The document discusses differing strategies among New York's leading health systems regarding growth and expansion. Some systems like Northwell, Montefiore, and Mt. Sinai favor aggressive expansion through mergers and acquisitions to increase scale and bargaining power. Others like New York-Presbyterian and NYU Langone are more cautious, focusing on ambulatory care and selective partnerships over acquiring additional hospitals. The strategies differ in views on vertical integration, population health management, and whether owning an insurance plan is advantageous.
Patient Centered Medical home talk at WVUPaul Grundy
To employers the cost of healthcare is now a business issue and this talk is about what one large buyer IBM did to drive transformation via broad coalition with other large employers to form the Patient Centered Medical Home movement and the covenant between buyer and provider away from the garbage we now buy episodic uncoordinated disintegrated care. In the change of convenient conversation we have worked with the Primary care providers to give us coordinated, integrated, accessible and compressive care with a set of principles know as the Patient centered medical home.
A Patient Centered Medical Home (PCMH) happens when primary care healers keeping that core healing relationship with their patients step up to become specialists in Family and Community Medicine. The move is to the discipline of leading a team that delivers population health management, patent centered prevention, care that is coordination, comprehensive accessible 24/7 and integrated across a deliver system. PCMH happens when the specialists in Family and Community Medicine wake up every morning and ask the question how will my team improve the health of my community today?
All over the world three huge factors are in play that is driving the concept of Patient Centered Medical Home. They are:
1) Cost and demography
2) Information technology and data (information that is actionable will equal a demand for accountability by the payer or buyer of the care)
3) Consumer demand to engage healthcare differently (at least as well as they can their bank- on line) have a question about lab results why not e-mail?
But at its core it is a move toward integration of a healing relationship in primary care and population management all at the point of care with the tools to do just that.
The document provides background information on advancing patient-centered medical homes (PCMHs) in New York State. It discusses the current status and rapid growth of PCMH adoption in New York over the past few years, with nearly 5,000 clinicians now working in NCQA-recognized PCMH practices. However, adoption seems to be leveling off, and three-quarters of primary care practitioners still do not work in PCMHs. It notes key challenges to further expanding the PCMH model in New York, including the need for multipayer alignment on supporting the model through payment and other systems changes.
This document provides an overview and introduction to palliative care. It discusses that palliative care focuses on relieving pain, symptoms and stress of serious illness to improve quality of life. Palliative care is delivered by an interdisciplinary team and can be provided at any stage of a serious illness alongside curative treatments. The document summarizes research finding that palliative care can reduce costs by lowering hospitalizations and emergency visits while improving quality outcomes like symptoms and satisfaction. It also outlines strategies some health payers and organizations are taking to integrate palliative care, like targeting high-risk patients, dedicating case management resources and reimbursing providers.
The document discusses healthcare changes in Oregon under the Coordinated Care Model, including the impact on clinicians. It describes how the model aims to improve health outcomes while lowering costs through coordinated care organizations (CCOs) that integrate services and receive incentives for quality. Interviews found that while some clinicians feel aligned with these goals, others expressed concerns about losing autonomy and taking on increased responsibilities. Overall, the reforms were described as bringing changes to clinical roles and uncertainty about the future, but also opportunities for collaboration and innovation.
The document summarizes New Mexico's broken behavioral health care system and provides recommendations for reform. Key issues include a long-standing provider shortage, lack of access to care, and no performance incentives for quality. The dominant governing body, the Behavioral Health Collaborative, has led to bureaucracy that does not empower patients or providers. Reforms proposed include expanding evidence-based practices, implementing mental health courts more widely, utilizing telehealth, and increasing the roles of care coordinators and peer support specialists to improve both the quality and availability of care.
Leanne Wells, Chief Executive Officer, Consumers Health Forum of Australia, gave the Ian Webster Health for All Oration to the annual forum of the Centre for Primary Health Care and Equity on 13 August 2015.
The document discusses several topics:
1. A new set of criteria has been developed by NCQA and PCPCC to recognize physician practices as patient-centered medical homes based on 7 principles.
2. Matria has partnered with Microsoft to support HealthVault, a new health platform that allows users to store and access personal health information online.
3. A case study describes how Matria client BD integrated disability management with disease management, increasing participation in health programs from 23% to 48%.
Patient Centered Medical home talk at WVUPaul Grundy
To employers the cost of healthcare is now a business issue and this talk is about what one large buyer IBM did to drive transformation via broad coalition with other large employers to form the Patient Centered Medical Home movement and the covenant between buyer and provider away from the garbage we now buy episodic uncoordinated disintegrated care. In the change of convenient conversation we have worked with the Primary care providers to give us coordinated, integrated, accessible and compressive care with a set of principles know as the Patient centered medical home.
A Patient Centered Medical Home (PCMH) happens when primary care healers keeping that core healing relationship with their patients step up to become specialists in Family and Community Medicine. The move is to the discipline of leading a team that delivers population health management, patent centered prevention, care that is coordination, comprehensive accessible 24/7 and integrated across a deliver system. PCMH happens when the specialists in Family and Community Medicine wake up every morning and ask the question how will my team improve the health of my community today?
All over the world three huge factors are in play that is driving the concept of Patient Centered Medical Home. They are:
1) Cost and demography
2) Information technology and data (information that is actionable will equal a demand for accountability by the payer or buyer of the care)
3) Consumer demand to engage healthcare differently (at least as well as they can their bank- on line) have a question about lab results why not e-mail?
But at its core it is a move toward integration of a healing relationship in primary care and population management all at the point of care with the tools to do just that.
The document provides background information on advancing patient-centered medical homes (PCMHs) in New York State. It discusses the current status and rapid growth of PCMH adoption in New York over the past few years, with nearly 5,000 clinicians now working in NCQA-recognized PCMH practices. However, adoption seems to be leveling off, and three-quarters of primary care practitioners still do not work in PCMHs. It notes key challenges to further expanding the PCMH model in New York, including the need for multipayer alignment on supporting the model through payment and other systems changes.
This document provides an overview and introduction to palliative care. It discusses that palliative care focuses on relieving pain, symptoms and stress of serious illness to improve quality of life. Palliative care is delivered by an interdisciplinary team and can be provided at any stage of a serious illness alongside curative treatments. The document summarizes research finding that palliative care can reduce costs by lowering hospitalizations and emergency visits while improving quality outcomes like symptoms and satisfaction. It also outlines strategies some health payers and organizations are taking to integrate palliative care, like targeting high-risk patients, dedicating case management resources and reimbursing providers.
The document discusses healthcare changes in Oregon under the Coordinated Care Model, including the impact on clinicians. It describes how the model aims to improve health outcomes while lowering costs through coordinated care organizations (CCOs) that integrate services and receive incentives for quality. Interviews found that while some clinicians feel aligned with these goals, others expressed concerns about losing autonomy and taking on increased responsibilities. Overall, the reforms were described as bringing changes to clinical roles and uncertainty about the future, but also opportunities for collaboration and innovation.
