Readers Write: Population Health Management is Key to Value-Based Care

Population Health Management is Key to Value-Based Care
By Justin Lanning

A group of 35 C-level healthcare executives polled at the recent Midas+ Annual Symposium unanimously agreed that population health management is necessary as the U.S. shifts to more value-based healthcare reimbursement and delivery models.

The group of executives, which collectively represents over 80,000 beds from more than 480 hospitals, was asked to provide their perspective on population health management, starting with how it should be defined. We asked them to rank five components of a definition in order of significance.

According to this group, the most important requirements of a population health management program are that it “facilitates care across the health continuum” and that it “supports providing the highest quality of care at the lowest cost.”

What is population health? Definition components were ranked in the following order:

1. Facilitates care across the health continuum
2. Supports providing the highest quality of care at the lowest cost
3. Uses actionable insight for patient care based on a variety of data
4. Targets a specific population of individuals
5. Enables patient engagement

And healthcare executives today aren’t just talking about population health; they’re putting real emphasis behind it. Our survey found that providers are optimistic about the progress their organizations can make, with 65 percent stating they believe their organizations will deliver fully-scaled population health management programs within five years, while 16 percent report their organizations area already doing so. It makes sense – with providers compensated for successful health outcomes, it’s critical for them to focus on effective management of patient populations.

But as with any major shift in an industry, there are a number of barriers to successful implementation and adoption. Survey respondents indicated the number one challenge is data management and integration capabilities, followed by a lack of financial incentives, poor coordination across care providers and the ability to create meaningful data that provides actionable insights

Ninety-five percent of an extended network of over 150 healthcare staff polled at the symposium believes their role at their healthcare organization will be impacted by an increasing focus on value-based care within the next two years. But how will providers actually make that transition? It’s helpful to look at one example that illustrates how this can come to life:

An analysis of statewide historical hospitalization data in Hawaii revealed high rates of preventable admissions due to bacterial pneumonia. Statewide data showed a pneumonia vaccination rate of 61 percent for men age 65 or higher, and a vaccination rate among Filipinos age 65 or higher of just 51 percent – much lower than the Healthy People 2020 target of 90 percent set by HHS.

Studying geographic data, Hawaii hospitals identified neighborhoods with high bacterial pneumonia hospitalization rates and high Filipino populations across the state. One hospital initiated a plan to increase vaccination among those populations through targeted community benefit activities and increased efforts to vaccinate the managed care population. The estimated potential cost avoidance for Hawaii if the target of 90 percent is reached is over $1.8 million.

Clinical decision support tools that offer consumer insights and engagement opportunities can provide critical support for providers who are looking to better manage care coordination, patient engagement, and chronic diseases, which can be too complex for staff with limited time and resources to handle on their own.

In addition, these tools address data management challenges by predicting health outcomes and providing actionable ways for clinicians to intervene and improve individual care – stated by polled executives as the as the most important driver of population health.

However, providers need to choose a trusted technology partner with proven methodologies. Our discussions with the executives at the symposium reveal that they are taking a staged approach to population health by implementing programs for targeted populations and scaling as they show success.

Justin Lanning is senior vice president and managing director, Midas+, A Xerox Company.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 6/18/15

Top News

The House approves Bill H.R. 2570, which includes a clause that patient visits to ambulatory surgical centers will no longer be treated as patient encounters under the Meaningful Use program, and that physicians won’t be penalized for failing to fulfill MU requirements for those visits. The clause ends three years after a facility’s EHR is certified under the program.

Webinars

June 30 (Tuesday) 11:00 ET. “Value Based Reimbursement – Leveraging Data to Build a Successful Risk-based Strategy.” Sponsored by McKesson. Presenters: Michael Udwin, MD, executive director of physician engagement, McKesson; Jeb Dunkelberger, executive director of corporate partnerships, McKesson. Healthcare organizations are using empowered physician leadership and credible performance analysis to identify populations, stratify risk, drive physician engagement, and expose opportunities for optimized care. Attendees will learn best practices in laying a foundation for developing a successful risk-based strategy.

Acquisitions, Funding, Business, and Stock

Sikka Software raises $10.5 million in Series C funding led by OrbiMed, with participation from Sierra Ventures and ATA Ventures, both previous investors. The company, which specializes in cloud-based technologies for the hearing, vision, dental, and veterinary markets, will use the investment to ramp up sales and marketing initiatives.

Announcements and Implementations

Practice Fusion optimizes its EHR for Android- and iOS-based tablets.

ClinicMind introduces revenue cycle management software for mental healthcare practices.

