The document discusses challenges that health systems face in managing costs under new bundled payment programs and global budgets. It provides an example from a pilot program in Maryland where costs have been capped and prices set in an effort to cut Medicare spending. The document outlines some of the key areas health systems need to address in both acute and post-acute care settings, such as optimizing patient mix and readmission rates, in order to successfully meet budget targets and quality measures. It provides details on specific strategies used by one Maryland health system to improve performance, such as reducing readmission rates from over 23% to less than 7%.
NCQA_Future Vision for Medicare Value-Based Payments FinalTony Fanelli
This document discusses principles for achieving an optimal future state of quality measurement to support performance-based clinician payment under MACRA. It outlines five principles: 1) Every Medicare enrollee needs a dedicated and well-organized primary care team; 2) Measurement must be specified appropriately for each different unit of accountability; 3) Measurement should support rapid improvement and clinical decision making; 4) A core set of measures will let all stakeholders make comparisons across programs; 5) Quality measure results should be easy for consumers and payers to get and use. The document emphasizes the importance of coordinated, team-based primary care and having measures tailored to different payment and delivery models.
The document provides information about the Academy of Managed Care Pharmacy (AMCP). It discusses:
1) AMCP was founded in 1989 and is a national professional society dedicated to promoting pharmaceutical care in managed healthcare environments.
2) AMCP's mission is to empower its over 5,700 members to improve healthcare for all individuals through the appropriate use of medications within managed care systems.
3) Key players in managed care include health plans, pharmacy benefit managers, the pharmaceutical industry, specialty pharmacy providers, retail pharmacies, and consulting firms. Pharmacists work in various roles across these organizations.
PGodfrey_Automation of Utilization ManagementPaul Godfrey
This document discusses a project to automate utilization management processes at Montefiore Care Management Organization using the Epic Tapestry system. The current system, CCMS, is not fully automated and leads to delays. Automating processes like authorization requests and notifications between facilities could improve patient outcomes and reduce costs. The project objectives are to streamline intake of authorization requests, apply validation checks, and route tasks. Stakeholders include various Montefiore departments and Epic. The plan is to implement Tapestry in phases, test functionality, and train staff on the new system to transition from the legacy CCMS system.
This document defines and outlines utilization management (UM). UM is the process of assessing healthcare services to determine if care is medically necessary, appropriate, efficient, and meets quality standards. The purposes of UM include ensuring effective and efficient use of resources, continually assessing access and quality of care, and complying with regulations. Goals are promoting high quality, cost-effective care and making decisions based on medical necessity. Types of UM include prospective review before care, concurrent review during care, and retrospective review after care. The structure involves UM committees and councils. Nurses' duties in UM include concurrent review, precertification, monitoring staff, discharge planning, and maintaining accurate records.
The Evolution of Physician Group from Patient Centric Medical HomesVitreosHealth
A Quest to Achieve Higher Quality and Bend the Employers Health Care Cost Curves. Medical Clinic of North Texas (MCNT) enjoys a stellar FY 2010 performance with Total Medical Cost trend for their managed population 2.4% better than market. We tried to understand the journey and the drivers behind the success of Medical Clinic of North Texas from its early years and its future direction.
NCQA_Future Vision for Medicare Value-Based Payments FinalTony Fanelli
This document discusses principles for achieving an optimal future state of quality measurement to support performance-based clinician payment under MACRA. It outlines five principles: 1) Every Medicare enrollee needs a dedicated and well-organized primary care team; 2) Measurement must be specified appropriately for each different unit of accountability; 3) Measurement should support rapid improvement and clinical decision making; 4) A core set of measures will let all stakeholders make comparisons across programs; 5) Quality measure results should be easy for consumers and payers to get and use. The document emphasizes the importance of coordinated, team-based primary care and having measures tailored to different payment and delivery models.
The document provides information about the Academy of Managed Care Pharmacy (AMCP). It discusses:
1) AMCP was founded in 1989 and is a national professional society dedicated to promoting pharmaceutical care in managed healthcare environments.
2) AMCP's mission is to empower its over 5,700 members to improve healthcare for all individuals through the appropriate use of medications within managed care systems.
3) Key players in managed care include health plans, pharmacy benefit managers, the pharmaceutical industry, specialty pharmacy providers, retail pharmacies, and consulting firms. Pharmacists work in various roles across these organizations.
PGodfrey_Automation of Utilization ManagementPaul Godfrey
This document discusses a project to automate utilization management processes at Montefiore Care Management Organization using the Epic Tapestry system. The current system, CCMS, is not fully automated and leads to delays. Automating processes like authorization requests and notifications between facilities could improve patient outcomes and reduce costs. The project objectives are to streamline intake of authorization requests, apply validation checks, and route tasks. Stakeholders include various Montefiore departments and Epic. The plan is to implement Tapestry in phases, test functionality, and train staff on the new system to transition from the legacy CCMS system.
This document defines and outlines utilization management (UM). UM is the process of assessing healthcare services to determine if care is medically necessary, appropriate, efficient, and meets quality standards. The purposes of UM include ensuring effective and efficient use of resources, continually assessing access and quality of care, and complying with regulations. Goals are promoting high quality, cost-effective care and making decisions based on medical necessity. Types of UM include prospective review before care, concurrent review during care, and retrospective review after care. The structure involves UM committees and councils. Nurses' duties in UM include concurrent review, precertification, monitoring staff, discharge planning, and maintaining accurate records.
The Evolution of Physician Group from Patient Centric Medical HomesVitreosHealth
A Quest to Achieve Higher Quality and Bend the Employers Health Care Cost Curves. Medical Clinic of North Texas (MCNT) enjoys a stellar FY 2010 performance with Total Medical Cost trend for their managed population 2.4% better than market. We tried to understand the journey and the drivers behind the success of Medical Clinic of North Texas from its early years and its future direction.
Co-located or embedded case management is a critical component of value-based care. The role of case managers has changed significantly over the past 25 years as the healthcare system has shifted from fee-for-service to value-based. Case managers are now seen as integral members of care teams in primary care offices, hospitals, and other settings. Having case managers embedded directly in these settings, rather than just co-located, has been shown to lead to more successful programs and better patient outcomes. As value-based programs and medical home models have expanded, the need for embedded case managers has grown substantially.
This document discusses several topics related to healthcare finance and quality reporting systems:
1) It summarizes the goals of the Physician Quality Reporting System (PQRS) and Value-Based Purchasing System (VBPS), including improving quality of care and tying reimbursement to quality metrics.
2) It outlines the roles of Health Information Management professionals in supporting these programs through data analytics and quality reporting.
3) It describes the roles of Quality Improvement Organizations in ensuring accurate medical coding and documentation for reimbursement.
4) It provides an overview of several laws and acts aimed at reducing healthcare fraud, including the Anti-Kickback statute and their effects on providers.
