Wednesday, May 8, 2013

Applying mobile health strategies to drive greater patient engagement and provider accountability

Applying mobile health strategies to drive greater patient engagement and provider accountability

Patient engagement and physician accountability are the cornerstones of today’s value-based care models. These strategies encourage patients to take an active role in their own health while offering the necessary incentives for providers to deliver effective, personalized health oversight and care to their patient population. By encouraging and pursuing these initiatives, population health can be improved by supporting patients both within and outside of the clinical setting. This is especially true when serving chronically ill populations, where these approaches can help prevent costly complications and acute care admissions.
Today’s mobile health technology provides an incredible opportunity to meet these demands by offering tools, insight and guidance that travels with patients as they go about their daily lives. This portability feature is crucial because patients are constantly making decisions that impact their health. Consumers make self-management choices throughout their day about diet, exercise, taking medication and/or following a treatment program for a specific health condition. Physicians don’t expect patients to manually log all of this information and, even if they did, most individuals wouldn’t comply. Even individuals who live with diabetes, a group expected to log blood sugar levels, rarely adhere to this cumbersome process, which often leads to inaccuracies and missed data.
With this reality, there is a missed opportunity – patients don’t have insight about how specific behaviors impact their health over time and providers lack validated information about a patient’s compliance and health status. This increases health and financial risk in patients with chronic conditions such as diabetes, high blood pressure and heart disease, where monitoring of health status and early intervention are crucial to best practices and lower costs.
The next wave of mobile health: Mobile monitoring devices.
Mobile health monitoring devices have the potential to address these issues by automatically tracking health and lifestyle data, storing it and transforming it into meaningful insight. While many are in the early stages of development, a variety of new mobile health monitoring products are being introduced at a rapid rate. These products are designed to be “smart” versions of existing medical devices – which could include blood glucose meters, blood pressure monitors and sleep apnea machines, to name a few. Since many patients with chronic illnesses are already actively using some form of these devices today, these optimized versions can provide an unobtrusive way to collect, manage and analyze validated data. Properly designed, these products are easy to use, require little to no manual data entry and can be easily transported with patients as needed.
Once data is captured by the device, wireless technology can transmit it to a secure cloud-based platform to store and track results over time. As a result, individuals have ready access to all liberated data and use it to better understand their health, while also sharing this real-time information with providers, caregivers or loved ones.
Empowering providers to improve outcomes.
By making it easy for patients to collect and store this data, mobile health monitoring devices will empower providers to offer a more personalized, patient-centered approach to care. While physicians are already inundated with information, from medical records to clinical journals, they are lacking key information about a patient’s daily behavior and compliance with treatment. By accessing the validated data derived from mobile health monitoring devices, providers will receive valuable insight for clinical decision-making support.
For example, data from these devices could give physicians the ability to determine whether a particular medication is having a positive impact on a patient’s blood pressure over time. Or a care manager may use this insight to determine that he/she needs to educate a diabetic patient on specific dietary modifications. By providing personalized data about a patient’s health status outside of a clinical setting, mobile health will truly “fill in the gaps” left by electronic medical records and eliminate the inaccuracies that come with self-reported data. As a result, these mobile health solutions can help providers improve outcomes and guide patients to make informed health and lifestyle decisions.
These devices could also be configured to alert providers to a specific or dangerous change in a patient’s health status that could lead to an acute event. These alerts could provide immediate notification of important data that might otherwise be overlooked by a busy physician’s practice. For example, if a patient’s blood pressure or blood glucose is very high over a sustained period, a provider could be automatically alerted and, if warranted, contact the patient to determine the cause, schedule an office visit or recommend appropriate action. During this critical time period, early intervention could be key to preventing devastating complications or avoidable hospitalization.
Reducing costs associated with chronic condition management.
A key part of the triple aim of health reform, reducing healthcare costs, relies heavily on the industry’s ability to prevent avoidable admissions and medical events, while also reducing duplication and waste. As the industry moves away from fee-for-service models, the ability to meet this goal will require intensive collaboration among providers, including data-sharing, and optimization of care management processes. Mobile health, specifically through monitoring devices and cloud-based connectivity, can support all of these processes.
Mobile health strategies also allow providers to offer holistic care based on an individual’s unique needs. A patient’s needs are dynamic, and many changes to a patient’s health status happen between office visits. Moreover, most of these changes do not elicit a patient to re-engage with his/her provider. By offering real-time monitoring and insight about a patient’s adherence with best self-management care practices and key markers of health, mobile health devices can provide the “missing link” that drives patient-centered care across the continuum.
The potential for cost savings through better management of a chronically ill population is significant. For example, the growing prevalence of diabetes within this country is having a substantial impact on healthcare costs. A study conducted by the American Diabetes Association determined that the total medical costs related to diagnosed diabetes has risen to $245 billion in 2012. This figure represents a more than 40 percent increase in just the past five years. Diabetes also costs our nation an estimated $69 billion in reduced productivity. These rising costs are putting a sizable burden on employers, healthcare organizations, patients and their families.
Providing peace of mind to patients and their loved ones.
In addition to its potential in improving healthcare quality and reducing associated costs, mobile health strategies can improve a patient’s overall satisfaction. Many patients, especially those with chronic conditions, feel “disconnected” from the healthcare system until they experience a serious medical event that requires intensive support. Mobile health devices can address this issue by enhancing the patient/provider relationship while also providing peace of mind to individuals through ongoing support.
For example, some devices offer two-way communication capabilities, allowing physicians or care managers to send personalized messaging in response to patient data or trends over time. These messages could point out opportunities for improvement, or reinforce positive behaviors and results. As a result, patients are more engaged and feel greater accountability for their decisions and a sense of connectedness with their care providers.
Offering insight into population health.
Beyond offering valuable patient insight at the point of care, data from mobile health devices can also be used to enhance population health management strategies. This data can reveal real-time insight about the effectiveness of health improvement efforts. It can also be used to refine risk profiles and predict future risk in groups that are non-compliant with care. Leveraging this unique data set and coupling it with traditional claims-based data sets, payers and value-based care models can better understand how patient behaviors, clinical interventions and outreach efforts are impacting overall population health and costs.
The future of mobile health monitoring in value-based care.
The popularity of mobile health is well documented within the wellness space, especially through mobile phone applications that track an individual’s fitness, nutrition and other health improvement activities. However, the potential for mobile health monitoring devices, especially in serving chronically ill populations, is still being realized.
As new and more robust products enter the market, we can envision a future where every medical device is enabled with wireless capabilities and connected to cloud-based data management. This vision of the future is well aligned with the intent of value-based care efforts – including the triple aim of improving care, reducing costs and enhancing patient satisfaction.
Mobile health strategies will help healthcare organizations stay plugged in to every patient’s unique needs and changing health status. Armed with this valuable insight, the healthcare industry can begin to make dramatic strides in achieving greater patient and provider accountability.
David Bjork, president of Telcare, Inc., has more than 20 years of executive experience in healthcare information technology and healthcare services. He has held leadership roles in a number of disciplines, including business development, strategic planning, M&A, sales, marketing, operations and product development.

