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GE Healthcare Camden Group Insights Blog

Should You Consider the Accountable Health Communities Model?

Posted by Matthew Smith on Feb 22, 2016 1:53:44 PM

By Tawnya Bosko, DHA, MS, MHA, MSHL, Vice President, and Megan Calhoun, MS, MSW, Manager,                   GE Healthcare Camden Group

questions.jpgOver the past five years, CMS has developed numerous innovative models, grants, and initiatives aimed at providing high-value care to vulnerable populations such as Medicaid and Medicare beneficiaries. CMS recently announced its most recent model, a five-year test named the Accountable Health Communities (“AHC”) Model. The underlying premise of this model is the assumption that enhanced coordination between providers and community-based social service organizations for Medicaid and Medicare patients can help to achieve the central tenets of the Triple AimTM: higher patient satisfaction, lower overall costs of care, and better clinical outcomes. With the introduction of each new model, organizations often wonder whether they would benefit from participation. 

Questions to Ask

If your organization answers “YES” to any of the questions below, you may want to consider application for the AHC Model!

  • Do you have a high volume of Emergency Department “frequent fliers” due to poorly managed psychosocial issues?

OR

  • Are healthcare services generally being mis-utilized due to the lack of sufficient psychosocial services?
  • Are there community-based organizations in your service area or surrounding neighborhoods that are not integrated into patient care plans or whose services are not fully utilized?
  • Does your payer mix consist of a high proportion of frail, underserved, or complex patients, such as Medicaid and/or Medicare patients or those dually eligible for Medicare and Medicaid?
  • Have you participated in or tried other care coordination initiatives (through CMS or otherwise) and been unable to successfully curb the cost curve?
  • Would you benefit from additional funding to integrate medical and behavioral care with social services?
  • Would your providers be open and willing to greater collaboration and coordination of care outside the four walls of current healthcare delivery sites?

It is clear that socioeconomic issues play a major role in the health of populations. According to CMS award recipients under the AHC model, referred to as “bridge organizations,” will oversee the screening of Medicare and Medicaid beneficiaries for social and behavioral issues, such as housing instability, food insecurity, utility needs, interpersonal violence, and transportation limitations, and help them connect with and/or navigate the appropriate community-based services.

If your organization struggles to manage the health of patient populations that have significant social support challenges, this program may be right for you. Up to 44 bridge organizations will be selected for the AHC model, which will deploy a common, comprehensive screening assessment for health-related social needs among all Medicare and Medicaid beneficiaries accessing care at participating clinical delivery sites.

Three Scalable Approaches

CMS has explained that the model will test three scalable approaches to addressing health-related social needs and linking clinical and community services – community referral, community service navigation, and community service alignment. Bridge organizations will inventory local community agencies and provide referrals to those agencies as needed. They may also provide intensive community service navigation such as in-depth assessment, planning, and follow-up until needs are

To measure the effectiveness of the model on impacting total cost of health care utilization and quality of care, the primary evaluation will focus on reduction in total health care costs, emergency department visits, and inpatient hospital readmissions.

Eligible applicants for the AHC model according to CMS are community-based organizations, hospitals and health systems, institutions of higher education, local government entities, tribal organizations, and for-profit and not-for-profit local and national entities with the capacity to develop and maintain a referral network with clinical delivery sites and community service providers.

Applications for the AHC model are due March 31, 2016.

Accountable Health Communities Model


bosko_headshot.pngDr. Bosko is vice president at GE Healthcare Camden Group and has over 20 years of experience in healthcare management and strategy. Her areas of focus and expertise include healthcare reform, market forces, and strategic analysis, specifically around hospital-physician alignment, emerging reimbursement and incentive models, performance optimization, payer strategy, and the intersection of health policy and delivery system transformation. Dr. Bosko is a nationally-recognized speaker on healthcare market trends and insights, focusing on the financing and delivery of care. She frequently presents at industry conferences and is the author of multiple articles for leading industry journals and publications on the transition to value-based reimbursement and health system strategy. She may be reached at Tawnya.Bosko@ge.com or 310-320-3990.

Megan.pngMs. Calhoun is a manager with GE Healthcare Camden Group and specializes in the areas of care management strategy and design, strategic and business planning analysis, accountable care organization applications, development and implementation, and the development of clinically integrated organizations. Ms. Calhoun has supported numerous clients with the completion of Medicare Shared Savings Program (“MSSP”) applications and implementation strategy and planning. Her experience includes care model design and implementation that spans the continuum. She may be reached at Megan.Calhoun@ge.com or 310-320-3990. 

