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GE Healthcare Camden Group Insights Blog

Redefine Your Practice's Care Team to Promote Patient-Centered Care

Posted by Matthew Smith on May 20, 2016 11:13:16 AM

Article and video courtesy of MGMA.com

Patient-Centered Care“If we’re not making the patient the boss right now, someone else is going to get our business. It’s as simple as that,” said William Faber, MD, MA, MS, senior vice president, GE Healthcare Camden Group, who spoke about the changing patient relationship during the MGMA/AMA Collaborate in Practice conference, March 20-22, Colorado Springs, Colo.

Faber and Marc Mertz, MHA, FACMPE, MGMA member, vice president, GE Healthcare Camden Group, elaborated on the topic during an exclusive video interview with MGMA [video below].

“We’re reaching a crossroads,” Mertz says. “Historically, practices have been very physician-centric in the way they operate [from scheduling appointments to physical exams]. Yet patients are increasingly demanding greater access and more information to be engaged in their care.”

Responding to that new dynamic requires a fundamental shift in practice operations. “In the past, practices competed against other practices,” Mertz adds. “Now there are retail clinics, urgent care clinics and concierge medicine. Patients will go where they can get the type of care they want.”

Accommodating Patient Demands

Meeting patient needs might require expanded hours, technology that allows patients to schedule appointments, get test results and ask questions online and a care team approach to increase access.

“The main issue is teamwork,” Faber says. “The doctor cannot just look at him- or herself as the full answer to the patient’s needs.” The more realistic answer, which will boost sagging morale, is to create a network. “Work with social workers, retail clinics, urgent care centers and care managers to address these needs,” he suggests. “Taking care of patients now is more of a team sport.”

Encouraging Change

“We are still incentivized to fill the schedule with as many patients as we can,” Mertz says. “Until some of the financial reimbursement models change, I think it will be hard for people to change.”

However, making small adjustments can ease the growing burden on doctors, Faber explains.  For example, he suggests that groups “Participate in new compensation programs that reward doctors for that which only doctors can do,” which means assigning low-acuity patients to other team members.

Collaboration between physicians and administrative leaders (dyads) is key for success. “I think of it as a marriage,” Mertz says. “They’re both jointly responsible and accountable for all aspects of the practice,” which means that neither party should shirk responsibility for clinical aspects or practical pieces of the business. “It’s a true partnership.

“Physicians are ultimately responsible for the clinical care but practice administrators need to be there to push and to challenge, to bring new, innovative technology, new processes and procedures to the table,” Mertz adds.

One new process they recommend: Create a network of facilities that provide convenient access for your patients and consider that network as your care team. “The biggest impediment is the human tendency to stay with what always worked before, just keep doing the same old thing,” Faber explains. “We’re practicing medicine as though it stayed stagnant in the 1970s or ’80s, and everything [has] changed around us.”

Watch more of the interview:

Webinar, Patient Experience, Patient Satisfaction

Topics: William K. Faber MD, Patient Access, Marc Mertz, Care Model, Care Delivery, Patient-Centered Care

9 Ways to 'Activate' Patient Engagement

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

By William K. Faber, M.D., Senior Vice President, GE Healthcare Camden Group

engagement.jpgNew 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


Dr. Faber is a senior vice president with GE Healthcare Camden Group. As a physician executive, Dr. Faber specializes in the development of clinically integrated networks, accountable care organizations, physician engagement programs, governance, population health management, and health information technology. Over the past three years, Dr. Faber has been instrumental in the establishment of six new clinically integrated networks, including their quality and care management programs and health information integration strategy. He currently supports two of those organizations as Interim Medical Director. He may be reached at william.faber@ge.com.

Topics: Population Health, William K. Faber MD, Patient Engagement, Patient Activation

Clinical Integration: There Will Be Winners and Losers

Posted by Matthew Smith on Feb 8, 2016 1:13:28 PM

By William Faber, M.D., Senior Vice President, GE Healthcare Camden Group

Clinical IntegrationDue to increasing deductibles and our improving ability to care for conditions in outpatient settings, hospital admissions have declined consistently over the past few years, and industry experts do not expect this trend to reverse. In response, healthcare systems are investing millions of dollars in acquiring physician practices and affiliating with independent physicians through clinically integrated networks in an attempt to enlarge their patient base. Though clinically integrated networks do enlarge the patient base, one of their aims is also to reduce the percentage of admissions from that base.

