Healthcare Intelligence Network

Aetna's practice of sending its providers periodic "care considerations" --- detailed clinical data that identify opportunities to improve care --- has been formalized in its patient-centered medical home (PCMH) pilot with Partners in Care (PIC), explains Dr. Don Liss, the regional medical director of Aetna's mid-Atlantic region. PIC providers' engagement with the care considerations is now a factor in the pay for performance aspect of the pilot. Dr. Liss shares some short-term indicators that demonstrate that the PCMH is working as well as the long-term view for medical home ROI, which can vary greatly for payors and providers. Dr. Liss, along with George Chedraoui, healthcare leader with IBM and immediate past president of Bridges to Excellence, shared different viewpoints --- the healthcare payor and purchaser --- and their strategies for achieving an ROI from the medical home during, Medical Home Metrics and Measurements for Achieving ROI.

IBM spends about $2 billion a year on healthcare for its 500,000 employees but doesn't believe it's getting its money's worth from the current system, explains George Chedraoui, healthcare leader with IBM and immediate past president of Bridges to Excellence. Chedraoui explains why IBM is banking on the patient-centered medical home (PCMH) --- with its focus on disease prevention and wellness --- to deliver this value, what impact $19 billion in health IT incentives will have on physician practices, and why it will take more than technology to transform a physician practice into a medical home. Chedraoui, along with Dr. Don Liss, regional medical director for the mid-Atlantic region of Aetna, shared different viewpoints --- the healthcare payor and purchaser --- and their strategies for achieving an ROI from the medical home during, Medical Home Metrics and Measurements for Achieving ROI.

According to Paul Terry, Ph.D., president and CEO of StayWell Health Management, when evaluating health coaching and population health programs, it is rare to see a return on investment in a program's first year, but generally by the second and third years, ROI begins to build. In addition to discussing ROI trends, Terry evaluates the value of self-reported data and the impact health coaching can have on an organization's productivity, presenteeism and absenteeism, and also gives some benchmarks for ROI in health coaching. Terry, along with Dr. Craig Nelson, director of health services research for American Specialty Health, described the measures to look at when evaluating health coaching and population health programs and provided case studies of how they are actually using these measures to demonstrate a health management ROI during a March 25, 2009 webinar, Calculating the Health Coaching ROI: Models and Results.

According to Dr. Bruce Bagley, the cornerstone of PQRI is quality improvement, and any bonus payments physicians receive for reporting efforts are just that --- by-products of the process. Dr. Bagley, medical director of quality improvement for the American Academy of Family Physicians, also shares his views on the value of patient registries and other healthcare IT for PQRI, and advises physicians who may be frustrated by their PQRI experiences. Dr. Bagley, along with Betsy Nicoletti, consultant, Medical Practice Consulting, LLC, described how PQRI can provide physician practices with a great start on registries and measurement and reporting and provided practical hands-on PQRI coding and auditing strategies during a March 18, 2009 webinar, Physician Quality Reporting Initiative in 2009: How To Avoid Submission Errors and Improve Reimbursement.

According to Dr. Agostino Villani, when it comes to pain management, the doctor-patient relationship far outweighs the pain treatment itself. Dr. Villani notes that patients who experience quality doctor-patient relationships are much more successful in their management of pain than those who do not. In part 2 of this interview, the internationally recognized expert on chronic pain, CEO of Triad Healthcare, Inc., and author of "Pain is Not a Disease," further discusses the physician-patient relationship, measuring the outcomes of pain management and med school curricula on pain management.

Too often, pain management tends to focus on the conditions rather than the people experiencing the pain, says Dr. Agostino Villani, internationally recognized expert on chronic pain, CEO of Triad Healthcare, Inc., and author of "Pain is Not a Disease." According to Dr. Villani, this way of thinking depersonalizes the experience of pain and treats it as a disease instead of the complex, personal event that it really is. In Part 1 of this interview with Dr. Villani, he discusses his new book as well as pain management programs, pain level reduction strategies, side effects of pain medications and the fight against commercialization of pain management.

The daily engagement of Medicaid beneficiaries in self-care health monitoring programs can help healthcare organizations avoid many of the challenges inherent in working with this frequently underserved population, explains Pharos Innovations CEO Dr. Randall Williams. Once participants are identified, they are very receptive to the daily contact, which has resulted in extremely high program engagement rates. Dr. Williams, along with Dr. Thomas Kline, medical director, Iowa Medicaid Enterprise, and Katherine Scher, R.N., C.C.M., program manager for the Center for Clinical Care Design at Henry Ford Health System, examined the factors that can impact engagement and explain how to continually strive to improve engagement rates during Improving Patient Engagement in Telephonic and Online Health Improvement Programs for Lasting Behavior Change.

There are so many benefits to implementing the medical home model, that they more than justify the initial investment needed, says Dr. Charles DeShazer, market medical officer at Humana. These benefits range from a decrease in fragmentation of care to an increase in quality care processes to even allowing physicians to manage their time more efficiently. DeShazer also discusses the importance of patient involvement, overcoming patient resistance and measuring the success of your medical home. Dr. DeShazer, along with Dr. Anita Murcko, medical director of clinical informatics and provider adoption with the Arizona Health Care Cost Containment System (AHCCCS), examined the various approaches to medical home assignment and the factors that can impact effective assignment in a February 12, 2009 webinar, Patient Assignment into the Medical Home: Building a Collaborative Patient-Centric Approach.