PokitDok introduces an identity management system designed to identify, map, match, and merge patient data for more personalized care. The HL7-compliant API is compatible with a variety of EHRs including Greenway Health, Athenahealth, Allscripts, DrChrono, and OpenEpic.

Research and Innovation

An AHIMA, eHealth Initiative, and Greenway Health study on ICD-10 preparedness finds that the majority of respondents have been preparing for the transition, yet still lag behind in terms of internal and external testing. Physician practices have fallen far behind their hospital counterparts in overall prep work. Top physician challenges include clinical workflow and productivity, vendor readiness, competing healthcare IT priorities, lack of testing, and timelines.

A team from MIT develops a USB-powered mobile stethoscope and companion smartphone app to offer health workers a cost-effective way to diagnose lung disease.  The team will use its $100,000 prize from last month’s Vodafone’s Wireless Innovation Project to field test the device.

NIH researchers develop a “placenta-on-a-chip” to study the structure and function of the placenta, and model the transfer of nutrients from mother to baby. Researchers hope the new biomedical device will enhance studies of placental processes and disorders.

Telemedicine

The New England Telehealth Consortium connects its 300th facility, Sebasticook Family Doctors (ME), to the network. The consortium launched in 2007 after receiving a $24.6 million grant from the FCC’s Rural Health Care Pilot Program, and anticipates connecting an additional 25 facilities in the near future.

Government and Politics

The House Appropriations Committee votes to approve a fiscal year 2016 spending bill, giving ONC just $60 million and eliminating AHRQ funding altogether, prompting industry outcry from several organizations and a #SaveAHRQ Twitter campaign. The bill would also slash mandatory funding for patient-centered outcomes research by $100 million and cut funding for the Center for Medicare and Medicaid Innovation by $6.2 billion. (I can’t help but notice that October 1 – the start of the federal government’s fiscal year – is a popular date in healthcare these days. Dare I mention it’s also the day on which I consistently turn a year older?)

Other

Humana and the American Diabetes Association collaborate to develop an educational, evidence-based diabetes curriculum for consumers in the hopes of slowing the disease’s progression. Included in the materials will be digital tools, support groups, and peer-to-peer services.

Fresh off a new funding round of $30 million, Aledade CEO Farzad Mostashari, MD, sporting a spiffy new headshot, tweets (and keynotes) from the ACO Summit in Washington, D.C. I’d love to hear from an attendee or two as to how worthwhile the event was. Registration rates ranged between $1,200 and $1,800, which would make me take a long, hard look at the bang I’d likely get for my buck.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 6/17/15

Top News

Doctor on Demand closes a $50 million round of Series B financing led by Tenaya Capital. The company, which also announced Union Bank & Trust as its 200th employer customer, has raised $74 million to date. 

Webinars

June 30 (Tuesday) 11:00 ET. “Value Based Reimbursement – Leveraging Data to Build a Successful Risk-based Strategy.” Sponsored by McKesson. Presenters: Michael Udwin, MD, executive director of physician engagement, McKesson; Jeb Dunkelberger, executive director of corporate partnerships, McKesson. Healthcare organizations are using empowered physician leadership and credible performance analysis to identify populations, stratify risk, drive physician engagement, and expose opportunities for optimized care. Attendees will learn best practices in laying a foundation for developing a successful risk-based strategy.

Announcements and Implementations

Drug development solutions vendor Icon launches the Firecrest Patient Portal to help eligible patients view and understand clinical trial and treatment information before consenting to participate.

Nextech Systems adds personalized scheduling and electronic prescribing of controlled substances to its EHR and PM solution.

United Radiology Group (KS) selects revenue cycle management services from Zotec Partners.

Research and Innovation

A Physicians’ Alliance of America EHR survey of predominantly pediatric, family medicine, and internal medicine practices reveals that an overwhelming majority of respondents feel comfortable with the technology, and prefer electronic to paper records. Physician frustrations with charting and loss of productivity were clear: Thirty-five percent spend 60 minutes or more every day on their end-of-day charting, while 74 percent note their productivity is the same or worse. Over 20 EHRs were represented in the survey. Top systems included Allscripts, EClinicalWorks, Office Practicum, Greenway/Vitera, and PCC (a PAA partner).

A look at ACA surveys over the last five years paints a slightly optimistic picture of physician acceptance, highlighting several studies that show an aggregate uptick in ACA favoritism. It’s no secret that the majority of providers have not yet warmed up enough to give the act an overwhelming “A.” Those who do view it favorably are more likely to be primary care providers, younger, and female.

People

Deven McGraw (Manatt, Phelps & Phillips LLP) joins the HHS Office for Civil Rights as deputy director for health information privacy. McGraw was also former chair of the Health IT Policy Committee’s Privacy and Security Workgroup.