Chronic diseases are the leading cause of death in the US. Managed care organizations implement disease management programs like smoking cessation programs to help prevent chronic diseases and lower costs. These programs aim to eliminate risk factors for disease such as smoking and provide incentives, care management, and access to services to help patients quit smoking. Quality of care is evaluated through structure, process and outcomes to ensure these programs are effective.
The document summarizes the key aspects of the American Recovery and Reinvestment Act (ARRA) related to economic stimulus incentives for healthcare providers to adopt electronic medical record (EMR) technology. It outlines the incentive payments available through Medicare and Medicaid programs for providers who can demonstrate meaningful use of certified EMR systems. It also describes the core objectives and clinical quality measures that providers must meet to qualify for the incentive payments. The summary concludes by advising healthcare providers to start researching their EMR options soon to take advantage of the front-loaded incentive payments.
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.
Closing the Loop: Strategies to Extend Care in the EDEngagingPatients
This HIMSS15 presentation discusses the challenges faced in hospital emergency departments and offers insights for implementing a process to follow up with discharged ED patients to enhance outcomes and satisfaction,while optimizing utilization and reducing risk.
This document discusses strategies that clinically integrated networks (CINs) can use to ensure patients stay within their network. It identifies five key areas of focus: 1) extending access beyond traditional models such as physician offices by partnering with urgent care and retail clinics, 2) managing patient migration outside the network through partnerships and narrow network contracts, 3) making it easy for patients to access care through optimized scheduling and expanded hours, 4) building engagement into clinical care through education and protocols, and 5) exploring innovative technologies like smartphone apps and social media to engage patients. The document emphasizes that keeping patients within the network is important for CINs to effectively manage patient care, costs, and outcomes under value-based payment models.
This document discusses team-based care in the context of the patient-centered medical home (PCMH) model. It outlines six key qualities of effective team-based care: 1) a physician servant leader, 2) a clear mission and goals, 3) defined roles, 4) strong communication, 5) optimized systems, and 6) enhanced training. The article then provides strategies for implementing team-based care in small practices, noting they have limited resources but are adaptable, and in larger practices with multiple locations. Overall, the document emphasizes that developing the right team is essential before practices can transform to the patient-centered medical home model.
Michigan Hospital Association Governance meetingMary Beth Bolton
Patient centered medical home activities in MI and Nationally and the opportunity to improve quality outcomes by increased access to primary care doctors who outreach members who are missing preventive and chronic care services.
CMS Case Study_Brown and Toland Physician's Approach to Serving High Ris...marcus zachary
Brown and Toland Physicians developed a tiered care management program to improve health outcomes and lower costs for high-risk, high-cost patients. They identify these patients through predictive modeling, hospital visits, and physician referrals. Patients are provided different levels of care management based on their needs, including transitional care after hospitalization, outpatient care for chronic conditions, and home-based care for frail patients. This approach aims to address patients' medical and social needs through coordinated care across settings.
This document provides an agenda and overview for a presentation on coordinating patient services to improve satisfaction. The presentation discusses WellSpan Health's efforts to coordinate scheduling across different departments and systems. It outlines challenges in coordinating imaging, registration, and other services across 11 different scheduling systems. WellSpan implemented a new coordinated scheduling system to integrate these systems and resolve conflicts. This improved patient satisfaction by reducing wait times and allowing physicians to schedule from their offices. The presentation discusses expanding this coordinated approach to other areas and creating complete patient itineraries.
This infographic speaks to the challenges Emergency Departments face in caring and following up with the growing population of patients they see, and demonstrates how some EDs are seeing measurable improvements in care, patient satisfaction and efficiency.
DeMarco and Associates and Pendulum HealthCare Corporation provide services to help organizations develop accountable care organizations (ACOs). They assist with infrastructure development, care coordination, and data analytics. Pendulum also designs, develops, and manages ACOs. An ACO aims to deliver coordinated, efficient care to a defined patient population through provider collaboration and accountability for costs and quality outcomes. Requirements include agreements between primary care physicians, specialists, and hospitals to be responsible for a minimum number of Medicare beneficiaries.
Using Patient Registries and Automated Patient Outreach to Qualify for NCQA L...Phytel
The document discusses using patient registries and automated patient outreach to help medical practices qualify for level 3 recognition as a patient-centered medical home according to NCQA standards. It describes how the Phytel system can mine practice data to identify patients for recommended care, contact patients via automated outreach scripts, and generate reports on quality measures and financial results to document improved performance. Using these tools helped one practice profiled achieve the highest level of NCQA medical home qualification.
Defining What is Value-Based Care for Patients with Relapsed/Refractory Chro...Carevive
The target audiences for these activities are hematologists, medical oncologists, pulmonologists, pathologists, physician assistants, nurse practitioners, registered nurses, oncology nurses, nurse navigators, palliative/symptom management teams who care for patients with chronic lymphocytic leukemia (CLL) and quality administrators responsible for their cancer center’s adherence to value-based care delivery models.
Population Health Management White Paper, Spring 2015Edward Pierce
Population health management (PHM) aims to improve health outcomes for groups of individuals through coordinated care and patient engagement. Key components of PHM include leadership from primary care physicians to develop customized care plans for each patient. Data analysis is used to identify at-risk patients and care gaps, while automation and technology help disseminate information to patients. Referral networks and payment structures incentivize physicians to focus on outcomes over volume. Hospitals are developing PHM strategies starting with their own employees to coordinate benefits, replicate the model, and expand it community-wide to improve affordability.
- Ascension Health, the largest nonprofit health system in the US, has two systems participating in the CMS Pioneer ACO program - Seton Health Alliance in Texas and Genesys Physician Hospital Organization (PHO) in Michigan.
- The goal is for these organizations to develop population health strategies and engage providers not employed by Ascension in financial risk-taking models.
- Seton Health Alliance and Genesys PHO chose different payment models from CMS - Genesys PHO selecting a fully population-based model in year 3 while Seton chose a model with no downside risk in the first year.
Lannes - Improving health worker performance The patient-perspectivelaurencelannes
PBF programs in developing countries aim to improve health worker performance through financial incentives tied to meeting targets. This document analyzes data from a PBF program in Rwanda to assess its impact on patient satisfaction. It finds that PBF had a positive effect on satisfaction with clinical services by improving productivity, availability, and competencies of health workers. PBF also positively impacted satisfaction with non-clinical dimensions, suggesting it incentivized improvements in those areas as well. The study concludes PBF can be an effective strategy for increasing patient satisfaction if programs include assessing satisfaction in their incentive mechanisms.
This document provides specifications for a kitchen renovation including:
- Engineered wood flooring and maple cabinets with espresso doors and linen panels.
- Double undermount sink, induction cooktop, wall oven, and dishwasher.
- Quartz countertops and ceramic tile backsplash.
- Recessed LED lighting, pendant light, and undercabinet lighting.
- Electrical plan and legend with outlet, switch, and lighting locations.
- Elevations showing cabinetry, countertops, backsplash, and other finishes.