 

Topics: CMS, Triple Aim, Tawnya Bosko, Megan Calhoun, Accountable Health Communities

5 Keys for Hitting the Healthcare IT Triple Aim

Posted by Matthew Smith on Feb 10, 2014 2:06:00 PM
By Daniel J. Marino
President/CEO
Health Directions
Daniel J. Marino, Health Directions, Triple Aim, Health IT, HITWhile health care’s complexities and challenges are unmatched by other industries, no one would disagree that our industry needs to make better use of IT. The success of healthcare IT projects depends on their ability to deliver on three main objectives comprising the Healthcare IT Triple Aim:
  1. improve care, 
  2. reduce costs, and 
  3. enhance the worker experience.

By adopting the Triple Aim, we can ensure that healthcare IT solutions have a positive impact and advance health care’s stature with regard to leveraging IT. The following are five keys to hitting the technology Triple Aim.

I. Technology is the Enabler, Not the Driver

The Triple Aim is the driver and technology is the enabler, not the other way around. Technology implementations are complex and sometimes develop a life form of their own, and before we know it, assume the role of driver. Another challenge is that IT departments often end up driving the implementation of IT solutions, which is not the best approach. Solutions should be driven largely by stakeholders and users who will benefit from the solution. IT departments are not necessarily to blame for assuming control as they often end up filling a void created by the lack of leadership. 

II. Trust the Technology

Remember when eCommerce came into being? One of the key issues was consumer trust in these new, Internet-based technologies that a user could not touch, talk to or see. Fear of stolen identity, financial loss and general mistrust of this new, technologically advanced way of doing things slowed adoption. We are in a similar place today with health care technology. Physicians, hospitals and patients are being asked to be more transparent and share information. We are entering a world where electronic visits and remote health monitoring are moving toward the norm. Health care providers are being asked to look at and respond to clinical and financial performance data, and are being told that their income will depend on that data. Like it or not, health care is fueled by data, and there is likely no escape. 

III. Pay Attention to the Often Overlooked Driver

Of the Triple Aim objectives, improving the health care worker experience is the one most often overlooked. Technology projects are usually born out of a desire to save money and decrease risk exposure thereby improving quality of care. Some electronic health record (EHR) projects were started with the notion that they would make a physician’s job easier. However, EHR implementations, in general, have not delivered on that objective; in fact, most have had the opposite effect. If technology doesn’t simplify a job, the job may not get done; or if the job does get done, it will be done at the high cost of lost productivity and worker dissatisfaction – negatively impacting the quality and cost of care. 

IV. Measure It

Is our technology improving care? Reducing costs? Enhancing worker satisfaction? If so, how and to what degree? These are questions that should be asked and measured specifically and quantifiably. Create key performance indicators (KPI) detailing the goals that support the overarching Triple Aim objectives. Items to be measured will vary by worker group. For example, physicians, nurses, schedulers, billers and administrators should all have unique KPI dashboard measures related to their specific objectives, and their capacity to impact care and cost. In addition, they should have their worker satisfaction evaluated on a regular basis. KPI’s may also vary depending on what issues the technology solution is intended to address but could include:

  • patient waiting time
  • gaps in care
  • patient satisfaction surveys
  • number of visits per day
  • number of same day visits
  • worker satisfaction surveys
  • hours required to wrap up the day after the last patient visit
  • traditional billing and financial measures.

V. Improve It

Improvement naturally follows measurement. With regard to IT improvements, there are two important things to keep in mind:

  1. Today’s solution may not suffice tomorrow, and if we think it will, we’ll get left in the dust. 
  2. The complexity of health care’s issues require adjusting on the fly.

If we wait for the perfect roadmap, the project will never get off the ground. Complex implementations such as ambulatory EHR solutions leave users feeling like overwhelmed. Likewise, data intensive accountable care models are complicated and not fully defined, requiring a lot of discovery and invention along the way. There is no linear path; missteps and rabbit trails will be the norm, not the exception. Many consulting firms and health system IT departments have assembled EHR optimization teams that follow implementation by 90 or more days, and work to improve processes of adoption after everything has settled. Technology optimization initiatives that involve a systematic plan of reviewing and responding to performance metrics should be widely used.

Seasoned veterans know that the devil is in the details when it comes to applying IT solutions to the complex issues of health care. Sometimes the biggest challenge is getting the proper stakeholders to spell out objectives and play a key role in the execution of the project to ensure that they are met. If you are considering a new technology implementation or find yourself in the throws of adversity from a previous implementation, it’s not too late to revisit the project and align with the Triple Aim objectives.

