1.800.360.0603

GE Healthcare Camden Group Insights Blog

Ten Benefits Resulting from Clinical Integration

Posted by Matthew Smith on Aug 29, 2013 9:00:00 AM

Clinical Integration, Top 10, TenIn today's health care 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 health care quality and patient satisfaction.

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

  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 health care 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 health care waste and redundancy, making it possible for hospital systems to provide patients focused seamless systems of care across and between health care 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 health care 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 health care 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 health care 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, Health Directions

Topics: Clinical Integration, Hospitals, Clinically Integrated Care, Physicians, Population Health Management

Launching Your Clinical Integration Program: 10 Defined Benefits

Posted by Matthew Smith on May 15, 2013 3:46:00 PM

Clinical Integration, Program LaunchIn 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 feasibility:

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, Launching a CI Program

Topics: Clinical Integration, Hospitals, Clinically Integrated Care, Physicians, Population Health Management

Joining Forces with Physicians to Achieve Clinical Integration

Posted by Matthew Smith on Apr 24, 2013 4:39:00 PM
By Patricia O’Connor, MD; Lucy Zielinski & Tina Wardrop, Health Directions. 

Clinical Integration, Hospital-PhysicianNew 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.

Originally published in Executive Insight, December 2012
Clinical Integration, CI, Physician Alignment

Topics: Clinical Integration, Hospitals, Clinically Integrated Care, Physicians, Population Health Management

Ten Direct Benefits of Clinically Integrated Care

Posted by Matthew Smith on Mar 25, 2013 1:27:00 PM

10 Benefits of Clinical IntegrationIn today's health care 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 health care quality and patient satisfaction.

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

  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 health care 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 health care waste and redundancy, making it possible for hospital systems to provide patients focused seamless systems of care across and between health care 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 health care 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 health care 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 health care 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, CI, Physician Alignment

Topics: Clinical Integration, Hospitals, Clinically Integrated Care, Physicians, Population Health Management

Join the Clinical Integration Conversation at HIMSS 2013

Posted by Matthew Smith on Feb 28, 2013 9:43:00 PM

Clinical Integration, Physician, HIMSS 2013Are you working to clinically integrate your organization?

Are you looking to learn more about Clinical Integration and its real-world applications?

If so, we invite you to join Health Directions President and CEO, Daniel J. Marino, and Tim Quinn, MD, from Mercy Hospital System in Iowa for a topical and comprehensive session on clinical integration. Dan and Dr. Quinn will offer recommendations on how to align community physicians with the hospital in building a clinically integrated care model.

Session Title: "Utilizing Clinical Integration to Align Physicians and Increase Market Share"

When: Wednesday morning, March 6th from 9:45am-10:45am (Education Session 142).

Join Health Directions President and CEO, Daniel J. Marino, and Tim Quinn, MD, from Mercy Hospital System in Iowa for a topical and comprehensive session on clinical integration. Dan and Dr. Quinn will offer recommendations on how to align community physicians with the hospital in building a clinically integrated care model.

Session objectives include:
  • Analyze 5 keys to creating quality clinical integration infrastructure
  • Identify complex questions that guide clinical integration
  • Define success criteria of clinical integration
  • Develop a plan for clinical integration based on the 4 Pillars approach
  • Identify how to track clinical outcomes starting with meaningful use data

If you would like to schedule a time to talk with Dan and Dr. Quinn about clinical integration, and the involvement of Health IT, please click the button, below, and complete the short form. Our team will respond right away to schedule a time at HIMSS.

Not going to HIMSS? We can still set up a time to talk. Please call Matthew Smith at Health Directions: 312-396-5407 or email [email protected]

Clinical Integration, HIMSS13, Dan Marino

Topics: Clinical Integration, Hospitals, Clinically Integrated Care, Physicians, Population Health Management

60 ACOs Launch National Association of Accountable Care Organizations

Posted by Matthew Smith on Feb 12, 2013 1:17:00 PM

ACO, Accountable Care Organization, NAACOSixty accountable care organizations are charter members of the new National Association of ACOs and seek more members.

The group recently formed and presently is governed by an interim board until elections in June. The Washington-based association will focus on fostering growth of ACOs, influencing development of public policy, developing uniform quality and performance measures, engaging the vendor community and educating the public.

The Centers for Medicare and Medicaid Services recently recognized 258 ACOs working with Medicare and/or Medicaid, and there are numerous other ACOs across the nation working with commercial insurers. Annual membership fees in the new association range from $3,500 to $10,000, depending the size of the ACO. The first annual conference of the association is scheduled for March 19-21 in Baltimore, by which time the group hopes to have more than 100 members.