Telemedicine

The Georgia Partnership for Telehealth offers telehealth training through three Web-based certification courses from the National School of Applied Telehealth, formed as part of an outreach program between GPT, the California Telehealth Resource Center, HomeTown Health University, and the Southeastern Telehealth Resource Center. Students can study with NSAT to become a Certified telemedicine clinical presenter, telehealth coordinator, or telehealth liaison.

Local drug stores are getting in on the telemedicine act: Canton, MS-based Mosby’s Drug Store partners with TelehealthOne to offer customers a new walk-in medical clinic.

Government and Politics

HHS seeks software developers to become Entrepreneurs in Residence for two development projects: an FDA cancer and hematology data aggregation analysis platform and a CMS system that connects providers to their Medicare interactions.

A GAO report reveals that CMS has doled out $18 billion worth of improper Medicaid payments, $9.6 million of them related to care for 200 deceased beneficiaries. The massive discrepancy is likely tied to the fact that the Social Security Administration’s “Death Master File” website shows that 7 million dead people still have active Social Security numbers.

Other

The Tennessee Dept. of Health issues an alert to healthcare providers urging them to ask their patients about recent travel in light of the MERS outbreak in South Korea. I’d be interested to hear from Tennessee physicians as to how EHR prompts left over from the Ebola scare are helping them remember to ask such questions.

Sponsor Updates

• ADP AdvancedMD offers “ICD-10 billing & coding help – just in the nick of time.”
• GE Healthcare General Manager of Monitoring Solutions Didier Deltort explains in The Financial Times how the demand for digital talent will change the healthcare job market.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 6/16/15

Top News

The Senate HELP Committee hosts its latest hearing on EHRs, this time focusing on usability. Sen. Bill Cassidy, MD (R-LA) chaired the hearing, noting physicians are frustrated at having to spend more time entering data and less time examining patients. He added, “that time is better spent looking into a patient’s eyes to make sure that she comprehends that even though she has cancer, there is hope, as opposed to clicking through a computer screen to document something unimportant to her, but required by someone far removed from the exam room.”

Sen. Sheldon Whitehouse (D-RI) made the case for more effective use of HIEs, citing Rhode Island’s CurrentCare as a model of interoperability in the making. The HIE has enrolled over 400,000 residents and now pulls data from 78 hospitals, labs, and physicians. Future plans include pulling real-time claims information from payers and developing health management apps for patients.

Webinars

June 30 (Tuesday) 11:00 ET. “Value Based Reimbursement – Leveraging Data to Build a Successful Risk-based Strategy.” Sponsored by McKesson. Presenters: Michael Udwin, MD, executive director of physician engagement, McKesson; Jeb Dunkelberger, executive director of corporate partnerships, McKesson. Healthcare organizations are using empowered physician leadership and credible performance analysis to identify populations, stratify risk, drive physician engagement, and expose opportunities for optimized care. Attendees will learn best practices in laying a foundation for developing a successful risk-based strategy.

Announcements and Implementations

Chase Clinical Documentation releases a remote scribing tool, enabling physicians to dictate patient encounters in real time. The tool then converts the dictation to text and inserts it in the appropriate area of the EHR.

Azalea Health incorporates real-time dictation from Scribe Healthcare Technologies into its EHR.

Planned Parenthood announces plans to release its Direct mobile app to California residents, offering users a way to confidentially order STD tests through their cell phone and receive treatment if they test positive. The new app is part of the organization’s push to offer sexual health and reproductive services digitally. It launched the Care mobile app in Washington and Minnesota last year, offering residents video consults with Planned Parenthood providers.

Research and Innovation

Swedish researchers test the idea of texting 10,000 certified volunteers to alert them about nearby cardiac arrests requiring CPR. Texting volunteers increased rates of Good Samaritan CPR among 667 instances of out-of-hospital cardiac arrest, prompting researchers to consider further trials.

Black Book ranks the Quest Diagnostics Care360 EHR as number one in satisfaction among physician practices and groups with two to five practicing physicians.

A corporate wellness study of user health data from 10,000 Withings smart devices finds that 70 percent of employees sit for extended periods, 56 percent prefer to eat at their desk, and a third snack throughout the day. Most employees also seem to gain weight when they start a new job. Overall, survey results point to higher-paying jobs being more detrimental to employee health. “People-facing” industries such as education, arts, media, or tourism and hospitality are among the most active. Health professionals are in the middle of the pack when it comes to activity level, while software developers and IT services managers near the top of the inactivity scale.

