On April 11, 2016, the Centers for Medicare and Medicare (CMS) announced an initiative called the Comprehensive Primary Care (CPC+). This initiative, which builds on CMS’s previous Comprehensive Primary Care (CPC) initiative, is designed to “improve the quality of care patients receive, improve patients’ health, and spend health care dollars more wisely ¹” and similar to the CPC initiative will focus on the five key comprehensive primary care functions: (1) Access and Continuity; (2) Care Management; (3) Comprehensiveness and Coordination; (4) Patient and Caregiver Engagement; and (5) Planned Care and Population Health.

CMS describes CPC+ as “a national advanced primary care medical home model that aims to strengthen primary care through a regionally-based multi-payer payment reform and care delivery transformation. CPC+ will include two primary care practice tracks with incrementally advanced care delivery requirements and payment options to meet the diverse needs of primary care practices in the United States (U.S.). The multi-payer payment redesign will give practices greater financial resources and flexibility to make appropriate investments to improve the quality and efficiency of care, and reduce unnecessary health care utilization. CPC+ will provide practices with a robust learning system, as well as actionable patient-level cost and utilization data feedback, to guide their decision making ¹.”

According to VMG Health, CPC+ is expected to involve up to 5,000 practices and 20,000 physicians in 20 regions, amounting to over 25 million patients, throughout its five-year plan starting January 2017 and providers can participate in CPC+ under two tracks, which will both provide a monthly care management fee and upfront performance-based incentive payments, the latter of which is subject to return at year end if certain quality and utilization standards are not met ². Key difference between the two tracks are as follows:

The Upside
The upside to CPC+ is the goal to shift from the traditional reactive, episodic-driven, fee-for-service model to a more proactive, comprehensive, value-based care delivery model has good intentions. To further support this methodology, CPC+ has identified five key components it’s aiming to achieve, at minimum ³:

• Support patients with serious or chronic illnesses to achieve their optimum health status
• Give patients 24-hour access to care and health information
• Deliver preventive care services to patients
• Engage patients and their families in their own care
• Coordinate the care of patients with other providers in the market

In order to hit the mark on these types of services, healthcare organizations are without a doubt going to have to heavily foster an IT dependent, data centric, collaborative approach amounts all the players. The support for is evident by CMS requesting vendors, within Track 2, to sign a Memorandum of Understanding (MOU) with CMS that outlines their commitment to supporting practices enhancement of health IT capabilities. Increasing the holistic model through information sharing is key to delivering the proactive, information driven, high-value care the initiative looks to accomplish.

In addition, according to analysis conducted by Paul Ginsburg, Margaret Darling, and Kavita Patel of the Brookings Institute, “The combination of larger per beneficiary monthly payments and lower payments for services is the most important part of the initiative. By blending capitation (monthly payments not tied to service volume) and FFS (fee-for-service), this approach might achieve the best of both worlds⁴.” The analysis also highlights the impact of increasing payments to access to care through maintaining primary care physicians, “An advantage of any program that increases payments to primary care practices is that it can partially compensate for a flaw in the relative value scale behind the Medicare physician fee schedule. This flaw leads to underpayment for primary care services. Higher payments for primary care practices through the CPC+ can help slow the degree to which physicians are leaving primary care until more fundamental fixes are made to the fee schedule.⁴”

The Potential Downside
As with most things in this world, with the good could come the potential bad. Though the CPC+ program certainly is in the right mind set to drive quality care via a more comprehensive delivery model, the Brookings Institute analysis notes two potential missed opportunities ⁴:

1. The lack of incentives for primary care physicians to take steps to reduce costs for services beyond those delivered by their practices. These include referring their patients to efficient specialists and hospitals, as well as limiting hospital admissions. There are rewards in CPC+ for lower overall utilization by attributed beneficiaries and higher quality, but they are very small.
2. The inability of physicians participating in CPC+ to participate in accountable care organizations (ACOs). One of [Centers of Medicare and Medicaid Innovation’s] challenges in pursuing a wide variety of payment innovations is apportioning responsibility across the programs for beneficiaries who are attributed to multiple payment reforms. As a result, ACOs are no longer rewarded for using certain tools to address overall spending, such as steering attributed beneficiaries to efficient providers for an episode of care or encouraging primary care physicians to increase the comprehensiveness of the care they deliver

The critical role primary care plays in reducing overall healthcare cost is well accepted and little to no argument should be made against initiatives that improve various aspects of its delivery whether clinical, operational and/or financial. What seems to be up for debate is, which of countless initiative does an organization/practice participate? Given that there seems to be overlapping and perhaps contradictory initiatives in place, it may be time to take a good hard look at the present state of healthcare and reassess, prioritize and, if needed, decommission those initiatives that are no longer applicable or can be replaces by one more suitable based on a more innovative path to drive optimal quality of care while reducing overall spend on healthcare.