Vendors also are encouraged to participate in the association as business partners. An annual “supporting membership” fee of $5,000 includes complimentary exhibit space at the March conference, the option to attend other meetings, a listing on the association Web site, and the ability to send emails to the member list twice annually.

More information for ACOs and vendors is available at naacos.com.

Topics: Accountable Care, ACO, Accountable Care Organizations, Population Health Management, Pioneer ACO, NAACOS

8 Issues Affecting Population Health Management Right Now

Posted by Matthew Smith on Dec 16, 2012 10:55:00 PM

population health managementIn late 2011, the Care Continuum Alliance, an advocate for population health management, surveyed industry leaders to assess the market and predict key issues for 2012. According to the alliance’s white paper, two predominant themes were brought to light as a result of the survey.

“First, significant market movement will occur toward accountability and value creation in healthcare, driven partly by new physician-guided and collaborative models,” according to the report. “And second, population health management is well-positioned to add value to and support these emerging models, but must continue to build the case for wellness and prevention.”

Here are eight additional key issues, identified in the report, that currently affect population health management. 

1. Accountable care and the Medicare Shared Savings program. Many comments from survey respondents centered on accountable care and collaborative models, as well as federal support for both. According to the report, population health has a lot to offer collaborative care, such as health risk assessment and predictive modeling, HIT infrastructure, data analytics, care coordination and other core competencies. “But tempering optimism around accountable care models were caveats,” the report noted. 

2. Consumer use of mobile and eHealth technologies. According to the report, population health management has been both a driver and benefactor of the rise in eHealth and mHealth technologies. The demand for these technologies, said one respondent, will drive healthcare “to adopt … a patient-centered, consumer-empowered, pull-rather-than-push model, which has already been realized in the music, travel, book and news industries.” The importance of social media was also noted by those surveyed, and when coupled with mobile technology, will be used as a tool and patient engagement and shared decision-making. 

3. Reducing avoidable hospital readmissions in Medicare. The Hospital Readmissions Reduction Program (HRRP) could be a “big opportunity for companies who have developed proven strategies for reducing hospital readmissions,” wrote one survey respondent. The program includes Medicare tracking readmissions for three conditions – heart failure, acute myocardial infarction and pneumonia – within 30 days on or after Oct. 1, 2012. Medicare will then reduce payments to hospitals to account for excess readmissions. 

4. Quality improvement in Medicare advantage. The Medicare Advantage’s (MA) “stars” rating system was another topic of discussion. The program will award bonus payments to plans under the stars system to assess performance on a myriad of measures. “The developing stars system appears [to be] headed toward a structure consistent with industry-advocated changes, including additional wellness and prevention measures and retirement of process-related measures,” the report read. It added that, combined with continued growth in the Medicare Advantage population, the need for plans to demonstrate improvement in wellness and chronic care measures will drive “expanded opportunities” in the Medicare managed care market, according to industry experts. 

5. Opportunities to support insourced programs. “An industry challenged at times by payer decisions to build rather than buy care management programs could face additional competitive pressure in 2012,” read the report. An industry leader added that the market will continue challenging the value of each program and, with the consolidation in the [managed care] industry, will continue looking at insourcing versus outsourcing. “ACOs may be a greater opportunity, but … these groups will often favor their own solutions rather than those from the outside,” he added. To that point, the report said, many components of population health management will likely prove especially valuable to health plans in 2012, regardless of the build or buy decisions. 

6. Improving care coordination for dual eligibles. Dual eligibles, or those eligible for both Medicare and Medicaid benefits, “attracted significant attention from policymakers in 2011 as economic pressures created an imperative for savings in both programs,” the report read. The need to reduce costs associated with this population is high, and as one respondent put it, “focus on improved care coordination for complex, multi-morbid patients is a must.” The report added Congress and the administration recognized the savings possible through better care coordination for dual eligible by formalizing federal oversight of the population in the ACA. “This heightened federal recognition … places a premium on care coordination services, such as those population health management provides.” 

7. Federal support for prevention and wellness. Although the ongoing deficit reduction debate in Congress has jeopardized federal support for wellness and prevention, said the report, industry leaders are optimistic about federal program opportunities. “The $15 billion Prevention and Public Health Fund … is an important part of the deferral effort, but only one element of a broader prevention and wellness strategy encompassed by the ACA,” according to the report. Since the law’s passage, Medicare has added annual wellness visits and expanded coverage of obesity and cardiovascular disease prevention services, “and the federal government has made significant grant funding available to states and communities for prevention and care coordination initiatives.”