Co-located or embedded case management is a critical component of value-based care. The role of case managers has changed significantly over the past 25 years as the healthcare system has shifted from fee-for-service to value-based. Case managers are now seen as integral members of care teams in primary care offices, hospitals, and other settings. Having case managers embedded directly in these settings, rather than just co-located, has been shown to lead to more successful programs and better patient outcomes. As value-based programs and medical home models have expanded, the need for embedded case managers has grown substantially.
This document discusses several topics related to healthcare finance and quality reporting systems:
1) It summarizes the goals of the Physician Quality Reporting System (PQRS) and Value-Based Purchasing System (VBPS), including improving quality of care and tying reimbursement to quality metrics.
2) It outlines the roles of Health Information Management professionals in supporting these programs through data analytics and quality reporting.
3) It describes the roles of Quality Improvement Organizations in ensuring accurate medical coding and documentation for reimbursement.
4) It provides an overview of several laws and acts aimed at reducing healthcare fraud, including the Anti-Kickback statute and their effects on providers.
Chronic diseases are the leading cause of death in the US. Managed care organizations implement disease management programs like smoking cessation programs to help prevent chronic diseases and lower costs. These programs aim to eliminate risk factors for disease such as smoking and provide incentives, care management, and access to services to help patients quit smoking. Quality of care is evaluated through structure, process and outcomes to ensure these programs are effective.
The document summarizes the key aspects of the American Recovery and Reinvestment Act (ARRA) related to economic stimulus incentives for healthcare providers to adopt electronic medical record (EMR) technology. It outlines the incentive payments available through Medicare and Medicaid programs for providers who can demonstrate meaningful use of certified EMR systems. It also describes the core objectives and clinical quality measures that providers must meet to qualify for the incentive payments. The summary concludes by advising healthcare providers to start researching their EMR options soon to take advantage of the front-loaded incentive payments.
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.
Closing the Loop: Strategies to Extend Care in the EDEngagingPatients
This HIMSS15 presentation discusses the challenges faced in hospital emergency departments and offers insights for implementing a process to follow up with discharged ED patients to enhance outcomes and satisfaction,while optimizing utilization and reducing risk.
This document discusses strategies that clinically integrated networks (CINs) can use to ensure patients stay within their network. It identifies five key areas of focus: 1) extending access beyond traditional models such as physician offices by partnering with urgent care and retail clinics, 2) managing patient migration outside the network through partnerships and narrow network contracts, 3) making it easy for patients to access care through optimized scheduling and expanded hours, 4) building engagement into clinical care through education and protocols, and 5) exploring innovative technologies like smartphone apps and social media to engage patients. The document emphasizes that keeping patients within the network is important for CINs to effectively manage patient care, costs, and outcomes under value-based payment models.
This document discusses team-based care in the context of the patient-centered medical home (PCMH) model. It outlines six key qualities of effective team-based care: 1) a physician servant leader, 2) a clear mission and goals, 3) defined roles, 4) strong communication, 5) optimized systems, and 6) enhanced training. The article then provides strategies for implementing team-based care in small practices, noting they have limited resources but are adaptable, and in larger practices with multiple locations. Overall, the document emphasizes that developing the right team is essential before practices can transform to the patient-centered medical home model.
Michigan Hospital Association Governance meetingMary Beth Bolton
Patient centered medical home activities in MI and Nationally and the opportunity to improve quality outcomes by increased access to primary care doctors who outreach members who are missing preventive and chronic care services.
CMS Case Study_Brown and Toland Physician's Approach to Serving High Ris...marcus zachary
Brown and Toland Physicians developed a tiered care management program to improve health outcomes and lower costs for high-risk, high-cost patients. They identify these patients through predictive modeling, hospital visits, and physician referrals. Patients are provided different levels of care management based on their needs, including transitional care after hospitalization, outpatient care for chronic conditions, and home-based care for frail patients. This approach aims to address patients' medical and social needs through coordinated care across settings.
This document provides an agenda and overview for a presentation on coordinating patient services to improve satisfaction. The presentation discusses WellSpan Health's efforts to coordinate scheduling across different departments and systems. It outlines challenges in coordinating imaging, registration, and other services across 11 different scheduling systems. WellSpan implemented a new coordinated scheduling system to integrate these systems and resolve conflicts. This improved patient satisfaction by reducing wait times and allowing physicians to schedule from their offices. The presentation discusses expanding this coordinated approach to other areas and creating complete patient itineraries.
This infographic speaks to the challenges Emergency Departments face in caring and following up with the growing population of patients they see, and demonstrates how some EDs are seeing measurable improvements in care, patient satisfaction and efficiency.
DeMarco and Associates and Pendulum HealthCare Corporation provide services to help organizations develop accountable care organizations (ACOs). They assist with infrastructure development, care coordination, and data analytics. Pendulum also designs, develops, and manages ACOs. An ACO aims to deliver coordinated, efficient care to a defined patient population through provider collaboration and accountability for costs and quality outcomes. Requirements include agreements between primary care physicians, specialists, and hospitals to be responsible for a minimum number of Medicare beneficiaries.
Using Patient Registries and Automated Patient Outreach to Qualify for NCQA L...Phytel
The document discusses using patient registries and automated patient outreach to help medical practices qualify for level 3 recognition as a patient-centered medical home according to NCQA standards. It describes how the Phytel system can mine practice data to identify patients for recommended care, contact patients via automated outreach scripts, and generate reports on quality measures and financial results to document improved performance. Using these tools helped one practice profiled achieve the highest level of NCQA medical home qualification.
Defining What is Value-Based Care for Patients with Relapsed/Refractory Chro...Carevive
The target audiences for these activities are hematologists, medical oncologists, pulmonologists, pathologists, physician assistants, nurse practitioners, registered nurses, oncology nurses, nurse navigators, palliative/symptom management teams who care for patients with chronic lymphocytic leukemia (CLL) and quality administrators responsible for their cancer center’s adherence to value-based care delivery models.
Population Health Management White Paper, Spring 2015Edward Pierce
Population health management (PHM) aims to improve health outcomes for groups of individuals through coordinated care and patient engagement. Key components of PHM include leadership from primary care physicians to develop customized care plans for each patient. Data analysis is used to identify at-risk patients and care gaps, while automation and technology help disseminate information to patients. Referral networks and payment structures incentivize physicians to focus on outcomes over volume. Hospitals are developing PHM strategies starting with their own employees to coordinate benefits, replicate the model, and expand it community-wide to improve affordability.
- Ascension Health, the largest nonprofit health system in the US, has two systems participating in the CMS Pioneer ACO program - Seton Health Alliance in Texas and Genesys Physician Hospital Organization (PHO) in Michigan.
- The goal is for these organizations to develop population health strategies and engage providers not employed by Ascension in financial risk-taking models.
