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GE Healthcare Camden Group Insights Blog

Five Focus Areas for Medical Groups in 2017

Posted by Matthew Smith on Jan 26, 2017 12:59:09 PM

For medical groups, the last few years have been tumultuous with the shift to value-based care. In 2017, medical groups will continue to experience change on all fronts, including payment, care delivery, and interaction and communication with patients. Medical groups must contend with new payment models, fierce competition in their markets, increased regulatory requirements, clinical advances, digital and information technology changes, and population health management implementation.

In response to these shifts, medical groups should focus on five key areas to position themselves for the future. As Socrates said, “The secret of change is to focus all of your energy not on fighting the old but on building the new.” And that is what medical groups need to do in 2017: build the new by transforming the old ways of practice management.

To read this article in its entirely, please click the button below to be taken directly to the HFMA website.

Medical Groups, 2017 Trends

Topics: Population Health, Medical Groups, Patient Access, Trends, Medical Group Transformation

Infographic: Population Health and Children's Hospitals

Posted by Matthew Smith on May 25, 2016 9:05:23 AM

The Children's Hospital Association ("CHA") collected data from a series of iterative population health surveys to provide members with timely, relevant benchmarking data and inform their shared planning. Findings from the first CHA survey offer a high-level overview of children’s hospitals engagement in population health. Seventy-three of 207 members invited to participate responded, yielding a response rate of 35%. This data collection is part of a larger CHA effort to support children’s hospitals in balancing the dual roles of healthcare delivery and creating child health.

Key takeways include:

  • More than two-thirds of respondents consider population health a top priority.
  • 95% of participants agree that Population health is aligned with their children’s hospital mission.
  • 68% of participants agree that population health is a top priority of their children’s hospital.
  • 63% of participants agree that financial resources are available for population health at their children's hopital.
  • Only 34% of particpating children's hospitals have reliable data to measure identified target population health outcomes.survey_results_Page_1.png

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Topics: Population Health, Children's Hospital Association, Children's Hospitals

9 Ways to 'Activate' Patient Engagement

Posted by Matthew Smith on Apr 18, 2016 10:53:06 AM

New 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. 


GE Healthcare Camden Group and Prophet recently hosted a webinar discussing their new patient experience study which was conducted to understand the consumer healthcare experience by assessing the gap between patient and providers’ expectations and perceptions. To view this webinar on-demand or stream it to your device, please click the button below.

Webinar, Patient Experience, Patient Satisfaction

Topics: Population Health, Patient Engagement, Patient Activation

MSSP and NGACO Application Windows Quickly Approaching

Posted by Matthew Smith on Apr 6, 2016 11:50:17 AM

CMS recently launched the first step of the application process for its Next Generation ACO (“NGACO”) Model, and next month opens the window to apply for the Medicare Shared Saving Program (“MSSP”) Initiative. The NGACO, CMS’ newest two-sided risk model, accepted 21 organizations for 2016. The MSSP, which also added enhanced risk-based options in 2016, had 100 new ACO participants this year, bringing the total to 434 ACOs at the start of the year. These numbers reinforce CMS’ stated goal to move 30 percent of traditional Medicare fee-for-service payments into alternative value-based payment models by 2016, and 50 percent by 2018.

MSSP: Zero Downside Risk

The MSSP Model was introduced in 2012 as a key component of the Medicare delivery system reform initiatives found in the Affordable Care Act and a new approach in the delivery of health care intended to facilitate coordination among providers to improve the quality of care. Among the primary attractions of the MSSP was the option to participate with zero downside risk, meaning if organizations outspent their target expenditures, they would not be liable to repay the difference to CMS. Through Track 1 there existed only upside, or the ability to share in any savings generated, an appeal that the MSSP Model maintains to this day. This allows organizations to dip their toes in the accountable, value-based waters and develop the infrastructure necessary for future success while still participating in a fee-for-service environment today. And the participating organizations have largely voiced their approval of the program – more than two-thirds renewed their participation when their initial agreement ended in December.