The document summarizes New Mexico's broken behavioral health care system and provides recommendations for reform. Key issues include a long-standing provider shortage, lack of access to care, and no performance incentives for quality. The dominant governing body, the Behavioral Health Collaborative, has led to bureaucracy that does not empower patients or providers. Reforms proposed include expanding evidence-based practices, implementing mental health courts more widely, utilizing telehealth, and increasing the roles of care coordinators and peer support specialists to improve both the quality and availability of care.
Leanne Wells, Chief Executive Officer, Consumers Health Forum of Australia, gave the Ian Webster Health for All Oration to the annual forum of the Centre for Primary Health Care and Equity on 13 August 2015.
The document discusses several topics:
1. A new set of criteria has been developed by NCQA and PCPCC to recognize physician practices as patient-centered medical homes based on 7 principles.
2. Matria has partnered with Microsoft to support HealthVault, a new health platform that allows users to store and access personal health information online.
3. A case study describes how Matria client BD integrated disability management with disease management, increasing participation in health programs from 23% to 48%.
This article analyzes annual cost profiles and consumption patterns of Medicare beneficiaries with diabetes from 2000 to 2006. It finds that while the percentages of beneficiaries and expenditures in different consumption clusters (ranging from "crisis consumers" to "low consumers") remained generally constant year to year, there was significant movement of individuals between clusters over time. Notably, a large proportion of those in the lowest clusters in one year transitioned to the highest clusters in subsequent years, representing a significant portion of inpatient costs. This dynamic migration between clusters, with individuals moving from low to high usage, was a previously unrecognized trend with important implications for targeting of disease management programs.
This document discusses strategies for home health care agencies to minimize risks from audits. It outlines the various entities that conduct audits, including RACs, MACs, and ZPICs. Key areas that auditors focus on include medical necessity, coding accuracy, documentation quality, and compliance with Medicare policies. The document provides guidance on ensuring documentation clearly supports the patient's homebound status, medical necessity of skilled services, and demonstrates progress towards goals. It emphasizes having objective data to justify findings and treatment plans.
Group Health implemented a patient-centered medical home (PCMH) model across its clinics. A 2-year evaluation found improved outcomes compared to control clinics, including higher patient experience scores, better quality scores, lower staff burnout, and decreased utilization and costs. Key changes included redirecting calls to care teams, secure messaging, pre-visit chart reviews, collaborative care plans, and quality improvement processes. The evaluation provided evidence that medical homes can improve care and potentially lower costs by reducing unnecessary emergency and hospital use.
White Paper: Money talks - Rethinking what it means to put patients firstTransUnion
The document discusses how healthcare organizations can better engage patients in financial conversations earlier in the revenue cycle process. It recommends training staff to feel confident discussing costs and payment options with patients upfront. It also suggests educating patients about rising healthcare costs and their obligations. The document proposes implementing data-driven workflows at key points like patient access, financial navigation, and revenue recovery to simplify financial conversations and enable continuous process improvements. The goal is to empower staff to act as financial advocates for patients, improve outcomes like collections and bad debt, and create happier employees and more satisfied patients.
Patient-centered medical home initiatives in several states have shown promising results in improving access to care, quality, and cost control for Medicaid patients. Oklahoma saw a $29 per patient annual reduction in Medicaid costs from 2008-2010 alongside increased use of preventive care. Colorado expanded Medicaid access from 20% to 96% of pediatricians at lower costs. Vermont saw 21-22% decreases in inpatient care use and costs from 2008-2010 alongside 31-36% drops in ER use and related costs. Washington state's acute care spending was 18% below average with 35% fewer inpatient stays per beneficiary. Overall, these initiatives demonstrate that the patient-centered medical home model can positively impact Medicaid programs.
The document discusses Pocahontas Memorial Hospital, a critical access hospital in rural West Virginia that faces numerous challenges. It conducts environmental, access, technology, market and SWOT analyses to assess the hospital's situation. Key recommendations include developing a new mission/vision, focusing on recruitment/retention, utilizing medical technologies, forming partnerships, and taking a strategic, lean approach to planning. The overall goal is for the hospital to remain competitive and continue serving its community.
Drhatemelbitar (1)MEDICAL CASE MANAGEMENTد حاتم البيطارد حاتم البيطار
1. The document discusses issues with the current healthcare system including lack of coordination between institutions, dehumanization of care, and rising costs.
2. It introduces case management as a promising solution, defined as a method that aims for continuity of services and quality clinical outcomes through efficient management of available resources for specific clientele.
3. Case management relies on thorough knowledge of client needs, estimating patient stay lengths, and planning coordinated treatment processes to improve care quality while controlling costs.
Drhatemelbitar (2)MEDICAL CASE MANAGEMENTد حاتم البيطارد حاتم البيطار
This document discusses new models of healthcare delivery that aim to improve care coordination. It describes two prominent models - patient-centered medical homes (PCMHs) and accountable care organizations (ACOs) - that are working to eliminate fragmented care through coordinated care. The case manager plays a key role in coordinating care across settings and providers in these new models, as their role in care coordination is becoming increasingly important with growing care complexity. The document uses Geisinger Health Plan as an example of an ACO that has successfully implemented a medical home program with embedded case managers to coordinate care.
Improving Patients’ Health Acute Care FinalmHealth2015
mHealth strategies have the potential to improve patient health and outcomes before, during, and after emergency department visits. By facilitating patient triage and decision making before visits, improving communication during visits, and enhancing health literacy and behavior change support after visits, mHealth can help emergency departments improve throughput and post-discharge outcomes. This can increase revenue, avoid penalties, and improve patient satisfaction. Two case studies show that text messaging improved satisfaction scores and appointment adherence for discharged patients from emergency departments.
The document discusses the challenges and limitations of the Physician Payments Sunshine Act, which requires drug and medical device companies to report payments and gifts provided to physicians. While intended to increase transparency, it faces issues in fully capturing all financial relationships and providing proper context. The data has had limited impact on physicians and patients, but is being utilized by other groups like researchers and lawyers. Overall, the Act faces obstacles in communicating complex financial data in a clear and meaningful way to different audiences.
HIMSS 16 Connected Health Experience Presentation on Telehealth in Population...Donna Cusano
This document summarizes a presentation about using remote patient monitoring technologies to improve outcomes for patients in accountable care organizations (ACOs). It discusses how the Veterans Health Administration has used remote monitoring successfully for over 12 years, improving outcomes and saving money. Remote monitoring is well-suited for ACOs seeking to improve quality and lower costs by focusing on high-risk patients. The document outlines a pilot program between an equipment provider and two physician-led ACOs to study the impact of remote monitoring on costs, utilization, and outcomes for high-risk patients with chronic conditions. Preliminary findings suggest remote monitoring shows potential for cost avoidance and reducing emergency room and hospital visits while improving patient satisfaction.
