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GE Healthcare Camden Group Insights Blog

Friday Fun Video: The Hospital of Tomorrow (as Imagined in the 1950s)

Posted by Matthew Smith on May 6, 2016 12:17:08 PM

Future.pngThis video showcases a medical dream come true from Henry Kaiser and Dr. Sidney Garfield of the Kaiser Foundation.

While many of these "dream" hospital features are now staples in every modern facility, you can't help but wonder whatever became of the sliding baby drawers (not to mention the unprotected X-Ray technician).

What part of the current hospital patient experience will remain 60 years from now? What will seem utterly ridiculous? Let's hear what you have to say in the comments section below.

 
To better understand how physical design and operational model of care will impact patients and staff in your proposed facility, please download our Design4Care case studies here:
 
Design4Care, GE Healthcare, Hospital Operations
 

Topics: Patient Care, Patient Experience, Hospital, Hospital Facilities, Health Care Quality, Design4Care, Friday Fun, Care Design and Delivery

PDF Download: The New Paradigm of Patient Access

Posted by Matthew Smith on Mar 9, 2016 2:18:02 PM

Patient AccessIn order for new clinically integrated networks (CINs) to achieve success, they must increase ways for patients to access care. To accomplish this, CINs and hospital leaders must embrace non-traditional access points that patients use to enter their systems.

Patients may choose to access the system through retail clinics because it is easy and convenient, and they are able to get what they need quickly. Those components, successfully integrated into a CIN, can serve as significant access points into a network.

In instances when CINs identify outside providers where their patients are going to get care, CINs should establish a contractual relationship with the provider. Such new access points come with their own challenges, including difficulty with sharing patient information and with communication. 

But hospitals need to think about the issue of access beyond patient visits to the emergency department, primary care, or even retail clinics. More CINs are focusing on access points to help keep patients in their networks. When analytics indicate the patient outmigration rate (patients going outside the network—often referred to as "leakage") is more than 5 to 10 percent, the providers must find ways to keep more patients in the network.

Increasing access can also turn into a selling point for the CIN to increase volume by touting its ability to provide convenient care. Selling the CIN to patients is particularly important in the era of high-deductible health plans, where patients actively select providers based on price and quality. 

This PDF download from GE Healthcare Camden Group provides insight surrounding:

  • How people rate access
  • What consumers want (old vs. new models)
  • Expectations surrounding access redesign
  • Consumer trust statistics
  • The new paradigm of patient access
  • Objectives of "best in class" patient access
  • Creating loyal patients for life
  • The continuum of organized care

Patient Access, Healthcare Networks

Topics: Patient Care, CIN, Patient Access, Continuum of Care

Stimulate Patient Engagement with these 9 Ideas for 'Activation' and Empowerment

Posted by Matthew Smith on Oct 13, 2015 9:57:58 AM

By William K. Faber, M.D., Vice President, The Camden Group

Patient EngagementNew payment models reward healthcare systems and providers for improving the health of populations. Providers are understandably concerned about the extent to which they can succeed in such models because so much of patient health is beyond their personal control.

Seventy-five percent of our health dollar is spent on chronic conditions that have everything to do with the choices made by patients, notably diabetes and degenerative joint disease as they relate to obesity. Therefore, engaging patients in the management of their own health is vital to achieving population health improvement.

At a recent national health conference I attended, the speaker asked the audience, “What is the least utilized resource in the American healthcare system?” After a few seconds of silence, as thousands scratched their heads for the answer, the speaker called out, “The Patient!”

Accountable systems and providers will increasingly need to learn how to empower and “activate” patients, rather than encouraging their dependence on the system to provide cures. Similarly, providers and care managers will need to reach out proactively to patients, rather than passively waiting for patients to seek care.

Here are nine key approaches to patient “activation”:

1. Charge Patients with the Primary Responsibility for their Own Care

Some patients have never been encouraged to think of their disease as their personal responsibility. Remind them there are some things they can do for themselves that no one else can do for them. For instance, no amount of insulin or other diabetic medication will overcome the effects of excessive eating.