According to Dr. Anita Murcko, medical director of clinical informatics and provider adoption with the Arizona Health Care Cost Containment System (AHCCCS), patient involvement and collaboration with providers are the keys to any successful medical home assignment --- not only understanding what a medical home can provide patients but also how this model of care can empower them. Dr. Murcko, along with Dr. Charles DeShazer, market vice president, clinical innovations at Humana, examined the various approaches to medical home assignment and the factors that can impact effective assignment in a February 12, 2009 webinar, Patient Assignment into the Medical Home: Building a Collaborative Patient-Centric Approach.

With a revenue cycle that is measured by claims denials, collaborative data mining by billing and IT can identify origins of financial "bleeding" and turn these problems into actionable items, explain Beacon Partner experts Kevin Burchill, director; Sean McDonagh, practice director; and Ben Tobin, management consultant. Patient-friendly IT can also improve the patient experience on the front end while obtaining data to improve collections on the back end. This is a practice frequently employed by more financially robust providers. The three experts also debate the merits of offering patient discounts for prompt payment and placing patient credit reports in providers' hands. Burchill, McDonagh and Tobin, along with Beacon senior consultant Greg Adams and principal Phil Villacci, provided practical strategies, techniques and tools to improve patient collections without alienating patients during Improving Patient Collections in an Unhealthy Economy: Technologies and Processes to Speed Payments.

Delaying of healthcare for economic reasons is causing volatility in hospital emergency room volumes that is expected to intensify. To handle staffing, equipment and treatment challenges posed by these census variations, hospital EDs must rethink processes and protocols. At Edward Hospital in Naperville, Il., a "culture of certification" that includes cash bonuses for certification and peer support during exam preparation helps to raise the caliber of the ER staff and maintain patient satisfaction levels. Cindy Rentsch, Edward Hospital's clinical director of emergency services, describes the culture of certification that has raised the caliber of Edward's ER staff, a marketing campaign to divert mental health patients from the ER and protocols for treatment of pediatric ER patients. Rentsch is joined by Joan Heater, director of nursing emergency services, Banner Gateway Medical Center and Kevin Roche, director of the management engineering program at Banner Health Corporation, during Emergency Room Utilization: Developing a Team Approach to Address Overcrowding Factors That Increase Wait Time, a January 14, 2009 webinar. The three presenters shared organizational strategies that improve throughput in the ER as well as increase efficiencies, reduce costs and improve patient outcomes and satisfaction.

Richland Care Medical Home's member services department serves as health navigator and problem solver for its clients, guiding patients to appropriate services within the medical home network, explains program director Marcus Barnes. Patient engagement in the Richland Care Medical Home often begins when a prospective client visits the emergency room, and often takes staff members out of the office to health fairs and community events to publicize the program. Richland Care also conducts home visits for the chronically ill. Barnes described how Palmetto Health has implemented a successful medical home model that ensures the goals of the medical home program are met, including reduced hospital admissions and improved quality of care and outcomes for the patients, during Medical Home Collaborations: How Hospitals Are Benefiting from Partnerships in Patient-Centric Primary Care, a December 17, 2008 webinar.

Integrative medicine includes the best of conventional medicine but expands the definition and focus of health to the person's body, mind, spirituality and community, explains Ruth Wolever, Ph.D., clinical health psychologist and director of research at Duke Integrative Medicine. Central to Duke's integrative health coaching program is mindfulness training and the "Wheel of Health" --- a key to defining health and assessing the individual's readiness to change. Encouraging health coaches to implement their own personalized health plans allows them to "walk the talk" and empathize with the client's position. Dr. Wolever, along with Dr. Karen Lawson, program director for the health coaching track at the Center for Spirituality and Healing, the University of Minnesota, examined integrative health coaching --- how health coaches can benefit from training in motivational interviewing, self-management and even spirituality and healing --- during, From Passive to Partner: Integrative Health Coach Training Using Motivational Interviewing for Behavior Change.

The definition of community in an individual's change process is unique to that individual, explains Dr. Karen Lawson, program director for the health coaching track at the Center for Spirituality and Healing, the University of Minnesota. In this interview, Dr. Lawson discusses healing and spirituality within the framework of a health coaching exchange and the appropriate moments for a coach to broach these subjects. While a health coach cannot be an expert in all available therapies, the coach can be a "curious explorer" who "dips their toes" into alternative health therapies and systems along with the client. Dr. Lawson, along with Ruth Wolever, Ph.D., clinical health psychologist and director of research at Duke Integrative Medicine, examined integrative health coaching --- how health coaches can benefit from training in motivational interviewing, self-management and even spirituality and healing --- during, From Passive to Partner: Integrative Health Coach Training Using Motivational Interviewing for Behavior Change.

Hospitals should take advantage of the typically competitive nature of physicians to encourage collaboration, says Nathan Kaufman, managing director of Kaufman Strategic Advisors. Kaufman notes that "quality dialogue" between hospitals and physicians is key to engagement. In this podcast, he also discusses how a physician champion can drive success and explains physicians' reluctance to adding technology to their systems of care. Kaufman, along with Dr. Todd Rowland, director of medical informatics at Bloomington Hospital and executive director of HealthLINC, will provide a thorough understanding of physician engagement strategies during a December 10, 2008 webinar, Physician Engagement: Creating Trust and Alignment Between Management and Physicians.