Drhatemelbitar (3)MEDICAL CASE MANAGEMENTد حاتم البيطارد حاتم البيطار
This document outlines case management guidelines for workers' compensation cases in Oklahoma. It was developed by the Physician Advisory Committee and adopted by the Administrator of the Oklahoma Workers' Compensation Court. The guidelines define case management, describe the benefits and role of case managers, and outline the case management process. They provide criteria for when a case should be referred to case management, including catastrophic injuries, noncompliance with treatment plans, frequent changes in providers, and issues that require in-person evaluation like language barriers. The guidelines are intended to help case managers provide coordinated, quality care to injured workers.
The document discusses New York State's efforts to promote the patient-centered medical home model. It notes that while New York spends a lot on healthcare, the quality and health outcomes are only middle of the pack. The Commissioner of Health believes the PCMH model can help strengthen primary care, improve chronic care management, and reduce avoidable costs. New York has promoted multipayer PCMH initiatives through legislation and programs. Initial PCMH pilot programs showed promising results, and the state has seen significant uptake of PCMH recognition across practices. Evaluations are still early, but results so far are encouraging regarding patient experience and quality measures.
The document discusses preventive and case-managed services offered by Nevada Medicaid. It describes how the Affordable Care Act expanded Medicaid coverage in Nevada, increasing the patient population for providers. The two main Medicaid managed care organizations (MCOs) in Nevada, Amerigroup and Health Plan of Nevada, are described as well as some of the preventive services they offer. The document recommends that the MCOs use Medicaid electronic health record incentive programs and encounter data to better monitor screening rates and identify gaps in care for populations. Using this data could help the MCOs improve outreach and preventive service delivery.
This document discusses trends and expectations for general practice and primary care in New Zealand towards the year 2030. It outlines that patients will expect quality, convenient, affordable and integrated care from competent professionals. There will be a focus on patient-centeredness, with information systems that communicate clinical information securely between providers and allow patients to access their own records. The future of primary care will rely on strong clinical leadership within a system that is primary care-led and flexible to meet local needs.
The Kaiser Permanente Homeless Navigator Pilot Program in Woodland Hills, California connects homeless patients with community resources to help them find housing and other services, placing over 576 homeless patients in shelters and programs since 2012. The program uses a team approach involving medical, social work, and community staff. It has been successful in transforming lives and ending homelessness for many patients.
This document discusses strategic issues facing the U.S. healthcare system. It argues that the U.S. does not have a functional competitive healthcare market, leading to higher costs, marginal quality improvements, and opportunistic innovation. It analyzes factors contributing to market failure and addiction to the growing healthcare economy. The document advocates for embracing concepts like consumerism, quality reporting, and globalization to increase competition and innovation in healthcare.
This presentation explains the concept of the patient-centered medical home (PCMH), its function and its intended effects. A brief overview of the history of PCMH is also provided, as well as a discussion of its operational characteristics, its principles and outcomes, and what is expected in the future for the PCMH model.
Presentation given by Eric C. Schneider, MD, Senior Vice President for Policy and Research of The Commonwealth Fund at the University of Michigan Institute for Healthcare Policy and Innovation in Ann Arbor, MI on December 7, 2017.
This document discusses the increasing importance of nonacute care to healthcare organizations' success. It notes that what happens outside the hospital, including primary care, home health, and long-term care, will determine hospitals' and health systems' future. It provides examples of how some organizations are investing in and partnering with nonacute care providers to coordinate care across settings and control costs.
The Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents is an initiative designed to improve care for people living in nursing facilities who are enrolled in Medicare and Medicaid.
Through this initiative, CMS will partner with independent organizations to improve care for long-stay nursing facility residents. These organizations will collaborate with nursing facilities and States to provide coordinated, person-centered care with the goal of reducing avoidable hospital stays.
In this webinar, staff from the Medicare-Medicaid Coordination Office (MMCO) and the CMS Innovation Center will provide an overview of the initiative, and offer information about how to apply.
More at: http://innovations.cms.gov/resources/Duals_rahnfr_apply.html
- - -
CMS Innovation
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This article analyzes annual cost profiles and consumption patterns of Medicare beneficiaries with diabetes from 2000 to 2006. It finds that while the percentages of beneficiaries and expenditures in different consumption clusters (ranging from "crisis consumers" to "low consumers") remained generally constant year to year, there was significant movement of individuals between clusters over time. Notably, a large proportion of those in the lowest clusters in one year transitioned to the highest clusters in subsequent years, representing a significant portion of inpatient costs. This dynamic migration between clusters, with individuals moving from low to high usage, was a previously unrecognized trend with important implications for targeting of disease management programs.
This document discusses strategies for home health care agencies to minimize risks from audits. It outlines the various entities that conduct audits, including RACs, MACs, and ZPICs. Key areas that auditors focus on include medical necessity, coding accuracy, documentation quality, and compliance with Medicare policies. The document provides guidance on ensuring documentation clearly supports the patient's homebound status, medical necessity of skilled services, and demonstrates progress towards goals. It emphasizes having objective data to justify findings and treatment plans.
Group Health implemented a patient-centered medical home (PCMH) model across its clinics. A 2-year evaluation found improved outcomes compared to control clinics, including higher patient experience scores, better quality scores, lower staff burnout, and decreased utilization and costs. Key changes included redirecting calls to care teams, secure messaging, pre-visit chart reviews, collaborative care plans, and quality improvement processes. The evaluation provided evidence that medical homes can improve care and potentially lower costs by reducing unnecessary emergency and hospital use.
White Paper: Money talks - Rethinking what it means to put patients firstTransUnion
The document discusses how healthcare organizations can better engage patients in financial conversations earlier in the revenue cycle process. It recommends training staff to feel confident discussing costs and payment options with patients upfront. It also suggests educating patients about rising healthcare costs and their obligations. The document proposes implementing data-driven workflows at key points like patient access, financial navigation, and revenue recovery to simplify financial conversations and enable continuous process improvements. The goal is to empower staff to act as financial advocates for patients, improve outcomes like collections and bad debt, and create happier employees and more satisfied patients.
Patient-centered medical home initiatives in several states have shown promising results in improving access to care, quality, and cost control for Medicaid patients. Oklahoma saw a $29 per patient annual reduction in Medicaid costs from 2008-2010 alongside increased use of preventive care. Colorado expanded Medicaid access from 20% to 96% of pediatricians at lower costs. Vermont saw 21-22% decreases in inpatient care use and costs from 2008-2010 alongside 31-36% drops in ER use and related costs. Washington state's acute care spending was 18% below average with 35% fewer inpatient stays per beneficiary. Overall, these initiatives demonstrate that the patient-centered medical home model can positively impact Medicaid programs.
The document discusses Pocahontas Memorial Hospital, a critical access hospital in rural West Virginia that faces numerous challenges. It conducts environmental, access, technology, market and SWOT analyses to assess the hospital's situation. Key recommendations include developing a new mission/vision, focusing on recruitment/retention, utilizing medical technologies, forming partnerships, and taking a strategic, lean approach to planning. The overall goal is for the hospital to remain competitive and continue serving its community.