2. Encourage Patients to Monitor their Own Conditions

Provide glucometers and blood pressure devices and ask patients to log their daily readings and progress. Let them know that you expect them to bring their logs (or devices that store results) to visits so you can monitor their progress. Teach them how to adjust their diets or medication to respond to their daily readings.

3. Encourage Use of a Patient Portal If You Have One (And Agitate Your System to Invest in Portal Technology if it Has Not Already Done So)

Make the procedure for signing up for the portal easy and understandable for the patient. Show them how to use the portal to check their own lab results or request appointments. Let them know that you want them to regularly use the portal so it can become a reliable channel of communication between you and them.

4. Plug your Patients Into Community and National Support Groups for their Condition

The local park district may hold free exercise classes, for instance. Many communities have free smoking cessation clinics. National organizations representing almost every major disease have websites that provide educational support materials and may introduce patients to local support groups for their condition.

5. Consider Group Visits

Group visits have several advantages that accrue to the providers (it saves time and enhances revenue) but one of the best outcomes of group visits is that they greatly increase patient engagement. Patients with chronic conditions gain significant emotional support and encouragement from interacting with other people “like them” who share their condition. Social support is one of the most powerful motivators of behavior. Group visits produce surprising improvements in the health of their members.

6. Pull Patients into the Electronic Health Records ("EHR") Screen in the Exam Room

EHRs threaten direct eye contact of health professionals with their patients. Savvy providers have learned to turn this liability into an asset by bringing the patient “into” the EHR as they work, showing them computer-generated charts, for instance, that trend their blood pressure or blood sugar, or to have the patient verify their medications and doses. The EHR becomes an engagement tool, and patient trust is enhanced when they realize the provider is not hiding information from them.

7. Use In-Office Instructional Videos

Some practices run motivational or educational videos in their waiting rooms or have a learning room with a library of instructional videos on a variety of health-related subjects. A well-organized file of printed educational materials is a low-tech way to achieve the same ends. The more information patients can absorb about their conditions, the more engaged they will be with their self-care.

8. Create an Interactive Website

Numerous providers have created their own webpage or blog and write about topics related to the health of their patients. These providers found that this strategy increased the engagement of their patients and generated new business.

9. Convey an Openness to Questions and Support Initiative

Consider the factors that might harm patient engagement and work to reduce them. Be there to support and respond to patients when they attempt engagement. This requires a positive response when the patient asks about their condition and how to improve it. Old-fashioned paternalism, which thwarts patient questioning, kills patient engagement. Patients respond to praise for even modest health improvements they achieve. 


Dr. Faber is a vice president with The Camden Group. As a physician executive, he specializes in the development of accountable care organizations and clinically integrated networks, physician engagement, and health information technology. Prior to joining The Camden Group, Dr. Faber served as Senior Vice President of the Rochester General Health System in New York, where he guided the development of the system’s clinical integration program and assisted more than 150 providers at 44 sites through the conversion process from paper records to an electronic health records system. He may be reached at wfaber@thecamdengroup.com or 312-775-1703.

 

Topics: William K. Faber MD, Patient Care, Patient Engagement, Patient Service, Patient Activation, Patient Portal

Addressing the Human Factors Behind Hospital Readmissions

Posted by Matthew Smith on Sep 2, 2013 7:31:00 PM

Hospital Readmissions

By Asad Zaman, MD, FACP, and Lucy Zielinski, Vice President, Health Directions

We wrote an article last summer about reducing readmissions from long-term care facilities. Several  readers commented on the article, providing great ideas on how hospital leaders can work with LTC facilities to lower rehospitalization rates. But one commenter noted that long-term care is just a piece of the readmission puzzle.

