The Collaborative Forum » Chronic Care Management

What Constitutes an Effective Hospital Readmission Program?

Randy Williams — Wed, 07 Jul 2010 22:17:49 +0000

I am sure you have seen the reports, including the 2009 article in the New England Journal of Medicine (Jenks, et al), that highlight the cost and prevalence of 30, 60 and 90 day hospital readmissions. I think it’s safe to say that we all agree that this is a major issue that our healthcare system needs to address.

Where we don’t all agree is how to get there. Organizations across the country are looking for effective initiatives and innovations to reduce these costs. In their quest, some organizations are looking for easy solutions, such as the simple scheduling of follow-up visits post discharge. However, as detailed in a new study from the Mayo Clinic, published in the Archives of Internal Medicine, siloed, quick-fix initiatives, while very important, alone will not provide the true behavior change needed for measurable reductions in avoidable hospital admissions and readmissions. (more…)

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Quality Can Be Improved and Measured Meaningfully

Randy Williams — Thu, 27 May 2010 03:16:42 +0000

I’ve been in the healthcare field for over 20 years now, and I still believe that the vast majority of those involved—whether on the payer or provider side—truly want what’s best for their patients or members. After all, healthcare quality and cost affects everyone.

In an editorial published earlier this week in the New York Times entitled “The Gaming Begins,” the editors point out the difficult struggle over how to calculate medical loss ratio under the new healthcare law and discussed concerns that insurers could “game” medical loss ratio by spending money on administrative costs, rather than on meaningful measures to improve quality.

Beginning in 2011, the new law requires health insurers to spend 80-85 percent of the premiums they collect on medical services or activities that improve the quality of care (the medical loss ratio). Insurers can then use the remainder of the premiums for things such as marketing, overhead, salaries, and profit. (more…)

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Simple Solutions Keep Coming Out on Top

Randy Williams — Tue, 02 Mar 2010 19:55:44 +0000

Right before Christmas, Atul Gawande, a surgeon at Brigham and Women’s Hospital in Boston and a prolific writer at The New Yorker who writes about the problems and challenges of modern medicine, published a book titled The Checklist Manifesto–How to get things right.

The gist of the book is that by employing simple checklists in hospitals, procedures are performed with fewer complications and patients get healthier. Gawande has been making the rounds on The Daily Show, PBS’ News Hour with Jim Lehrer, NPR and other media outlets promoting his book and discussing the remarkable success checklists can produce. (more…)

Tags: EHR

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Setting the Record Straight: Chronic Care Management CAN be Successful

Randy Williams — Wed, 10 Feb 2010 14:58:45 +0000

Clearly, the need to reduce healthcare costs without affecting the quality of healthcare delivered is at the center of our country’s healthcare debate. However, a recent BusinessWeek article of February 4, 2010, by Chad Terhune and Arlene Weintraub, makes the mistake of lumping together all disease management programs and then goes on to cite examples in which particular programs have demonstrated no cost-savings nor any apparent increase in the health of patients.

That is not, however, true of all programs that aim to manage chronic disease and demonstrate reduced costs.

As a cardiologist and CEO of Pharos Innovations, a company that focuses on managing chronic disease while demonstrating real reductions in avoidable hospital admissions and overall healthcare costs for Medicaid, Medicare, the VA, commercial health plans and provider systems, I think it’s important to set the record straight. There ARE well-proven ways to reduce costs AND keep patients healthier. (more…)

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Post tags: Care management, CMS, Disease management, Health plan, Medicaid, Medicare, Population Health, Remote Patient Monitoring

Tags: Care management, CMS, Disease management, Health plan, Medicaid, Medicare, Population Health, Remote Patient Monitoring

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Making Healthcare Better

Randy Williams — Tue, 10 Nov 2009 21:00:12 +0000

I read an interesting article on Sunday, in The New York Times Magazine, Making Healthcare Better. The article discusses Dr. Brent James of Utah’s Intermountain Healthcare and the results that he and his team are producing with their patients. The Intermountain team has been improving healthcare and reducing costs by following treatment protocols and estimates indicate that the data-driven changes they’ve made at Intermountain have saved thousands of lives a year. In total, Intermountain has developed protocols for 50 clinical conditions, which accounts for more than half of their patients.

There are plenty in the medical field who are skeptical of Dr. James and his approach—and the balanced article includes them—but the results speak for themselves. In the end, what Dr. James and his team at Intermountain have done, is take a different approach to practicing medicine. They’ve looked at the way things were done, and effectively disrupted the intuitive approach to medicine. By providing protocols as a guideline, their doctors have saved thousands of lives.

