Join Us at The Value Based Health Care Congress 2016

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The Value-Based Health Care Congress is just a week away and we’re excited to announce we’ll be there, standing alongside industry veterans and learning more about the state of value-based care. Under The Value-Based Health Care Congress are 3 individual tracks for providers, each covering some of the key pillars of the landscape today:

  1. The MACRA Strategy Collaborative Summit
  1. Value-Based Network and Contract Management Summit
  1. ACO Strategy Summit

We went ahead and listed some of the conference sessions around care quality and health care IT that we’ll be looking forward to attending, and hopefully you will too. Be sure to stop by the CareSkore booth in the exhibit hall to see our Personalized Population Management™ platform, and learn how your healthcare organization can improve both clinical and financial outcomes. Without further ado, here are some of the sessions that we’re excited to see (exact times subject to change):

 

1. Measuring for Value – Panel Discussion

Track and Time: Main Summit, Day 1 @2:05pm

Core quality measure sets are in place and we’ve taken a significant leap forward in providing accurate, useful information on healthcare quality that can inform decisions. The next step in this transition to value-based care rests on our ability to integrate quality and resource use performance to ultimately drive better outcomes.

  • Understand the quality-spending relationship and how it promotes provider buy-in and success in risk-based contracts
  • Learn how to incorporate the patient voice to develop meaningful measures
  • Align measures across the continuum of care to reduce burden and improve efficiency

Speakers:

David Introcaso (@HealthcareIssue)

Helen R. Burstin (@HelenBurstin) – Sr VP, Performance Measures at National Quality Forum

Kate Goodrich – Director, Center for Clinical Standards and Quality at CMS

John S. O’Shea – Sr Fellow, Center for Health Policy Studies at The Heritage Foundation

Stephen L. Ondra (@StephenOndra) – Chief Strategy Officer at Amida Technology Solutions

Linda Walker – VP, Health Security at AARP

 

2. Examine the Role of Health IT in Delivery System Transformation

Track and Time: MACRA Summit, Day 2 @10:45am

Healthcare IT is undoubtedly a critical piece to how we advance quality and value. ONC’s Elise Anthony gives us the catch-all on healthcare technologies—from flow of health info to patient data access, and care delivery—required for participating in CMS programs.

  • Understand how health IT is the foundation to better care, smarter, spending and healthier people
  • Learn about new health IT initiatives that can support practical needs of patients and providers

Speaker:

Elise Sweetney Anthony (@Policy2Progress) – Director, Office of Policy at ONC

 

3. Explore the Ingredients of a Health IT Value Strategy

Track and Time: MACRA Summit, Day 2 @11:30am

Implementing health IT does not guarantee success. These technologies—focused on improving care must allow stakeholders to be able to find usability and usefulness that also support processes—both business and clinical—of a value-based reimbursement system.

  • Review the HIMSS STEPS™ model and its five components
  • Identify areas where health IT has proven value and non-technical barriers to IT optimization
  • Explore potential new functions of health IT that should support value-based care

Speakers:

Peter Basch – Medical Director, Ambulatory EHR and Health IT Policy at MedStar Health

Patricia Wise – VP, Health Information Systems, HIMSS

 

4. Engage Physicians in ACO and Other Value-Based Models to improve Quality

Track and Time: ACO Summit, Day 2 @2:15pm

Successfully engaging physicians ensures that ACOs and other value-based endeavors reach potential, but that is easier said than done. It’s especially challenging when physicians continue to receive fee-for-service and value-based payments simultaneously.

  • Understand physicians’ risk-based payment and MACRA, and how to transition to a value-based mix
  • How to coordinate for optimal management of complex patients
  • Utilize integrated and actionable claims data, not multiple EHRs, and learn how to report data that demonstrates the impact of clinical decisions

Speaker:

Abigail Chen – Medical Director, Quality and Clinical Integration at Mount Sinai

 

5. Achieve Better Quality, Less Effort, and Greater Savings – How You Can Have All Three

Track and Time: ACO Summit, Day 2 @3:00pm

Through organizing information and communicating it with providers in addition to focusing on specific efforts such as cardiac and respiratory conditions, providers can improve cost and quality metrics in parallel and demonstrate the value throughout the health care community.