- Seton Health Alliance and Genesys PHO chose different payment models from CMS - Genesys PHO selecting a fully population-based model in year 3 while Seton chose a model with no downside risk in the first year.
Lannes - Improving health worker performance The patient-perspectivelaurencelannes
PBF programs in developing countries aim to improve health worker performance through financial incentives tied to meeting targets. This document analyzes data from a PBF program in Rwanda to assess its impact on patient satisfaction. It finds that PBF had a positive effect on satisfaction with clinical services by improving productivity, availability, and competencies of health workers. PBF also positively impacted satisfaction with non-clinical dimensions, suggesting it incentivized improvements in those areas as well. The study concludes PBF can be an effective strategy for increasing patient satisfaction if programs include assessing satisfaction in their incentive mechanisms.
This document provides specifications for a kitchen renovation including:
- Engineered wood flooring and maple cabinets with espresso doors and linen panels.
- Double undermount sink, induction cooktop, wall oven, and dishwasher.
- Quartz countertops and ceramic tile backsplash.
- Recessed LED lighting, pendant light, and undercabinet lighting.
- Electrical plan and legend with outlet, switch, and lighting locations.
- Elevations showing cabinetry, countertops, backsplash, and other finishes.
Chi Anyalewechi is a musician and artist manager from Richmond, Virginia who is passionate about music. She has experience in artist management through internships with Nippy Fonaa and Dawgman Ent. Her skills include active listening, teamwork, communication, and she has experience with projects at Events By Will. Chi provides her contact information and links to her website and social media.
This document discusses the health benefits of coconut oil and warns against consuming four common vegetable oils: canola, cottonseed, safflower, and soybean oils. It notes that before World War II, people in island countries consumed diets high in coconut oil and experienced good health. However, after the war the US promoted hydrogenated oils as healthier alternatives, despite little evidence. This led to a decline in coconut oil consumption and a rise in diseases. The document cautions that the four oils mentioned above are highly processed and linked to health issues. It encourages readers to avoid these oils and use coconut oil instead.
El documento presenta un cronograma de actividades para un curso de diseño curricular que incluye presentaciones magistrales del profesor, talleres grupales, videos y asignaciones como mapas conceptuales y resúmenes. Las temáticas a cubrir son diseño curricular, desarrollo curricular y evaluación curricular.
This document appears to be a student record containing identifying information for a student named Freddy Pérez including their student ID, professor, and class/section. In 3 sentences or less, it provides basic identifying details for a student named Freddy Pérez along with their professor and class information.
Ernie Ianace – Understanding Business Through Comprehensive PerspectivesErnie Ianace
Ernie Ianace is a successful member of the corporate world due to his wealth of experience in various business industries. A Texas native, he graduated with honors from Amberton University in Garland, Texas and holds a Microsoft Certified Solutions Expert certification. Mr. Ianace has also served on the city of Frisco's Mayor's advisory council, though he is most famous for his impressive professional career built on understanding business through comprehensive perspectives.
El documento define conceptos clave como didáctica, estrategias de enseñanza y aprendizaje. Explica que la didáctica se enfoca en mejorar la enseñanza mediante métodos y técnicas. Las estrategias de enseñanza son los procedimientos usados por los maestros, mientras que las estrategias de aprendizaje son procesos usados por los estudiantes. También describe teorías de aprendizaje, elementos de la didáctica, la diferencia entre métodos, estrategias, técnicas y actividades, y
El resumen del documento es el siguiente:
1. El Lic. Robles entrevista al Lic. Rodríguez para conocerlo mejor y discutir temas que lo inquietan.
2. El Lic. Rodríguez expresa algunas desventajas en la empresa como falta de atención al personal.
3. El Lic. Rodríguez ha recibido una oferta de gerencia en otra empresa, y el Lic. Robles ofrece mejorar las prestaciones para retenerlo.
[CCC] Bilan moral 2016 et programme 2017Eric Culnaert
Lors de l'Assemblée Générale de Digital Aquitaine du 13 décembre 2016, le Club Commerce Connecté a présenté son bilan moral 2016 ainsi que son programme prévisionnel 2017.
CCC-projeCtion 31 mai 2016 "stratégie et projets 2016-2017", avec Cap DigitalEric Culnaert
Le Club Commerce Connecté tenait le 31 mai 2016 un atelier co-conçu et co-animé avec Cap Digital, pôle de compétitivité mondial sur le numérique, qui établit chaque année une Cartographie des tendances du numérique organisée autour de ses différents “marchés” et “leviers”:
http://www.capdigital.com/publications/a-propos-cap-digital/
Les contributions des participants permettront au Club Commerce Connecté et à Cap Digital de proposer à la rentrée de septembre:
- un fascicule synthétique destiné à intégrer la Cartographie des tendances Cap Digital (2015-2016) pour mise à jour du “marché” commerce-marketing;
- des éléments de feuille de route 2016-2017 pour le Club Commerce Connecté;
- des pistes de projets pouvant être accompagnés par le Club Commerce Connecté et par les financeurs.
SUMARIZE THE NEXT ARTICLE (250 words-APA format) Then respond to the.docxrafbolet0
SUMARIZE THE NEXT ARTICLE (250 words-APA format) Then respond to the 2 analysis at the end (150 words Each)
Geriatric care management reduces Medicare losses
Healthcare costs for the elderly are rising rapidly in the United States. One way for a hospital to control these rising costs is to implement a geriatric care management system. The goal of a system is to change the way the hospital treats medically complex Medicare patients and, thus, reduce unnecessary hospital costs. Such a system requires a process for identifying elderly patients in need of geriatric care management services, treating them efficiently, and assessing the system itself. An effective process usually results in significant cost savings for the hospital as well as improved patient care and satisfaction.
While people aged 65 and older make up 12 percent of the U.S. population, they account or 6 percent overall healthcare expenditures.(a) By the year 2000, the elderly population will be responsible for 58 percent of all hospital days and almost half of all healthcare expenditures.(b) Furthermore, fragmentation of services and funding sources makes it difficult for the elderly and their families to obtain appropriate care.
Thus, care management becomes extremely important in order to effectively address the increasing healthcare needs and costs of elderly Americans.
A geriatric care management system designed to restructure the delivery of care for Medicare patients is one way hospitals can control costs. Such a system is based on the concept that a relatively small proportion of Medicare patients must be targeted for focused care management in order for hospitals to increase the quality of care, avoid financial losses, and prevent poor clinical outcomes. The patients targeted are those who, without focused management, would account for the majority of hospital problems involving excessive resource use and long lengths of stay. Because these patients can be prospectively identified, focused care management techniques can be employed to ensure appropriate and efficient hospital care, thereby reducing lengths of stay and costs. The geriatric care management system thus provides hospitals with ways to reduce a patient's length of stay and to use hospital resources more effectively.
The system focuses on three functions: identification of patients needing care management, geriatric care management intervention, and program performance evaluation. The performance evaluation provides information a hospital can use to improve the use of its resources and reduce patients' lengths of stay.