Disruptive innovation—a theory of Clayton Christensen—discusses that the way to affect real change, is to disrupt the way things have been done. Disruptive innovation can have characteristics that traditional segments may not want (protocols vs. intuitive medicine). In fact, I founded Pharos Innovations and developed Tel-Assurance® based on Christensen’s notion of disruptive innovation. (more…)

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From an Island of Technology to a Community that Communicates

Bonni Kaplan — Fri, 02 Oct 2009 21:11:42 +0000

I have recently returned from the DMAA: The Care Continuum Alliance’s annual trade association meeting in San Diego and have had time to reflect on what I saw and learned. By way of background for those not familiar with the Care Continuum Alliance’s Annual Forum, this meeting assembles arguably the best and most established companies and thought leaders in the field of chronic disease and wellness. No, not necessarily policy wonks, nor highly published academic researchers. But rather the folks who over the past decade have built a multi-billion dollar industry from scratch while improving the lives of countless individuals and the profitability of their customers.

As a newly appointed member of The Care Continuum Alliance’s board, I am humbled by the great minds working together to solve our healthcare crisis. In years past, I have witnessed many call-outs of the problem and seen many potential solutions arise. Notably, one major element has been missing from the solution — collaboration. This year is different. I walked away with the sense that our industry is finally in agreement that change is needed – that what has been is not sustainable in the future – and that collaboration is the key to that change. I also walked away with the keen sense that the DMAA: The Care Continuum Alliance is a catalyst to help us move in that direction.

I am excited for the work ahead of me and The Care Continuum Alliance’s board as we help guide this movement.There were three other key themes that marked this year’s meeting, which I’d like to explore. These themes, to an outside observer, might seem unrelated in many ways. But my sense is that taken together, they represent an important milestone in the healthcare industry, perhaps even a pattern – one that appears to represent nothing short of a seismic shift. (more…)

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The Medicare Medical Home Demonstration: Crawling Out From Under the Rock – Part II

Bonni Kaplan — Thu, 03 Sep 2009 15:52:12 +0000

Table of contents for Medicare's Medical Home Challenge

The Medicare Medical Home Demonstration: Crawling Out From Under the Rock – Part II

On August 4th, 2009, my fellow blogger (and mentor), Vince Kuraitis of Better Health Technologies, wrote a guest post on the topic of the Medical Home. His premise was simple: as currently conceived, the CMS Medical Home demonstration, called MMHD, is doomed to failure because it will NOT SAVE MONEY!

Vince’s post begs the question: “So…if one were to redesign the MMHD to fulfill the potential for both improving care quality (through access to an appropriate “Medical Home”) while simultaneously reducing healthcare costs, where might we start?”

Vince points us in the right direction in his post, calling our attention to the work of Randall Brown in his report of another CMS demonstration, the Care Coordination Demonstration. Brown points out two key observations:

1. Care Coordination, to save money, must start with the “right” population target; and,

2. Care Coordination interventions can only save money if they don’t COST more than about $120 per participant per month (the amount likely to be saved from a well-designed intervention).

In other words, the solution to the dilemma has two aspects: 1. FOCUS and 2. EXECUTION. (more…)

© Bonni for The Collaborative Forum, 2009. | Permalink | 3 comments | Add to del.icio.us
Post tags: Care coordination, Care management, CMS, EMR, Medical Home, Medicare, Remote Patient Monitoring

Tags: Care coordination, Care management, CMS, EMR, Medical Home, Medicare, Remote Patient Monitoring

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The Value Quadrant of Healthcare Reform – Part I: Focus on Chronic Disease

Randy Williams — Thu, 16 Jul 2009 01:24:59 +0000

President Obama has made healthcare – and rising healthcare costs – a national priority, and it’s easy to see why. As a country, we spend 2 Trillion dollars a year on healthcare, yet one in two Americans, or close to 200 Million of us, suffer from chronic diseases that decrease quality of life and increase healthcare costs.

Click on The Value Quadrant To Enlarge

Chronic disease is a problem that many physicians see daily in their clinical practices…I sure did. It is one that causes countless unnecessary and avoidable hospitalizations. This problem largely reflects a lack of simple coordination of information and care processes, as well as a lack of programs and approaches for patients with chronic disease to become more involved in their daily self-care.

Unfortunately, the burden of chronic disease falls largely to the elderly and vulnerable, in other words, Medicare and Medicaid beneficiaries. As an example, if you are a Medicare beneficiary with congestive heart failure, you and your peers consume 40% of the Medicare annual budget. A short list of chronic conditions account for 95% of Medicare expenditures, and over 80% of Medicaid costs. It is a small wonder that the Medicare Trust Fund is predicted to be insolvent by 2018!

So…how can healthcare reform properly focus on achieving the biggest bang for the buck? (In other words, move to the Value Quadrant). (more…)

© Randy for The Collaborative Forum, 2009. | Permalink | 2 comments | Add to del.icio.us
Post tags: Care coordination, Care management, Healthcare delivery system, Healthcare reform, Medicaid, Medicare, The Value Quadrant of Healthcare Reform

Tags: Care coordination, Care management, Healthcare delivery system, Healthcare reform, Medicaid, Medicare, The Value Quadrant of Healthcare Reform

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