceutical Management: Most medication errors are not caused by individual carelessness, but rather by faulty processes that lead people to make mistakes or fail to prevent the mistakes. CI improves pharmaceutical management allowing hospitals to identify gaps in the medication management process and allow them to take actions to help make patients safer.

10. Improved Health of the Community: CI emphasizes wellness initiatives such as outreach programs and classes to empower the patient with tools, knowledge, and practical solutions to participate actively in their care, ultimately leading to a healthier population. Extensive research in the past three decades indicates that receiving wellness and prevention advice and care from trusted local hospitals and physicians resonates with individuals.

Clinical Integration, Strategy Development

Topics: Clinical Integration, Clinically Integrated Care, Attestation, CI, Coordinated Care, Physicians

JAMA: Coordinated Care Leads to 6% Decrease in Hospitalization Rate

Posted by Matthew Smith on Jan 28, 2013 10:16:00 PM

Clinical IntegrationAccording to a study recently published in the Journal of the American Medical Association, coordinated care, seen in new care models like accountable care organizations, caused a 6 percent decrease in the number of hospitalizations and re-hospitalizations among Medicare beneficiaries. Approximately 20 percent of this patient population is readmitted to a hospital within 30 days of discharge as a result of care transitions.

Coordinated care relies heavily on the use of health information technology, such as electronic health record and clinical archiving systems, as tools to share patient information among providers. This process can be facilitated through health information exchanges, which connect multiple community or statewide medical centers. Setting up these networks is a large component of stage 2 of meaningful use, as it helps promote quality care delivery for Americans.

The investigators conducted this study as a project to see the impact that coordinated care has on healthcare, especially since without it, Medicare beneficiaries have a tendency to experience errors when transitioning among different medical facilities, which can cause them to be re-admitted to a hospital. They evaluated different communities to see how the new care model impacted them before and after the transition.

The researchers discovered that those communities that transitioned to coordinated care experienced a decline in 30-day hospitalization and all-cause hospitalization.

"This has far reaching implications for the future of healthcare at any level," said lead author Jane Brock, M.D., chief medical officer, quoted by Healthcare IT News. "When a community works together to improve care at the system level, everyone involved will see the positive effects."

In addition, the National Institutes of Health conducted a study in which they found that coordinated care is especially beneficial for patients who have multiple chronic conditions, and lowers their use of emergency departments. 

Topics: Clinical Integration, JAMA, Study, Coordinated Care

Hospitals & Physicians Join Forces to Achieve Clinical Integration

Posted by Matthew Smith on Jan 9, 2013 3:42:00 PM
By Patricia O’Connor, MD; Lucy Zielinski & Tina Wardrop, Health Directions. Originally published in Executive Insight, December 2012

Clinical IntegrationNew payment models are making it more important than ever for hospitals to collaborate with physicians. From readmission penalties to bundled payments to ACOs, providers have a growing economic incentive to pool resources, share information, coordinate care and services and cooperate on quality improvement. 

But while the incentives are strong, the obstacles to clinical integration are daunting. Hospital-physician collaboration is operationally complex. Although physician employment can smooth out some of the bumps, practice acquisition is expensive. While a handful of large health systems have devoted extensive resources to launching clinical integration initiatives, most smaller organizations are still sorting out their options.

How can hospitals integrate with physicians without creating political and financial problems? The solution is to focus on building mutually beneficial relationships and use existing resources wisely.

The following practical approach will help healthcare leaders achieve clinical integration by engaging physicians, strategizing collaborative programs and making targeted investments.

1. Understand Physician Motivation

Convincing physicians to collaborate more closely with a hospital can be challenging. Physicians are trained as autonomous decision makers. Perfectionism and the need for control can make it difficult to weave physicians into an integrated organization. But there is a positive side to the medical personality: No doctor wants to be an outlier.

Engage physicians by presenting data on their patient outcomes. Most physicians will discover at least a few areas in which their performance falls short of their peers.

Talk to doctors about their patients’ flu vaccination rates, medication reconciliation rates, performance on diabetes control measures, etc. This is easiest for hospitals that have access to physician claims data through a physician-hospital organization (PHO) or that offer physicians a subsidized electronic medical record (EMR) with built-in Clinical Quality Measure (CQM) templates that facilitate reporting.