NGACO: Higher Risk/Higher Rewards

While the MSSP Model was the right first step for many organizations beginning their journey towards value-based care, it was in many ways insufficient for more advanced organizations experienced in care management and risk-based contracting. Thus the Next Generation ACO model was born, providing a higher-risk, higher-reward alternative to the MSSP, while simultaneously responding to and improving upon its oft-maligned and challenged predecessor, the Pioneer Model, with a refined attribution process and enhanced benchmarking methodologies. Now organizations can select between two risk options from 80 to 85 percent on the shared savings option all the way to a full-risk opportunity. Now if organizations overspend their benchmark expenditures, they will have to cut CMS a check at the end of the year. This may seem daunting, but many organizations view this as the natural programmatic evolution and that the increased skin in the game can be the push their organization might need to really enact the necessary transformation. In fact, seven of the new NGACO participants came from the MSSP program, demonstrating the interest of existing program participants to advance their risk exposure and opportunity based on their work and success to date.

The NGACO, with its enhanced risk profile, is obviously not for everyone, which explains why only 21 were accepted in the past cycle. As stated above, the NGACO was effectively developed for those organizations with experience in commercial ACOs or with value-based contracts, or that had experienced success in the MSSP and had outgrown the less-lucrative risk arrangement. Accordingly, in addition to the seven MSSP converts to the NGACO program, eight made the transition from the similarly two-sided, but less favorable Pioneer model.

Deadlines Approaching

The good news for organizations wanting to prepare for a value-based future is that the 2017 application windows for both programs are upon us. Organizations contemplating their fit in either initiative can apply for one or both, but need to submit their Notice/Letter of Intent by the respective deadlines to be considered. These submissions are non-binding, so we encourage organizations at all considering participation to file one and then assess their options in the next few months. One caveat is that while organizations can simultaneously apply for both models, they will ultimately only be able to participate in one of the two initiatives.

The NGACO Letter-of-Intent is due May 2, with the MSSP Notice-of-Intent due May 31. Additional key milestones for both models can be found below:

NGACO_Milestones.png

With the continuous innovations of both payment and delivery models, CMS is maintaining its commitment to the transformative shift to value-based care. While that momentum is undeniable, not all organizations are necessarily ready for that transition just yet, particularly in the riskier models. We recommend undergoing a comprehensive (and candid) self and market assessment of your organization’s present situation and evolution in what GEHC Camden Group considers the eight core domains essential for clinical transformation to successfully thrive in a value-based world. A commitment must be demonstrated in the below key operational competencies in order to achieve success in the changing landscape.

Key_operational_competencies.png

CMS has reiterated its commitment to population health with its ongoing development and support of these accountable initiatives. Even more encouraging, CMS has demonstrated a willingness to adapt and improve to encourage participation and collaboration. The strongest healthcare organizations tend to be the ones that are proactive rather than reactive. For organizations that can see what’s coming down the tracks, there may be no better time than now to begin preparing for a value-based future.

Next Generation ACO

Topics: ACO, MSSP, Population Health, CMS, Next Generation ACO Model, MSSP ACO, NGACO

10 Myths of Population Health and Clinical Transformation

Posted by Matthew Smith on Mar 1, 2016 11:40:34 AM

It is a confusing time in United States healthcare. Healthcare organizations are faced with the new reality of value-based care and are identifying the necessary steps for success in an evolving healthcareenvironment. For many, this transformation is difficult, and fear of this change may hinder progress. However, at present, a lack of true understanding of the care processes, tools, and consequences of this transformative shift persists in the healthcare community, and with the public at large. The delivery and consumption of care is rapidly changing for both provider and patient, and not everyone is on the same page. Below are ten myths associated with clinical transformation and its ability to position an organization for success in a value-based world, along with the realities with which providers and organizations must face.

Myth #1:  The best care (or better care) is provided in hospitals.

RealityFor many years, the United States healthcare system has been very hospital-centric. Patients who were sick were directed to go to the Emergency Room or the hospital to get better, and physicians were paid handsomely for services provided in the hospital setting. This cycle has engrained within Americans (and within many physicians) that the hospital is the setting for receiving the highest quality of care. Patients will often even ask to be admitted to the hospital because they believe superior care will be provided there. Today, the healthcare system has begun to shift to improve and increase the suite of outpatient healthcare services to include ambulatory surgery centers, urgent care centers, retail clinics, even home-based care. The hospital is no longer the only place to go to receive care and, in fact, the best interventions will keep patients safely in their homes and out of the hospital altogether.