Tennessee Oncology Chooses Navigating Cancer's Patient Engagement Portal

Tennessee Oncology Chooses Navigating Cancer's Patient Engagement Portal

Leading provider of oncology patient portals to support Tennessee's largest oncology practice in delivering patient-centered care

SEATTLEMay 7, 2013 /PRNewswire/ -- Navigating Cancer, the leading provider of oncology specific patient portals, announces that Tennessee Oncology has selected Navigating Cancer's Patient Engagement Portal for its practices and patients.  Navigating Cancer's portal will enable Tennessee Oncology to provide a more coordinated and patient-centered approach to the care it delivers to patients and help the practice meet all the new patient-centered care requirements.  With nearly 800 providers signed up for Navigating Cancer's Portal, Tennessee Oncology joins an established and expanding network of influential oncology practices that are working to improve healthcare by engaging patients in their care.  
Navigating Cancer's cloud-based Patient Engagement Portal integrates with any electronic medical record (EMR) system, enabling providers to easily and securely connect patients to their personal health information and educational resources.  More than 45,000 patients currently use Navigating Cancer to learn more about their condition, receive copies of their health information and stay connected with their healthcare team. Navigating Cancer helps practices meet many of the new patient-centered care requirements that are part of HITECH Meaningful Use, new medical home and accountable care organization models and updated care standards from professional organizations such as the American College of Surgeon's Commission on Cancer.
"Our focus is to provide innovative, exceptional cancer care that puts patients and their families first," said Jeff Patton , M.D., CEO of Tennessee Oncology. "This partnership gives our patients easy access to their personalized treatment information and resources to help them better understand their diagnosis, allowing them to be at the center of their care and well-equipped to make important healthcare decisions."
"Tennessee Oncology has a long-standing reputation for innovation and thought leadership in oncology, which translates to state-of-the-art cancer care for their patients," said Gena Cook , CEO of Navigating Cancer. "We're excited to work with Tennessee Oncology providers and patients and are looking forward to a strong partnership in the coming years as we work together to improve the quality and efficiency of care through the use of our service."
About Tennessee Oncology
Tennessee Oncology, PLLC is one of the nation's leading teams of cancer care specialists, nationally recognized for improving patient outcomes and innovative treatments. Its comprehensive range of cancer care services include specialized oncology nursing care, laboratory services, outpatient chemotherapy, PET/CT services and patient education and support services. Founded in 1976, Tennessee Oncology is one of the largest physician-owned practices in the country, employing more than 75 physicians in 30 locations throughout Middle Tennessee, Chattanooga, and Northwest Georgia. for more information.
About Navigating Cancer
Navigating Cancer's mission is to transform healthcare through patient centered care by using technology to connect cancer patients to their healthcare team, their own health records, and the right information at the right time. Navigating Cancer's Patient Engagement Portal provides oncology clinics with a branded, online extension of their care model, empowering them to save time and money while providing better quality care. The company was founded in 2008 by technology and healthcare veterans and is based inSeattle, Washington.
SOURCE Navigating Cancer


