The Collaborative Forum

What it ACTUALLY takes to impact healthcare cost and quality

Randy Williams — Fri, 12 Aug 2011 22:00:44 +0000

Earlier this week, CMS reported the 5th year performance impact for the Physician Group Practice Demonstration (PGP Demo). The PGP Demo has served as the learning laboratory for 10 organizations across the country seeking to improve quality and reduce costs of care for the Medicare population. We are privileged to have worked closely with Park Nicollet Health System as they navigated the journey to success. (Park Nic received a substantial bonus payment from CMS this year). We’ve had a bird’s eye view on this effort over the past 5 years, and have MUCH to share!!

But before I tell you more, please take the time to see the CMS press release:

https://www.cms.gov/apps/media/press/release.asp?Counter=4047

And while you are at it, you may want to read more about Park Nicollet’s approach as covered by the Minneapolis Star Tribune:

http://www.startribune.com/business/127283643.html

In the coming days, visit the Collaborative Forum to hear more about the lessons learned, the impact seen, and the challenges faced to get there. I promise it will put you several steps ahead on the journey from fee for transactional care to transformational care coordination!

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Post tags: Care coordination, CMS, Remote Patient Monitoring

Tags: Care coordination, CMS, Remote Patient Monitoring

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Testing Technology vs. Enabling a System of Chronic Care – Results of the NIH Tele-HF Trial

Randy Williams — Tue, 16 Nov 2010 21:53:59 +0000

The results from the National Institutes of Health (NIH)-sponsored Tele-HF trial are in, and the findings are worth considering . The results are counter to most of the findings of other studies examining telemonitoring for heart failure and at face value are disappointing to us, and the industry. Upon closer examination, however, this study offers us an excellent opportunity for further innovation, refinement of solutions and continuous improvement. It also provides a snapshot of how significant the challenges remain in transforming U.S. healthcare – from a system that is episodic, reactive, acute care based to a system of care that incorporates proactive, interactive, continuum-based chronic care management.

The genesis for this study stretches back nearly 10 years, from conceptualization to the results we see reported today. This randomized, controlled multi-centered trial was designed to compare an automated, daily symptom and self-reported weight monitoring technology with “usual care” in reducing hospital readmissions and mortality among patients recently hospitalized with decompensated heart failure. The boldness of vision should not be underrepresented: Tele-HF is the largest study of a non-pharmacological intervention for heart failure ever conducted.

At a high level, the results showed “no significant differences” between the group receiving usual care and the group randomized to receive telemonitoring. I cannot say that these are the results we were hoping for. However, I urge those in our industry and other key stakeholders to take a closer, more informed view, and to reach their own conclusions and insights.

The Details

First, I want to thank and acknowledge the great work of the investigators, study sites and everyone involved in this trial. It was a long process and everyone worked with the utmost integrity and professionalism. We were privileged to have been selected for participation. I also want to acknowledge the value of conducting large, multi-centered, randomized, controlled trials in terms of advancing medical science.

The patient interventions in this study took place in 2006-09 and omit many of the processes and techniques Pharos uses today to achieve the necessary critical mass of physician and patient involvement. Here are the limitations of this particular study – from my perspective: (more…)

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Post tags: Care management, Disease management, Remote Patient Monitoring

Tags: Care management, Disease management, Remote Patient Monitoring

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The Correct Approach to Care Management

Randy Williams — Sat, 13 Nov 2010 00:47:46 +0000

A couple of weeks ago, I had the pleasure and honor of moderating a webinar, sponsored by the Care Continuum Alliance, which included Aaron McKethan, PhD, Beacon Community director, Department of Health and Human Services, Office of the National Coordinator for HIT; and Patrick Gordon, Colorado Beacon Consortium director. I wrote favorably about the Beacon Community Program when it was announced in May, because I view this program as a true Beacon for change in healthcare IT in this country.