Most physicians do not track and evaluate their own performance, let alone measure their performance against peers. Relevant patient statistics will earn physicians’ attention and generate interest in working more closely with hospital staff to improve outcomes.

It is also important to educate physicians on the evolving healthcare market. Explain how payers are creating incentives for clinical integration though bundled or global payments and per patient/per month care coordination fees. As physicians become more aware of these payment trends, many will embrace the opportunity to increase their salary by partnering with the hospital.

2. Create True Physician Governance

To gain the most under new payment models, physicians and hospitals have to play nice in the sandbox. The key is establishing a governance body that allows physicians to guide the development of care strategies and clinical protocols. Physician-led governance will create physician awareness and support for clinical integration initiatives and make a positive impact on the overall success of the program. Make sure the clinical integration governance committee includes physicians from solo practices and small partnerships as well as large groups. Include representatives from a range of specialties.

Most important, the governance body should include physicians who are critical or even negative about the clinical integration initiative. Often these “difficult” physicians simply want to be heard and provide their input. Making these physicians feel included will go a long way toward smoothing the transition to integration.

3. Focus on Quality, Not Finances

Physicians are concerned about productivity and payment, but concentrating exclusively on financial metrics will disenchant many providers. Focus instead on clinical quality and performance improvement. After all, this is the main reason physicians entered medicine — to provide quality care to the patients they serve.

The clinical integration committee should establish quality benchmarks and treatment protocols that define performance standards. Benchmarks can be based on evidence-based standards and care plans developed by national quality organizations and disease associations. Micromanaging clinical decisions will be unpopular, so care protocols should be broad guidelines that allow room for individual judgment.

To choose initial improvement goals, review admission and inpatient reports to identify areas of low quality and high cost. For which conditions does the hospital see the greatest number of admissions? Which conditions have the longest length of stay? Physicians using an EMR may be able to report on certain quality measures. For example, what is the percentage of hypertensive patients with adequate blood pressure control? How many heart disease patients have an up-to-date lipid profile?

Begin the clinical integration outreach with physicians in specialties linked to poorer outcomes and higher costs. Another logical starting point is primary care. Family practice physicians and internists often have the greatest impact on chronic disease management.

4. Concentrate on Care Coordination

One of the biggest opportunities in clinical integration is better coordination of care. Focus on high- and medium-risk patients who are responsible for the highest costs or who will likely increase costs in the near future. Target care transitions between the hospital and admitting specialists or primary care physicians. Involve physical therapy, home health providers and long-term care facilities in clinical coordination planning.

Physicians need to ensure that discharged patients complete follow-up visits. The hospital can assist by sponsoring a care coordination team for the entire organization to help manage follow-up appointments, referrals and home health services. To help guide care coordination, stratify hospital discharges by risk of readmission, complication or care plan non-compliance.

5. Use Technology to Get Providers Talking

Clinical integration is nearly impossible without an EMR system, but many medical practices are not far along in EMR adoption. Most practices cite expense as the main obstacle.

To overcome the cost hurdle, consider subsidizing EMR systems for practices that agree to join the integrated organization. Relaxation of the Stark laws allows hospitals to subsidize as much as 85 percent of the purchase and support costs of an EMR system. Subsidy agreements can require physicians to report quality measures and meet quality performance thresholds.

However, do not expect physicians to acquire the same EMR system as the hospital. Many small practices can do very well with free and low-cost alternative systems. The hospital should build interfaces for exchanging information with the EMR systems used by the majority of integrated physicians.

Many physicians who have implemented EMRs have participated in the Medicare and Medicaid EHR Incentive Program. As part of demonstrating Meaningful Use under the program, these physicians have already begun tracking clinical quality measures. Clinically integrated organizations should use the EMR to create aggregated quality reports and share them with physicians. Weekly or monthly reports can track disease management data such as HbA1c levels, cholesterol, blood pressure and preventive screenings. Giving physicians the chance to view quality performance metrics will engage both their competitive personalities and their collaborative spirit.

6. Build Financial Incentives

Clinical integration will require physicians to invest time and money into patient education, technology and additional staff. The problem is that methods of compensating providers for care coordination are still being developed and tested by payers. Given the costs being shouldered by physicians, financial incentives are critical.

Regardless of how incentives are distributed, hospital leaders should reward physicians either for controlling costs, achieving quality benchmarks or both. Focus on achieving care management quality metrics early on, since reduced costs tend to follow well-managed patients. Establish and re-assess these performance targets annually.