In her hospital, she wrote, more readmissions come from discharges to subacute rehabilitation facilities and from patients sent home. The comment is on target, and it raises some important issues. Consider the following scenario:

A patient undergoes emergency bypass surgery. After three nights in the hospital, he is ready for discharge. The medical staff want to send him to a subacute rehabilitation facility for a few days, but the patient wants to go home, and his children are confident they can take care of his needs. In the days that follow, however, the patient develops wound complications. Family members are soon unable to control his pain. Five days later, the patient is back in the hospital.

What does this scenario show? It demonstrates that rehospitalizations are a true communitywide problem that involves providers, patients and family members. Human factors — not just clinical and organizational processes — drive many readmissions. Solving this complex problem requires unconventional thinking. Five planning strategies will help health care leaders to address the human factors that lead to hospital readmissions.

Plan for Success and Failure

Health care today is focused on outcomes. The goal is to design optimal clinical pathways that proceed smoothly from care through recovery. But while it is important to envision success, we are missing an opportunity if we fail to think about minimizing the inevitable failures.

Let's return to the bypass patient. What could have been done to keep this patient in good health? The possibilities include better discharge planning, better use of technology and better use of social services to support home care. Thinking along these lines is important, but we should also plan what happens if patients run into trouble.

One solution is to connect patients proactively with a skilled nursing facility in the hospital network. The hospital forwards the patient's records to the SNF and provides clear instructions to the family about when to turn to the facility for assistance. If the bypass patient's family had been put in touch with this resource, they could have asked SNF staff about wound care and pain control. And if the patient had developed a defined condition (such as shortness of breath), the family could have transported him directly to the facility.

A system that plans for failure will allow many patients to get appropriate care more quickly. It also can prevent a significant portion of hospital readmissions.

Tinker and Troubleshoot

Some ideas for reducing readmissions will fail and should be discarded. Some failures, however, can be turned into successes with just a bit of tinkering.

One reader who commented on our previous article argued for stationing nurse practitioners at LTCs. This is a good idea, but making it work can be a challenge. An LTC in the Chicago area recently experimented with hiring a nurse practitioner. Unfortunately, the NP found it almost impossible to reach physicians to get critical direction. The experiment was both frustrating and ineffective. But should the idea be scrapped? No — better to scrutinize the specific problems and troubleshoot a solution.

One possible modification is simply to rework the chain of command for clinical advice. If an attending physician does not respond to the NP within an appropriate time frame, the NP should page the LTC medical director as the supervising physician. Streamlining the process bypasses communication roadblocks. How will this arrangement be coordinated with primary care providers? One approach is to send physicians a memo clarifying that the LTC medical director will be responsible for all newly admitted and readmitted patients, as well as any patients who need acute attention. This will clarify that patients remain under the care of their primary physician and will avoid HIPAA violations.

Avoid One-Size-Fits-All Solutions

Eliminating variations in care is one key to improving quality and reducing readmissions. At the same time, clinical leaders should not miss opportunities to tailor care paths to different situations.

For example, a hospital's standard protocol when discharging a patient to a subacute rehabilitation facility might include nurse-to-nurse communication. However, this one-size-fits-all protocol might not be optimal for the most complex patients, such as a chronic obstructive pulmonary disease patient with acute pneumonia. For these transfers, consider having the attending physician or hospitalist communicate directly with the subacute rehabilitation facility medical director to discuss patient problems and care needs.

It would be too expensive to apply this process to all handoffs, but it could be appropriate and cost-effective for patients in certain high-risk categories.

Forget about the Small Change

Cost control is a critical part of health care reform, but hospitals should avoid being penny-wise and pound-foolish. Our previous article looked at the problem of missed drug doses following transfer to a long-term care facility. One commenter suggested that hospitals send medications (such as high-end cardiology drugs) to the LTC with the transferred patient and work out reimbursement later.

