Population Health Management Weekly Wrap Up 3/5/17

Palmetto Health Quality Collaborative goes live on Caradigm’s population health management solutions.

Casenet integrates its TruCare population health and care management solutions with MCG Health’s evidence-based guidelines to improve the prior authorization process.

Patrick Kennedy (PJ Consulting) and Janet Niles, RN (Timmaron Group) join HealthEC’s Board of Directors.

CDC publishes the 500 Cities Project, which allows visually comparing and downloading the prevalence of 27 chronic health condition measures between cities and down to the census tract level in a chosen city.

Netsmart extends its behavioral population health solutions to post-acute providers.

The nonprofit Central New York Care Collaborative will use IBM Watson’s Care Manager technology as part of a broader population health management program that aims to reduce ED visits and hospital readmissions by 25 percent. CNYCC works with over 170 organizations to coordinate and improve access to care for over 200,000 Medicaid beneficiaries and uninsured patients across six counties.

Cascade Health Alliance – one of 16 organizations in Oregon that manage benefits for Medicaid beneficiaries – selects population risk management analytics from Milliman.

The Bronx RHIO – part of New York’s statewide HIE – will implement data management and population health reporting tools from Imat Solutions.

Florida Blue Cross Blue Shield parent company GuideWell Mutual Holdings acquires Tempe, AZ-based PopHealthCare in an effort to formally expand into population health management. Terms of the deal were not disclosed. PHC will operate as an independent subsidiary, focusing on post-acute and in-home care for chronically ill patients and those with complex illnesses. Founded in 2005, PHC uses analytics to help payers identify and care for at-risk patients. PHC CEO Mike Tudeen has done stints at Inspiris, Healthways, and Optum. I assume he’ll stay on to smooth the transition.

Sponsor Updates

• Medicity launches Community Interchange, which creates a single, de-duplicated, and normalized CCD for hospitals.
• NVoq will exhibit at the CHA Rural Health and Hospitals Conference March 8-10 in Denver.

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Jenn, Mr. H, Lorre

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News 3/2/17

Top News

The Senate Finance Committee votes 13 to 12 to advance the nomination of Seema Verma for CMS administrator to a full Senate vote. “We need experienced and responsible leadership at the helm of our federal agencies and CMS is no exception,” said Chairman Orrin Hatch (R-Utah) after the vote was concluded. “The challenges plaguing both Medicare and Medicaid require a strong partnership between the administration and Congress to improve these programs and help enact the necessary reforms to ensure their solvency for future generations. Ms. Verma will help facilitate that partnership and as we work to repeal and replace Obamacare, she will play a vital role in realigning the focus on patient-centered solutions. I look forward to her nomination being considered by the full Senate.”

Webinars

March 9 (Thursday) 1:00 ET. “PAMA: The 2017 MPFS Final Rule.” Sponsored by National Decision Support Company. Presenter: Erin Lane, senior analyst, The Advisory Board Company. The Protecting Access to Medicare Act of 2014 instructed CMS to require physicians to consult with a qualified clinical decision support (CDS) mechanism that relies on established appropriate use criteria (AUC) when ordering certain imaging exams. Providers must report AUC interactions beginning January 1, 2018 to receive payment for Medicare Advanced Imaging studies, with the CDS recording a unique number. Outliers will be measured against a set of Priority Clinical Areas and interaction with the AUC. This webinar will review the requirements for Medicare Advanced Imaging compliance and will review how to ensure that CDS tools submit the information needed for reimbursement. 

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services. 

Acquisitions, Funding, Business, and Stock

Bedford, TX-based Quatris Health acquires Atlanta-based HealthSystems for an undisclosed sum. Both companies specialize in services, products, and software maintenance for GE Healthcare’s Centricity technology for physician practices. HealthSystems CEO Maurice Rosenbaum and COO Larry Stoumen invested in the transaction and will transition to the Quatris team.

Announcements and Implementations

Multi-location Abilene Diagnostic Clinic (TX) streamlines its disparate billing processes with the adoption of InstaMed’s OneBill solution.

Harrisonburg Emergency Physicians (VA) selects RCM technology and services from McKesson Business Performance Services.

In other McKesson news, Black Book has recognized the company’s IKnowMed EHR as the highest-ranked such product for oncologists and hematologists.

Oberd develops an online enrollment portal to help practices sign up for and implement its patient data collection software, including its MIPS Performance Dashboard.

Telemedicine

Salt Lake City-based PM and virtual consult company TruClinic acquires software integration startup Overl.ai in an effort to provide easier EHR integration and patient intake processes for its end users. Terms of the deal were not disclosed.