Myth #2:  All organizations should be negotiating value-based payment contracts.

Reality:  While value-based payments are a driver for clinical transformation, organizations should move at the pace of their market (and their own capabilities). Each market across the county differs in its pace in the shift from a volume to value-based environment. Organizations who are maintaining success in a primarily fee-for-service environment may not be ready for an immediate switch to value-based payments. Instead, these organizations should begin undertaking efforts to prepare for an eventual change to value-based contracting through improved medical management efforts and regular analysis on clinical outcomes and cost of care. This transition for some has had to be rapid, given the speed with which the market had adopted value-based payments. However, for many others who are not yet positioned for success in a value-based market, this transition should be gradual as the organization begins to develop the necessary capabilities; in a volume-based environment, these changes can still have positive outcomes through a focus on treating patients in appropriate care settings, thereby increasing capacity and access. Therefore, the focus for all organizations should be developing and implementing the clinical care model that is in sync with its payer contracting strategy.

Myth #3: Interoperability among information technology (“IT”) systems results in clinical integration.

Reality: As healthcare organizations begin to explore the clinical transformation needed to achieve clinical integration, the number one barrier frequently identified is the lack of interoperability among the health IT systems. Often, organizations may decide a complete IT overhaul is necessary (very costly) or that clinical integration is simply not possible and withdraw from the effort. However, highly integrated IT systems do not magically result in clinical integration. IT systems lack the clinical judgment that is necessary to provide high-quality, patient-centric care. IT systems cannot identify population health objectives and goals and design interdisciplinary medical management programs that aim to meet population health goals. It is the aligned vision for improving health outcomes among all care team members that results in clinical integration; IT systems can simply enable this type of care through real-time alerts, evidence-based clinical pathways, and historical and predictive trending of clinical data and notes. Interoperability should be viewed as a means, not as a deal breaker in its absence.

Myth #4:  Electronic Medical Records (“EMRs”) make physicians lives easier and provide better patient care.

Reality: Advances in technology have provided innumerous innovations to the majority of industries and society in general. While healthcare has been an undeniable benefactor, it is widely assumed that because electronic tools have made the public’s lives significantly easier, healthcare providers have experienced the same benefits and welcome all advancements. Healthcare IT, including EMRs, can provide the care team (e.g., the physician, medical assistant, nurse, social worker, or other care coordinator), with a wealth of knowledge about each patient. Tools exist that track and trend lab results, maintain and update a singular care plan, and provide point-of-care alerts to close gaps in care. Many organizations rely heavily on the information provided through these tools to provide patient-centered, high-quality care. However, it is not the information contained within these tools that has enhanced patient care; instead, it is the care processes and workflows that have been developed to ensure this information is meaningful and utilized that has enhanced care. Without clear care protocols or actionable reports, physicians can be frustrated by the vast amount of information presented to them and the myriad of tasks they must complete within multiple IT systems. Too much data contained in a myriad of health IT systems can actually result in less coordinated care between physicians and across care settings. It is the integration of this information, in a succinct form, into clearly defined care processes that enables the delivery of high-quality patient care and allows the technology to ease the burden on the provider, rather than add to it.

Myth #5: Population health management requires significant IT capital and increased staffing.

Reality: Additional capital to support informatics and staffing are a luxury and can improve efficiency and effectiveness of care management initiatives, but they are in no way a necessity for population health management. Population health management begins with a cultural transformation within the organization that is centered on a dedication to providing high-quality, patient-centric care. A clinical transformation subsequently occurs that leads to the development and establishment of refined clinical pathways and processes and often the redeployment of staff. IT tools can assist with these processes, but they should not drive the clinical transformation that needs to occur within the care teams. Similarly, the role of support staff (e.g., care managers, social workers, health coaches) does not actually increase; instead roles are assessed and redefined, as necessary, to ensure staff resources are deployed in a manner that is targeted to meets the needs of the population and the associated intervention. Too often organizations making this transition attempt to run before they can walk.