Drhatemelbitar (1)MEDICAL CASE MANAGEMENTد حاتم البيطارد حاتم البيطار
1. The document discusses issues with the current healthcare system including lack of coordination between institutions, dehumanization of care, and rising costs.
2. It introduces case management as a promising solution, defined as a method that aims for continuity of services and quality clinical outcomes through efficient management of available resources for specific clientele.
3. Case management relies on thorough knowledge of client needs, estimating patient stay lengths, and planning coordinated treatment processes to improve care quality while controlling costs.
Drhatemelbitar (2)MEDICAL CASE MANAGEMENTد حاتم البيطارد حاتم البيطار
This document discusses new models of healthcare delivery that aim to improve care coordination. It describes two prominent models - patient-centered medical homes (PCMHs) and accountable care organizations (ACOs) - that are working to eliminate fragmented care through coordinated care. The case manager plays a key role in coordinating care across settings and providers in these new models, as their role in care coordination is becoming increasingly important with growing care complexity. The document uses Geisinger Health Plan as an example of an ACO that has successfully implemented a medical home program with embedded case managers to coordinate care.
Improving Patients’ Health Acute Care FinalmHealth2015
mHealth strategies have the potential to improve patient health and outcomes before, during, and after emergency department visits. By facilitating patient triage and decision making before visits, improving communication during visits, and enhancing health literacy and behavior change support after visits, mHealth can help emergency departments improve throughput and post-discharge outcomes. This can increase revenue, avoid penalties, and improve patient satisfaction. Two case studies show that text messaging improved satisfaction scores and appointment adherence for discharged patients from emergency departments.
The document discusses the challenges and limitations of the Physician Payments Sunshine Act, which requires drug and medical device companies to report payments and gifts provided to physicians. While intended to increase transparency, it faces issues in fully capturing all financial relationships and providing proper context. The data has had limited impact on physicians and patients, but is being utilized by other groups like researchers and lawyers. Overall, the Act faces obstacles in communicating complex financial data in a clear and meaningful way to different audiences.
HIMSS 16 Connected Health Experience Presentation on Telehealth in Population...Donna Cusano
This document summarizes a presentation about using remote patient monitoring technologies to improve outcomes for patients in accountable care organizations (ACOs). It discusses how the Veterans Health Administration has used remote monitoring successfully for over 12 years, improving outcomes and saving money. Remote monitoring is well-suited for ACOs seeking to improve quality and lower costs by focusing on high-risk patients. The document outlines a pilot program between an equipment provider and two physician-led ACOs to study the impact of remote monitoring on costs, utilization, and outcomes for high-risk patients with chronic conditions. Preliminary findings suggest remote monitoring shows potential for cost avoidance and reducing emergency room and hospital visits while improving patient satisfaction.
Drhatemelbitar (3)MEDICAL CASE MANAGEMENTد حاتم البيطارد حاتم البيطار
This document outlines case management guidelines for workers' compensation cases in Oklahoma. It was developed by the Physician Advisory Committee and adopted by the Administrator of the Oklahoma Workers' Compensation Court. The guidelines define case management, describe the benefits and role of case managers, and outline the case management process. They provide criteria for when a case should be referred to case management, including catastrophic injuries, noncompliance with treatment plans, frequent changes in providers, and issues that require in-person evaluation like language barriers. The guidelines are intended to help case managers provide coordinated, quality care to injured workers.
The document discusses New York State's efforts to promote the patient-centered medical home model. It notes that while New York spends a lot on healthcare, the quality and health outcomes are only middle of the pack. The Commissioner of Health believes the PCMH model can help strengthen primary care, improve chronic care management, and reduce avoidable costs. New York has promoted multipayer PCMH initiatives through legislation and programs. Initial PCMH pilot programs showed promising results, and the state has seen significant uptake of PCMH recognition across practices. Evaluations are still early, but results so far are encouraging regarding patient experience and quality measures.
The document discusses preventive and case-managed services offered by Nevada Medicaid. It describes how the Affordable Care Act expanded Medicaid coverage in Nevada, increasing the patient population for providers. The two main Medicaid managed care organizations (MCOs) in Nevada, Amerigroup and Health Plan of Nevada, are described as well as some of the preventive services they offer. The document recommends that the MCOs use Medicaid electronic health record incentive programs and encounter data to better monitor screening rates and identify gaps in care for populations. Using this data could help the MCOs improve outreach and preventive service delivery.
This document discusses trends and expectations for general practice and primary care in New Zealand towards the year 2030. It outlines that patients will expect quality, convenient, affordable and integrated care from competent professionals. There will be a focus on patient-centeredness, with information systems that communicate clinical information securely between providers and allow patients to access their own records. The future of primary care will rely on strong clinical leadership within a system that is primary care-led and flexible to meet local needs.
The Kaiser Permanente Homeless Navigator Pilot Program in Woodland Hills, California connects homeless patients with community resources to help them find housing and other services, placing over 576 homeless patients in shelters and programs since 2012. The program uses a team approach involving medical, social work, and community staff. It has been successful in transforming lives and ending homelessness for many patients.
This document discusses strategic issues facing the U.S. healthcare system. It argues that the U.S. does not have a functional competitive healthcare market, leading to higher costs, marginal quality improvements, and opportunistic innovation. It analyzes factors contributing to market failure and addiction to the growing healthcare economy. The document advocates for embracing concepts like consumerism, quality reporting, and globalization to increase competition and innovation in healthcare.
This presentation explains the concept of the patient-centered medical home (PCMH), its function and its intended effects. A brief overview of the history of PCMH is also provided, as well as a discussion of its operational characteristics, its principles and outcomes, and what is expected in the future for the PCMH model.
Presentation given by Eric C. Schneider, MD, Senior Vice President for Policy and Research of The Commonwealth Fund at the University of Michigan Institute for Healthcare Policy and Innovation in Ann Arbor, MI on December 7, 2017.
This document discusses the increasing importance of nonacute care to healthcare organizations' success. It notes that what happens outside the hospital, including primary care, home health, and long-term care, will determine hospitals' and health systems' future. It provides examples of how some organizations are investing in and partnering with nonacute care providers to coordinate care across settings and control costs.
The Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents is an initiative designed to improve care for people living in nursing facilities who are enrolled in Medicare and Medicaid.
Through this initiative, CMS will partner with independent organizations to improve care for long-stay nursing facility residents. These organizations will collaborate with nursing facilities and States to provide coordinated, person-centered care with the goal of reducing avoidable hospital stays.
In this webinar, staff from the Medicare-Medicaid Coordination Office (MMCO) and the CMS Innovation Center will provide an overview of the initiative, and offer information about how to apply.
More at: http://innovations.cms.gov/resources/Duals_rahnfr_apply.html
- - -
CMS Innovation
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Services (CMS) recently announced 23 additional participants for the Community-based Care Transitions Program (CCTP). These participants will join seven other community-based organizations already working with local hospitals and other health care and social service providers to support high-risk Medicare patients in maintaining the healing process as they transition from hospital stays to home, a nursing home, or other care setting.