What do you think? Do you think CPC+ will drive changes in primary care practices?

Resources for this blog post:

1. https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus
2. http://vmghealth.com/comprehensive-primary-care-plus-fair-market-value/
3. http://www.mckesson.com/blog/assessing-practice-readiness-for-medicares-comprehensive-primary-care-plus-initiative/
4. https://www.brookings.edu/2016/05/31/cmmis-new-comprehensive-primary-care-plus-its-promise-and-missed-opportunities-2/

Medicare is basing hospital reimbursements on performance measures. Patient satisfaction determines 30% of the incentive payments, and improved clinical outcomes decide 70 percent (source). So, it is no surprise that the term “patient experience” is rolling off people’s tongues very matter-of-fact like.

With the focus primarily on the hospital or inpatient setting, it’s easy to forget about the ambulatory or outpatient setting when it comes to patient experience. However, as the country continues to shift its efforts to preventing medical problems rather than simply fixing them, the spotlight is moving to the outpatient setting. Therefore, it is equally, if not more important for those in the medical practices to take the necessary steps to assure their patients’ experiences are top notch in this new care delivery model.

Positive Outcomes and Opportunities

The benefits to improving patient experience are plentiful, regardless of the care setting. However, the Language of Caring has done a great job highlighting and explaining specific areas within the outpatient setting where increasing quality patient experience can bring about positive contributions and opportunities. Here are the exact details they provide:

1. Improved outcomes and healthier patients – Improved quality patient experience in medical office settings brings about optimal health outcomes. Patients are less anxious in their visits and communications with the physician and care team. The physician and other staff are more successful eliciting needed information from patients and engaging them in decisions that affect their health. Because of greater trust, they are more likely to relax and cooperate during procedures, take their medicine, adhere to their care plans and follow-up with their care, improving care outcomes.
2. Patient retention, loyalty, and growth – By providing consistently satisfying patient experiences, medical practices and other ambulatory care centers win patient loyalty and become a provider of choice. Patients spread the word, which brings in even more patients. As people engage in provider-shopping, services that provide a quality patient experience attract new patients via positive word-of-mouth from their current patients. Also, provider scorecard initiatives are proliferating to assist purchasers in their buying decisions. Providing a quality patient experience is a powerful growth strategy.
3. Success with accreditation and regulatory agencies – Agencies that accredit health plans now scrutinize patient satisfaction data during the accreditation process. Health plans annually measure patient satisfaction as an external review and accreditation requirement of the National Committee for Quality Assurance (NCQA), which instituted a member satisfaction survey as part of its Healthcare Effectiveness Data and Information Set (HEDIS) quality standards as well as the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey that measures the experiences of patients with their physicians and medical groups.
4. Favored relationships with health plans – To become the plan of choice for consumers, health plans want to show high CAHPS scores to prospective customers. They know members defect when they are dissatisfied and they want to retain them in their plans, so most have instituted several incentives or sanctions–all designed to encourage practices and other ambulatory care settings to enhance the patient experience. The better a medical practice or ambulatory care center satisfies its patients, the greater negotiating power with payers.
5. Lower costs of doing business – By providing the exceptional patient experience, medical practices and ambulatory care centers also reduce the costs of doing business. Patients more satisfied with their experience are also less likely to file malpractice lawsuits that drain provider time, energy and coffers. Also the work climate is more satisfying to staff which in turn reduces costly staff turnover.
6. Reputation, pride and satisfaction – In an atmosphere of consumer savvy and scrutiny, the quality patient experience wins physicians and ambulatory care centers an admirable reputation and a grapevine that results in widespread respect in the community. Members of the care team build relationships with patients that last. People trust the care team, and because they are more satisfied, they complain less. All of this translates into the psychic rewards of greater job satisfaction for the care team and greater pride in their impact on their patients’ health status.
7. Profitability – By providing an exceptional patient experience, medical practices and ambulatory care centers win favor from consumers, purchasers, accrediting agencies and health plans that affect their practice’s financial health and profitability. 

As the U.S strives to change patient experience from a fad to a priority in how we deliver care, outpatient medical practices need to understand the positive impact improvement can make, not only to their business operations, but more importantly to the outcome of patient care.

What other benefits do you see by improving your patient’s experience?

Once upon a time last year, in a town not too far from you, there was a big hospital where a bright, young physician was providing care to a sick, old patient. Okay, let me save you some time. This fairytale, unlike those you are used to, doesn’t end simply by having Prince Charming (the physician) swoop in and save the beautiful, damsel in distress (patient). This fairytale has a bit of twist that changes the standard storyline. This twist is referred to as Patient Engagement.