There is hardly a healthcare system in a competitive market in the U.S. that is not pursuing some form of clinical integration strategy, and competition is being felt in more and more communities. Healthcare leaders know our society is headed towards payment-for-value and away from fee-for-service payment, and they do not want to be found without a competitive value-oriented structure.

Leaders should not assume, however, that just because they invest in clinical integration that their patient bases will be adequately enlarged to keep their hospitals filled. Their competitors are also spending millions on clinical integration strategies in hopes of enlarging their bases! The base does not automatically enlarge because an investment is made. Ultimately, there will be winners and losers.

More Than a Marketing Strategy

Winners will tend to get their fully functional clinically integrated network to market quicker than their competitors and ultimately, winners must create networks that perform better than those of competitors. Specifically, they will do a better job than competitors at controlling the cost of care and demonstrating higher quality and service. The creation of a clinically integrated network must not be just a marketing or physician alignment strategy – it must truly enable effective population health management.

As quality, cost and service information on healthcare providers becomes more readily available, individual consumers and employers will choose networks that provide greater value. Competition will put pressure on under-performers. Some systems that have invested in clinical integration will go out of business or be acquired by more successful systems, which in turn will downsize or divest those facilities.

Physician Competition Heats Up

Likewise, competition among physicians will heat up as consumers have more data upon which to make educated choices. Again, there will be winners and losers. Physicians who chose to not join narrow networks will lose access to patients. If there is an over supply of certain specialists in a certain geography, those who have poorer access, service or quality outcomes will get fewer referrals than others.

We like to think that no healthcare facility or provider should be forced to change or go out of business. We like to think that all of us can grow our patient bases to sustain our hospitals. We often act as if just the right number of facilities was built in a geographic area and that just the right number of physicians decided to go into each specialty. But we know at the macroeconomic level that none of this is true. Informed consumers will give us incentive to change, and some will win through effectively managing change, and some will lose by ignoring reality.


will_faber.png

Dr. Faber is a senior vice president with GE Healthcare Camden Group. As a physician executive, Dr. Faber specializes in the development of Clinically Integrated Networks and ACOs, physician engagement and governance, population health management, and health information technology. Dr. Faber has recently been instrumental in the establishment of six new Clinically Integrated Networks and the development of their quality and care management programs and health information integration strategy, later supporting two of those organizations as Interim Medical Director. He may be reached at william.faber@ge.com or 312-775-1703.

Topics: Clinical Integration, William K. Faber MD, Clinically Integrated Networks

Clinical Integration Via Strategic Physician Engagement: 7 Approaches

Posted by Matthew Smith on Jan 26, 2016 3:19:40 PM

By William K. Faber, M.D., Senior Vice President, GE Healthcare Camden Group

physician_engagement.jpgNew 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 approaches 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.


Dr. Faber is a senior vice president with GE Healthcare Camden Group. As a physician executive, Dr. Faber specializes in the development of Clinically Integrated Networks and ACOs, physician engagement and governance, population health management, and health information technology. Dr. Faber has recently been instrumental in the establishment of six new Clinically Integrated Networks and the development of their quality and care management programs and health information integration strategy, later supporting two of those organizations as Interim Medical Director. He may be reached at wfaber@thecamdengroup.com or 312-775-1703.

Topics: Clinical Integration, William K. Faber MD, Clinically Integrated Networks, Physician Engagement

Best of 2015: Six Benefits System Execs Can Achieve Via Clinical Integration

Posted by Matthew Smith on Dec 29, 2015 10:37:54 AM

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

clinically integrated careLeading into the new year, GE Healthcare Camden Group will be re-publishing the most shared and popular blog posts of 2015.