This webinar will allow stakeholders to hear directly from some of the newly selected sites. CMS Innovation Center staff will provide additional information about the program and will be available to answer questions.
More at: http://innovations.cms.gov/resources/CCTP-RdcReadmiss.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
March 27, 2012
The Center for Medicare & Medicaid Services (CMS) announced 23 additional participants for the Community-based Care Transitions Program (CCTP). These participants will join seven other community-based organizations already working with local hospitals and other health care and social service providers to support high-risk Medicare patients in maintaining the healing process as they transition from hospital stays to home, a nursing home, or other care setting.
This webinar will allow stakeholders to hear directly from some of the newly selected sites. CMS Innovation Center staff will provide additional information about the program and will be available to answer questions.
More at: http://innovations.cms.gov/resources/CCTP-RdcReadmiss.html
- - -
CMS Innovation
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Dr. Iacuone has over 40 years of experience in healthcare, including 29 years in private practice and 20 years as an academic professor. He has held executive roles such as Chief Medical Officer for hospitals and health plans. Most recently, he was President and Chief Clinical Officer of Vantage Cancer Care Network, which was acquired by McKesson in 2016 where he remains in the same role. He brings extensive clinical, academic, and executive experience across multiple areas of healthcare.
August/September 2011 Issue
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Quality Matters offers reports on emerging models and trends in health care quality improvement and interviews
with leaders in the field.
Hospital at Home Program in New Mexico Improves Care Quality and Patient
Satisfaction While Reducing Costs
Summary: An integrated delivery system in Albuquerque, New Mexico, has been able to better meet the needs of its patient
population by offering those who need acute care and meet specific criteria the option of being treated in their homes instead of
the hospital. The program has reduced the average length of stay and cost of care and improved patient satisfaction.
By Vida Foubister
Issue
U.S. hospitals face bed shortages that are expected to intensify as the population ages. To ensure access to care, health care system
leaders have begun to look for creative ways to care for patients. "Hospital at Home," a program designed to provide acute care
services in the homes of patients who might otherwise be hospitalized, has been demonstrated to increase the quality of care
patients receive, improve their satisfaction, and reduce the cost of hospital care by at least 30 percent. [1] Despite its promise,
broader adoption of the model by health systems across the country has been limited by payment policies that restrict
reimbursement to care provided in the hospital setting. This case study profiles the work of one health system that launched a
Hospital at Home program with the support of its health plan.
Organization and Leadership
Presbyterian Healthcare Services (http://www.phs.org/ (http://www.phs.org/)) (PHS) is an integrated delivery system based in
Albuquerque that provides care to more than 750,000 patients throughout New Mexico. Presbyterian's network includes eight
hospitals, a medical group with 34 locations statewide, home care services, and inpatient and outpatient hospice programs. Its
managed care organization, Presbyterian Health Plan, provides commercial health insurance, Medicaid, and Medicare products to
more than 500,000 members.
The Hospital at Home program was developed by leaders of Presbyterian Home Healthcare, the health system's home care and
Hospital at Home Program in New Mexico Improves Care Quality and Pat... http://www.commonwealthfund.org/publications/newsletters/quality-matte...
1 of 5 12/19/2014 10:42 AM
hospice agency, who include Lesley Cryer, R.N., the agency's executive director; Karen Thompson, clinical director of special
programs and Hospital at Home; and Scott Shannon, M.B.A., director of finance. They worked with Bruce Leff, M.D., professor
of medicine at Johns Hopkins University School of Medicine (Johns Hopkins), who developed the Hospital at Home model. The
system's executive and senior vice presidents were also ...
In January 2013, Catholic Health Initiatives began a multi-phase journey to develop a population health management solution across all of its regions. This presentation will describe the strategies the health system pursued for: creating a clinically integrated network as a first step in managing the health of populations and integrating care across the patient experience; aligning hospitals and physician groups to create successful clinical models; creating a data platform to share clinical measures and benchmarks; and ultimately becoming a risk-bearing shared savings ACO. Participants will hear real-world examples of best practices for how to meet FTC regulations, create an effective governance structure to manage performance, and align financial incentives. Learn how one of the nation's largest hospital systems developed a system-wide population health management solution in order to achieve the necessary transformation from fee-for-service to fee-for-value.
This monograph provides an assessment of the current hospital-physician landscape and outlines an innovative vehicle for advancing hospital-physician relationships that has the potential to improve care delivery and coordination, clinical quality, and patient cost. Our findings and recommendations address:• Changes in the market place.• The concept of an integrated medical staff model.• The role of operational clinical integration, enabled by an Electronic Medical• Record, toward creating virtual medical staffs.• Benefits to the hospital, physicians, patients and community.• What boards and senior management can do to move toward the model.
The document discusses the challenges facing U.S. hospitals as the healthcare system shifts from fee-for-service to value-based payments. This shift requires hospitals to change their business model from focusing on individual interventions to providing integrated, population-based care. A survey found that hospital executives recognize the need to substantially change their business model to survive financially under the new system. The experiences of integrated healthcare systems that have adopted this new model show improved health outcomes and cost savings. However, making the transition will be difficult and involves cultural as well as operational changes.
The article discusses the patient medical home model for creating an integrated healthcare system with improved coordination of care. A patient medical home is a longitudinal general practice supported by a team including physicians and other healthcare professionals. The model aims to enhance support for patients, particularly vulnerable groups, through strengthened connections between providers. Examples of similar models in Ontario and Alberta integrating primary care teams within communities are provided. The goals of BC's patient medical home initiative through the General Practice Services Committee include increasing access to quality primary care and contributing to a more effective and sustainable healthcare system.
Dr. Michael Nochomovitz has been appointed as the new senior vice president and chief clinical integration and network development officer for the NewYork-Presbyterian Healthcare System. In this role, he will be responsible for developing the physician enterprise and integrating and collaborating physicians within NewYork-Presbyterian and its affiliated medical schools. Dr. Nochomovitz brings 17 years of experience managing physician networks and previously served as president of the physician services organization at a hospital system in Cleveland. Leaders at NewYork-Presbyterian feel he is well-qualified to foster collaborations between providers to develop an integrated healthcare delivery system.
How to Engage Physicians in Best Practices to Respond to Healthcare Transform...PYA, P.C.
PYA Principal Kent Bottles, MD, spoke about physician engagement when it comes to value payment models during “How to Engage Physicians in Best Practices to Respond to Healthcare Transformation” at the Georgia Society of Certified Public Accountants’ (GSCPA) 2016 Healthcare Conference, February 11, 2016. Dr. Bottles discussed the difficulty of weaning physicians from fee-for-service payment models and the often-unappreciated reasoning behind the shift to value-based payment models. He also highlighted MACRA, MIPS, patient satisfaction surveys, Physician Compare, and the ProPublica Surgeon Scorecard.