Changing of the Patient-Provider Fairytale

The concept of patient engagement has changed the way providers tell their patient stories. It is no longer, once upon a time, a patient was sick, the physician cured him/her, the end.

The fairytale now reads more like this…

1. Patient came in.
2. Physician introduces him or her to supporting characters (care team).
3. The patient and physician discuss the plot (disease state) with alternative endings (treatment options).
4. They co-write the script (care plan), including ideas for props (patient education, care communities, etc.) that will enhance the story.
5. The physician quickly publishes (uploads to portal) the manuscript and associated material for review and follow-up (provides email, direct scheduling option, mobile alerts, etc.).
6. And instead of “the end”, it is more like, “to be continued…”

Patient engagement is not a new concept, just one that has been brought to the forefront as part of the healthcare industry’s increased efforts around coordinated care. So much so, that this year at the Health Information Management System Society’s (HIMSS) Annual Conference in Orlando, FL., there are over 20 educational sessions on the topic. Given the importance of patient engagement, I can assure you there will be longer lines to get into these sessions than there will be to get into the castle of the ultimate fairytale princess, Cinderella, at Disney World down the street.

Patient engagement allows patients and their families to be active participants in their care through increased collaboration and communication with their care teams. It moves away from the “I say, you do” approach and allows patients and providers to make informed decisions as they advance toward agreed upon goals surrounding care. As a justifiable way to increase quality of care and reduce healthcare costs, providers are being financially incentivized, through things like Meaningful Use Stage 2, to increase their efforts surrounding patient engagement in hopes that they realize the many benefits it can bring.

The Happily Ever After

To promote stronger engagement, the Agency for Healthcare Research and Quality (AHRQ) developed the Guide to Patient and Family Engagement in Hospital Quality and Safety, a tested, evidence-based resource to help hospitals work as partners with patients and families to improve quality and safety¹. In this guide, AHRQ has identified and explained seven key areas where improving patient engagement can greatly benefit your organization²:

• Improve quality and safety -By focusing on patients and their families, they become allies in your efforts to improve quality and safety. They contribute through informed choices, safe medication use, infection control initiatives, observing care processes, reporting complications, and practicing self-management. All this translates into measurable improvements in quality and safety.
• Improve financial performance – Patient-and family-centered care decreases litigation and malpractice claims and leads to lower costs per case due to fewer complications and shorter length of stay. It can also improve patient flow and bed capacity and reduce overcrowding, with engaged patients and families serving as an early warning system for potential bottlenecks in care processes. When patients and families remain disengaged, hospitals waste resources in the form of delays and waste due to higher call volume, repetitive patient education efforts, increased diagnostic tests, and a greater need for referrals.
• Improve CAHPS^(R) Hospital Survey scores – Many of the CAHPS Hospital Survey measures reflect key elements of patient and family engagement, particularly related to patient-provider communication, pain management, medications, and discharge information. Under the Centers for Medicare and Medicaid (CMS) Value Based Purchasing Program, reimbursement is tied to benchmarked performance on the CAHPS Hospital Survey, and hospitals are rewarded or penalized based on their performance on specific CAHPS measures. Hospitals that have implemented strategies to improve patient engagement have seen subsequent improvements in patients’ ratings of care. For example, at Georgia Health Sciences Medical Center, implementing patient and family engagement strategies on one unit led to an increase in patient satisfaction scores from the 10th to the 95th percentile.
• Improve patient outcomes – Engaging patients and families through improved communication and other practices also has a positive effect on patient outcomes, specifically, emotional health, symptom resolution, functioning, pain control, and physiologic measures such as blood pressure and blood sugar levels. In addition, strategies that promote patient and family engagement can help hospitals reduce their rate of preventable readmissions.
• Enhance market share and competitiveness – For many hospitals, establishing a brand identity around patient and family engagement becomes a competitive edge in the marketplace. Findings from a survey of more than 2,000 patients found 41 percent indicated they would be willing to switch hospitals for a better patient experience.
• Increase employee satisfaction and retention – Patient and family engagement strategies help improve employees’ satisfaction with their work. This, in turn, leads to higher levels of retention and an improved ability to recruit quality talent. For example, at Bronson Methodist Hospital in Michigan, implementing patient-and family-centered care practices led to a decrease in the average nurse turnover rate (from 21 to 7 percent). The hospital estimates that higher nursing staff retention has led to a savings of $3 million over 5 years.
• Respond to Joint Commission standards – Patient and family engagement helps hospitals respond to Joint Commission’s six standards that recognize the need for patients and families to be active and informed decision makers throughout the course of care.