IDENTIFICATION
The task of identifying Medicare patients who require geriatric care management starts with an analysis of hospital data related to discharge geriatric patients. This process involves analyzing hospital data to identify DRGs and admitting diagnoses as well as characteristics of patients and physicians associated with inappropriate lengths of stay; excessive resource use (such as l.
4508 Final Quality Project Part 2 Clinical Quality Measur.docxblondellchancy
4508 Final Quality Project
Part 2: Clinical Quality Measures for Hospitals
Overview
This activity focuses on Quality Measures for Hospitals. The activity uses online resources from
the CMS website. The Clinical Quality Measures for Hospitals activity focuses on the Hospital
Value Based Purchasing (VBP) Program
Background
The National Quality Strategy (NQS) was first published in March 2011 as the National Strategy
for Quality Improvement in Health Care, and is led by the Agency for Healthcare Research and
Quality on behalf of the U.S. Department of Health and Human Services (HHS). Today, the NQS
serves as a guide for identifying and prioritizing quality improvement efforts, sharing lessons
learned, and measuring the collective success of Federal, State, and public‐ and private‐sector
healthcare stakeholders across the country.
The Aims of the NQS are threefold:
Better Care: Improve the overall quality by making health care more patient‐centered,
reliable, accessible, and safe.
Healthy People/Healthy Communities: Improve the health of the U.S. population by
supporting proven interventions to address behavioral, social, and environmental
determinants of health in addition to delivering higher‐quality care.
Affordable Care: Reduce the cost of quality health care for individuals, families,
employers, and government.
To align with this, CMS has set goals for their Quality Strategy. These include:
• Make care safer by reducing harm caused in the delivery of care
– Improve support for a culture of safety
– Reduce inappropriate and unnecessary care
– Prevent or minimize harm in all settings
• Strengthen person and family engagement as partners in their care
• Promote effective communication and coordination of care
• Promote effective prevention and treatment of chronic disease
• Work with communities to promote best practices of healthy living
• Make care affordable
CMS’s vision states that if we can find better ways to pay providers, deliver care, and distribute
information than patients can receive better care, health dollars are spent more wisely, and
there are healthier communities, a healthier economy, and a healthier county. It is with this in
mind that they have created multiple quality payment programs.
In January 2015, the Department of Health and Human Services made an announcement that
set in place measurable goals and a timeline to move the Medicare program towards paying
providers based on the quality of care rather than the quantity. This was the first time in the
history of the program that explicit goals were set. They invited private sector payers to match
or exceed these goals as well. These goals included:
1. Alternative Payment Models
a. 30% of Medicare payments tied to quality or value through Alternative Payment
models by the end of 2016 and 50% by the end of 2018
2. Linking Fee‐For‐Service payments to Quality/Value
a. 85% of all Medi ...
4508 Final Quality Project Part 2 Clinical Quality Measurromeliadoan
4508 Final Quality Project
Part 2: Clinical Quality Measures for Hospitals
Overview
This activity focuses on Quality Measures for Hospitals. The activity uses online resources from
the CMS website. The Clinical Quality Measures for Hospitals activity focuses on the Hospital
Value Based Purchasing (VBP) Program
Background
The National Quality Strategy (NQS) was first published in March 2011 as the National Strategy
for Quality Improvement in Health Care, and is led by the Agency for Healthcare Research and
Quality on behalf of the U.S. Department of Health and Human Services (HHS). Today, the NQS
serves as a guide for identifying and prioritizing quality improvement efforts, sharing lessons
learned, and measuring the collective success of Federal, State, and public‐ and private‐sector
healthcare stakeholders across the country.
The Aims of the NQS are threefold:
Better Care: Improve the overall quality by making health care more patient‐centered,
reliable, accessible, and safe.
Healthy People/Healthy Communities: Improve the health of the U.S. population by
supporting proven interventions to address behavioral, social, and environmental
determinants of health in addition to delivering higher‐quality care.
Affordable Care: Reduce the cost of quality health care for individuals, families,
employers, and government.
To align with this, CMS has set goals for their Quality Strategy. These include:
• Make care safer by reducing harm caused in the delivery of care
– Improve support for a culture of safety
– Reduce inappropriate and unnecessary care
– Prevent or minimize harm in all settings
• Strengthen person and family engagement as partners in their care
• Promote effective communication and coordination of care
• Promote effective prevention and treatment of chronic disease
• Work with communities to promote best practices of healthy living
• Make care affordable
CMS’s vision states that if we can find better ways to pay providers, deliver care, and distribute
information than patients can receive better care, health dollars are spent more wisely, and
there are healthier communities, a healthier economy, and a healthier county. It is with this in
mind that they have created multiple quality payment programs.
In January 2015, the Department of Health and Human Services made an announcement that
set in place measurable goals and a timeline to move the Medicare program towards paying
providers based on the quality of care rather than the quantity. This was the first time in the
history of the program that explicit goals were set. They invited private sector payers to match
or exceed these goals as well. These goals included:
1. Alternative Payment Models
a. 30% of Medicare payments tied to quality or value through Alternative Payment
models by the end of 2016 and 50% by the end of 2018
2. Linking Fee‐For‐Service payments to Quality/Value
a. 85% of all Medi ...
Employer Sponsored Medical Clinics white paperTom Pascuzzi
Employer-sponsored medical clinics have evolved from providing only basic convenience care to playing a larger role in actively managing chronic conditions to help control employers' health care costs. Successful clinics are integrated into the employer's data-driven health strategy and hold the clinic accountable for meeting cost and productivity goals. Different clinic models provide varying levels of services from basic care to full primary care management. For an on-site clinic to be effective, employers need to analyze their claims data to identify conditions driving costs and those amenable to improved management. The Affordable Care Act has prompted some employers to reconsider clinics to help manage costs and improve access to care.
This document provides an overview of a study on implementing total quality management (TQM) in the healthcare sector in India. It includes an abstract that describes the rising costs and pressures in healthcare that have led organizations to adopt quality management approaches like TQM. The introduction discusses issues in healthcare quality and the need for reforms. The document then proposes a model for TQM implementation that identifies key factors like leadership, momentum, teamwork, training, focus on core processes, and measures.
Read the scenario that you will use for the Individual Projects in ea.pdfashokarians
Read the scenario that you will use for the Individual Projects in each week of the course. The
Centers for Medicare and Medicaid Services (CMS) has taken on a more visible role in health
care delivery. Many changes have transpired to improve patient safety along with the
implementation of additional quality metrics, and these changes impact reimbursement rates
Likewise, the Patient Protection and Affordable Care Act has changed the reimbursement fee
structure of Medicare and Medicaid reimbursement for health care services. Other legislation
including the HITECH Act and the Medicare Authorization and CHIP Reactivation Act of 2015
(MACRA) all impact how healthcare organizations receive reimbursement and demonstrate use
of data to improve quality and delivery of patient care Mr. Magone, CEO of Healing Hands
Hospital, has asked you to join the \"Future of Healing Hands Task Force, and your first
assignment is to work with the Hospital Chief Financial Officer, Mr. Johnson, and provide a
summary of the current regulations regarding Medicare reimbursement including how MACR
impact reimbursement if/when Healing Hands coordinates delivery of services by affiliating with
physician practices For this assignment, write a 2-3 page report that you will deliver to Mr.
