Readers Write: Maximizing Patient Engagement Amid Resource Limitations

Maximizing Patient Engagement Amid Resource Limitations
By Devin Gross

In today’s rapidly evolving healthcare environment, new reform measures and emerging payment models have put a focus on delivering positive health outcomes and high-quality healthcare, while containing costs. These new demands can only be fully achieved when healthcare organizations and physicians actively – and successfully – engage patients in their care. This requires organizations to extend the reach of their clinicians beyond the clinical setting to drive enhanced relationships with patients that generate stronger engagement.

This poses a significant challenge for independent practices as, historically, reimbursement models have not been optimized for them, nor are these groups fully equipped to engage patients beyond episodic visits. Traditionally, reimbursement for physician practices has been tied to episodic care, with little incentive to collaborate or activate patients in care decisions. These newly introduced value-based payment programs are requiring a change in care delivery for maximum reimbursement and encouraging a more coordinated care effort across patient populations. This additional step serves as an added hurdle for physician practices, which are navigating these complex requirements while facing significant bandwidth issues generated by consolidation pressures and resource constraints.

While physician practices are facing numerous challenges, they must consider new approaches to drive quality outcomes, and effectively treat and engage patients. These methods go beyond employing a larger staff to reach populations, which can be a significant undertaking. Technology can serve as a powerful tool to help extend the reach of physician practices in an effective engagement strategy. Developing and implementing an engagement strategy requires a thoughtful methodology. Before deploying a new strategy, there are three things every practice should consider:

1. An engagement strategy must fit within the current workflow and culture, and align with the organization’s business priorities. If a strategy does not seamlessly fit into the organization, it will not be supported by the stakeholders expected to adopt it. Thoughtful planning and deployment is required for success.
2. An engagement strategy must address patient needs. Patient engagement initiatives must be delivered to patients at the right place and right time, but also be designed to create an emotional connection that cultivates and extends the patient-provider conversation. Technology can support this. But, technology that fails to mimic human interaction and is designed without an empathetic approach to communication and content will not be successful in strengthening the physician’s relationship with the patient.
3. Measurement is key. It is important to establish goals and regularly measure progress. Understanding what is not working is as critical as understanding what is, so necessary refinements can be made. This intel can only be gained by consistently evaluating the efficacy of an engagement strategy.

While the race to implement a patient engagement strategy can be seen as an uphill battle, technology can play a significant role in overcoming barriers. Practices are typically built to support episodic patient visits. But the transition to value-based care requires maintaining relationships beyond the clinical setting – an expensive task if poorly executed. This, coupled with limitations created by inadequate resources, increases the strain on physicians to manage these patient populations, making way for technology to deliver on its promise.

Patient engagement isn’t easy, and pressure will continue to mount for practices to engage patients in the management of their own care. Extending the clinician’s reach and, ultimately, the relationship with the patient beyond the four walls of the clinical setting, is necessary to successfully engage patients that generate optimal reimbursement as financial models continue to emerge and evolve. The need for technology will be driven by resource constraints on independent practices hoping to survive amidst the changes. The potential value of technology is great – and practices able to recognize that value and implement in a meaningful way will not only be able to drive improved clinical outcomes, but also address key business problems impacting reimbursement.

Devin Gross is CEO of Emmi Solutions in Chicago.

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News 1/9/17

Top News

UnitedHealth’s Optum health services company acquires ambulatory surgery provider Surgical Care Affiliates in a $2.3 billion deal. SCA, which operates 205 facilities across 30 states, will combine with Optum’s OptumCare primary and urgent care delivery services business. SCA CEO Andrew Hayek believes the deal will “enable us to better support and empower independent physicians, helping them provide high-quality care for their patients while making health care more affordable. The combination of SCA and OptumCare is another step forward toward our vision of becoming the partner of choice for surgeons.”

Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Jason Burum, chief client officer, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

Announcements and Implementations

Privia Health’s Gulf Coast network doubles thanks to the addition of 125 physicians over the last six months. The practice management company, which launched the Houston-based network late 2015, works with 1,400 providers in six states via its network of medical groups.

People

Spurred by an unspecified amount of financing from Kinderhook Industries, Stratus Video appoints Mark Knudsen (CareCloud) VP of product innovation and AnnaMaria Turano as VP of marketing for its new Telehealth division.