With its many benefits, clinically and financially, patient engagement is encouraging a new kind of storytelling. It is allowing providers to take the basic patient-provider fairytale and turn it into a memorable one, one that people want to keep reading because the ending is so good. You know, the “and they lived happily ever after” kind.

Are you writing memorable patient stories through patient engagement?

Come see us at HIMSS 2014 – Booth # 2035.

Resources for this blog post:

1. http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/index.html
2. http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/patfamilyengageguide/howtogetstarted/How_PFE_Benefits_Hosp_508.pdf

What’s transforming the ways in which healthcare is provided?

• legislation
• new competition
• innovative incentives
• a call to refocus on priorities
• a more empowered and digitally engaged consumer, who has more and greater expectations for quality of care and convenience of care.
• a renewed attention on healthcare by the consumer market thanks to ongoing press about healthcare.gov and the Affordable Care Act
• new services and business models in healthcare that we’d never seen before recent reform

…and much more.

Susan DeVore, CEO of our partner and client Premier healthcare alliance, wrote a post yesterday fro HealthAffairs.gov titled, “The Changing Health Care World: Trends To Watch In 2014.” In the article, she introduces the new trends she expects to see in healthcare this year. We are also seeing each of these trends impact conversations about investments our clients need to make this year and next year.

I have summarized the trends below.

1. Investments in Chronic Care –

• Chronic conditions increase costs by 3X, so, “The biggest health care consumers are those with multiple chronic conditions.”
• We should see more investments in Ambulatory ICUs and patient-centered medical homes as providers work to improve their shared savings payments and better manage chronic conditions within primary care facilities.

2. New Job Roles in Healthcare

• DeVore has seen an increase in the popularity of hiring “health coaches” who are there to listen, inspire and motivate and spend time getting to know the patient’s family and life situation as it affects their ability to both access care and to care for themselves.

3. Home Health Care

• Back to the days of the house call.
• “Marketing firm BCC Research predicts that the market for remote monitoring and telemedicine applications will double from $11.6 billion in 2011 to about $27.3 billion in 2016.”
• Technology is increasing access and convenience of healthcare from outside the traditional care setting, especially for rural, hard-to-access locations.

4. Employer Attention on Health

• The Accountable Care Act lets employers increase wellness incentive dollar value from 20 to 30 percent of total coverage.
• Many employers offer incentives for pedometer use or for quitting tobacco or lowering obesity and diabetes rates.

5. Private exchanges become more popular

• This puts the power of choice into the hands of the employee / consumer
• Employees can also customize their coverage to their own needs and better manage their healthcare budget.

6. Further movement toward Value-Based Purchasing

• The Hospital Value Based Purchasing (SVSP) program penalizes provider organizations who fall behind their peers on key metrics such as clinical quality and patient satisfaction, with the penalties set to go up in the next few years. The program also rewards organizations that improve their score over time and outperform industry benchmarks.
• Sustainable growth rate (SGR) is a method for calculating physician payments. Congress will vote this year to “fix” problems with SGR, moving physicians to VBP. This will tie incomes to quality of care and cost improvements.

7. Data will begin to talk as walls fall down

• DeVore says, “Providers are inundated with new technologies that enable them to automate processes and capture new types of clinical data.” That’s quite an understatement from what I have seen.
• More systems will become open to innovation and sharing of data this year, in a provider-led push to do so.

8. New and more creative partnerships in healthcare

• Last year, “drug chains partnering with physician groups to create ACOs based around retail clinics,” says DeVore. But this year, “look for the trend to include community-based groups, including social service agencies, area gyms, and other non-health care service providers.”
• Providers are beginning to look at the “whole person,” and this means unconventional, innovative ways of providing care.

Exciting stuff!

I just finished watching a quick slideshow on the Health Data Management website, “Enterprise Analytics: Moving on Up” and as luck would have it, I also watched several sessions of the live Webcast from the Healthcare Innovation Day Conference 2014 in Washington, DC, sponsored by West Health Institute and the Office of the National Coordinator for Health Information Technology (ONC).

While I was watching these, I was intrigued by the thought of how Accountable Care Organizations (ACO) can leverage existing solutions, combined with point solutions, to accomplish their reporting, analytics and beyond, and use interoperability wisely. One of the key learning points for me from these sessions was this: “Reframe the problem”….advice from Malcolm Gladwell’s keynote address.

How do we “reframe the problem” when it comes to ACO reporting and analytics? There are defined metrics that are required for these organizations, so how can we leverage existing systems to create these reports and analytics? Do we “build vs. buy”? Depending upon the organizational size, legacy systems and IT support, the decision can be difficult. What is good for one system may not work in another. So where do we start?