Myth #6: Clinical integration results in mass layoffs of staff.

Reality:  The Triple Aim® consists of three components: improved health outcomes, improved patient experience, and reduced overall cost of care. While it is imperative that all three of these tenets are taken into consideration for successful clinical transformation, providers frequently focus on the latter and associate it with cost and workforce reductions. Often, organizations are not over-staffed for population health management; instead, staff members are simply not working to the top of their license and are not always providing care to the right cohort of patients, at the right point in time, with the right care interventions to meet the patient’s needs. A reduction in staff will only increase the volume strain all staff is already experiencing. Instead, an assessment and redesign of clinical protocols should inform the medical management staffing. A re-deployment of staff may be necessary to ensure staffing levels are congruent with the acuity of the patient population, and additional training may become necessary to ensure all staff members are able to perform effectively and efficiently in new roles. In many cases, rightsizing can be replaced by adhering to clinical protocols and reallocating existing workforces.

Myth #7: Buying services that span the continuum is the only way to achieve clinical integration.

Reality:  The desire to purchase services that span the continuum stems from a need to be able to share clinical information, conduct warm handoffs between care settings, and keep healthcare costs and revenue under a single umbrella. However, just because an organization may own these services does not mean that these services are the highest quality, nor even utilized by other providers in the continuum. What is most important when developing a clinical integration model is the provision of high-quality, patient-centric care across the continuum. Services do not need to be owned to meet this obligation. Organizations should be looking, instead, to develop formal relationships with the most high-quality and value-based healthcare service providers. Referrers should have access to cost and quality metrics for all partner organizations and should utilize these results to drive care to the most appropriate providers. Preferred networks should be developed to enable care model development in conjunction with these partner organizations, all with the intent to provide patients with coordinated, seamless care transitions across care settings and, when appropriate, back to their home. There are several ways to achieve tightly aligned networks – organizations should be judicious when deciding if ownership over all components is the right strategy for them.

Myth #8: Maintaining universal physician satisfaction is a critical success factor for population health management.

Reality:  Physicians are critical to cultural and clinical transformation – this is an undeniable truth. However, not all physicians are well-educated about or in favor of clinical transformation to position them for success in population health. Some may be nearing the end of their careers, and this change may present a large burden. Placating to physician needs and preferences will not always bring about successful and unified change within an organization. Instead, try performance transparency. Initially, this may cause some discomfort among physicians; however, no physician wants to be the poorest performer, and this tactic may bring about the most rapid change in behavior. The enforcement of remedial action plans for physicians who do not follow established evidence-based protocols may also not be welcomed by all physicians, but will ultimately ensure that high-quality care is provided. While physician engagement is a critical element for success in population health management, it must be a mutual effort. Organizations that make the successful voyage to population health management need to weed out those vocally not on board, as well as those refusing to row in the same direction in their practices.

Myth #9: Patient satisfaction is the same as optimizing the patient experience.

Reality:  Despite what physicians may think, patients aren’t really rating physicians on whether they “always communicated well with them” or “always controlled their pain well.” The truth is that patient satisfaction has many components. Ultimately, patients are rating physicians on factors such as whether they got better and had timely access, which can ignore critical aspects such as the cost and appropriateness of care being provided. One prominent study contended that patients who reported being most satisfied with their physicians had higher healthcare and prescription costs and were more likely to be hospitalized than less satisfied patients. Could physicians who have patient satisfaction scores tied to their compensation be less likely to advocate against unnecessary requested treatments or less likely to raise concerns about lifestyle and behavioral modification issues?  Or could there be a correlation between high patient satisfaction scores and providers who actively tackle the hard-to-discuss issues the best? More research – and specifically innovative research – is necessary. Further complicating this issue is the new trend towards Yelp-style online public reviews influencing local perceptions of healthcare providers. As with any crowd-sourced review product, an issue arises when the public tends to only be inclined to offer their opinions when the service is exceptional, or the experience was considered an unpleasant one. Managing digital perceptions is yet another responsibility that consumer advancements and innovations have required of providers.