Telemedicine

SnapMD closes $3.25 million in Series A financing, bringing its total raised to $9.15 million since getting off the ground in 2013. CEO Dave Skibinski has three goals in mind for the new funding. “First, to continue to add innovative features to our Virtual Care Management Platform to better meet the clinical needs of the medical community,” he explains. “Second, support our numerous channels partners, especially Konica Minolta and Athenahealth to accelerate sales. Third, to continue to raise awareness of our approach to telemedicine and our Virtual Care Management platform.”

Teladoc, which recently celebrated its 2 millionth visit, adds lab testing services from Analyte Health to its virtual consult capabilities. Physicians in the Teladoc network will now be able to order lab tests and review results through the company’s telemedicine technology. Patients will be sent to an offsite location for testing. Both companies envision making these services available in a single day via upgraded mobile capabilities.

The Lewisville, TX-based company reports preliminary 2016 results: $123 million in revenue – a 59-percent increase over 2015; and a 43-percent increase in year-over-year membership, amounting to 17.5 million users.

Government and Politics

HHS Secretary Sylvia Burwell looks back on her two-and-a-half-year tenure with what seems to be a mix of satisfaction and frustration, given the incoming administration’s predicted efforts to repeal and replace the ACA (a phrase she refers to as a “campaign slogan.”) She includes open enrollment as one of her biggest challenges as secretary: “One of the biggest issues is that there are always a number of serious challenges at the same time. When I came to the department, I needed to make decisions on technology for the next Affordable Care Act open enrollment, on issues related to the unaccompanied children crossing the border from Central America and the Ebola crisis. There were other pressing issues, such as how to deal with growing opioid abuse. The department’s jurisdiction is so broad and the challenges come all at once.” Fun fact: National Security Advisor Susan Rice was Burwell’s basketball coach at Oregon University, and indirectly helped Burwell meet her future husband.

OCR decides not to sanction Senator Siobhan Dunnavant, MD (R-VA) for a HIPAA violation related to a letter for political support sent to patients during her 2015 campaign. The sharing of patient contact information with her campaign team, though found to be “impermissible” under HIPAA law, did not result in a fine because the former Ob/Gyn took immediate action to ameliorate the situation. Dunnavant claims she cleared the letter, which was intended to notify patients that her run for office would not affect their care, with her medical practice board and lawyers.

Research and Innovation

A survey of 2,223 adults finds that 19 percent have visited a retail clinic in the last month. I’m a bit surprised that the number isn’t higher given how ubiquitous they’ve become. It would be interesting to ask those who hadn’t if they opted for telemedicine services instead. Good news for retailers: Fifty-three percent of visitors purchased a product before or after their clinic visit.

Other

NPR looks at the role EHRs are beginning to play in using aggregated data to customize patient care. It highlights the data mining Kaiser Permanente clinicians often do to help patients better understand how others going through the same treatments are faring (a concept that sounds very similar to that of ASCO’s CancerLinq). Genetic testing could be the key to taking this type of precision medicine one step further. “Medicine’s got to catch up, and medicine’s got to understand how best to take advantage of all the information that’s been generated every day,” says Yale University Professor Harlan Krumholz, MD. “The quality of data [collected in medical records] is not necessarily research quality.”

This story highlights the ways in which public libraries are adapting to meet the healthcare needs of their patrons. The Philadelphia Free Library, for example added a pediatric and primary care clinic on its top floors last year as part of its transition to the South Philadelphia Community Health and Literacy Center. Arizona’s Pima County library system has teamed with the health department to have employed nurses make rounds throughout its 27 branches – a move that has resulted in the library substantially reducing its 911 calls made for behavioral issues.

Surely there’s a Hallmark card for this: The Iphone celebrates its 10th anniversary amidst declining sales and a corresponding 15-percent pay cut for CEO Tim Cook (who still takes home $8.7 million). Honestly I think just about every healthcare IT startup out there should have a party in honor of the device, given its impact on the industry at large and, on a more granular level, the power it has given to the patients who want it.

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Population Health Management Weekly Wrap Up 1/8/16

The University of Maryland Medical System appoints Stacy Garrett-Ray, MD (VA) president of the University of Maryland Quality Care Network and vice president/medical director of the UMMS population health services organization.

Self-service health kiosk vendor Pursuant Health closes a a $12.8 million Series A round of financing. The Atlanta-based company (fka Solo Health) will use the investment to expand its offerings to include texting, mobile, and incentive management capabilities. It has established several high-profile wellness programs and partnerships over the last year with organizations including the American Diabetes Association and Anthem Blue Cross and Blue Shield.

Dallas-based Christus Health expands its relationship with Phillips, adding the company’s somewhat newly acquired Wellcentive population health management capabilities across its 50 hospitals and 175 clinics. The health system will also use technology to better manage the health plans it offers its employees and the public via state-based exchanges.