A strategic evaluation of current state and desired future state with the development of a road map may be a logical first step. Data Governance also needs to happen early on in the process to allow an organization to create data standards that will drive reporting and analytics. Once these steps have occurred, an organization can feel confident that they can make an informed decision to “build or buy.”

If you choose to build, there are excellent offerings for Enterprise Data Warehouse (EDW), Enterprise Master Patient Index (EMPI), and reporting and analytics solutions from IBM, Microsoft and Oracle.

The “buy” decision can be even tougher because there are numerous point solutions available which can be layered onto existing legacy systems to extract data for reporting and analytics. Many times these solutions have very defined purposes, which may be exactly what you need to fill a gap in your reporting structure at a lower cost than building it. There are solutions which focus primarily on ACO’s, Care Coordination or Population Health. If needed, there are also point solutions which provide excellent reporting capabilities with familiar outputs such as PowerView and PowerPivot, Cognos or Business Objects.

So “reframe the problem” by evaluating what works best for your organization.

“Take all these extraordinary tools we have out there, and have them work together and who knows what extraordinary changes that can bring about?” Gladwell concluded in his speech. “You are on to something very crucial here, and I wish you all the best.”

Go to HIMSS and start looking. Perficient would be happy to help! Stop by Booth 2035 to see us.

The patient centered medical home (PCMH) emphasizes care coordination and communication between various healthcare delivery systems. This coordinated care system can lead to better quality healthcare delivery as well as a better patient experience – but in order to achieve these benefits, providers must be able to see and interpret data from across the many entities the patient interacts with.

Leveraging clinical data from EMRs, HIEs and patient devices allows organizations to:

• Enhance access and continuity
• Identify and manage patient populations
• Plan and manage care
• Provide self-care support and resources
• Track and coordinate care
• Measure and improve performance

Join us October 29th for the webinar “Make the Most of Your ACO with Healthcare Analytics.” You will learn how Oracle Enterprise Health Analytics (EHA), coupled with Oracle Business Intelligence and Oracle WebCenter, fulfills the ACO mandate for a patient centered medical home.

Click here to register for the webinar.

Oracle OpenWorld 2013 turned out to be one of my best experiences with a trade-show ever!  I made new contacts, I learned about product strategy and I learned about awesome customer stories related to innovative healthcare solutions.

Perficient’s Lesli Adams @lesliadams  provided innovative solution overviews highlighting healthcare business intelligence solutions #OBIEE for Patient Centered Medical Home and Accountable Care analytics with Dr. Marcie Stoshak-Chavez @DrMarcieSC, as well as, a session presentation highlighting use cases for #BigData in Healthcare.  Lesli also provided great insight to information discovery using both structured and unstructured data at the #BigData demo grounds with Oracle’s Jim McDowell .

I also attended several sessions about how provider organizations are leveraging Hyperion Profitability & Cost Management to achieve profit and loss transparency via activity based costing.  These leading edge organizations are working with both hospitals and physicians to build models that truly capture service line and encounter level profitability and cost.

I made many new contacts in the Oracle CX space while also beefing up my knowledge about Oracle SOA and the Oracle HC SOA Adapter solution with Perficient’s Eric Roch @eroch2 about automating migrations from legacy HL7 platforms to Fusion Middleware.  I’m looking forward to more thought leadership about both these subjects in the coming months from Perficient.

These solutions are innovating and these organizations are movers and shakers and I couldn’t be more excited about working with Oracle Healthcare solutions in the coming year!

Follow me on Twitter @teriemc

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

Accountable Care Organizations: First Year Results

An ACO is a group of healthcare providers that partner under a payment and delivery reform model that become collectively accountable for the full continuum of care for a population of patients. This reform model ultimately ties reimbursement to quality metrics and reductions in the total cost of care for the patient population. First year results for ACOs were recently released, with very mixed success and several hospitals dropping out of the program.

• The First-Year Pioneer ACO Results: Predictable Bumps In The Road
• Annual ACO survey shows care coordination remains a work in progress for many providers
• Seven ACO Pioneers Drop Out, Others Say It’s the Future
• Obamacare’s ACO Conundrum
• CMS’s Pioneer ACO May Lose Nearly Half Of Its Participants

The Quantified Self

With the progression of patient engagement, consumers are looking to become involved in their own care and health. The quantified self movement helps patients track their health, physical activity, food consumption, heart rate, and more. From mobile apps to worn digital sensors like the FitBit to implanted devices, patients keep track of their own health data – which eventually may be used to create a more personalized experience.