Myth #10:  Patient satisfaction will increase if physicians spend more time with each patient.

Reality: Patient satisfaction is about much more than the length of an appointment. Ultimately, patients are concerned about receiving personal, high-quality care at the time they need it. A patient will be satisfied with their care if they feel they can access it when they need it; for example, when a patient is able to schedule an appointment on the day and at the time they wish to see their physician or other provider and if their wait time is minimal.  Or, when a patient contacts their physician via a patient portal and receives a timely response. Furthermore, the patient wants to feel as though their physician is utilizing the appointment time to truly discuss their care, rather than reviewing old notes and labs and consistently typing on a computer; patients respond very positively to eye contact and listening skills as indicators that a physician is interested in a patient. A medical assistant or other office support staff can greatly assist physicians prepare for their appointments so that patients feel as though they are receiving the physician’s full attention, thereby bolstering the patient’s satisfaction with their visit.

Topics: Clinical Integration, Population Health, Regional Clinical Integration Networks, Clinical Transformation

Moving from Utilization Management / Referral Authorizations to True Population Health Management

Posted by Matthew Smith on Feb 9, 2016 4:28:16 PM

Historically, many organizations managing care in a risk-bearing structure such as independent practice associations, medical groups, or related enabling entities such as management services organizations have primarily concentrated on utilization management, referral authorization, and claims processing, with attention to cost containment and ensuring all compliance standards are met. These functions have served as an "operational core," focused on getting the job done and meeting necessary requirements.

As they evolve, these organizations realize that simply "getting it done" will not suffice; they need to increase the focus on the clinical delivery process in order to affect the health outcomes of their populations.

To read this article in its entirety, please click the button below to immediately access CAPG Health.

 Population Health

Topics: Population Health, Risk-Based Contracting, Healthcare Analytics

Asked and Answered: Frequently Asked Questions by Physicians About Clinically Integrated Networks

Posted by Matthew Smith on Sep 21, 2015 3:35:11 PM

By Daniel J. Marino, MBA, MHA, Executive Vice President, GE Healthcare Camden Group

While clinical integration development continues to build momentum, many questions still remain. The following questions and answers will help communicate the value of clinical integration and clinically integrated networks ("CINs") to your physicians. If you're a physician, these questions and answers should help you with some recurring and nagging issues.

What is clinical integration?

Clinical integration is an effort among physicians, often in collaboration with a hospital or health system, to develop active and ongoing clinical initiatives focused on delivering quality, performance, efficiency and value to the patient.

What’s driving the movement toward clinical integration?

In the years ahead, physicians and hospitals must partner more closely than ever before to ensure that the community receives the highest quality and value. As we move from today’s fee-for-service reimbursement models to new performance- and value-based pay models, CINs enable healthcare providers to join together to enhance the health of a community. These networks bring value to patients, payers, and physicians by improving transitions of care, coordinating chronic disease management, and managing the health of a population.

What does a CIN do?

A CIN helps physicians align with the hospital to coordinate care across caregivers, focus on quality and performance, and prepare for new, incentive-based compensation programs in addition to the base compensation they already receive. The network will develop new payment systems and methods that focus on achieving quality, efficiency, cost-management measures, and enhancing value.

What is the purpose of the CIN?

The principal purpose is to enhance the quality and efficiency of patient care services provided by the participating providers to the community. A CIN with participating providers works together to develop clinical performance standards and protocols for the network. These will form the basis for the network to negotiate contracts with payers for performance incentive programs.

How is it structured?

The CIN is a wholly owned subsidiary of the health system managed by its own Board of Directors, with community physicians and hospital members. Physicians willing to participate in a meaningful way have the opportunity to be involved in the organizational committees that drive the network.

What are the benefits of joining?

For physicians, the network offers the opportunity to:

  • Become available as a preferred network provider to members
  • Use care management resources provided by the CIN
  • Identify and measure best practices
  • Improve outcomes for patients
  • Receive financial rewards for value-based outcomes and achievements

The goal of the CIN is to provide an exemplary patient experience and improve the health of individuals in our community in a continuum of care that is focused on quality, performance, efficiency, and value. This serves as the platform that will determine financial incentives for physicians.