Glendale, CA-based Apollo Medical Holdings merges with Alhambra, CA-based Network Medical Management to become one of the country’s “largest integrated population health management companies.” The newly combined company, which will operate under the Apollo name, will provide medical management services for 700,000 patients through its 3,000 clinicians and 400 employees. NMM CEO Thomas Lam, MD will join APM CEO Warren Hosseinion as co-CEO of the new company.

Caradigm enhances its population health management solutions to support MACRA and bundled payments, adding Care Bundles, Content Builder, MACRA solutions, Advanced Computation Engine, and Utilization and Financial Analytics.

University of Missouri Health Care implements Cerner’s HealtheIntent population health management across the Health Network of Missouri’s,six facilities, each of which uses a different EHR. The network serves predominantly rural patient populations through the sharing of health data and best practices.

Vicky Ann Ducworth (The Boeing Company) joins EQHealth Solutions as SVP of government operations.

Sponsor Updates

• What your health IT peers found interesting in 2016 (Nordic Consulting)
• How Front-End Speech Can Assist the Pathology Workflow (NVoq)
• Healthcare is Ripe for Tools to Enable Value-based Collaborative Care (PerfectServe)

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Jenn, Mr. H, Lorre

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News 1/5/17

Top News

Arcadia Healthcare Solutions lands $30 million in growth capital led by investments from GE Ventures and the Merck Global Health Innovation Fund. The Boston-based company, which has raised a total of $43 million since launching in 2011, will use the financing to further develop its analytics offerings for providers and payers, and to grow its population health management presence across the country. It acquired EHR support services company Concordant in 2011, and managed care services firm Sage Technologies in 2015.

Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Charlotte Brien, MBA, solutions consultant, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

Announcements and Implementations

Mutare Health upgrades its Vital Link secure messaging technology to include voicemail replacement capabilities. Voicemails can now be recorded, converted, and delivered to physicians via Instant Message, email, or text.

Ingenious Med develops a charge-capture app specifically for physician practices that also includes secure messaging, management reports, and dashboards.

People

The California-based Central Coast Medical Association appoints primary care internist David Dodson, MD president of its 2017 Board of Directors.

JC Muyl (Medivo) joins payer-focused behavioral telehealth company AbleTo as SVP of operations.

Laura Hobbs (Bausch & Lomb) joins patient registration kiosk company Clearwave as director of sales.

Government and Politics

New York lawmakers pass legislation giving physicians the ability to access the health data of patients between 10 and 17 through the state’s HealtheLink HIE. Parents must sign a consent form giving physicians permission. Though the new law will help make pediatric medical records more accessible, HealtheLink Executive Director Dan Porreca stresses that, “Participating providers need to be aware that it is possible that the minor patient’s record may contain sensitive information that is protected under New York state law and may not be re-disclosed to the minor’s parent or guardian without the minor’s written consent.” Such information could pertain to mental health or substance abuse treatment, reproductive health services, or STD treatment.

Telemedicine

White-label telemedicine vendor SnapMD joins Athenahealth’s More Disruption Please program. Athenahealth will incorporate the company’s Virtual Care Management software into its EHR and RCM products.

The Indiana Rural Health Association facilitates the launch of three school-based telemedicine clinics in Austin, Crothersville, and Southwestern Jefferson County. The program has avoided outsourcing clinical expertise thanks to employed nurses and specially trained teachers and secretaries. IRHA plans to open clinics in five more school systems by the end of the year. The association is particularly focused on launching the clinics in rural and underserved areas. As I briefly mentioned in yesterday’s post, Indiana does not yet offer Medicaid reimbursement for such visits.

Other

Family physician Henry Hochberg, MD laments the demise of the small, independent practice and the resultant lack of patient-provider relationship-building that such offices can typically provide:

“The reality is that medicine has become largely corporate and depersonalized. The office visit must be recorded electronically, often right in front of the patient. Metrics rule the day. Physicians now get paid and evaluated by codes. There are diagnosis codes, procedure codes and, to a certain extent, ‘time spent’ codes. We can be as precise as coding for a patient who was ‘sucked into a jet engine’ (V97.33X) or suffered from ‘water skis on fire’ (V91.07XA)!

But there is no diagnosis code for ‘loss of eye twinkle.’ And no time code for ‘needing to be heard.’ So, will you miss us when we’re gone? There may come a time in the future when you wave a Bluetooth device over your body, get a diagnosis on your computer and a drone drops a fix at your door. But who will listen to Ms. Smith?”