• Hang on; I’m getting a notification from my body on my phone
• How the Quantified-Self Will Make Big Data a Normal Part of Life
• Tell me EVERYTHING about you: What’s next in Quantified Self?
• Tracking the Quantified Self
• Are you sensing my stress?

Healthcare Payment Reform

It is a common opinion that our healthcare system does not provide good value for the care received. Incentives for hospitals are not properly matched with delivering the best possible care at an affordable rate. In response, healthcare payment reform models have been created. Bundled payments reimburse healthcare providers based on the expected cost of a group of services delivered, instead of payment for each treatment provided. Hospital value based purchasing tie reimbursement to the quality of care delivered based on clinical results and patient satisfaction.

• Rising To The Challenges Of The Evolving Reimbursement Environment
• Hospitals Keep Eye on Patient Satisfaction
• Insurer’s Reimbursement Model Rewards Lower Costs
• Don’t Give Up on Health Care Cost Control
• Survey Assesses Views Of Physicians Regarding Controlling Health Care Costs

The Obamacare Delay

The Patient Protection and the Affordable Care Act, or Obamacare, was introduced in 2010 as a national healthcare plan to reform the American healthcare system. Starting in October 2013, over 48 million uninsured Americans will be eligible for enrollment in subsidized plans through state-run health insurance exchanges, with annually increasing fines for those who go uncovered. A recent delay in the requirement that employers with over 50 employees provide health insurance or face a penalty has caused a stir, as some interpret this as the government acknowledging the heavy strain of Obamacare.

• Obamacare’s rule delay could make mandate difficult to enforce
• It’s not just the employer mandate: Three Obamacare delays you haven’t heard about
• Obamacare delay emboldens repealers, makes it 2014 issue
• Obamacare delay passes insurance burden onto workers
• Far-Reaching Implications of Obamacare Delay of Employer Mandate

Population Health Management

PHM aims to improve the overall health of high- and low risk patients by addressing personal health behaviors. PHM places an emphasis on primary care to provide preventative, acute and chronic illness care, which is coupled with efforts to educate patients and encourage behavior and lifestyle changes.

• Harnessing Hospital Data to Improve Healthcare
• IOM calls for ‘unified portfolio’ of population health
• Population Health Pros Get National Support
• Study shows savings within two years of program launch
• How to aggressively pursue population health

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

ACOs and Patient Centered Medical Homes

An ACO is a group of healthcare providers that partner under a payment and delivery reform model that become collectively accountable for the full continuum of care for a population of patients. This reform model ultimately ties reimbursement to quality metrics and reductions in the total cost of care for the patient population. Patient Centered Medical Homes (PCMH) focus on improving the quality of care delivered by creating a health care environment that facilitates communication between the patient and their physician, allowing patients to receive and understand the care they need when they need it.

• Will ACOs drive up costs for patients?
• Infographic: Accountable Care Organizations Tools for Success
• Study: Accountable Care Organizations may improve quality and lower costs
• Medical home initiative reduces costs
• Patient-Centered Medical Home Program Trims Expected Health Care Costs by $98 Million in Second Year

Telehealth and Remote Patient Monitoring

The healthcare industry is experiencing revolutionary changes stemming from the rapidly shifting role of the patient within the continuum of care. This is resulting in high demand for easier access to healthcare professionals, access to online medical information, and alternatives to traditional care. Telehealth allows for the transmission of medical images, video, audio and information related to diagnosis and treatment can be stored and sent from the provider’s computer or mobile device via secure data exchanges. Remote Patient Monitoring allows patient’s health data to be sent electronically to a provider who then can analyze it and respond with appropriate recommendations.

• Telehealth sees explosive growth
• 5 focal points for telehealth efforts
• Informed consent central to telehealth, poses challenges
• Tool Forecasts Remote Patient Monitoring ROI
• Health apps, virtual visits and remote monitoring

Health Insurance Exchanges

Exchanges are organizations that will encourage a more organized and competitive market for buying health insurance. They offer different health plan options; certifying plans that participate and providing information to help consumers better understand their options. These exchanges will open in October 2013 with a required start date by 2014, and will assist individuals and small businesses in comparing and purchasing health insurance coverage.

• 100 days to ‘biggest ever’ health insurance open-enrollment season
• What if the Exchanges Aren’t Ready On Time?
• Health-Insurance Exchanges Are Falling Behind Schedule
• Health insurance exchange law confuses still
• Healthcare Reform: Payers – HIXs and Eligibility

ICD-10

Starting in October 2014, the U.S. healthcare system will begin mandating the use of ICD-10 codes to replace the ICD-9 coding system. The updated ICD-10 codes will be more specific and allow for more precise billing and address advances in medical knowledge and technology. While ICD-10 implementation can be challenging and places new demands on the provider community, it also opens up the opportunity for deeper data, which can be a tool to improve care and lower costs.