What’s in it for me? That’s a question systems should ask--and answer--before taking on the challenges of forming a clinical integration program or becoming an accountable care organization. Failure to create a shared vision, and an informed commitment to that vision despite all obstacles and concerns, can easily derail change management initiatives down the road. It is important to identify likely concerns and objections, and formally articulate a response to them, early on in the planning process.

Some of the most common concerns we’ve heard from system executives are one or more of the following:

  1. Why change at all?  Fee-for-service is still working for us in this market. In fact, our entire business model is predicated upon it. Specifically, the Medicare penalties for excess rates of readmissions – an early area of focus for many Accountable Care Organizations ("ACOs") - are a just a small “cost of doing business” compared to the potential lost revenue from commercial insurers if we really improved in this area.
  2. Why change now?  We’ve been told before that “the end is near” and that we have to change. Those predictions did not come true then, so why should I believe they’ll come true now?  In particular, what happens to ACOs and shared savings-type contracts once all the savings have been wrung out?
  3. Can we afford it?  How much will it cost, and for how long will we have to subsidize the program?  We have a lot of competing demands for dollars.
  4. What’s the ROI?  Traditional financial models struggle to find a reasonable return on investment. In fact, some show material losses.
  5. Do we have to partner with “community” physicians to do this?  Many systems have invested heavily in physician employment. Some are struggling to integrate them or to see demonstrably better quality as a result of these investments. Why spend more now with non-system employed physicians?

Here are some of the more common responses to physician concerns:

  1. Better Care for Patients: The investments the network will make in information technologies, care coordination, performance feedback and other initiatives can drastically improve outcomes for patients. It has been demonstrated by other successful clinical integration programs. The vision statement for most every healthcare system talks to the preeminence of caring for the patient. Clinical integration and accountable care structures allow systems to reach whole new levels of quality, value and care.
  2. Responsive to Market Demands: The sheer number of ACOs – both Medicare and commercial – that have emerged in just the past year or so is the best evidence that value-based payment arrangements are in demand. More and more insurers are moving to narrow network products too, as employers have become more open to these kinds of models to help rein in their healthcare benefits expense.
  3. Avoid Risks of Non-Participation: A common characteristic of ACO and shared savings-type contract arrangements is that network physicians – or at least primary care physicians – can only be listed in one ACO in the market. Furthermore, commercial insurers are moving more and more into narrow network products that only contract with organized networks of physicians – primary care and specialists. Few systems are able to employ enough physicians to satisfy the network requirements of even the narrowest of these networks. As more and more organizations are forming ACOs, and as narrow networks are increasingly introduced to markets, systems face increasing risk of being “left out in the cold” as markets mature around them.
  4. Upside Payment Potential: Reductions to “unit price” fee schedules by both Medicare and commercial insurers are widely anticipated. Participation in value-based payment models offer systems some opportunity to access additional payment streams from various “value based” contracting forms that are recently or will shortly be emerging.
  5. The Program Can Increase My Business: One of the concerns commonly expressed by system executives is that greater access to primary care services, care coordination and the creation of other efficiencies – typical areas of focus for ACOs – will cut into traditional hospital “profit centers” such as longer than necessary lengths of stay, excessive Level 1 and 2 ER visits, avoidable readmissions, etc. Appropriately designed, there are many ways in which programs can help direct care “in network” to ensure quality- and efficiency-enhancing protocols are followed. Furthermore, many healthcare systems are now contracting with their own clinical integration programs for the health benefits of their employees. Savings realized by more efficient care management of system employees and family members can represent a significant offset to other lost or diminished sources of revenue.
  6. Our Prospects Are Better Together: There are those systems that think they could participate as effectively in value based payment models by themselves or with just their employed base of physicians. There are certain areas of value creation that can only be achieved through close working relationship with a broad base of physicians in specialties and geographic locations beyond those in which they have employed physicians.
Clinical Integration Networks, CIN, Daniel J. Marino

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

Topics: Clinical Integration, William K. Faber MD, Clinically Integrated Care, Clinically Integrated Networks

Patient Access Innovations: Integrating Patients Within the System of Care

Posted by Matthew Smith on Dec 1, 2015 3:21:44 PM

As the nation's healthcare system continues to be reshaped by the forces of reform, increased patient engagement will emerge as a defining outcome of this profound transformation. 