EWellness will release a patient-facing version of its Phzio remote physical therapy treatment app for use with its provider-facing Phzio Telehealth platform. The company will first roll out the app, which will help PTs monitor patient therapy in real time, to patients in California, New York, and Virginia. A nationwide roll out will follow three to six months after.

Government and Politics

A 69-page OIG audit of HHS cybersecurity practices finds that, while the department has improved – especially in the area of continuous monitoring and overall governance – there is still work to be done. Areas found lacking include identity and access management, risk management, incident response, security training, contingency planning, and contractor systems – all of which could “potentially compromise the confidentiality, integrity, and availability of HHS’ sensitive information and information systems.”

Research and Innovation

The Consumer Technology Association (organizer of the annual CES conference) believes healthcare is just three years away from reaching “critical mass” when it comes to physicians using patient-generated data from wearables. CTA bases its assumption on several market forces, including the increasing use of wearables in payer and employer health and wellness programs and the increasing willingness of patients to record and submit data via such devices thanks to incentives from the aforementioned programs. (Check out “Health IT Changes the Game for Workplace Wellness” for a a look at how several companies are using technology to improve employee health and their bottom lines.)  The association’s prediction may come true, but only if stakeholders can get past that pesky interoperability problem.

Other

Take a seat, Batman: Lego will introduce a set of figures based on pioneering female NASA scientists, including computer scientist Katherine Hamilton (depicted in the film Hidden Figures), astronaut Mae Jemison, MD astronomer Nancy Grace Roman, and the late astronaut Sally Ride. MIT News editor Maia Weinstock suggested the idea through Lego’s Ideas program and eventually beat out 11 other entries with 10,000 votes.

Contacts

Jenn, Mr. H, Lorre

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From the Consultant’s Corner 3/2/17

Value-Based Reimbursement: Five Success Factors for Medical Groups

Despite uncertainty about the future of the ACA, value-based reimbursement will remain an unwavering reality in healthcare. While leaders may disagree over specific legislation, all approve the overall goal of value-based reimbursement, which is to encourage both cost reduction and improved patient outcomes.

That means medical groups should continue to explore value-based opportunities through commercial payers and CMS. For example, MACRA, which takes effect this year, consolidates previous programs including Meaningful Use, PQRS, and Value Based Modifier. Approved by a bi-partisan Congressional vote, MACRA is likely to stand as enacted and impact a significant portion of practice Medicare payments starting in 2019. Yet MACRA isn’t the only initiative designed to enhance revenue and patient care. Medical groups can also take advantage of programs such as Chronic Care Management, Transitional Care Management, Patient Centered Medical Home, and Bridges to Excellence.

No matter which value-based path a practice chooses, there are five factors that will be integral to success:

1. Patient engagement. Reports show that patients who are engaged in their care have better outcomes,[i] and most patients desire deeper involvement. So what’s the obstacle? Transparency. Medical groups will need to be more transparent about their services and costs to engage their patients.

2. Investments. Achieving transparency requires access to information. Practices need to invest not just in EHR and PM systems, but also in frequent training to expand their use. By now, most providers have an EHR; 78 percent of all office-based physicians and 96 percent of all non-federal hospitals had a certified EHR as of 2015.[ii] The key going forward is to optimize those systems and workflows to accomplish value-based objectives.

3. Data and analytics. Data truly is king. Creating appropriate data in EHR and PM systems — and then analyzing it through business intelligence software — enables practices to best evaluate the needs of their patients. Ensuring accurate ICD-10 coding, for instance, helps practices paint a more precise patient picture.

4. Population health. With data and analytics, practices can better identify gaps in care and the target those patient populations most in need of intervention. For example: The PQRS and MU quality measures that are now part of MACRA are also being used by many commercial payers. Obtaining this quality data at the point of care — rather than from retrospective reports — allows practices to effectively use resources to proactively engage patients and improve their care.

5. Practice performance/EHR workflow. Efficiency will continue to gain importance as value-based reimbursement models reward reduced costs and increased patient satisfaction. To fuel the kind of efficiency that lowers cost and makes patients happier, make sure providers are maximizing the EHR’s capabilities at the point of care.

Together Toward Value

While data, technology, and patient engagement will lay the foundation for value-based reimbursement, be careful not to overlook the importance of governance as well. More than ever before, practices must bring together their CMOs, CMIOs, CFOs, IT directors, and other organizational leadership to develop a unified value-based care strategy. Consider establishing a governing council to evaluate value-based opportunities, inform and train staff, and implement plans. Solidarity, communication, and attention to the five factors listed above will go a long way toward achieving a smooth transition to value-based reimbursement.