Magone on how the new CMS initiatives and regulations impact the organization\'s revenue
structure. In your presentation, address the following questions: Why did CMS become more
involved in the reimbursement component of health care? How does CMS\'s involvement impact
the reimbursement model for Healing Hands Hospital and other health care organizations If
CMS reimbursement regulations for Medicare and Medicaid change, does it follow that other
insurance providers change heir policies on reimbursement? What tools can be implemented to
ensure organizations such as Healing Hands Hospital and physician practices are meeting the
policies and procedures set forth by CMS? Identify 3 tools from the CMS Web site that are
helpful in meeting the requirements for Medicare reimbursement set forth by CMS
Solution
Part-a & part-b:
The physician’s work, practice expense, and malpractice, RVU values, CMS (centers for
Medicare and Medicaid services) is required to control overall expenditures in health care
organization. Therefore, CMS become highly involved in the reimbursement component of
health care to patients as per their \"insurance packages\". The CMS\' involvement in “budget
Neutrality” & the reimbursement model at Healing Hand hospital & other health care
organizations is mainly for physician RVU based payments from Medicare & Medicare that can
control its physician costs by adjusting physician payment rates based on “previous periods in a
calendar year” as per federal acts and regulations. The Medicare is going to control physicians
costs according to “medical procedures and medical visits of their record” in a Jan- 1 ending Dec
31. Conversion Factor is main basis to control the physician costs ac.
Meritage ACO developed a care transitions program with three elements: care transitions coaching, complex care management, and care coordination between care settings. The program aims to reduce preventable hospital readmissions, which cost the healthcare system an estimated $25 billion per year. Care transitions coaches visit patients before discharge to educate them and plan for their needs. Complex care management involves using tools like the Coleman Care Transitions Intervention and motivational interviewing. Care coordinators help with non-clinical needs. The program seeks to shift clinicians' thinking to a team-based approach focused on continuous care between settings and patient care goals.
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.
Hospital case costing methods aim to control rising healthcare costs while maintaining quality. Total healthcare costs result from many decisions at various levels. Macro cost control requires micro-level analysis of costs. Hospitals have increasingly adopted cost accounting and case mix analysis to provide a link between costs and activities to better understand and control cost trends through "total cost management" using activity-based costing. Accurately estimating hospital service costs is important for efficiency and transparency under DRG-based prospective payment systems.
A few months ago I wrote an article entitled Unplanned Readmissions: Are They Quality Measures or Utilization Measures? It explained the Hospital Readmissions Reduction Program (HRRP) that began in October 2012 as part of the Affordable Care Act (ACA). That article explained the program and its results over the past 5 years. However, more and more healthcare leaders and organizations are beginning to question whether HRRP is a valuable program or whether it is time to move on to something that focuses on quality of care and clinical outcomes, rather than cost savings. This article will address those issues. (In this article “readmissions” mean unplanned or preventable readmissions).
Running head HEALTH LEADERSHIP PRESENTATION1HEALTH LEADERSH.docxcowinhelen
Running head: HEALTH LEADERSHIP PRESENTATION1
HEALTH LEADERSHIP PRESENTATION2
7-2 Final Project Milestone Two: Healthcare Leadership Presentation
Introduction
In the current setting, healthcare facilities are faced with workplace hurdles such as the increasing demands of the access to health care. In this case, an appropriate clinical leadership is a critical skill to optimize effective management of the care in the healthcare setting. The significance of an active clinical guidance is to facilitate an extended quality of health care system that regularly offers innocuous as well as well-organized healthcare. As such, any health care institution should incorporate clinical leadership to the boldest extent. Also, all the obstacles that provide against effective clinical leadership will be looked. This strategy to overcome such barriers guarantees the quality of clinical leadership in the healthcare system. This paper will discuss the quality of clinical leadership in the healthcare system.
Overview of Microsystem
An overview of the microsystem involves my capacity to serve in the healthcare system as a cardiothoracic surgeon. As such, I attend to patients who suffer from cardiac failure. To achieve full capacity in my area of service, I developed a team that entails the physician assistant, cardiothoracic surgeon, percussionist, physician assistant, anesthesiologist, the scrub nurse as well as the primary care physician that plays a key role in the cardiac failure medication. There have been increased cases of heart failures and thus, schematic education is necessary to deal with the rampant and increasing cardiac failure. It also provided a key pathway to counter the knowledge gap and increase the limited cardiac diagnosis services in cardiac failure medication
Essentially, understanding the pathophysiology of cardiac failure is a broad course that tends to illustrate the causes of heart failure from mild to acute infection. The process uncovers the development of the cardiac failure and thus, it is essential for the clinical leaders to be well acquainted with this knowledge to prompt quality care on the disorder. In addition, the knowledge about the signs and symptoms of the cardiac failure is key as it influences the type of medication that is provided to the patients. Furthermore, the diagnostic tests, as well as the current evidence-based healthcare, should be highly pursued by the clinical leadership in order to determine the process of heart failure of the patient in the organization. In respect to this, the use of the electrocardiograph substantially helps in determining the heart rhythm problems. In line, the section provides alternatives medical therapies that play a vital role in the treatment and diagnosis of heart failure.
The microsystems in our cardiac diagnosis clinic involve patients who first encounter the scrub nurse who then plays a role of giving direction on the most appropriate centers where the operation of th ...
in order to meet cost reduction targets, CMOs
* Share patient data across ecosystems
* Embed shared organizational intelligence
* Establish guidance for quality & cost within physician workflows
* Prepare physician leaders to create a culture of continual improvement
This document summarizes discussions from a series of panel discussions on the future of post-acute healthcare. Key concerns discussed include the need for better coordination and pathways between acute and post-acute care to reduce hospital readmissions, ensuring clinical staff in skilled nursing facilities have sufficient skills and training, understanding new models like Accountable Care Organizations, managing increased utilization of managed care plans with lower reimbursement rates, and navigating changes to state Medicaid systems. Potential solutions focus on developing partnerships across settings, sharing clinical information, participating in advocacy, and using technology and analytics to improve coordination and decision making.
Hospitalist programs are increasingly used by hospitals to manage the shift to value-based care and reduce costs. The use of hospitalists has grown significantly, with approximately 75% of hospitals now utilizing hospitalists. Hospitalist programs can improve outcomes, drive cost efficiencies, and increase reimbursements by reducing lengths of stay and readmission rates. While hospitalists provide benefits, there is debate around their impact on overall patient health and outcomes. As value-based payments increase, demand for hospitalists is expected to continue growing as they help hospitals achieve quality metrics and financial targets.