• Who Will Blink First On Government ICD-10 Deadline?
• AMA refuses to accept ICD-10 implementation again
• Mostashari: No more ICD-10 extensions
• ICD-10 Impact on Productivity – Offensive vs. Defensive Game
• Preparing For ICD-10: Staying Ahead Of The Compliance Curve

Social Media

Social networking and collaboration tools provide one-to-one streams of interactive communication which enable patients to seek out information about diseases and treatment options. Social tools can also be used to facilitate collaboration within the enterprise between clinicians, researchers, and partners. Social media has been used effectively for patients with cancer, diabetes, congestive heart failure, asthma, obesity etc. to help patients manage chronic disease and prevent readmission.

• Social Digestion: Social Media and the Thinking Organization
• 5 ways hospitals can use social media
• The (Healthcare) Social Network
• Social media helps patients share their medical news
• 5 benefits of online patient communities

I was recently talking with one of my colleagues about a strange situation that happened to her when her local hospital and healthcare provider merged with a larger healthcare system. As a result of the merger, she no longer had a local healthcare provider in her town that took her insurance plan. In essence, she was a victim of healthcare merger mania and had to find a new healthcare insurance plan for coverage. Healthcare organization mergers are part of a broad national trend that is driven by accountable care and the tremendous pressure to cut costs, improve productivity and improve outcomes.

As a result of this merger trend, medical care is being concentrated in fewer institutions, and concern about the impact on higher prices is increasing. A hospital merger boom in the 1990s increased patient costs by 5 to 40 percent in areas where only a few hospitals dominate, according to the Robert Wood Johnson Foundation. Large healthcare organizations with multiple hospitals tend to charge higher prices in communities where they outnumber their rivals, says health economist James C. Robinson of the University of California, Berkeley. This information contradicts the usual arguments for accountable care that merging or affiliating with generate greater efficiencies, higher quality of care and increased savings. More than 100 hospital merger deals took place in 2012, double the number of only three years earlier. Here is the scary statistic: Of the 5,724 hospitals in the United States, about 1,000 will have new owners in the next seven years or so, according to Gary Ahlquist, a senior partner with the consulting firm Booz & Company.

In a sense, the days of the community hospital as a stand-alone operation are coming to an end like the family farm was pushed out by corporate farming. With the recession and higher deductibles causing people to put off medical treatments, the hospital is faced with empty beds and a pressing need to consolidate to lower costs. As patients seek lower costs, many of them opt for out-patient surgery or procedures conducted in the doctor’s office versus the hospital. One irony is that hospitals that hire physicians or acquire physician practices then see an increase in patients as they come to see their doctors.

The Affordable Care Act will flood millions of new patients into the health care system with a goal of promoting competition and lowering the cost of care. To lower costs, the law reduces the rate of growth in Medicare payments to hospitals. In addition, the law provides incentives for hospitals to form Accountable Care Organizations. Instead of separate fees for each procedure, ACOs will receive a lump sum payment, called a bundled payment, to care for patients. The bundled payment is designed to make hospitals work harder to provide good care, control costs and keep patients healthy. The ACO concept is encouraging these mergers or consolidations rather than driving more competition. As a result, less competition will drive up costs for patients, especially in a regional area.

A system of multiple hospitals formed as an ACO creates a collective bargaining unit that is better positioned to bargain with health insurance companies. As a result, the ACO can demand higher prices for its services and, potentially, remove healthcare access for patients that have healthcare plans that won’t meet these new demands. The statistics from James C. Robinson, the health economist from Berkeley, show that prices for six major cardiac and orthopedic surgery procedures, in hospitals in eight states, were 13 to 25 percent more than in areas where there was less competition. Ultimately, the patient pays the higher prices in insurance premiums, deductibles, co-payments and hospital bills when the ACOs win out over the health insurance companies.

Where is the oversight on these hospital mergers and the examination of the loss of real competition in a regional area? The Federal Trade Commission, the Justice Department and some states require oversight of mergers and a few hospitals mergers have been blocked. More care must be taken by these regulatory bodies to avoid regional mini-monopolies that can be created by ACOs and the subsequent loss of healthcare access experienced by people with the “wrong” health insurance company. In addition, a broader scrutiny beyond Medicare and Medicaid needs to be instituted around the impact of ACOs on the medical costs to patients. It is fair to say that hospitals and physician practices are in a tough squeeze with more patients and cost reduction pressures, but ACOs need more focus on the downstream impacts of driving up costs for their patients or potentially removing their access to local healthcare.