Who can join?

To ensure the best value for patients and payers, the CIN welcomes physicians who want to be accountable and raise the quality of care. These physicians can be:

  • Independent community physicians who seek clinical and quality alignment
  • Physicians employed by a health system
  • Physicians who contract with the hospital to provide services in specialties such as emergency medicine, anesthesiology, and pathology

Do physicians join as individuals, or do all the physicians in a practice need to join?

For independent physicians, a delegated representative from a group practice may sign the participation agreement and code of conduct on behalf of the practice to enroll all providers. However, in most instances, each individual physician in the group will need to complete a short application packet. Physicians employed by the health system will be enrolled with other members of their practice groups.

Will members be required to refer enrolled patients to other network members?

In-network referrals allow for the efficient accumulation and reporting of data, promote coordination and continuity of care and ensure adherence to evidence-based medicine.

What type of data is monitored?

Network leaders and physician advisory committees will determine details on clinical initiatives and data to be monitored and reported. Collected data likely will be similar to that being measured for Medicare programs, such as the Physician Quality Reporting System.

How will clinicians submit data to the network?

Providers will submit clinical and claims data on a timely basis to a secure, web-based platform that is HIPAA compliant and password protected. The web-based platform enables physicians to conveniently and easily submit data from any device with internet access.

What is the difference between a CIN and an Accountable Care Organization ("ACO")?

According to the Centers for Medicare and Medicaid Services, an ACO is accountable specifically for Medicare beneficiaries. It is an organization of healthcare providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries enrolled in the traditional fee-for-service program who are assigned to the ACO. Similarly, a CIN is an alignment model, coordinating care across affiliated caregivers and developing contracts with payers to improve quality while controlling growth in total cost of care, including value-based contracting initiatives with commercial payers and Medicare.

Clinical Integration Networks, CIN, Daniel J. Marino


Daniel J. Marino, The Camden Group, Clinically Integrated NetworksMr. Marino is an executive vice president with GE Healthcare Camden Group with more than 25 years of experience in the healthcare field. Mr. Marino specializes in shaping strategic initiatives for healthcare organizations and senior healthcare leaders in key areas such as population health management, clinical integration, physician alignment, and health information technology. He may be reached at dmarino@thecamdengroup.com

 

 

Topics: Population Health, Clinically Integrated Care, Clinically Integrated Networks, Clinically Integrated Network, Daniel J. Marino

7 Ways to Achieve Clinical Integration Through Strategic Physician Engagement

Posted by Matthew Smith on Aug 19, 2015 12:11:58 PM

New payment models make it more important than ever for hospitals to collaborate with physicians. From readmission penalties to bundled payments to Accountable Care Organizations ("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.

Topics: Clinical Integration, Population Health, Physician Engagement, Governance, Care Coordination

New Download: Building the Information Management and Data Governance Strategy for Value-Based Care

Posted by Matthew Smith on Aug 6, 2015 10:37:35 AM

This new download from GE Healthcare Camden Group focuses on how successful organizations:

  • Identify current information technology solution needs and challenges
  • Categorize existing issues in capturing and aggregating data as well as translating this information into clinical workflows
  • Create the blueprint for an information management and data governance strategy
  • Document and prioritize steps related to the "future state" information technology solutions framework and management strategies needed to support current and future business needs.

To download the PDF document, please click the button below to access the download page.

Data Governance, Value-Based Care, Population Health

Topics: Value-Based Care, Population Health, HIT, HealthIT, Data Governance

Building the Data Governance Strategy for Effective Population Health Alliances

Posted by Matthew Smith on Aug 5, 2015 12:42:52 PM

By Tara Tesch, MHSA, Senior Manager, GE Healthcare Camden Group

This is the third of three articles in the Population Health Alliances series. The first article examined physician engagement strategies and detailed specific strategies that have proven successful for alliances. The second article focused on the value of true care redesign.