  • Explore feasibility of collecting and tracking patient data to understand quality performance
  • How cutting costs and increasing quality scores can earn shared savings
  • Illustrate examples of payer-provider engagement and alignment around shared objectives

Speaker:

John Haughton (@haughton_md) – CIO at Chautauqua AMP; CQO at Independent Health Plan

 

Where EHRs Fall Short: 3 Reasons Doctors Need Personalized Population Management

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Look into the center of a hospital’s information technology stack, and you’re bound to find electronic health record systems (EHRs) to be the cream of the crop, costing healthcare providers tens to hundreds of millions of dollars for implementation and use. As the core system of record within a healthcare organization, when it comes to providing the 360-degree view on any given patient or patient population, EHRs fall short on giving the complete picture.

 

The State of Electronic Health Record Systems

It’s no doubt that EHRs are critical to a hospital or health practice. An EHRs’ core capability rests on being able to store significant amounts of patient data records and is used across multiple functions—care quality, finance, and operations—within a health organization. Whether it’s capturing notes on patient encounters, insurance claim information, or data on historical visits, you name it—EHRs are effective in that regard. This, however, is what EHRs were designed to do, and nothing more; to operate as silos of unstructured data.

Storing data and interpreting data are two independent undertakings. It’s important for doctors to be able to distinguish between the two without overspending on time and resources. In order to capture the complete picture on a patient population, clinical and financial departments need a dedicated system that allows for seamless interpretation of patient data, predictability, and personalized patient communication at will. Keep an eye out for the following when looking into a population management solution:

 

 1. Predicting no-shows and patient risks

Tracking historical patient data is fundamental. But what about predicting and planning for the future? As healthcare providers continue to amass increasingly large amounts of patient data from socioeconomic to demographic inputs, not leveraging that data is an opportunity missed. Where EHRs lack, a Personalized Population Management™ can make up in value, as EHRs were not designed to predict future occurrences from their stored data. Doctors need a solution that not only enables them to manage no-show and cancellation rates but addresses dire questions like, Which patients within my population are at-risk? What are the leading factors for my patients’ risks? How can I improve the health of my patient population?

 

 2. The need to engage patients

Doctors and physicians want to spend more time doing what they do best: caring for their patients, not trying to make sense of high volumes of unstructured data. When relying on EHRs for patient engagement, physicians and nurse practitioners can face barriers; meeting personalized demands, usability issues, unnecessary workload. What doctors and physicians seek is a tool that not only gives back lost time from using EHRs but a tool that enables bi-directional patient communication even when patients leave the premise. This calls for a communication medium to be put in place dedicated to engaging patients and helping doctors get what patients need when they need it.

 

 3. Meeting regulatory reporting requirements

One thing is true. It’s becoming much more difficult for doctors to focus on their population. While the rise of the health IT landscape was meant to automate certain tasks, the reality is it’s taking up more and more of a doctor’s time. With new reporting and payment regulations underway, doctors must have a solution fixated to handling this department. EHRs alone aren’t enough and extracting data from these systems can be a daunting task. Orchestrated in alignment, however, EHRs and predictive analytics make a formidable pair. Together as the bread-and-butter of the health IT stack, EHRs and predictive analytics empower healthcare providers to capture data, interpret it for actionable insights—regardless of complexity or magnitude—and help providers with their patients in the continuum of care.

 

Personalized Population Management does not replace an EHR. Rather, Personalized Population Management complements a robust EHR system. In this new era of healthcare, predictability tied with communication and reporting gives doctors the ability to ultimately improve their financial and clinical outcomes and focus on what matters most, the patient.

 

The Medicare Access and CHIP Reauthorization Act (MACRA) is underway to completely change how healthcare providers approach medicare payments. Are you ready? Join us as we discuss how to approach MACRA in our upcoming webinar, MACRA: Addressing the Transition.

 

I Will Keep Them From Harm and Injustice (Part 1)

Part 1: Identifying and Reducing Readmissions Rates

Oliver Leung CareSkore

 

It’s no secret that America’s health care system needs intensive care. $180 billion is wasted every year on operational inefficiencies, and the condition is not improving. This is largely attributed to a fee-based system that incentivized volume over value.

In 2010, the Affordable Care Act made health care providers an offer they couldn’t refuse — a mandate to increase efficiency or feel the pain of stiff financial penalties. This ideology shifted the practice from fee for service to value-based care. Loved it or loathed it, health care providers are forced to play with the cards they were dealt with.