As a quick refresher, the Beacon Community Cooperative Agreement Program provides funding to selected communities to build and strengthen their health information technology (health IT) infrastructure and exchange capabilities. The program supports these communities at the cutting edge of electronic health record (EHR) adoption and health information exchange to push them to a new level of sustainable health care quality and efficiency. The program also will show how other communities can use health IT to achieve similar goals.

The purpose of this federally-funded pilot is to provide selected members of the healthcare community with the potential to define HIT’s influence on the future of healthcare delivery as we push toward accountable, evidence- based, community-focused care. During the webinar which discussed the program at length both from an administrative perspective as well as an “on the ground” perspective, I was particularly struck by one of Dr. McKethan’s slides: (more…)

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Post tags: Care management, eHealth, EHR

Tags: Care management, eHealth, EHR

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The Future of Medicare Advantage

Randy Williams — Fri, 29 Oct 2010 13:21:34 +0000

Earlier this month, CMS announced that enrollment in Medicare Advantage plans will climb an estimated 5 percent next year. Conversely premiums are expected to drop on average.

It’s really no surprise to any of us in the healthcare industry that with reform come significant challenges to health plans. Health plans are being forced to dramatically change how they do business to remain profitable.

In my ongoing conversations with health plan leaders, they confirm that Medicare Advantage plans, Special Needs plans (SNPs) and Medicaid are faced with a very large challenge: How to maintain profitability in this new era of healthcare.

It seems to us that taking the correct approach to medical management is the key. (more…)

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A Beacon of Light in Transforming Healthcare Delivery, Part II

Randy Williams — Wed, 20 Oct 2010 22:06:34 +0000

In May, I first wrote a post that discussed the Beacon Community Program, the new program from the Office of the National Coordinator for Health Information Technology (ONC) that’s designed to actually encourage innovation to transform and improve healthcare delivery in this country.

As part of the program, the ONC has allocated $235 million to develop cooperative agreements with communities to build and strengthen their health IT infrastructure and health information exchange capabilities. Looking for measurable improvements in health care quality, safety, efficiency and population health, the ONC is funding 17 of these awards to different communities across the country.

The challenge with past chronic care management pilots/demonstrations is that even with the best of intentions, the stringent design and methodology actually stifled innovation and destined many of these projects to fail. However, through the advanced use of IT the Beacon Communities are set to tackle specific goals of improving health care and population health status.

Next week, in partnership with the Care Continuum Alliance, Pharos Innovations is presenting a webinar on Wednesday, October 26, at 1 PM, EDT that carefully discusses and considers the Beacon Community Program. As the newly elected Chair of the Government Affairs Committee of the Care Continuum Alliance, I am honored to be participating in this webinar. (more…)

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Looking to the Future – DMAA Re-brands

Randy Williams — Wed, 22 Sep 2010 21:16:21 +0000

Pharos Innovations is a long standing and proud member of the Disease Management Association of America, which as of today, ceases to exist as the DMAA. Today, the organization has changed its name to the Care Continuum Alliance (CCA) to better align its name with its ongoing work on behalf of organizations and individuals that provide healthcare at all stages of well-being.

The organization’s decision to change its name away from one that focuses on disease management reflects our industry’s evolution toward care across the continuum of health. This is a move away from a disease focus to a more comprehensive, patient-focused approach. (more…)

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The Responsibility Falls to Us All

Randy Williams — Thu, 16 Sep 2010 18:37:16 +0000

Just a few days ago, Donald Berwick, MD, in his first major speech since taking the helm of the Centers for Medicare & Medicaid Services (CMS) two months ago, urged insurers, employers, professional groups, and communities to come together to advance healthcare reform goals. We applaud Dr. Berwick’s sentiments and agree that none of us can “do this alone.” He warned that those who are interested in preserving the status quo would not be considered “constructive contributors to our nation’s future.”

He went on to say, “All of us have to change the way we do business…CMS can’t do this alone. Government can’t do this alone. We will either build a new healthcare system for our country together…or we’re not going to build it at all.”