Telemedicine

MyIdealDoctor receives an undisclosed amount of funding from holding company ValorBridge Partners, which it will use to scale up its telemedicine and digital health services. ValorBridge Partners will receive a seat on MyIdealDoctor’s Board of Directors. The funding comes just over a week after MyIdealDoctor announced a partnership with healthcare navigation app developer Zest Health.

The local paper highlights the progress telemedicine is making in Minnesota. Recent legislation includes requiring payers to reimburse for telemedicine appointments at the same rate as for in-person exams, and streamlining interstate physician licensure by joining the Federation of State Medical Board’s Interstate Medical Licensure Compact. (Check out my interview with FSMB CEO Humayun Chaudhry, DO here.)

People

The Electronic Health Record Association nominates Leigh Burchell (Allscripts) as its chairperson and Sarah Corley (NextGen) as vice chair. Rick Reeves (Evident) has rejoined the association after a three-year hiatus.

Former Massachusetts Governor Deval Patrick and Brendan O’Grady (Teva Pharmaceutical Industries) join American Well’s Board of Directors. It’s likely an interesting time to join the company, given the recent filing of a patent infringement lawsuit against competitor Teladoc. Both companies haven’t been shy about trading barbs in the media. Teladoc has been quick to assert it was around long before American Well, though American Well Chairman and CEO Ido Schoenberg, MD was just as quick to point out that “Comparing the original Teladoc service to American Well is like comparing 1-800 catalog shopping to ordering on Amazon.”

Other

United Airlines Senior Vice President of Corporate Safety Michael Quiello highlights the high cost of mid-flight medical diversions, pointing out the need for a cost-effective technology that uses cabin-based Wi-Fi to help air and ground personnel communicate quickly about a passenger’s vital signs to determine if a medical diversion is necessary.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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5 Questions with Humayun Chaudhry, DO President/CEO, Federation of State Medical Boards

Humayun Chaudhry, DO joined the Federation of State Medical Boards as president and CEO in 2009. Prior to FSMB, he practiced in New York for many years, and still maintains a medical license in the state. In addition to his current position, Chaudhry also serves as a clinical associate professor of internal medicine at the University of Texas Southwestern Medical School in Dallas.

Chaudhry, FSMB staff, and the Council of State Governments provided support and resources during the development of the Interstate Medical Licensure Compact, an initiative driven by state medical board representatives that aims to streamline the process of medical licensure across state lines. Nine states have enacted the compact, triggering formation of the Interstate Medical Licensure Compact Commission, which will develop and administer the interstate licensing process.

Did the FSMB realize when the Compact was created last year that it would be a driving force behind telemedicine adoption across the country?
One of the anticipated benefits of the Compact has been that it will increase access to telemedicine services by making it easier for physicians to practice telemedicine across state lines.

Did you expect that it would be triggered this quickly?
Many medical boards have been very supportive of the concept of the Compact since boards first gathered in early 2013 to explore various pathways in which states could expedite multi-state licensure. This early enthusiasm continued as the framework of the Compact was developed over the next 18 months. Given this strong support, we anticipated the Compact would be established relatively quickly once the framework was in place.

What are the next steps as far as the Compact Commission and its work moving forward? Who will be involved?
We anticipate that the transition period for the Compact to become operational will be 12 to 18 months. The Interstate Commission will meet later this year and establish various committees to draft the bylaws, rules, and processes that will be used by participating states as they begin expediting licensure for eligible physicians, create the technical infrastructure necessary to facilitate licensure, and perform necessary outreach.

The Interstate Compact Commission’s membership will be comprised solely of representatives from states that have enacted the Compact legislation. The FSMB will have no formal role on the Commission. It will continue to be available to provide support when requested by the Commission.

Do you have an idea of what this new, streamlined licensure process will look like? How long do you think it will take to develop?
Many details on how the Compact will actually operate will be worked out by the Interstate Commission in the months ahead. In general, physicians eligible to participate in the Compact would designate a member state as the state of principal licensure and select the other member states in which a medical license is desired. The state of principal licensure would verify the physician’s eligibility and provide credential information to the Interstate Commission. The Interstate Commission would then collect applicable fees and transmit the physician’s information and licensure fees to the additional states. Upon receipt in the additional states, the physician would be granted a license. The Compact would substantially reduce the time it takes to receive multiple licenses. As soon as eligibility is verified and fees are transferred, additionally selected states would issue a full and unrestricted license to the physician. Interested physicians can find more information at www.licenseportability.org.

What are the FSMB’s ultimate goals for the compact and the physicians it will serve?
The FSMB’s goal is to continue to support the state medical boards as they work to make the Compact operational. Our hope is that the Compact will help the states achieve expedited multi-state licensure, facilitate access to telemedicine services, and increase access to care in underserved areas.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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