A New Payer Model for Medical Management ExecutionCognizant
To combat rising costs and inefficient use of resources, payers can streamline utilization management and optimize care management through medical management delivered as a service.
Partnerships between Finance and Case Management Departments are Key to Accur...CBIZ, Inc.
Given the complexity of the regulatory and financial environment, the CFO must initiate an active relationship with case management and utilization review staff. Often, the essential relationship between the CFO and Case Management/Utilization review departments is only superficially actualized.
To lower health costs, physician networks and medical homes must employ a closed loop population management program that focus on patient SOH stratification, chronic disease management, care coordination and incentive management. This approach will enable them to consistently reduce ER and inpatient admissions, which are the greatest expenditures in health care today.
This e-book focuses on Health Management Solutions the value it adds alongside other systems that are already in place throughout the care lifecycle...
This document discusses a model for coordinating care for patients traveling long distances to an academic medical center. It proposes assigning each patient a "temporary medical home" based on their condition to coordinate all aspects of care during their episode of care. This includes assigning a dedicated nurse to coordinate appointments, financial clearance, and navigation through intake, treatment, discharge and follow up. The goals are to improve patient and provider experience, increase patient volumes and revenue, and support the institution's research mission.
Similar to TASP White Paper Monitoring the CAP (20)
1. Executive Summary
Extensive government regulation of hospital prices has
placed pressure on health systems to cut costs as well as
improve their quality of patient care.
In a pilot bundled payment program, Maryland has
capped hospital spending and set prices in an effort to cut
$330 million in Medicare spending over the five-year life
of the program.1
This regulation marks a trend expected to
expand to other states in the transition from a volume- to
value-based health care system.
In this paper, we examine the challenges health systems
face under new budget policies, such as the Global Budget
Revenue cap, and key areas providers should address in
acute and post-acute care settings to successfully meet
the target rate and quality care measures. We discuss a
methodology used in a Maryland health system as
an example.
Issue Background
Global Budget Revenue (GBR) methodology is central to
promoting better care, better health, and lower cost for
Maryland patients. The new all-payer model focuses on
controlling increases in total hospital revenue per capita.2
The GBR is a pilot program in Maryland that is expected
to be implemented in other states if it successfully reduces
Medicare spending.
Under this methodology, hospital revenue must fall
within 5% of the budget. If a hospital is outside of this
window, CMS penalizes the hospital relative to its size
and structure.
1 The Washington Post. “Maryland’s Plan to Upend Health Care
Spending.” Last modified January 10, 2014. http://www.washingtonpost.
com/news/wonkblog/wp/2014/01/10/%253Fp%253D74854/
2 The Maryland Health Services Cost Review Commission. “Completed
Agreements under the All-Payer Model.” Accessed September 22, 2015.
http://www.hscrc.maryland.gov/gbr-tpr.cfm
In the world of cap management, seamless communica-
tion and high quality care are necessities. Acute and post
acute settings within the health system must work hand
in hand to optimize patient outcomes and focus on key
revenue-driving areas in their respective settings to meet
budgetary requirements.
Methodology
Acute
Patient Mix
Looking at patient mix, we see that utilization impacts cap
in different shapes and forms. In facilities with a blend of
high acuity patients with short length of stays combined
with behavioral health patients with long lengths of stay
and less utilization, achieving the right blend can help
significantly influence cap rate. Navigating these two types
of patients and the clinical support needed also makes the
cost of care a challenge to balance.
Key results at a Maryland
health system
• 6% closure on global cap, placing the
hospital within 2% of budget
• 16% reduction in 30-day readmissions
• 7% increase in skilled nursing facility
RUG scores
• 23% increase in resident
satisfaction scores
Turning Around a Health Care System in a Global
Cap Environment: A Balancing Act in Acute and
Post-Acute Care
Alon Moritz, Practice Director, Turnaround and Strategic Planning
2. To achieve a balanced patient mix, examining and
adjusting these critical intake areas can significantly
influence hospital revenue:
1. Payer sources
2. Patient types and how they drive or erode revenue
3. Communication among doctors, nurses,
and administration
In a Maryland facility, the team identified poor payer
sources, categorized patient types, and limited bad debt.
Multi disciplinary rounding ensured patients received
optimal care and as a result, patients transitioned out of
the hospital sooner. The team worked to attract specific
patient types, based on reimbursement and rate
structure. With a dashboard to track admissions,
census, and discharges, administrators were kept abreast
of trends. With the hospital at 8% under cap with only
4 months left in the fiscal year, we were able to quickly
and efficiently narrow the gap to 2%, well within the 5%
threshold. . This adjustment saved the health system over
$1 million in CMS penalties.
Readmission Rates
One of the biggest challenges faced today by hospitals
is the risk of readmission penalties. Coordinating the
care for patients beyond an acute care stay is a duty that
increasingly falls on hospitals.
1. Attention to patients condition and proactive medicine
2. Projecting the patients future conditions and
possible needs
3. Aligning the staff (nursing and physicians) goals
and work flow
4. Multi disciplinary rounding with rigorous preparation
and process
5. Shift management and case management
6. Improved relationships with home health agencies
and aligning expectations and plans of care
At one facility the rate for readmission was over 23%.
McBee Associates consultants worked with the facility
and within three months, this rate was reduced to less than
7% with better care planning, coordination, and referral
relationships.
Cost of Care and Utilization Ratios
Cost of care in high utilization low stay units can help
quickly drive hospital revenue, yet also increase the
cost of care provided. The balance of nursing needs
and capabilities are among the biggest challenges.
For medium- to large-sized health systems, reducing
readmissions is a major priority. In assessing the
contribution to cap while addressing the cost of care
we see that the high intensity unit can help drive down
readmissions for the entire health system.
Costs of care can be lowered by assessing each cost
center and aligning the cost centers to the quality of care
goals. Working with the staff (clinical and administrative)
to establish goals and create a clear road map to meet
those goals helps reduce costs and improve quality. In a
number of health systems in the Mid-Atlantic region, we
found that engaging in close and transparent relationships
with patients and their families helped encouraged mutual
respect and appreciation among the hospital staff and
patients. These relationships allowed the staff to work with
patients and better address challenges as they arose.
Human Resources
We have found that having a theme to the facility
(e.g. behavioral health focus) instead of a comprehensive
traditional hospital setting can help in driving down
turnover and properly utilize the expertise of the clinical
staff. It is easier to attract, on-board, and train the staff
when there is a focus to the organization. However,
in vertically integrated health care systems, dealing
with a variety of patients is common and the need for
multidisciplinary staffing is necessary.
In traditional hospital settings without a guiding theme,
appointing liaisons to inform and communicate with clinical
staff about specific care quality and financial goals of the
health system, as well as monitor progress toward those
goals, helps increase quality and morale in clinical staff.