Business Innovations in Global Health Care program

Harvard Business School has launched a new executive education program aimed at improving worldwide healthcare delivery. 

The Business Innovations in Global Health Care program will take place June 26-29 on the HBS campus just outside Boston.

"We created this new program to help entrepreneurs and executives, both in developing and developed countries, think differently," said Regina E. Herzlinger, PhD, professor of business administration and faculty co-chair of the program. "These are exciting times. Before us is a huge opportunity to improve the way that healthcare is delivered and technology is used. We can learn vital lessons from entrepreneurs and private enterprises that are creating innovative ways to deliver basic health services as well as highly targeted care to chronically ill populations."

The program will feature global case studies and engaging discussions allowing participants to learn how entrepreneurs around the world are overcoming barriers to provide more efficient care and medical technology to underserved populations.

"In addition to conventional models, participants will be exposed to enterprises that focus on the base of the pyramid while generating attractive returns," said Michael Chu, MBA, senior lecturer of business administration and faculty co-chair of Business Innovations in Global Health Care. "Global leaders in entrepreneurial health care faced with real-life cases will help each other discover new concepts and practices for their organizations."

© Copyright ASC COMMUNICATIONS 2012.

Improving the Affordable Care Act by modifying the MLR rule

Improving the Affordable Care Act by modifying the MLR rule

The Affordable Care Act is a big step in the right direction but like any big complex new thing (think 787 Dreamliner) there are likely to be hiccups coming out of the gate. I’d like to see us learn from implementation of the law and make improvements along the way. Unfortunately many opponents take the opposite view –and would still rather repeal the whole law or resist implementation. For example, Eric Cantor is again vowing a House vote on full repeal, states are rejecting the Medicaid expansion and having the federal government run insurance exchanges in their states rather than doing it themselves.
In the spirit of improving the law, I’d like to see a modification to the minimum medical loss ratio rules for health plans. Under the law, plans have to spend at least 80 percent (individual and small group) or 85 percent (large group) of premiums on medical costs. On the positive side this ensures that health plans use their resources on medical care and reduces incentives to restrict access, but it also limits the incentives for health plans to contain costs. After all, if medical costs are contained “too much” then the plan has to pay a rebate.
But we really should want plans to contain costs: by negotiating hard with providers, by introducing better network designs, and improving payment methodologies. Plans should be rewarded financially for doing this.
One way to make it happen would be to let plans with a strong track record of cost containment escape the MLR, at least partially. For example, if a plan raised its premiums by less than the market rate or less than some external benchmark such as the Consumer Price Index, it could be allowed to have a lower MLR –and higher profit margin. That would encourage plans to do a better job of holding the line on costs because it would be the surest route to enhanced profitability.