Networks, Patient AccessProvider coordination is of paramount importance for healthcare organizations preparing for the industry’s shift in focus from volume to value. The most ambitious coordination model that has been developed to date is the clinically integrated network ("CIN")—a contractual collaboration among hospitals, physicians, and other providers to manage patients across the entire continuum of care. A CIN uses population health management tools, including care management techniques, to build value through improving patient outcomes and controlling costs. This innovative model offers providers access to value-based payment contracts and an opportunity to improve quality and reduce costs.

Despite the compelling benefits of clinical integration, this approach also poses risks. Value-based payment contracts hold CIN participants accountable for both clinical and financial outcomes, although the ability to influence these outcomes depends largely on patient choice and patient compliance. Whenever a patient leaves the CIN, even if the patient returns to the network for certain services, network providers lose the opportunity to fully manage the patient’s care and utilization, ultimately undercutting their ability to coordinate the patient’s care and accrue the benefits of improved clinical outcomes and reduced costs.

This risk makes it critically important for CINs to keep patients within their organized systems of care. CINs need to make sure patients can access the network easily and are motivated to stay connected, requiring a strategic focus on patient access and engagement.

Based on the experiences of leading CINs, strategies aimed at improving patient access tend to be most effective when they are focused on three primary objectives: expanding entry points to the network, making access more convenient and inexpensive, and keeping patients engaged in the care they receive from network providers. The following five strategies, in particular, have been proven effective for ensuring in-network access and strengthening patient engagement.

To read the rest of this article in its entirety, please click the button below to immediately access the article on the hfm magazine site:

  Patient Access, Clinically Integrated Networks

Topics: Clinical Integration, William K. Faber MD, Clinically Integrated Networks, Patient Access, Patient Engagement, Daniel J. Marino, Value-Based Payments

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

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

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

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

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

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

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

Here are nine key approaches to patient “activation”:

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

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

2. Encourage Patients to Monitor their Own Conditions

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

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

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

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

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

5. Consider Group Visits

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

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

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

7. Use In-Office Instructional Videos

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

8. Create an Interactive Website

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

9. Convey an Openness to Questions and Support Initiative

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


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

 

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

Advanced Access: a Winning Approach for Patients, Providers, and Staff

Posted by Matthew Smith on Oct 5, 2015 3:14:13 PM

By Mary Witt, MSW, Senior Vice President, and William K. Faber, M.D., Vice President, The Camden Group

Advanced AccessAccess to the right medical care at the right time in the right setting improves patient satisfaction. It also attracts new patients, retains existing patients, supports safety, improves outcomes, and reduces cost. So why do so many medical practices still struggle to provide adequate access to achieve these goals?Traditional approaches to improving access have focused on:

  • Recruitment--which may be costly, impossible, or too much of a long-term challenge
  • Partnering with urgent care centers or retail clinics which do not facilitate continuity or an ongoing relationship with your medical practice
  • Managing demand through triage, which has only led to greater patient dis-satisfaction
  • Holding a fixed number of appointments for patients (which are never the right number) needing to be seen the day they call, often called "carve-out scheduling"

Under any of these approaches, physicians and staff struggle to meet the needs of today, as well as those of patients who have waited days or weeks for appointment.

Access may be improved significantly through practice optimization, and by employing the principles of advanced access. Advanced access is appointment availability that reflects the real-time demand of patients and, therefore, reduces or eliminates queuing. It is a philosophy that focuses on “doing today’s work today.” However, it is more than just changing the schedule. It is an innovative way of thinking about patient care. It emphasizes improvement of the total care experience, from the initial telephone call to follow-up care. Advanced access works because it predicts demand and then focuses on maximizing daily capacity so that daily demand can be met. It also does not occur in a vacuum. It requires that the processes in a practice be reviewed and often modified. 