By Randall Shulkin, executive consultant, Culbert Healthcare Solutions

[i] Patient Engagement Report: Improved Engagement Leads to Better Outcomes, but Better Tools Are Needed; Insights Report; May 12, 2016; Kevin Volpp, MD, PhD & Namita S. Mohta, MD

[ii] Health IT Dashboard; The Office of the National Coordinator for Health Information Technology; January, 12, 2017

Contacts

Jenn, Mr. H, Lorre

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News 3/1/17

Top News

The Senate Finance Committee makes little headway in this morning’s confirmation proceedings for CMS Administrator nominee Seema Verma. With an equal number of ayes and noes, presumably along party lines, plus a number of absent committee members, chairman Orrin Hatch (R-UT) called for a recess with the intent to reconvene for a final vote later today. Verma’s nomination is expected to advance despite concerns about the conflicting hats she wore as both a government and vendor contractor while helping to expand Indiana’s Medicaid program.

HIStalk Practice Announcements and Requests

Welcome to new HIStalk Practice Gold Sponsor Saturn Care. The Conshohocken, PA-based company’s technology-enabled chronic disease management program helps primary care practices participate in programs like CPC+ and MACRA. CDMP features include a single-screen snapshot of EHR and patient-generated data, risk scoring, and decision-support and mobile patient engagement tools – all designed to fit within existing workflows. Co-founder and CEO Phil Heifetz also helped to found the Philadelphia Health IT Circle networking group, and served as president and CEO of medical imaging company EyeIC. Thanks to Saturn Care for supporting HIStalk Practice.

Webinars

March 9 (Thursday) 1:00 ET. “PAMA: The 2017 MPFS Final Rule.” Sponsored by National Decision Support Company. Presenter: Erin Lane, senior analyst, The Advisory Board Company. The Protecting Access to Medicare Act of 2014 instructed CMS to require physicians to consult with a qualified clinical decision support (CDS) mechanism that relies on established appropriate use criteria (AUC) when ordering certain imaging exams. Providers must report AUC interactions beginning January 1, 2018 to receive payment for Medicare Advanced Imaging studies, with the CDS recording a unique number. Outliers will be measured against a set of Priority Clinical Areas and interaction with the AUC. This webinar will review the requirements for Medicare Advanced Imaging compliance and will review how to ensure that CDS tools submit the information needed for reimbursement. 

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services. 

Announcements and Implementations

Athenahealth will partner with specialty medical societies on campaigns to help keep physicians abreast of new clinical guidelines, and to help them identify patients likely to be impacted by them. Initial messaging will focus on preventing medication safety risk during pregnancy, managing opioids and chronic conditions, and cholesterol treatment for cardiovascular patients.

Austin Regional Clinic (TX) adds evidence-based clinical guideline support from Wolters Kluwer to its Epic EHR. The multispecialty medical group cares for nearly half a million area residents at 21 locations in seven cities.

Meridian Medical Management adds Quippe Clinical Lens – a new point-of-care decision-support tool from Medicomp Systems – to its EHR.

Acquisitions, Funding, Business, and Stock

Bozeman, MT-based CrossTx brings its total funding to $1 million thanks to a $735,000 angel round led by Frontier Angel Fund 2. The company, which is working to develop cloud-based care coordination technology for PCPs and payers, will focus the investment on sales, development, and customer retention efforts. The city of Bozeman has developed quite a reputation for itself in tech circles, adopting the moniker of “Silicon Peaks” to reflect the startup culture it seems to be engendering. I can only assume that its cost of living is slightly more affordable than Silicon Valley, whose skyrocketing housing prices have forced its software engineers to seek housing further afield.

France-based medical device company Visiomed opens an office in Boston that will serve as the North American headquarters of its BeWellConnect subsidiary, which develops connected health devices for remote patient monitoring.

People

Sajid Ahmed (Martin Luther King, Jr. Community Hospital) joins the Safety Net Connect advisory board.

Outer Cape Health Services (MA) promotes Andrew Jorgensen, MD to CMO, effective May 1.

Government and Politics

The CMS Innovation Center asks for input on a draft pediatric care model concept, including what a pediatric ACO would like and ways to more effectively use health IT to better integrate Medicaid providers and other social services like CHIP. Comments are due March 28.

Telemedicine

Vigilias Telehealth rolls out Azalea Health’s EHR, PM, and RCM technologies to its 40 physicians caring for patients in the central and southwest US.