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Jenn, Mr. H, Lorre

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Readers Write: Steady Sailing for the Future of Value-based Care

Steady Sailing for the Future of Value-based Care
By Joe Guerriero

Changes are coming for healthcare reform—that is a certainty under President-elect Trump’s incoming administration. However, while some aspects of current legislation may be in question, the future of value-based care remains secure.

The reality is that the accountable care movement has experienced notable growth, and demand for value-based care is not going away. Consider recent statistics published by CMS. The number of ACOs participating in the Medicare Shared Savings Program (MSSP) grew from 200 in 2013 to 432 in 2016, now representing nearly 7.8 million beneficiaries. More importantly, early indicators reveal that value-based models work. Average quality measures by MSSP program participants improved by more than 15 percent between 2014 and 2015, and 31 percent generated savings above their minimum rate in 2015.

For many industry stakeholders, the big questions are: “Will the ACA be repealed?” and “How will changes impact current value-based care models?” By all accounts, eliminating every piece of the legislation is unlikely, and the more probable scenario involves keeping what is popular with voters as well as the most effective measures, and tossing the rest.

To date, President-elect Trump has consistently advocated price transparency and greater consumer empowerment in healthcare. As such, cost management and clinical outcomes are expected to remain a focal point of his administration. That means providers must continue preparing for the future of value-based care by leveraging evidence-based tools that deliver the most effective, cost-efficient clinical guidance.

What to Expect Going Forward

While no crystal ball exists that will foretell the future of value-based care, the Trump administration’s agenda will likely pursue a less-regulated approach to alternative payment models. In addition, Trump’s previous policy statements and the cabinet he is assembling suggest that bundled payment expansion and Medicaid reform may take precedence over MSSPs and ACOs. Meanwhile, providers can expect increased scrutiny of the Center for Medicare and Medicaid Innovation, the arm of CMS that is responsible for assessing the viability of innovative payment and care delivery models. Current political and industry criticism of the program could lead to congressional pursuit of more control, and many insiders expect at least some changes that increase oversight of payment reform decisions.

While the face of value-based care models may change, industry stakeholders — including the American Academy of Family Physicians — consistently assert that implementation of MACRA will continue. Now in effect, MACRA was not only overwhelmingly supported by Congress to address needed payment reform, but also ups the ante on participation in risk-bearing arrangements.

In truth, questions regarding how the new administration will view penalties versus incentives for quality performance are important to consider. While previous programs financially incentivized participation in quality reporting, MACRA is designed to penalize those slow to join the value-based movement. If this trend continues, the stakes for performance improvement will become increasingly heightened. To prepare, providers need to equip themselves with tools to support the efficient delivery of high-quality care. Evidence-based decision support platforms, for example, can help them design the most effective treatment plans in less time. In turn, they can avoid unnecessary care and hospitalizations that increase costs and reduce payment under MACRA and other value-based reimbursement models.

Advancing Evidence-Based Practice

The costly impact of unnecessary care and care variations is well documented, with some estimates pointing to between $158 billion and $226 billion in overtreatment alone, according to a Health Affairs 2012 Health Policy Brief. Recognizing this variation is critical. Providers are increasingly acknowledging the importance of reliable, evidence-based clinical decision support tools in reducing needless variation and increasing care standardization. These tools exist to help physicians and multi-disciplinary clinical teams more accurately and efficiently assess patients and target the most appropriate and effective interventions. Furthermore, clinically validated guidelines help physicians and patients set realistic recovery expectations, building stronger provider-patient partnerships and better overall patient engagement. The result is a faster and more cost-effective return to health.

When shared across the care continuum, point-of-care, evidence-based guidelines empower better care coordination by keeping clinical teams on the same page. Physicians have access to the same clinically validated treatment plans and can review recovery expectations, benchmark progress, and make needed adjustments. Ultimately, care delivery becomes more effective and efficient— the overriding goal of value-based care.

Value-based Care is Here to Stay

There is much hanging in the balance for the healthcare industry as 2017 ushers in a new president, administration, and Congress. In the face of uncertainty, providers can bank on two projections – changes are coming to the ACA and value-based care is here to stay. Thus, the logical response is to stay aware of evolving policy changes and continue preparations for value-based care — especially MACRA. Forward-looking providers are already on this path, recognizing the importance of standardized care and implementing the best evidence-based decision support tools at the point-of-care to guide providers toward higher-quality, cost-effective clinical decisions.

Joe Guerriero is senior vice president of Reed Group’s MDGuidelines in Westminster, CO.

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