The document outlines an agenda for a presentation on new models for aligning value-based incentives with physicians, systems, and payers. The agenda includes discussions on Humana's commitment to population health, Transcend's partnership framework and value-based reimbursement models, a physician perspective from Chauhan Medical Center in Florida, and how Saint Luke's Health System in Kansas City is preparing for the transition from fee-for-service models. An interactive session will examine organizational readiness to transform from volume-based to value-based care through discussions on clinical integration, leadership capabilities, physician engagement, market strength, and relationships with business partners.
The document summarizes Kenya's health care system structure and organization. It begins with background on health issues in Kenya like malaria, tuberculosis, and HIV/AIDS. It then defines a health system and describes Kenya's system. Kenya's system is structured in a step-wise manner from dispensaries up to national referral hospitals. It is organized across several administrative levels from community to county to national. The roles of the Ministry of Health and other actors in service delivery are also outlined. With devolution in 2010, county governments now manage health care delivery while the national government focuses on policy and national facilities.
The document discusses how convenient care clinics are improving healthcare access, affordability, and quality. It notes that millions of Americans lack access to primary care due to lack of insurance or a regular doctor. Convenient care clinics are filling this gap by providing affordable and high-quality care for common medical issues outside of emergency rooms. The number of these clinics has grown significantly in recent years and research shows they can reduce costs while meeting quality standards. The document argues convenient care clinics will continue growing and partnering with other providers to help address healthcare challenges under the Affordable Care Act.
This document provides an overview of hospital revenues. The primary source of revenue for hospitals is operating revenue, which is generated from providing patient care services. Operating revenue is categorized as either gross or net patient service revenue. Gross patient service revenue is the total amount hospitals would receive if paid in full for all services, while net patient service revenue is the actual amount collected after deducting for charity care and contractual adjustments agreed to with insurance companies. Other sources of revenue include other operating revenue from non-patient care activities and gains/losses from peripheral business activities.
RUNNING HEAD: Progress Report1
Senior Project Progress Report
Melonie Lindsey
HCA 459
Vicki Sowle
June 2, 2014
Topic:
The topic that I selected for my senior project was “challenges of employee recruitment and retention of health care professionals”. I chose this topic because it is a growing problem among the healthcare institutions. The professionals who are capable of delivering best efforts in health care institutions are less in number and the opportunities that they have in this modern world are a lot. The human resources department of health care institutions adapt many modern ways to overcome these challenges. It is very interesting to understand such modern methods of human resources department for employee retention. At the same time, it’s interesting to visualize how the employees react to the actions performed by the human resources department of such healthcare institutions. In case the human resources department is unable to retain their employees irrespective of the hard measures taken by them, the backup plans executed by them in such cases are also worth studying.
Organization Specific Rationale:
New York Presbyterian is the health care organisation that I have selected for my senior project. This health care organisation is one of the top medical service providers in US. They have won several awards for maintaining good quality in delivering the health care services. The latest award that they have won is the “Energy Star Award” from EPA. This health care organisation offers a wide variety of medical services for their patients. The staff of this organisation is highly capable of delivering the best results. (http://nyp.org/, n.d.)
There are several challenges and opportunities that impact the balance between the health care costs for this organisation. Although NYP (New York Presbyterian) is a known name in medical field, it has to enforce several strict measures to control the cost and maintain steady income. The services offered by NYP are high class services so it’s not necessary that all the insurance plans cover it. Therefore only a specific category of patients can afford to have a treatment from this hospital. The running cost of the medical equipment installed in this hospital is also very high therefore the government aides are often necessary for this hospital. The salaries of the staff (including doctors) is also a major expense for the organisation.
NYP does not compromise with the quality of the health care services. Although the cost is directly proportional to the quality, the organisation manages its cost in such a way that the reputation of the hospital is never at stake. The multiple awards that are received by NYP is a result of the consistent reputation of the hospital is never at stake. The multiple awards that are received by NYP is a result of the consistent quality delivery. (http://nyp.org/services/index.html, n.d.)
Training:
The intended audience for this training can include t.
Perpetual Mercy Hospital (PMH) is concerned about a new clinic opening five blocks from their Downtown Health Clinic (DHC). The new clinic could take patients from DHC and hurt its business. DHC currently sees most patients between 11AM-2PM and patients have requested expanded hours and added services like gynecology. PMH will consider alternatives like extended hours or adding a physician based on profitability, customer satisfaction, attracting new patients, and cost-benefit to decide how to respond to the new nearby clinic.
Running head MARKETING PLAN 1MARKETING PLAN 14.docxjeanettehully
Running head: MARKETING PLAN 1
MARKETING PLAN 14
Bellevue Hospital
Luz Rodriguez
Southern New Hampshire University
Mission, Vision, and Goals
Bellevue hospital in the New York is one of the leading healthcare centers. It is known facility for its competitive care. The hospital has highly trained medics, physician, and nurses and they provide quality services to patients who live in New York City. The trained medics and other officers advance the healthcare services, give innovative treatment programs to children, seniors, and adults (NYC Health + Hospitals / Bellevue, 2018). The hospital encourages its services to the target market through the use of social media stands such as Twitter, Facebook, and Instagram. The social media is resourceful for the public because it makes it easy for the population to realize medical solutions which are offered in the hospital. Bellevue hospital is guide by a mission and vision statement. The mission is to advance high level of healthcare to the people living in New York while taking up dignity, consideration, and cultural understanding. Moreover, as parts of the organization mission, the hospital aim at ensuring health is available to all patients irrespective of their economic background. The hospital vision is to be the prudent facility in the America. All the operational goals are set to boost the organization to achieve this vision and mission. Some of the strategic goals include helping the poor in the society, cutting medical cost, and understanding innovative ways to develop quality relationship with all stakeholders.
State of the Service
Bellevue Hospital has goal to join different organization in the New York to manage the services of patients. The state of medical care in this facility is efficient and it is one of the best in terms of emergency care. The facility Level I Trauma Center is known for quick response to adult psychiatric and pediatric emergencies. The facility has neonatology, cardiology, and neurology centers. The organization (Bellevue Hospital) is the pioneer in training psychiatrist and psychiatric nurses, these are important specialists in detecting and managing mental illnesses (NYC Health+Hospitals|Bellevue, 2016). The facility is also celebrated for being the top institution in cardiovascular programs in America. Its Geriatric Ambulatory Care Program accommodated over 5,000 older patients each years and this makes it one of the busiest facility in the US. To boost its productivity and improve the service delivery, the facility has formed alliance with the “New York University School of Medicine”. Since Bellevue Hospital offers different specialties, it must be guided by some marketing strategies and plans. The hospital must have some ethical positions to ensure that the patients’ satisfaction is guaranteed.
Services in relation to Organization
Organizational goals should align with the interests of the stakeholders. For example, the mission stateme ...
1. How New York’s
Leading Health Systems
Differ on Growth Strategy
Richard D. Fenton, MBA
Sr.Vice President, Executive Search
Tal Healthcare
2. New York’s leading health care systems have
split into two opposing camps on the question
of preparing for a long-term future in the
industry.