8. Development of ACA health insurance exchanges. According to the report, development of the reform law’s health insurance exchanges – scheduled to open their doors in 2014 – will draw significant attention in 2012. “Especially with respect to how CMS structures the essential benefits package all participating plans must offer,” it said. Industry leaders said the challenge is ensuring the package is comprehensive and plans don’t dilute population health services to maintain competitive pricing in the exchange market. 

Topics: Accountable Care, ACO, Medicare, ACA, Affordable Care, Population Health Management, Mobile Health

6 Population Types Benefiting from Clinical Integration

Posted by Matthew Smith on Dec 12, 2012 10:30:00 AM

Clinical IntegrationHospitals and physicians face mounting pressures to change their care delivery models moving from encounter-based care to population health management. This results in challenges such as:

  • Patients experiencing fragmented and uncoordinated care between the hospital, post-acute and ambulatory setting
  • Physicians unable to access the most appropriate clinical information at the point of care resulting in misdiagnosis, redundant care delivery and high costs
  • Hospital and providers struggling with managing patients with chronic diseases and complex illnesses—resulting in lower quality patient outcomes, higher readmission rates and higher costs
  • Hospitals and physicians feeling pressures from payers to accept lower reimbursement while focusing on improve patient care outcomes

A fully implemented Clinical Integration program benefits everyone in the community. Here is a look at who stands to benefit from clinically integrated care, and how each group will benefit.

Patients

  • Improved safety

  • Improved quality of health care

  • Better access to the latest proven techniques and treatments

  • Streamlined interactions with health care system—less waiting and duplication

  • Fully informed physicians and medical staff

Physicians

  • Ability to spend more time with patients, less time with paperwork

  • Access to complete patient information

  • Ability to deliver higher quality care

  • Ability to monitor patient compliance

  • Ability to sell combined services of network to payors, making independent practice more viable, especially for small practices

Hospitals

  • Higher degree of effective collaboration

  • Improved clinical quality and patient safety

  • Base of independent physicians aligned with hospital

  • Ability to manage costs

  • Differentiation in the market as high quality provider

Insurers

  • Higher subscriber satisfaction

  • Cost efficiencies and savings

  • Higher quality health care for subscribers

  • Easy access to objective utilization data

Employers

  • Containment of health care costs

  • Healthier employees

Community

  • Ability to maintain independent physician practices

  • Better health care

  • Ability to recruit medical talent to area

Topics: Clinical Integration, Clinically Integrated Care, Clinical Care, Population Health Management

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

Report: ACOs Now Serve 31 Million Patients Nationally

Posted by Matthew Smith on Nov 28, 2012 9:13:00 AM

Accountable Care OrganizationsAs many as 31 million Americans now receive healthcare through an accountable care organization (ACO) according to the recent report, "The ACO Surprise," from consulting group Oliver Wyman. And, in just two years, this new model of healthcare has captured 10 percent of the market.

The report contends that while many believe ACOs have had little impact on the market to date, the sheer numbers of patients getting healthcare via an ACO tells a different story.

In its analysis, Oliver Wyman researchers determined that about 2.4 million Medicare beneficiaries were receiving care via the different Medicare ACO programs run by the Centers for Medicare & Medicaid Services; another 15 million non-Medicare patients received care at these Medicare ACOs; and 8 million to 14 million are part of ACOs run by large national and regional insurers for their non-Medicare populations.

In total, the research indicates that nearly 45% of the population live in a primary care service area (PCSA) served by at least one ACO and 17% live in a PCSA that is served by two or more, a number that is likely to rapidly increase in the coming years.

The report also notes that the competition for primary care doctors that has been occurring for the past few years is likely to intensify as more PCSAs have multiple ACO competitors.

Oliver Wyman researchers found a significant number of patients in ACOs, even when eliminating for the purposes of this study organizations that are doing such things as piloting bundled payments since they are not population-based programs, or those that receive pay-for-performance and care coordination payments since they are not value-based programs. That said, they still provide a significant caveat to the state of the ACO market. Namely, even those included in the study still fall short of being a “true” ACO, one that shares both upside and downside risk.

To view the full report click here.

 

Topics: Accountable Care, ACO, Clinical Integration, Clinically Integrated Care, Accountable Care Organizations, Population Health Management

Subscribe to Email Updates

Value Model, Health Analytics

Posts by Topic

Follow Me