Daniel J. Marino, Triple Aim, Health IT, HITAs President/CEO of Health Directions, Daniel J. Marino shapes strategic initiatives for healthcare organizations and senior health care leaders in key areas such as population health management, clinical integration, physician alignment, and Health IT. With a broad background in all aspects of practice management and hospital/physician alignment, Dan is nationally recognized as a strategic leader in Accountable Care Organizations and clinical integration development. He frequently speaks at national conferences and regularly authors articles for the nation’s top healthcare industry publications related to current transformations in healthcare delivery. Dan may be reached via email at dmarino@healthdirections.com or by phone at 312-396-5400.

Topics: HIT, Health IT, Triple Aim

Hitting the "Triple Aim" by Classifying Patient Populations

Posted by Matthew Smith on May 17, 2013 4:05:00 PM

Triple AimAn article co-authored by researchers at Walgreens and the National Health Service of Great Britain projects that by taking an innovative approach to classifying patient populations, health systems can more effectively prevent “triple fail” events – or outcomes which fail to advance population health, reduce per capita health care costs, and improve individual patient experience. The article, titled How Health Systems Could Avert ‘Triple Fail’ Events That Are Harmful, Are Costly, And Result in Poor Patient Satisfaction, was published in the April edition of Health Affairs.

“As pressures on the global health care system continue to mount, the triple aim framework has increasingly been recognized as critical to improving outcomes while lowering costs,” said Jeffrey Kang, M.D., Walgreens senior vice president, health and wellness services and solutions. “At Walgreens, we have seen firsthand through our work with physicians, health systems and our own ACOs the importance of looking for innovative approaches to coordinating care – such as the one analyzed in this article –to keep populations healthy.”

The research examines how classifying (or ‘stratifying’) patients according to individual risk and expected response to an intervention can further the “triple aim.” The triple aim framework, created by the Institute for Healthcare Improvement (IHI), asks that health systems evaluate performance by simultaneously pursuing three dimensions:

  • improved patient experience of care (including quality and satisfaction),
  • improving population health and
  • reducing per capita cost of health care.

The article examines two approaches that have been used to achieve the triple aim — the population strategy, which seeks to lower risk across an entire population; and the targeted strategy, which seeks to lower risk by identifying and intervening with high-risk individuals.

The “stratified approach” is presented in the article as a third and novel method, focused on identifying and prioritizing subpopulations according to their risk of health encounter failures and their likelihood of benefiting from preventive care. To identify at-risk subpopulations, health providers must analyze medical claims, pharmacy claims, electronic health record information and other administrative data to predict individuals’ risk of different triple fail events.

Clinical Integration, Health Directions

Topics: Population Health, Triple Aim, Triple Fail, Walgreens, Stratified Approach

New Article Urges Stratifying Populations to Avoid "Triple Fail"

Posted by Matthew Smith on Apr 16, 2013 11:51:00 AM

triple aim resized 600An article co-authored by researchers at Walgreens and the National Health Service of Great Britain projects that by taking an innovative approach to classifying patient populations, health systems can more effectively prevent “triple fail” events – or outcomes which fail to advance population health, reduce per capita health care costs, and improve individual patient experience. The article, titled How Health Systems Could Avert ‘Triple Fail’ Events That Are Harmful, Are Costly, And Result in Poor Patient Satisfaction, was published in the April edition of Health Affairs.

“As pressures on the global health care system continue to mount, the triple aim framework has increasingly been recognized as critical to improving outcomes while lowering costs,” said Jeffrey Kang, M.D., Walgreens senior vice president, health and wellness services and solutions. “At Walgreens, we have seen firsthand through our work with physicians, health systems and our own ACOs the importance of looking for innovative approaches to coordinating care – such as the one analyzed in this article –to keep populations healthy.”

The research examines how classifying (or ‘stratifying’) patients according to individual risk and expected response to an intervention can further the “triple aim.” The triple aim framework, created by the Institute for Healthcare Improvement (IHI), asks that health systems evaluate performance by simultaneously pursuing three dimensions:

  • improved patient experience of care (including quality and satisfaction),
  • improving population health and
  • reducing per capita cost of health care.

The article examines two approaches that have been used to achieve the triple aim — the population strategy, which seeks to lower risk across an entire population; and the targeted strategy, which seeks to lower risk by identifying and intervening with high-risk individuals.

The “stratified approach” is presented in the article as a third and novel method, focused on identifying and prioritizing subpopulations according to their risk of health encounter failures and their likelihood of benefiting from preventive care. To identify at-risk subpopulations, health providers must analyze medical claims, pharmacy claims, electronic health record information and other administrative data to predict individuals’ risk of different triple fail events.