High-performing organizations possess robust information technology ("IT") infrastructure and associated tools to deliver, track, and document patient-centered, evidence-based care at the point of service and can disseminate actionable and meaningful data quickly and transparently. IT infrastructure implementation is an iterative process and rarely do organizations have a “fully baked” IT solution at the onset of implementation.

There is no single vendor that can provide a comprehensive data analytics solution to meet all needs (see graphic below) at this time.


 Future State CI Network Platform

Population Health, Data Governance

© The Camden Group 2015


In order to truly impact how care is delivered, end users must have actionable information in real time to support care redesign efforts. Providing patient-relevant decision support at the point of care can improve provider effectiveness in delivering appropriate and necessary interventions, furthering the organization’s goals of improving individual and population health. Too many organizations stall in developing their IT infrastructure by letting “great get in the way of good.” IT should support the care not drive it, therefore, systems and tools must translate and support care redesign. Too much data that is not well organized or analyzed can simply create confusion and cloud the necessary focus required to impact population health.

It is critical for population health alliances to have a well thought-out IT strategy and data management plan that will provide connectivity between members. The strategy should call for a means to collect the data, offer a robust tool to aggregate the data, and support reporting that will translate information into behavioral change and allow providers to more effectively communicate with and engage patients. The key factor for success: build your strategy beginning with the end in mind.


 Data Governance Strategy Build

© The Camden Group 2015


Success begins with the development of an information management and data governance strategy, which includes a data governance structure (who is going to own it, clean it, analyze it), organizational structure (what resources and types are required), and core data needs (reportable, transactional). An objective of the strategy is to take data and create meaningful information that leads to action-oriented knowledge. Out of the strategy, capabilities will be identified that drive interoperability and analytics requirements. These requirements should provide the criteria for selecting health information technology (“HIT”) that support the business and clinical needs of the alliance. Avoid buying the tool then trying to create a strategy around it; this will inevitably fail.

Defining Objectives

Designing the data strategy requires a sophisticated understanding of the alliance’s business and clinical objectives, clinical guidelines and care processes, and requirements of analytics to support these activities. First, define the end goal (outputs) such as care management or value-based contracting, and identify the data sources that will be used (i.e., EHR, claims, ADT, etc.). Next, determine how the data will be used to support the outputs; will it be reportable and retrospective (e.g., risk stratification, predictive modeling, scorecards) or transactional and action-oriented (e.g., point of care, gap closure, alerts, real time analysis to support decision-making).

To be successful, this planning process must include clinical/operational leadership (e.g., chief medical informatics officer, care management leads), in addition to finance and the member organization chief information officers. Staffing should include a data architect and a clinical informaticist able to translate the data into clinically meaningful information.

Once the strategy has been defined, identify the data requirements and associated capabilities. This may include standard processes and reporting templates – tools to automate the current state and optimize care delivery. Next, select a vendor that either has the ability to grow with your organization as it evolves or decide to pursue a “plug and play” vendor approach. Either way, the vendor must support the alliance’s CIN data requirements and capabilities.

In the end, it is critical to maintain strong, positive relationships with clinicians during the design and development of these key technology capabilities. Clinicians drive the clinical care of patients and care models to support the delivery of clinical protocols. Organizational and individual needs will evolve based upon initial successes and challenges, and clinicians will bring forth a multitude of suggested and needed changes after the initial “go live.” Technology is the tool to support the clinical requirements, and developing ongoing processes to solicit clinician feedback for continued improvement is an important contributor to long-term success.

Data Governance, Value-Based Care, Population Health


Ms. Tesch is a senior manager with GE Healthcare Camden Group in the clinical integration practice with more than 18 years of experience as a healthcare leader and strategist. Ms. Tesch specializes in value-based care delivery strategic planning, CIN development and implementation for commercial, Medicare, and Medicaid populations, health information technology data governance and analytics strategy, as well as care management strategy, design, and implementation. She has worked with a variety of healthcare providers, including integrated delivery networks, academic health centers, regional referral centers, rural community providers, and national non-profit and faith-based health systems. She may be reached at tara.tesch@ge.com

Topics: Population Health, HIT, HealthIT, Data Analytics, Population Health Alliance, Tara Tesch, Data Governance

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