3. Northwell, Montefiore,
Mt. Sinai
One camp, consisting of Northwell, Montefiore and Mt. Sinai,
believes in aggressive up-sizing.
Expansion through mergers with other systems and acquisition
of satellite campuses
• achieving administrative efficiency,
• increasing bargaining power,
• diversifying revenue and
• gaining the ability to act as their own insurers.
4. New York-Presbyterian,
NYU Langone
The other camp, comprised of New York-Presbyterian and NYU
Langone, is more cautious – wary of affiliating with other brick-
and-mortar hospitals in an era of declining utilization rates.
• NYU has shied away from affiliations outside the city
• New York-Presbyterian isn’t affiliating at all. They have instead
made strategic investments and focused on ambulatory care
and their traditional role as teaching hospitals.
• They have steered well clear of the insurance business.
5. House Calls Returning
Providers in New York and across the nation are
bringing back the house call. But it’s not for when a
patient is ill. These 21st century house calls are for
before an exam and after a procedure.
“Your ability to take care of patients when they are not
sitting across from you in the examination room
becomes key,” said Montefiore Medical Center chief
medical officer Dr. Andrew Racine. “We have visiting
nurses out there all the time.”
6. Northwell
(formerly North-Shore LIJ)
• Has been the most aggressively expansionist of all the systems.
• Announced partnerships with The Cleveland Clinic,
• Started its own insurance company (called CareConnect),
• Offered help to other health systems converting to the ICD-10
disease classification system,
• Took over Lenox Hill,
• Turned the former St. Vincent’s into the city’s first freestanding
emergency department,
• Announced a plan to open 50 ambulatory clinics across the state
and
• Finalized an agreement with Phelps Memorial and Northern
Westchester Hospital
7. Mt. Sinai Health System
• The Brooklyn Hospital Center, which earlier
this summer announced it would be affiliated
with Mount Sinai.
• Mount Sinai is also affiliating with Valley
Hospital in New Jersey, which ended its
relationship with Presbyterian at the end of
2014.
8. Mt. Sinai Health System
Kenneth Davis, Mount Sinai’s C.E.O. recently explained his
thinking about the new health care landscape in a controversial
op-ed for the Wall Street Journal.
• “To mitigate that risk, hospitals need to broaden the
populations they serve, and offer services that cover a larger
geographical area.”
• “Without that wide range, there is too great a risk that costs
beyond hospital walls during post-acute care, patients who
are high utilizers of medical services, will unbalance the
scales. Hospitals need a large pool to survive any increased
medical needs and costly care.”
9. Mt. Sinai Health System
Mt. Sinai is beginning to blur the lines between provider and
insurer.
• In October: announced the establishment of a new Medicare
Advantage plan for Manhattan residents co-sponsored with
Healthfirst.
• Beginning 2015, Empire BlueCross BlueShield, the largest
health insurers in New York, and the Mount Sinai Health
System established an accountable care arrangement which
will create individualized health plans to guide Empire’s
48,000 commercial and Medicare lives attributable to Mount
Sinai
10. Montefiore
Medical Center
• Partnering with White Plains hospital in
Westchester and Nyack Hospital in Rockland
County.
• Bought Sound Shore in New Rochelle and
Mount Vernon Hospital in 2013.
• Offering its own insurance product. The
Montefiore Insurance Co., launched in January
2015, will offer coverage to small businesses.
11. Montefiore
Medical Center
The advantage Montefiore has over its competitors is that it has
a long and successful track record of providing care to low-
income patients, having dealt with a payer mix dominated by
the federal government since the creation of Medicare and
Medicaid in the mid-60’s.
• one of 32 health systems across the country to implement
Pioneer Accountable Care Organization as part of the
Affordable Care Act.
• one of a handful of few success stories, achieving costs
savings of 7 percent during the first two years.
• ACOs set payment limits and force hospitals to provide care at
a set cost. They function well with large patient volume.
12. Montefiore
Medical Center
Their gamble is that their success at managing
large populations in the Bronx can be replicated
in the Hudson Valley where the physicians are
independent contractors used to a certain
freedom to practice as they see fit, not direct
employees of Montefiore.
13. New York-Presbyterian
New York-Presbyterian’s recent approach exemplifies the alternative,
consolidationist attitude that has set it apart in recent years from North
Shore-LIJ, Montefiore and Mount Sinai.
• Retrenching, allowing community hospitals to affiliate with other systems
focusing greater attention on core assets such as New York Downtown
Hospital in Manhattan or New York Methodist in Brooklyn.
• That has in turn allowed the people who run New York-Presbyterian to
maintain greater control of all the elements of their system. They aren’t
interested in affiliations; they want asset-based mergers.
• New York-Presbyterian took over Lawrence Hospital Center in Bronxville in
July. And in November, Hudson Valley Hospital Center in Cortlandt
• Divested from its insurance companies SelectHealth in 2012, Community
Health Plan, a Medicaid managed care plan, in 2009.
14. New York-Presbyterian
That gave New York-Presbyterian less of an incentive to branch
out. While it still needs volume and administrative efficiencies, it
doesn’t need a million customers like Montefiore does, because
Presbyterian’s payer mix is so much wealthier, or like LIJ does,
because Presbyterian has no insurance company to peddle.
New York-Presbyterian embarked on a $2 billion capital
campaign, supported by a $100 million gift from businessman-
activist David Koch, to build an ambulatory care center on York
Avenue less than two miles north of NYU Langone, and about
two miles south of Mount Sinai.
15. NYU Langone
NYU Langone has taken a similar tack.
“Hospitals are in no way shape or form the primary strategy,” Brotman said.
“It’s not that you can do without any hospitals but we are extremely selective
in thinking about relationships with hospitals.”
Executives at Langone don’t believe that adding more brick-and-mortar
hospitals to the portfolio will pay off in the long run, they said.
“The need for hospital beds is dropping rapidly and being in a state where it’s
not so easy to close or modify a hospital, and the notion of acquiring X
hospitals and assuming that you are going to be able to take out 50 percent of
the physical assets and repurpose them for something else, we think is a very
expensive, highly risky proposition,”
No interest in operating as an insurer, which means they have one less
incentive to affiliate across the state.
16. NYU Langone
“It’s not our core competence. … What we are interested in is moving the in-
patient setting to the ambulatory setting and we’ve moved rapidly in that
direction.”
• Between 52 percent and 57 percent of NYU Langone’s revenue is now in
ambulatory care.
• Only one-third of NYU’s 42,000 surgeries are classified as in-patient.
• Focus on out-patient ambulatory care centers, and NYU has opened nearly
three dozen during the past few years.
• That explains why NYU Langone was keen to affiliate with Lutheran
Hospital, which has a robust out-patient network, including 28 school-
based health centers and relationships with several federally qualified
health centers.
17. NYU Langone
Part of the hospital systems’ decision-making is guided by the simple
question of how much faith they have in the ability of affiliated doctors and
institutions to act efficiently as brokers.