Are ACOs causing unintentional consequences on costs for patients? What’s your opinion?

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

Patient Engagement and e-Patients

The term “patient engagement” is on the tip of the healthcare industry’s tongue these days. We can only end the long-running trend of low patient engagement, along with the dangerously high cost of care, by shifting to true patient engagement that holds the patient experience, and the power of the resulting data, at forefront of healthcare business strategy. The healthcare industry is shifting emphasis to the patient, caused not only by government mandates but also by a shift in consumer expectations inspired by other industries that have permeated healthcare.

• Patient Digital Experience: The “Other” Other 99%
• Patient engagement is critical for better outcomes
• 7 key issues to tackle in patient engagement
• Survey: Use of Patient Engagement Support Tools Low among Physicians
• What the “E” in E-Patient Really Means

Healthcare Payment Reform

It is a common opinion that our healthcare system does not provide good value for the care received. Incentives for hospitals are not properly matched with delivering the best possible care at an affordable rate. In response, healthcare payment reform models have been created. Bundled payments reimburse healthcare providers based on the expected cost of a group of services delivered, instead of payment for each treatment provided. Hospital value based purchasing tie reimbursement to the quality of care delivered based on clinical results and patient satisfaction.

• Taking back the reins: Value-Based Purchasing in Healthcare
• Maximizing Financial Rewards from Hospital Value Based Purchasing
• Value-Based Purchasing: How Physicians Will Be Compensated in the Future
• What do Hospitals, Physicians Think of Bundled Payments?
• 4 Considerations for Hospital Bundled Payment Programs

Patient Protection and the Affordable Care Act

The Patient Protection and the Affordable Care Act, or Obamacare, was introduced in 2010 as a national healthcare plan to reform the American healthcare system. Starting in October 2013, over 48 million uninsured Americans will be eligible for enrollment in subsidized plans through state-run health insurance exchanges, with annually increasing fines for those who go uncovered. Adding millions of consumers to the health care system will increase consumption dramatically and put a strain on providers.

• 216 Days Until Obamacare is Fully Enacted — Do You Know What To Expect?
• States scrambling to figure best path forward for ACA
• Insurers pick up $147 million tab for young adults under Obamacare
• How the Affordable Care Act Affects Healthcare Construction
• Amount of Uninsured Americans Increases Prior To Launch of the Affordable Health Care Act

ACOs and Population Health Management

An ACO is a group of healthcare providers that partner under a payment and delivery reform model that become collectively accountable for the full continuum of care for a population of patients. This reform model ultimately ties reimbursement to quality metrics and reductions in the total cost of care for the patient population. PHM aims to improve the overall health of high- and low risk patients by addressing personal health behaviors. PHM places an emphasis on primary care to provide preventative, acute and chronic illness care, which is coupled with efforts to educate patients and encourage behavior and lifestyle changes.

• Accountable Care Organizations: An Opportunity for Synergy
• A Framework For Accountable Care Measures
• Payers anticipate rapid move towards accountable care
• Report: Data Analytics Crucial for Population Health, ACOs
• Becoming An ACO: 7 Steps To Better Population Health

Big Data

The healthcare industry generates massive volumes of data, which often isn’t leveraged to its full potential. In an industry where competitive pressures and regulatory demands are intense, information is a critical business asset, and healthcare organizations can’t afford to stay behind. Analysis of Big Data can help proactively monitor the health of the community population and respond to conditions such as potential illness outbreaks.

• How Big Data could change the way hospitals treat patients
• How Big Data Can Help Healthcare Providers Manage Risk
• EHR oracles: Merging big data streams could create mission control for healthcare
• Big data could mean big health cost savings and better outcomes
• Big Data Security

Almost everyone can relate to being a patient but not everyone can relate to the challenges of coordinated care management.  I’m here at the Patient Experience Summit at the Cleveland Clinic learning how providers will need to shift their culture and their resources to engage patients to be involved in their own care as well as working with the community for case management.

In addition to this culture shift, providers need to think strategically about technology to innovate in this space. I saw a great presentation that explains how many progressive organizations are shifting to a 360 view of the patient viewing using service automation technologies like those that have been innovating within other industries for years. These organizations are cultivating patient experience across many domains… not just their health and wellness. For example, how many former patients put their names on new buildings?

Perficient is uniquely positioned to provide both strategic consulting and technology innovation to help meet these challenges through our partnership with Oracle and experience implementing social collaborative technologies via Oracle platforms such as WebCenter Suite, RightNow, and other CX solutions.

Stop by booth #27 to see our portal demo that showcases engaged patients using social media technology. The demo provides examples of physician to physician collaboration, branding, service catalog, way finding and mobile health.