The Collaborative Forum

Underserved Populations and Hospital Pay-for-Performance

Randy Williams — Wed, 21 Jul 2010 01:17:30 +0000

In the healthcare reform debate, hospital pay-for-performance has received plenty of discussion—how it could impact health outcomes, how it could promote efficiency, how it could change care coordination. In 2013, we’ll see the first step toward hospital pay-for-performance: hospitals will have some revenues withheld by Medicare and then returned if they meet specific clinical targets.

According to a new study published in the Journal of Public Library of Science, there are economic and human resource issues that may hinder some hospitals from meeting those pay-for-performance targets. And if that happens, the study’s authors are concerned that funding will be taken away from hospitals that provide care in poor and underserved communities.

The study’s lead author, Jan Blustein, MD, PhD, a New York University professor of health policy and medicine, analogizes hospital pay-for-performance with the “No Child Left Behind“ initiative for education that was started several years ago. In an interview earlier this month with HealthLeaders, Dr. Blustein said, “’One of the problems is we know very little about what helps and what works.’ In education, schools are told to do better—‘but there is no science there.’”

Dr. Blustein goes on in the interview, “’And the same thing is true in healthcare. We know a lot about what works to improve a patient’s health, but we really don’t know about what works to improve organizational performance.’”

And this is where I part ways with Dr. Blustein and her colleagues. (more…)

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Post tags: Care coordination, CMS, Healthcare reform, Medicaid, Medicare

Tags: Care coordination, CMS, Healthcare reform, Medicaid, Medicare

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Strong Communication and Medical Management Skills Produce Better Outcomes

Randy Williams — Fri, 16 Jul 2010 16:27:23 +0000

A recent study published in the Archives of Internal Medicine (from McGill University in Montreal) examined patient medication adherence and concluded that a physician’s medical management and communication skills influenced whether a patient stuck with the regimen. Given the significant impact medication adherence has on healthcare quality, costs, and outcomes, we all have a stake in figuring out what makes patients adhere to doctors’ treatment recommendations.

The study found doctors with strong communication skills had the lowest noncompliance levels and concluded that these findings are significant because they point to possible steps providers and healthcare organizations could take to improve medication adherence by educating and training physicians. Researchers felt that the more communicative physicians may have had better results “either because they followed up with their patients more effectively, or their patients were more motivated to report problems.”

Communication is key! This study bears out the importance of communicating effectively, to get better outcomes. We know that and see that all of the time. (more…)

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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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Yet Another Study on Readmission Rates for Heart Failure Patients

Randy Williams — Wed, 09 Jun 2010 23:08:28 +0000

In the vein of my post last week, there is yet another new study that discusses hospital readmissions for heart failure patients: this one published in the Journal of the American Medical Association. Over the past 15 years or so, hospitals have been discharging patients after shorter stays in order to cut costs. However, the JAMA study of Medicare heart-failure patients from 1993-2006, showed that more patients are returning to the hospital for additional care within a month of their initial treatment.

This is the very same problem I saw in my work as a cardiologist, which is why I founded Pharos Innovations to develop Tel-Assurance^â in the first place. With “in the trenches” patient care experience rather than simply a technology or marketing vantage point, we understood the root causes of frequent readmissions. Namely, challenges with individuals modifying their behavior. (more…)

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Emergency Department Visits Drive Up Readmission Rates Far Higher than Originally Presumed

Randy Williams — Thu, 03 Jun 2010 21:14:17 +0000

Another article caught my attention last week. It was an article in HealthLeaders on a report issued as part of the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project, which covered 12 states including Arizona, California, Florida, Hawaii, Massachusetts, Missouri, Nebraska, New Hampshire, New York, South Carolina, Tennessee, and Utah.

The key finding of the report was that the problem of readmissions and use of emergency room resources is more problematic than originally presumed.

According to the AHRQ report, “most readmission studies only report information on patients who have multiple hospital inpatient stays,” and in so doing exclude patients who seek care in the emergency department (ED). Once the researchers included ED visits, the rate of multiple visits jumped by more than one-third—from an average of 1.5 to 2.1 acute care hospital visits per patient. (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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A Beacon of Light in Transforming Healthcare Delivery

Randy Williams — Sat, 08 May 2010 19:36:42 +0000

Earlier this week, the Department of Health and Human Services announced it awarded grants totaling $220 million to organizations across 15 communities that will be pilot sites for the comprehensive use of health information technology in transforming healthcare delivery. We should all be very heartened by this news.

In establishing this Beacon Community Program, the Office of the National Coordinator for Health Information Technology (ONC) has taken a significant lesson from past chronic care management demonstrations. Through the advanced use of I.T. the Beacon Communities are set to tackle specific goals of improving healthcare and population health status. They will address obesity and diabetes management; preventable emergency department visits and re-hospitalizations; increased immunizations; better adherence to smoking cessation; and appropriate cancer screening guidelines, among others. (more…)

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A Week to Remember

Randy Williams — Mon, 22 Mar 2010 19:28:06 +0000

In the busyness of life, sometimes we need to be reminded to stop and take stock in the moment. This past week is one such time in the history of our nation, and in the history of our company.

For most of us, the passage of healthcare reform has broad political implications but lately the political process seems to have taken control of the deeper and more relevant meaning of health reform. Whichever way the politics play out on this, one thing is certain: Healthcare in America is about to embark on widespread change. (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…)

© Randy for The Collaborative Forum, 2010. | Permalink | No comment | Add to del.icio.us
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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