One important note: Make sure primary care physicians get a piece of the pie. Although surgical specialists might be responsible for most of the hospital’s costs and revenue, primary care doctors have the most frequent patient contact and are also responsible for most of the work of chronic disease management.

Invest Early for Healthy Returns

Even hospitals without the resources of a large medical system can achieve clinical integration by focusing on strategic investment and engaging community physicians through quality improvement. Hospital leaders need to allow physicians to establish the quality benchmarks and evidence-based protocols for the organization’s costliest conditions. Leaders can then concentrate on linking doctors through technology, assisting with care coordination, and negotiating with payers on bundled payments or pay-for-performance incentives.

To read this article in a PDF format, please click on the button below:

Topics: EHR, EMR, Electronic Health Records, Electronic Medical Records, Clinical Integration, Health IT, Video, Coordinated Care

VIDEO: A Passionate Case for Coordinated Care--A Wife's Story

Posted by Matthew Smith on Jan 8, 2013 4:53:00 PM

Electronic Health Records, EHRWatch this impassioned story--straight from a wife who fought for her dying husband's medical records. This clearly illustrates how coordinated care can help not only the patient but also the families of the sick.

Roger Holliday was diagnosed with kidney cancer, and throughout his diagnosis and treatment was unable to conveniently obtain his medical records. Access to his paper medical records was nearly impossible to get, was costly and extremely time consuming. 

Regina knew that if her husband's records had been stored as an EHR both her husband's doctors and she would have had access to the health information instantly, thus allowing for the coordination and continuity of care required of a cancer patient. 

While EHR detractors may argue that some of the challenges she faced were clearly hospital policy issues, it is clear that an EHR could have alleviated her and her husband's stress at the end-of-life stage.

 

 Video courtesy of HealthIT.gov
Electronic Health Records EHR Assessment

Topics: EHR, EMR, Electronic Health Records, Electronic Medical Records, Clinical Integration, Health IT, Video, Coordinated Care

New Study Says Primary Care Docs Meet Diabetics' Needs

Posted by Matthew Smith on Dec 13, 2012 3:36:00 PM

Diabetic ManagementAccording to a new study by Brigham and Women's Hospital, primary care doctors provide superior care for patients with diabetes and note that electronic health records provide a solution to bridging the gaps observed in their research.

"We found that primary care physicians provide better care to diabetes patients when compared to other providers in a primary care setting because they were more likely to alter medications and consistently provide lifestyle counseling," study senior author Dr. Alexander Turchin, a physician and researcher in the division of endocrinology at Brigham and Women's Hospital, said in a hospital news release.

The study assessed primary care received by more than 27,000 diabetes patients at two academic medical centers. In total, the patients had nearly 585,000 primary care appointments over an average of five years and five months, and 83 percent of those visits were with a primary care doctor. The rest of the visits were with a covering physician, nurse practitioner or physician assistant.

Overall, medication intensification (either having a new medication prescribed or the dose of a current medication increased) occurred in 10 percent of the visits, and lifestyle counseling occurred in 40 percent of the visits.

But the researchers found that the likelihood of medication intensification and lifestyle counseling were much higher when patients saw a primary care doctor than when they saw another health care provider, according to the study published in the Dec. 10 issue of the journal Diabetes Care.

"Access to care is important and covering physicians and other providers play an important role in increasing access, especially in patients with acute complaints," Turchin said. "With growing focus on a team-based approach to practicing medicine, this finding should help guide the development of new models of primary care, especially in the care of diabetes patients."

To help bridge the gaps observed in the study, the researchers recommend better documentation and communication of the treatment plan through electronic medical records to other care providers.

Click the button, below, to learn how Health Directions helps primary care physician practices:

  • Achieve CMS EHR “meaningful use” or NCQA PCMH recognition
  • Leverage “reportable” quality of care and outcomes for better reimbursement
  • Participate in pilot programs with local payers
  • Partner with local health systems to create electronic linkages
  • Increase patient satisfaction
  • Improve practice profitability
  • Strategically position themselves for the future 

 

Topics: EHR, EMR, Electronic Health Records, Electronic Medical Records, Clinical Integration, Health IT, Clinically Integrated Care, Clinical Care, Coordinated Care

Subscribe to Email Updates

Value Model, Health Analytics

Posts by Topic

Follow Me