As with all illnesses, we begin with identifying the symptoms of a broken health care system, so we can follow through with a diagnosis and treatment. In this ten-part series, we will:

  • Identify the most pressing challenges facing our health care system
  • Address opportunities for improvements, and
  • Make recommendations for enhancements

Finding solutions to fix our health care system won’t be resolved overnight, but it is prudent to focus on the elements that are causing inefficiencies. Then implement noninvasive solutions that are quick, intelligent, and cost-effective.

 

Challenge #1: Readmission

When our vehicle breaks down, we go to the mechanic to get it fixed. We expect our vehicle to function after our visit because it is part of a mechanic’s duty of care.

Similarly, a doctor’s obligation is to treat patients with a level of care that is consistent with the Hippocratic Oath. Unlike a machine, however, humans can’t be recalled. We either heal, deteriorate or perish. Readmissions are a serious threat to not only our health but to our health care system.

By far, Medicare bears the greatest burden of readmission and is the gold standard by which health care providers measure performance on. The three greatest preventable conditions for Medicare readmissions are:

  1. Congestive heart failure (24.5%)
  2. Septicemia (21.3%)
  3. Pneumonia (17.9%)

The conditions above cost hospitals over $4.3 billion. The government (and ultimately the taxpayer) foots 43% of our national health bill. Consequently, hospital reimbursements have recently been restructured under the Hospital Readmission Reduction Program (HRRP) in October 2012. The program focuses on patients who are readmitted within 30 days for high-cost or high-volume conditions and procedures. Specifically, heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), hip/knee replacement, and coronary artery bypass graft (CABG).

The Hospital Readmissions Reduction Program is designed to improve the quality of care by incentivizing the reduction of hospital readmissions and penalizing underperforming hospitals.

 

Oliver Leung CareSkore Readmission Rates

 

Since the initiation of the program, readmission rates have declined 1%, from more than 19.0% to less than 18.0%. Although this is an improvement, 50% of hospitals received readmission penalties of up to 3% for failing to meet the national readmission benchmark.

The financial cost is merely a symptom of the problem. Readmitted patients are preventable and increase demand for doctors who already have long waitlists. It also places a hindrance on society since patients are required to take repeated time off work or home care. In short, remitted patients are not given the proper treatment, which is simply poor quality of care.

 

Opportunity: Preventing Readmission

Readmission rates are calculated using discharge data for each hospital from the three years prior to the year in which the penalty is assessed. According to the Centers for Medicare & Medicaid Services (CMS), The two criteria for evaluating the impact of readmissions are volume and costs. To understand the impact of these variables, we need to look at the data that drives the numbers.

The average readmission rate for the top ten high volume conditions among Medicare beneficiaries is 19.6%. Simply put, nearly 1 in 5 patients return for preventable retreatments.

However, the quality of care is not solely dependent on hospital care. Hospitals serve patients of varying risk profiles. External factors such as socioeconomic status and demographics come into play and should be taken into consideration.

Despite these discrepancies, there are currently no provisions in the Health care Readmissions Reduction Program to account for these external factors. This could adversely (and often unfairly) impact the perception of a health care provider. These external data sets are largely unaccounted for but have a significant impact on patient readmission.

 

Recommendations: Patient-centered care.

There are ways to mitigate the risk of patient readmission. It begins with intimately knowing your patient. This may sound daunting at first, but it can be easier than you think.

The difference between a stranger and a loved one is data. With a friend, you know what appeals to them as much as what repulses them.

In the same way, health care providers can leverage data to determine whether a patient is considered at risk of readmission. But data itself is inert. It can’t predict and won’t prevent readmissions on its own. Therefore, health care providers need to aggregating and normalizing the data in order to understand the probability of readmission. Only then can you make accurate decisions.

Finally, patients need to be nurtured throughout their medical journey. Patient engagement is like following through on your golf or tennis swing. It takes practice, but it will certainly improve your game.

It starts with asking, “How have you been?” It’s simple, but not easy. Engaging your patients is very involving and can take tremendous resources from your admin staff. So new technologies such as CareSkore actively engages patients using artificial intelligence (A.I.) to prevent readmissions from occurring.

“A spoonful of sugar helps the medicine go down…”
Reducing readmissions isn’t a trivial task, but it is one that deserves attention. Readmissions prevent doctors from seeing fresh patients, disrupts the wellbeing of a patient, and drives costs to health care providers. There are early indicators that the health care industry is adopting methods to reduce readmissions. Not only because it is mandated by the government, but because prevention is better than treatment. Solutions are available to transform hospitals from a destination to a journey.