Clinical Integration, CI, Physician Alignment

Topics: Population Health, Triple Aim, Triple Fail, Walgreens, Stratified Approach

5 Steps for Targeting Healthcare IT Triple Aim

Posted by Matthew Smith on Jul 5, 2012 9:37:00 AM

Healthcare IT Triple AimWhile health care’s complexities and challenges are unmatched by other industries, no one would disagree that our industry needs to make better use of IT. The success of healthcare IT projects depends on their ability to deliver on three main objectives comprising the Healthcare IT Triple Aim:

  1. improve care, 
  2. reduce costs, and 
  3. enhance the worker experience.

By adopting the Triple Aim, we can ensure that healthcare IT solutions have a positive impact and advance health care’s stature with regard to leveraging IT. The following are five keys to hitting the technology Triple Aim.

I. Technology is the Enabler, not the Driver

The Triple Aim is the driver and technology is the enabler, not the other way around. Technology implementations are complex and sometimes develop a life form of their own, and before we know it, assume the role of driver. Another challenge is that IT departments often end up driving the implementation of IT solutions, which is not the best approach. Solutions should be driven largely by stakeholders and users who will benefit from the solution. IT departments are not necessarily to blame for assuming control as they often end up filling a void created by the lack of leadership. 

II. Trust the Technology

Remember when eCommerce came into being? One of the key issues was consumer trust in these new, Internet-based technologies that a user could not touch, talk to or see. Fear of stolen identity, financial loss and general mistrust of this new, technologically advanced way of doing things slowed adoption. We are in a similar place today with health care technology. Physicians, hospitals and patients are being asked to be more transparent and share information. We are entering a world where electronic visits and remote health monitoring are moving toward the norm. Health care providers are being asked to look at and respond to clinical and financial performance data, and are being told that their income will depend on that data. Like it or not, health care is fueled by data, and there is likely no escape. 

III. Pay Attention to the Often Overlooked Driver

Of the Triple Aim objectives, improving the health care worker experience is the one most often overlooked. Technology projects are usually born out of a desire to save money and decrease risk exposure thereby improving quality of care. Some electronic health record (EHR) projects were started with the notion that they would make a physician’s job easier. However, EHR implementations, in general, have not delivered on that objective; in fact, most have had the opposite effect. If technology doesn’t simplify a job, the job may not get done; or if the job does get done, it will be done at the high cost of lost productivity and worker dissatisfaction – negatively impacting the quality and cost of care. 

IV. Measure It

Is our technology improving care? Reducing costs? Enhancing worker satisfaction? If so, how and to what degree? These are questions that should be asked and measured specifically and quantifiably. Create key performance indicators (KPI) detailing the goals that support the overarching Triple Aim objectives. Items to be measured will vary by worker group. For example, physicians, nurses, schedulers, billers and administrators should all have unique KPI dashboard measures related to their specific objectives, and their capacity to impact care and cost. In addition, they should have their worker satisfaction evaluated on a regular basis. KPI’s may also vary depending on what issues the technology solution is intended to address but could include:

  • patient waiting time
  • gaps in care
  • patient satisfaction surveys
  • number of visits per day
  • number of same day visits
  • worker satisfaction surveys
  • hours required to wrap up the day after the last patient visit
  • traditional billing and financial measures.

V. Improve It

Improvement naturally follows measurement. With regard to IT improvements, there are two important things to keep in mind:

  1. Today’s solution may not suffice tomorrow, and if we think it will, we’ll get left in the dust. 
  2. The complexity of health care’s issues require adjusting on the fly.

If we wait for the perfect roadmap, the project will never get off the ground. Complex implementations such as ambulatory EHR solutions leave users feeling like overwhelmed. Likewise, data intensive accountable care models are complicated and not fully defined, requiring a lot of discovery and invention along the way. There is no linear path; missteps and rabbit trails will be the norm, not the exception. Many consulting firms and health system IT departments have assembled EHR optimization teams that follow implementation by 90 or more days, and work to improve processes of adoption after everything has settled. Technology optimization initiatives that involve a systematic plan of reviewing and responding to performance metrics should be widely used.

Seasoned veterans know that the devil is in the details when it comes to applying IT solutions to the complex issues of health care. Sometimes the biggest challenge is getting the proper stakeholders to spell out objectives and play a key role in the execution of the project to ensure that they are met. If you are considering a new technology implementation or find yourself in the throws of adversity from a previous implementation, it’s not too late to revisit the project and align with the Triple Aim objectives.

Topics: healthcare consulting firm, Triple Aim, IT

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