Here are five tried and true principles:

1. Understand Your Demand and Capacity

It is well known that Monday is always the day of highest demand for primary care providers (or Tuesday after a three-day weekend). Tuesday often has the second greatest demand, and demand on Wednesday through Friday is about equal. Most patients would appreciate some early evening and weekend availability too. We also know that winter flu season is the busiest time of year and that if a practice performs school physicals, July and August will have greater demand.

Does your provider capacity match patient demand?  Do you maximize provider availability for your high-demand hours?  You may find that you have too many physicians working mid-day Thursday and not enough on Monday morning. Talk with your providers about the mismatch of appointment availability to the known hours of patient demand. Let them work out a fair distribution within the parameters you give them. Most of the redistribution can often be accomplished voluntarily. Provider vacations can be managed to minimize coverage holes at times of greatest demand.

2. Decrease Appointment Types

Much inefficiency and unnecessary queuing results from the creation of too many appointment types. Many systems try to handle demand by creating more appointment types to “manage” the schedule, but that has only created additional complexity and limited appointment availability. Best practice is to reduce appoint types to two: a short and a long (with the long being twice the length of a short). You may decide to have 15 and 30-minute appointments or 20 and 40-minute appointments for instance. Relegate all patient needs to one of the two. This gives your scheduler much more flexibility to get patients in. Also, if you know that a certain patient always runs over, give them a longer appointment.

3. Manage Your Daily Appointment Inventory

Many providers clog up all their future appointment availability for those who are acutely ill by unnecessarily scheduling follow-up appointments. A protocol change, for instance, of seeing patients for blood pressure checks every quarter instead of every other month immediately creates capacity. The same is true for diabetics or anyone with a chronic disease. Of course, different patients need to be seen on different intervals due to the severity of their disease or their compliance with treatment. The point is to be mindful of that need rather than rescheduling routinely in a pattern that limits future availability.

Use a morning and afternoon huddle with your medical assistant to review the schedule and plan for the day. Identify patients whose needs could be met by a phone call to free up space on the schedule. If someone being seen today has a future appointment, take care of both issues during the first appointment if possible.

4. Create Contingency Plans

Create provider care teams to ensure that vacations, sick time and temporary absences do not significantly impact same-day appointments. Proactively develop plans to handle peak demand such as flu season and school physicals.

5. Measure and Monitor Access on an Ongoing Basis

Unless access is routinely measured (third available appointment), it is easy to fall into old habits and slip into postponing work until tomorrow. When contingency plans are implemented, they need to be monitored to identify what is working and what is not so that problems can be quickly identified and resolved before backlog creep occurs.

Advanced Access Is Win-Win

Everyone wins with advanced access: patients, physicians, staff, and management by:

  • Increasing patient satisfaction
  • Improving clinical outcomes for patients through better continuity of care (patients now see their own doctor) and greater emphasis on prevention
  • Enhancing quality of practice life for physicians and staff
  • Increasing efficiency in patient flow
    • Fewer no shows
    • Less phone calls
    • Minimizes re-work
  • Decreasing costs through decline in ER and urgent care visits
  • Potentially increasing in net revenue
    • More new patients
    • Ability to do more for patient through max-packing
AccuTracker, Workflows

Ms. Witt is a senior vice president with The Camden Group and has over 25 years of healthcare experience. She has held management positions in hospitals, health systems, and management services organizations (MSOs). She has extensive experience in medical group and integrated delivery system development and management. This includes developing patient-centered medical homes, practice management, performance improvement, physician compensation, managed care, strategic planning, healthcare marketing, and physician recruitment. She may be reached at mwitt@thecamdengroup.com or 424-201-3971.

 

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

 

Topics: William K. Faber MD, Mary Witt, Medical Group Efficiency, AccuTracker, Advanced Access, Medical Group Transformation

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

FAQ, Clinically Integrated NetworkWhile 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 a senior vice president with The 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 or 312-775-1701.

 

 

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

 

Topics: Population Health, William K. Faber MD, 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

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

Physician Engagement, The Camden GroupNew 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.


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

 

Topics: Clinical Integration, Population Health, William K. Faber MD, Physician Engagement, Governance, Care Coordination

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