Why not go one step further? Hospitals should consider sending along an extra day of medications for certain patients, such as those with diabetes or congestive heart failure,and not worry about the reimbursement. You're probably wondering, Won't this add pharmacy costs that are included in the hospital DRG payment? Yes, but focus on the bottom line. If providing transition medications to 100 patients (in certain defined categories) prevents just one readmission, the small investment will be well worth the realized savings. The key here is to look closely at individual situations and identify the true cost/benefit of different approaches.

Create Collaboration within Competition

To secure discharges, LTCs, subacute rehabilitation facilities and other post-acute facilities must now demonstrate that they are able to keep readmissions down. This competition is spurring many providers to elevate their standard of care. However, competition can have negative effects. The least sophisticated facilities (and their patients) may be left behind as the bulk of resources flow to the strongest performers.

This is a problem for hospitals. Even if a hospital cultivates a network of preferred post-acute providers, many patients will "leak out" to other facilities. For instance, many patients will choose to transfer to a non-network LTC if a family member works nearby. From a population health viewpoint, hospitals should foster a collaborative environment that will improve post-acute care in the entire community.

One option is to sponsor regular meetings of the medical and nursing directors of local LTCs and subacute rehabilitation facilities to share information and explore solutions to shared problems. To focus and energize the discussion, the hospital should monitor and share key post-acute metrics such as 30-day readmissions and lab turnaround time. Hospital leaders can encourage cooperation by vocalizing the expectation that all providers will work together to improve performance.

Accentuate the Practical

The common denominator of all these strategies is that they represent a practical approach to a complex problem. Understanding the human factors at play in the post-discharge period will help hospitals and their partners to develop workable systems for preventing unnecessary readmissions.

Asad Zaman, M.D., F.A.C.P., is a member of the board of directors of Advocate South Suburban Physician Partners and the immediate past chair of the department of medicine at Advocate South Suburban Hospital in Hazel Crest, Ill. He is also the medical director of Symphony of Crestwood (Ill.) and ManorCare of Homewood (Ill.). Lucy Zielinski is a vice president at Health Directions LLC in Oakbrook Terrace, Ill.

Topics: Hospitals, Patient Care, LTC Readmissions, Long Term Care Readmissions, Readmissions

5 Strategies that Address the Human Factors Behind Readmissions

Posted by Matthew Smith on Jun 4, 2013 12:34:00 PM

By Asad Zaman, MD, FACP, and Lucy Zielinski, Vice President, Health Directions

Readmissions, Hospital Readmissions, LTC, Health DirectionsWe wrote and published an article last summer in Hospitals & Health Networks Daily about reducing readmissions from long-term care facilities. Several H&HN Daily readers commented on the article, providing great ideas on how hospital leaders can work with LTC facilities to lower rehospitalization rates. But one commenter noted that long-term care is just a piece of the readmission puzzle.

In her hospital, she wrote, more readmissions come from discharges to subacute rehabilitation facilities and from patients sent home. The comment is on target, and it raises some important issues. Consider the following scenario:

A patient undergoes emergency bypass surgery. After three nights in the hospital, he is ready for discharge. The medical staff want to send him to a subacute rehabilitation facility for a few days, but the patient wants to go home, and his children are confident they can take care of his needs. In the days that follow, however, the patient develops wound complications. Family members are soon unable to control his pain. Five days later, the patient is back in the hospital.

What does this scenario show? It demonstrates that rehospitalizations are a true communitywide problem that involves providers, patients and family members. Human factors — not just clinical and organizational processes — drive many readmissions. Solving this complex problem requires unconventional thinking. Five planning strategies will help health care leaders to address the human factors that lead to hospital readmissions.

Health Directions, Readmissions

Topics: Hospitals, Patient Care, LTC Readmissions, Long Term Care Readmissions, Readmissions

Video: Henry Kaiser's Hospital of Tomorrow (as imagined in the 1950s)

Posted by Matthew Smith on Feb 19, 2013 10:31:00 PM

Hospital Design, Patient EngagementA medical dream come true from Henry Kaiser and Dr. Sidney Garfield of 
the Kaiser Foundation.