In an article Dr. Berwick co-authored two years ago—long before being named to head CMS—he and his colleagues said the “The Triple Aim” of health care would be simultaneously “improving the experience of care, improving the health of populations, and reducing per capita costs of health care.”

That’s been our aim since founding Pharos Innovations: providing better care, with improved outcomes and reducing healthcare costs. We looked at an existing problem—high readmissions for heart failure—and developed a disruptive solution: Tel-Assurance. (more…)

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RPM and a just-released Tel-Assurance Evaluation

Randy Williams — Tue, 17 Aug 2010 14:03:29 +0000

Very recently, I wrote about remote patient monitoring (RPM) systems and how they are gaining traction with healthcare payers, such as insurance companies. Historically, health plans have under-invested in optimizing the management of medical expenses, choosing instead to maximize rates where possible. As a result, they’ve experienced high medical losses and have triggered financial pressure and constraints on revenue growth.

Health plans can and are beginning to consistently and sustainably improve outcomes and reduce medical losses by monitoring the daily status of at-risk members through RPM. We’ve just released the results of an evaluation of a large national Medicare Advantage plan that partnered with Pharos Innovations to improve the hospitalization costs in their population. The results speak directly to why RPM systems like Tel-Assurance can play a key role in our healthcare system going forward.

Nationally, 10% to 14% of Medicare Advantage members have heart failure (HF), and they account for 15% of Medicare Advantage plan hospitalizations. Additionally, 25% of those hospitalized are readmitted within 30 days. This is the cycle that RPM can break.

The evaluation results just released covered Medicare Advantage members for a 17-month period from January 1, 2008 to May 31, 2009. The HF cohort experienced 1,639 admissions per 1,000 during the 12-month baseline period. A matched member cohort studied simultaneously experienced no decrease compared to the baseline rate. However, during the same period, Tel-Assurance enrollees experienced an all cause hospital admission rate of only 351 per 1,000, a 79% decrease compared to the baseline period. (more…)

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Post tags: Care management, Health plan, Medicare, Remote Patient Monitoring

Tags: Care management, Health plan, Medicare, Remote Patient Monitoring

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Remote Patient Monitoring Plays a Large Role in Successful Outcomes

Randy Williams — Tue, 17 Aug 2010 00:22:42 +0000

It seems more and more often lately, I’ve been reading about remote patient monitoring (RPM) and how different segments of the healthcare industry are turning to these technologies as an effective and cost-efficient means of reducing hospital readmissions. The lead sentence of a recent WSJ article read: “Technology that aims to keep congestive heart failure patients out of the hospital is gaining traction.”

This is a good thing. We at Pharos have been using behavior change technology and RPM as a very effective tool for keeping heart failure patients healthier for the past 14 years. Providers and home care agencies have been embracing and using it for years.

The WSJ article cites some examples of payers who are turning to RPM, too. We are encouraged by the growth we are seeing in that segment of the healthcare market – growth that clearly indicates that these types of technologies are becoming more broadly valued and accepted as a critical element in cost containment and improved health outcomes. (more…)

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Moving the Needle in Transforming Our Healthcare System

Randy Williams — Tue, 10 Aug 2010 21:22:03 +0000

Healthcare reform is a hot topic. And rightly so. If done right, it has the potential to truly transform our healthcare delivery system. Recently, Secretary of Health and Human Services Kathleen Sebelius, posted a piece on the Commonwealth Fund website which discussed the need to approach healthcare delivery in a coordinated and patient-centered way that focuses on keeping patients healthier.

Secretary Sebelius cites the statistic that two-thirds of Medicare spending goes toward beneficiaries with five or more chronic diseases. Yet under the current payment system, doctors are paid for quantity of individual services instead of for managing and coordinating the care of their patients across time and location. She writes, “Dysfunctional incentives create fragmentation and fail to address the underlying drivers of disease.” And there are ways to create open communication between patients and care managers to address the drivers of disease and keep patients healthier, all at significant cost savings to Medicare. We’ve seen it work. (more…)

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