• NYU Langone, for example, is heavily focused on affiliating with physician
practices and medical groups, and counts on physicians to manage the
primary care and refer patients back to them for anything major. That
gives them the advantage of a referral service without the financial
commitment of a community hospital.
• We think it’s the doctor, not the hospital. So if a doctor in Queens, one of
our doctors, says to a patient, ‘You need a cardiac cath, I want you to go to
NYU,’ or, ‘You have pneumonia, I want you to go to New York Hospital
Queens right down the road,’ we think that patient is going to agree.
18. Northwell
(formerly North-Shore LIJ)
Northwell executives see it a bit differently.
In a payment model that rewards population health
management, they say, vertical integration is crucial.
“The big issue is care coordination,” “The same systems mean
doctors have ways to communicate with each other, share lab
results, imaging.”
For the vast majority of patients it really doesn’t matter whether
they are treated at an LIJ facility. But for a select few—the
chronically ill, co-morbid cases that are the most expensive to
treat—it matters a great deal, and if LIJ isn’t ensuring that these
costliest 5 percent of patients are appropriately treated, their
business will suffer.
19. Northwell
(formerly North-Shore LIJ)
“Many of these conditions require a high degree of care
coordination,” “There is a level of care management and care
coordination that is required to have outcomes that yield a
favorable result.”
The larger health systems can bring the capital, the staff and the
expertise to develop and run programs specifically aimed at
managing costly chronic diseases such as diabetes, or
hypertension.
“The strategy we are talking about is very long in its gestation,”
Racine said. “You can’t really do care management overnight.
You have to spend a long time developing architecture. You make
mistakes along the way.”
21. Necessary Characteristics
for Health System Success
• Market power is key
• Focusing on the total consumer experience is critical
• Constantly improving operations is critical
• Owning practices (a dominant physician network) is critical
• The jury is out on owning an insurance plan
• Bundled payment efforts are growing
• A constant focus on what drives cash flow is very important
• Developing and recruiting great people is critical
22. Necessary Characteristics
for Health System Success
We also believe healthcare systems and their
leadership should define clearly their core overriding
goals. Ideally, the system can move beyond the first
goal and focus on Nos. 2 through 4.
• Financial survival
• Greatness in certain specific areas
• Dominant in a market
• Great international brand. This often starts with first
meeting goals 1, 2 and 3.
23. Necessary Characteristics
for Health System Success
An article breaks down strategy and certain core observations as follows:
• Market Power Wins.
• Know Your Business; Double Down on Cash Cows; Test New Areas.
• No Single Strategy; No Static Solution.
• There Will Still be a lot of Fee-For-Service. Bundled Payments are a Type of
Fee-For-Service.
• Owning an Insurance Product Requires a Great Deal of Market Position
and Risk Tolerance.
• Most Systems Must Own Practices.
• Consumer-Driven Healthcare.
• Talent Management.
24. AAMC Increases Estimate of
Physician Shortage:
What to Know
Richard D. Fenton, MBA
Sr. Vice President, Executive Search
Tal Healthcare
25. Physician Shortage:
What to Know
• The U.S. faces a shortage of physicians ranging
between 61,700 and 94,700 over the next
decade, according to a new report from the
American Association of Medical Colleges.
• This report updates a 2015 projection that
estimated the nation would need between
46,100 and 90,400 physicians by 2025, though
it is still below a 2010 estimate that projected
a shortage of 130,600 physicians by 2025.
26. Physician Shortage:
What to Know
Perhaps most striking is the addition of an analysis on the needs
of underserved Americans that shows how many more
physicians the country would need if these patients were able to
fully utilize healthcare. These numbers are not included in the
overall projections because they only provide estimates for 2014
levels of care.
"These updated projections confirm that the physician shortage
is real, it's significant, and the nation must begin to train more
doctors now if patients are going to be able to receive the care
they need when they need it in the near future."
27. Physician Shortage:
What to Know
• The overall physician shortage of 61,700 to 94,700
physicians by 2025, no matter the scenario, is in line
with 2015 estimates, according to the AAMC.
• Primary care shortages are expected to range 14,900
to 35,600 by 2025.
• Non-primary care specialties are expected to need
between 37,400 and 60,300 additional providers by
2025.
28. Physician Shortage:
What to Know
• Surgical specialists comprise the only category of
physicians that is expected to decline by 2025.
• In all other categories, the number of physicians is
growing, but demand is outpacing supply.
• Surgical specialties that will be affected include
ophthalmology and urology. AAMC estimates the
shortfall for these physicians to range 25,200 to
33,200 by 2025.
29. Physician Shortage:
What to Know
From 2014 to 2025, the U.S. population is expected to increase
by about 8.6 percent
the population aged 65 and over is expected to grow 41 percent
in that time.
It follows that the demand for healthcare services that seniors
need will be higher than the demand for pediatric services.
• Due to the large numbers of aging physicians, retirement
decisions are expected to have the single greatest impact on
supply.
• More than one-third of physicians will be 65 or older in the
next decade, according to AAMC.
• Increasing demand can be traced to population growth and
aging.
30. Physician Shortage:
What to Know
The effects of the Affordable Care Act on
physician demand are small:
The AAMC expects this will only increase
demand by about 10,000 to 11,000 physicians,
or 1.2 percent.
31. Physician Shortage:
What to Know
If barriers to care were removed for currently
underserved populations and these populations
had similar patterns of use to the rest of the
population, the AAMC found the nation would
have needed as many as 96,200 additional
physicians in 2014.
32. Comparing Cost of Care:
MD vs. NP
Richard D. Fenton, MBA
Sr. Vice President, Executive Search
Tal Healthcare
33. Comparing Cost of Care:
MD vs. NP
Increasing the use of nurse practitioners to meet
the growing demand for primary care services
for Medicare beneficiaries may actually
• reduce costs for the government program
• while still providing beneficiaries with high-
quality care, payments to PCPs and NPs
34. Comparing Cost of Care:
MD vs. NP
PCP NP Difference
Inpatient services $22,898 $20,380 -11 percent
Part B services $2,955 $2,433 -18 percent
Outpatient evaluation and management $705 $498 -29 percent
Adjusted work relative value $1,911 $1,629 -15 percent
Evaluation and management relative
value unit
$713 $585 -18 percent
35. Comparing Cost of Care:
MD vs. NP
• NPs may be providing excellent, efficient care at a lower price,
as the average number of Medicare beneficiaries seen by
each PCP was double that seen by each NP (367 beneficiaries
compared with 183, respectively).
• While it is possible PCPs work more quickly, it is likely that
NPs spend more time with each patient to provide more in-
depth care, which in turn enhances quality, efficiency and
better outcomes.
• On the other hand, shorter, more rushed visits may result in
more diagnostic tests ordered, more medications prescribed
and more referral requests.
36. New York Metro Market
Work Place Environments
• Large, Academic Medical Systems
• Faculty Practice Organizations
• Community Medical Centers
• Federally Qualified Health Centers
• Neighborhood Health Centers
• Private Practices
• Other…