Note that there was an emphasis on imroving patient medical records back then as well (0:15).

While many of these "dream" hospital features are now staples in every modern facility, one can't help but wonder whatever became of the sliding baby drawers. Perhaps they fell victim to stringent JCAHO regulations.

What part of the current hospital patient experience will remain 60 years from now? What will seem utterly ridiculous? Let's hear what you have to say.

Topics: Patient Care, Patient Experience, Hospital, Hospital Facilities, Health Care Quality

Aging Populations Mean Big Opportunities in Healthcare IT

Posted by Matthew Smith on Nov 28, 2012 10:45:00 AM

Courtesy of CNBC.com

Healthcare ITAccording to the United Nations, the overall median age in developed countries rose from 29.0 in 1950 to 37.3 in 2000, and is forecast to rise to 45.5 by 2050.

The aging population comes with many challenges — across social, financial, economic, and political dimensions. Managing healthcare quality and costs for this demographic is one of the key focus areas in the U.S.

Healthcare spending has grown from 5% of U.S. GDP in 1960 to about 17%, or $2.4 trillion, in 2008. The Centers for Medicare and Medicaid Services (CMS) expect healthcare spending to nearly double to $4.4 trillion by 2018 (20 percent of GDP).

While the cost of healthcare continues to increase with age, there is significant evidence that a collaborative approach between consumers, providers and payers has a very meaningful impact on reducing long-term healthcare costs. 

The effective use of healthcare information technology is one of the primary levers for achieving this objective. Healthcare IT offers a tremendous opportunity to support many high impact areas in health care delivery.

Here's some ways it can help:

  • Enhanced consumer awareness and tracking of healthcare conditions: patient portals allow easy access of healthcare information to patients, while consumer health technologies allow effective use of consumer health devices and self-management software for consumers.
  • Increased focus on chronic condition management: complete patient records would enable physicians to access patient information integrated across healthcare providers. Business intelligence and analytics could be used to identify high risk patients and proactively manage care.
  • Reduced cost of hospitalization and re-admissions: cost tracking tools would enable organizations to clearly track true input costs and efficiencies, optimize resource utilization and reduce costs.
  • New cost effective healthcare delivery models created: The use of home monitoring and tracking applications could  reduce the need for hospitalization, while the use of new Internet video/audio capabilities could enable consumers and patients to increase access to physicians and nursing staff without need for visits or hospitalization.

The federal government is recognizing the positive impact of health care IT on managing and the reducing the cost of health care. 

The American Recovery and Reinvestment Act of 2009 (ARRA) provides $19 billion to promote the adoption and use of technology in healthcare. The law provides financial incentives for hospitals and doctors to adopt and use electronic health records, and financial penalties for physicians and hospitals who do not use them meaningfully by 2015.

There are many new healthcare technology organizations emerging in the market — resulting in a high level of venture capital and private-equity funding.

In addition to technology focus, providers, payers, and government need to work closely to create the right financial incentives for all stakeholders to collaborate effectively in a win-win environment. 

Traditional volume-based fee-for-service models need to transition towards outcome-driven models for patient care. Many new initiatives — pay for performance, bundled payments, accountable care organizations and patient-centric medical homes — are aligned in this direction.

Healthcare IT can be leveraged to integrate clinical information with financial and operational data, provide evidence-based insights and actionable intelligence, and reduce the risk involved with the new performance-based payment models.

In summary, the aging population is one of the most key issues facing the U.S. and most other Western countries. Given the high level of inefficiency in the healthcare ecosystem today, there is significant potential to reduce costs while still protecting the financial interest of all the stakeholders.

Our experience with healthcare technology over the years has consistently demonstrated that there is tremendous opportunity in using technology to enhance healthcare delivery for the aging population and reduce costs. From the healthcare IT perspective, the journey has just begun!

Topics: ACO, HIT, Health IT, Patient Care, ACO Models, Accountable Care Organizations, Population Health Management

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