Research and Innovation

A CDW retrospective study looks at the evolution of patient engagement programs and technology. Findings include:

• Nearly 75 percent of patients have registered for a patient portal versus 45 percent in 2016.
• Eighty percent of providers are working to make PHRs easier to access, versus 67 percent. A similar percentage of patients would like easier access to their health records.
• Sixty-four percent of patients would, if possible, submit real-time health data to their providers. (No mention is made of whether providers would accept or act on the data.)
• Surprisingly, just 30 percent of patients believe telemedicine would help them to better engage in their care. Perhaps that’s because their providers either don’t understand it, can’t afford it, or haven’t yet looked into it. Only 9 percent of providers are “very comfortable” with the idea of virtual consults.

Sponsor Updates

• AdvancedMD will introduce a new dermatology practice model, Practice 2.0, at the ADAM/AAD meetings in Orlando this week and next.
• CommonWell TV interviews Aprima COO Neil Simon at HIMSS17.
• EClinicalWorks successfully deploys CommonWell services.

Blog Posts

• The Top 10 Reasons Transformation is the New Normal for Healthcare – Reason 7 (GE Healthcare)

Contacts

Jenn, Mr. H, Lorre

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News 2/28/17

Top News

CMS awards $20 million to 11 organizations as the initial part of its five-year program to provide free, in-the-trenches Quality Payment Program training and education to solo or small group practices. It will give out up to an additional $80 million over the four remaining years. The organizations include Altarum, Georgia Medical Care Foundation, Healthcentric Advisors, Health Services Advisory Group, IPRO, the Network for Regional Healthcare Improvement, QSource, Qualis, Quality Insights, Telligen, and the TMF Health Quality Institute. CMS has also launched a helpline – 1-866-288-8292 – for providers who need assistance with the program.

Webinars

March 9 (Thursday) 1:00 ET: “PAMA: The 2017 MPFS Final Rule.” Sponsored by National Decision Support Co. Presenter: Erin Lane, senior analyst, The Advisory Board Company. This webinar will offer a discussion on the implications of the Protecting Access to Medicare Act and steps to take to ensure compliance for the January 1, 2018 deadline. Attendees will also learn about CDS tools that can be implemented to ensure they have the information to submit for reimbursement.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

Announcements and Implementations

FirstApproved develops payment software that helps providers assess patient eligibility and determine up-front costs, plus links them with third-party financing when available.

Jacksonville Children’s & Multispecialty Clinic (NC) selects paperless billing technology from PatientPay, and integrates it with its NextGen PM software.

Southwest Diagnostic Imaging (AZ) implements NextGate’s EMPI and associated patient identity management solutions across its 33 centers in the greater Phoenix area.

People

Primary care management services business VillageMD appoints Ezekiel “Zeke” Emanuel, MD to its Board of Directors. It will be Emanuel’s first stint on a private-sector board. Fun facts: Emanuel, an oncologist and former advisor to the Obama administration, is the older brother of Chicago Mayor Rahm Emanuel and the newest correspondent for Fox News.

Benedikt Brueckle joins CompuGroup Medical US as CEO. Current CEO Werner Rodorff will continue in the role of CTO.

Acquisitions, Funding, Business, and Stock

Integra Connect formally launches to offer cloud-based technologies and services to oncology and urology groups, and EMS and life sciences organizations. The West Palm Beach, FL-based company is led by founder and former P4healthcare CEO Raj Mantena and former Healthagen CEO Charles Saunders, MD.

CitiusTech opens a technology center in Rochester, MN shortly after opening similar facilities in India and the UAE. It is the global healthcare technology and services company’s third US location.

Research and Innovation

A survey of 766 providers reveals that a third are thinking about moving to new payment models like direct primary or concierge care within the next three years. Top motivators for the impending change include the desire to spend more time with patients, improve work/life balance, and unshackle their practices from the administrative chains that bind them to payers. The grass isn’t always greener, though: Thirty-five percent of providers working at fee-for-service practices cite financial viability as their biggest challenge, while nearly 40 percent of direct primary care providers call patient recruitment their main hurdle.

Telemedicine

Teladoc integrates its app with Kinsa’s smart thermometer app as part of a broader effort to attract and retain large employer customers. The integration will enable users to import up to 10 days of temperature readings for physician review.

An Excellus BCBS telemedicine survey of 2,000 adults living in upstate New York finds that 25 percent plan to use telemedicine and 25 percent don’t, with the rest undecided. Those that have used telemedicine or plan to reported that an in-person visit is still their preferred method of care, followed by a telemedicine visit with their physician, trip to an urgent care center, and a virtual visit with a different provider. Interest in virtual visits seemed to decline with the age of the respondent. Excellus launched telemedicine visits via MDlive last month.

Contacts

Jenn, Mr. H, Lorre

More news: HIStalk, HIStalk Connect.

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