Quality Measures and Costs
One of the first priorities for all health systems should be
to meet and exceed all quality goals and measures.
In health care organizations with weak financial outcomes,
there is often a direct correlation with unmet quality
metrics. In one facility, our team worked with the quality
department and the clinical staff to meet quality metrics.
Figures 1a. and 1b. show the charted measures and
changes within five months.
“If you can control quality and control expenses,
you’re going to make a profit.
”— Alon Moritz, Practice Director,
Turnaround and Strategic Planning
3. Figure 1a. Hospital Revenue and Variance from
5% Benchmark
Figure 1b. Quality Measure Improvements
Quality Measure Goal March April May
Percent of falls
with injury
24% 25.64% 18.6% 19.23%
Rate of facility
acquired UTIs
.21 .33 .00 .00
Rate of facility
acquired catheter
related UTI’s
4.80 4.20 4.65 7.98
Long term care—
Abaqis
83% 93.1% 89.29% 92.86%
Pressure Ulcers—
Specialty Hospital
1.58 .30 1.27 2.09
Pressure Ulcers—
Long term care
.78 .98 .17 .32
CAUTI—
Specialty Hospital
4.80 4.00 .00 .00
CAUTI—
Long term care
4.80 4.20 4.65 .00
Readmissions—
Specialty Hospital
14.7% 26.92% 16.33% 6.38%
Leadership
For any organization to be successful, leadership needs
to understand the task at hand and buy into the goals.
From the outset, it is important to assess the issues,
analyze how they occurred, and implement a corrective
plan and time frame.
Once the goals are clear and a new strategic plan is set,
the tactical execution of the plan involves making sure
that everyone from top to bottom understands what needs
to be done, how, and by when. We also focus on making
sure that the floor level has leadership that understands
the big-picture mission at hand. Floor leadership is very
important to the clinical service level and the oversight that
process needs.
Communication between the nurses and the doctors is
very important. Strong communication leads to the best
outcomes. To foster a high level of communication,
several important techniques can be applied:
1. Open communication with a team approach
2. Multi disciplinary rounding
3. Weekly clinical leadership meetings
The combination of these techniques leads to a better
understanding of the patients and their needs, and it
encourages the team to openly communicate and plan
each patient’s care as a unit.
Post-acute
Interdepartmental Communication
The relationship between the floor and the billing
department of the Maryland long-term care facility
needed to be strengthened. We found that increasing
communications between the floor and the billing group is
fundamental to improving quality scores in post-acute care.
As in all long-term care settings, patient status may
change frequently over time. Monitoring patient status,
understanding the direction of care needed, and aligning
caregivers to the goal of care are important factors to
increasing care quality in this setting. Using strategic
analysis to predict future care needs is a critical first step
that helped the organization become more proactive and
prevent medical issues. This analysis addressed the first
two factors in improving care.
In addressing the third factor, aligning the care givers to
the mission led us to improved quality results as seen
across all the quality measures and was highlighted in
patient satisfaction scores increasing by 23%.
RUGs scores improved dramatically (Figures 1a., 1b.).
Falls
Patient falls can have a major impact on long-term care
providers. On average, the cost of a fall with injury (legal
costs) is approximately $90,000 per case at a minimum.
4. We found that falls with injury accounted for approximately
25%–30% of all falls in one single month
at the Maryland long-term care facility.
In most discussions surrounding falls, it is common to
focus on preventing injury more than preventing the falls.
In the Maryland facility, the team analyzed issues that may
cause falls, such as memory loss, in an effort to better
understand these issues and attempt to decrease the
probability of falls. Understanding these issues in detail
and breaking down the components that contribute to fall
risk and injury is key to improving in this area. These are
among the key analytics:
1. Call bell response time
2. GNA and nursing routines
3. Memory care issues and vulnerabilities
(stages and potential behavioral aspects)
4. Preventative measures and risk management
5. Training and awareness
6. Family participation
Aligning Clinical Skill Sets
As the type of patients entering long-term care changes,
a change in the type of clinical staff is needed for LTC
facilities is also needed. The focus is now on shorter stays
with higher utilization of resources (more intense care in
a shorter time). The new “super skilled nursing facility” is
becoming a reality. As such, the quality of care givers and
their skill sets are similar to the care given in acute care.
It is now more likely that the patient going to a skilled
nursing facility will need highly skilled care, while in
the past we have seen longer stays with less intensity.
Hospitals that discharge a patient to an assisted living
facility or a home health agency save a great deal of
money. Statistically, hospital discharges could be as much
as 50% higher than needed to skilled nursing facilities
depending on the hospitals and the physicians. We see a
trend that in the future these discharges will be planned
differently. Most likely, discharges to home health agencies
and assisted living facilities will become more frequent
under bundled payment arrangements. Thus, the patient
population going to skilled nursing facilities will need
caregivers who can deliver high intensity, short term care.
In light of this trend, we have changed the caregiver focus
to highly skilled staff who are able to provide high levels
of care and function closely with the physician staff at
the Maryland long-term care facility. This process was
supported by:
1. Communications plans
2. Multi disciplinary rounding
3. Data analysis and predictability
4. Proactive care planning
Conclusion
As states across the nation adopt bundled payment
programs, such as the GBR, providers must focus
on meeting key metrics that drive both care quality
and revenue.
Bundled payment programs require providers to have
seamless communication and high quality care across
acute and post-acute settings. Therefore, each setting
across the health system must work in concert to optimize
patient outcomes, monitor key revenue-driving areas,
and adjust as necessary to meet budgetary goals.
We found that working to meet the following quality
measures was fundamental in influencing both patient
care and revenue at a Maryland facility under GBR:
Acute
1. Patient mix
2. Readmission rates
3. Costs of care and utilization
4. Staffing to patient needs and clinical competency
5. Patient length of stay in relation to their payment
sources
6. Alignment of billing process, care provided, and
insurance requirements
7. Quality measures
Post-acute/Long term care
1. Interdepartmental communication
2. Falls
3. Clinical skill sets
In both settings, providing multi disciplinary care
and increasing communication among clinicians and
administrators were important adjustments that improved
quality metrics. The methodology used and the results
outlined in this paper may serve as an example for
other health care organizations under bundled
payment arrangements.
Sources:
The Maryland Health Services Cost Review Commission. “Completed
Agreements under the All-Payer Model.” Accessed September 22, 2015.
http://www.hscrc.maryland.gov/gbr-tpr.cfm
NPR. “Maryland’s Bold Plan to Curb Hospital Costs Gets Federal
Blessing.” Last modified January 10, 2014. http://www.npr.org/sections/
health-shots/2014/01/10/261370766/maryland-s-bold-plan-to-curb-
hospital-costs-gets-federal-blessing
The Washington Post. “Maryland’s Plan to Upend Health Care Spending.”
Last modified January 10, 2014. http://www.washingtonpost.com/news/
wonkblog/wp/2014/01/10/%253Fp%253D74854/