Health Business Blog by David E. Williams of the Health business blog  /  9h  //  keep unread  //  preview

Biggest U.S. Hospice Co Defrauded Medicare, Feds Charge

Biggest U.S. Hospice Co Defrauded Medicare, Feds Charge
DOJ Fingers Vitas Hospice For Faking "Tens of Millions" in Claims
The Department of Justice is accusing the country's biggest provider of for-profit hospice services of fraud.
Vitas Hospice Services and its parent company, Chemed Corp. of Cincinnati, are accused of having "misspent tens of millions of taxpayer dollars from the Medicare program," according to a statement released by the Justice Department on May 2.
In a complaint filed the same day in the District Court for the western district of Missouri, the government contends that since 2001 Vitas has defrauded Medicare two ways: It has accepted for hospice care patients not eligible to receive it, billing Medicare for their treatment; and it has charged Medicare for "crisis care" given to patients who didn't need it and/or never got it.
Only dying patients with six or fewer months to live are eligible to receive Medicare-reimbursed hospice care.
Of those patients, only ones "experiencing an acute crisis that requires the immediate and short-term provision of skilled nursing services" are eligible to receive so-called crisis care, which is, according to the complaint, the most costly form of hospice care provided to persons dying at home: In 2013, it says, Medicare's daily reimbursement rate for crisis care overall was $742 more per patient than the daily rate for routine home care. The lawsuit cites as an example of fraud a California patient identified only as "MC."
At the same time that Vitas was representing MC to Medicare as eligible for hospice, Vitas' own records, cited in the complaint, state that MC did not have a terminal illness whose prognosis was six months or less. Rather, it says, MC was "living independently and performing daily activities without assistance."
For example, "during the time that Vitas billed Medicare for crisis care for MC, Vitas's nursing notes state that MC was doing her own laundry."
For this one patient alone, Medicare paid close to $170,000 in claims between 2009 and 2012, according to the complaint.
An analysis by Justice found that Vitas' billings for crisis care in general were "almost six times what would be expected if its crisis care figures were in line with the national average."
A Vitas nurse, cited in the complaint, reported that on more than one occasion she had arrived at the home of some patient described by Vitas as needing crisis care, only to find the patient out—"at church, at the beauty parlor, or playing bingo." Despite the fact that these patients did not need or receive crisis care, says DOJ, Vitas nonetheless billed Medicare for the services.
The crux of the government's charge is "that Vitas focused on maximizing Medicare reimbursements for as many patents as possible while disregarding patients' medical needs and Medicare guidelines. Vitas regularly ignored concerns expressed by its own physicians and nurses regarding whether its hospice patients were receiving appropriate care."
A request by ABC News for further comment from the U.S. Attorney's Office got no response. A request for comment from Chemed and Vitas was answered by a repetition of a statement Chemed released May 3rd, which says in part that Chemed and Vitas intend to defend themselves vigorously. It confirms that the government is seeking treble damages, statutory penalties, court costs and interest.
"Chemed and Vitas have made significant investments in controls, systems and procedures to uphold the highest industry standards and to maintain compliance with all regulatory requirements," says the May 3 statement. "Our compliance efforts are designed to ensure our services are provided only to eligible patients."

Copyright © 2013 ABC News Internet Ventures

HHS to providers: Check lists of excluded Medicare personnel

HHS to providers: Check lists of excluded Medicare personnel

HHS maintains a list of 51,588 people who are categorically excluded from providing even indirect care to Medicare patients, and new guidelines that will be published today recommend healthcare providers check their personnel rosters against the list ...

Slowdown In Health Care Spending Growth Could Save Americans $770 Billion

Slowdown In Health Care Spending Growth Could Save Americans $770 Billion

08 May 2013 

A slowdown in the growth of U.S. health care costs could mean that Americans could save as much as $770 billion on Medicare spending over the next decade, Harvard economists say. 

In a paper published in Health Affairs, David Cutler, the Otto Eckstein Professor of Applied Economics, and co-author Nikhil Sahni, a senior researcher in Harvard's Economics Department, point to several factors, including a decline in the development of new drugs and technologies and increased efficiency in the health care system, to explain the recent slowdown. 

If those trends continue over the next decade, they say, estimates of health care spending produced by the Congressional Budget Office and Centers for Medicare and Medicaid Services (CMS) Office of the Actuary could be off by hundreds of billions. 

"Historically, as far back as 1960, medical care has increased at about one-and-a-half to two percent faster than the economy," Cutler said. "In the last decade, however, medical care has not really grown as a share of the GDP. If you forecast that forward, it translates into a lot of money." 

Money, Cutler said, that could have a profound effect not just on government spending, but on average workers as well. 

If the growth in costs remains flat, Cutler said, money companies might otherwise spend on health care could be directed back to workers in the form of increased salaries. Reduced health care costs could also help relieve financial strain on other critical government programs at both the state and national level. 

"At the federal and state level, we've cut everything but health care," Cutler said. "If we can hold the growth in health care spending down, it would reduce the pressure on government, and would allow us to avoid funding one program at the expense of others, or raising taxes." 

While recent forecasts by the CBO and Medicare actuaries have taken the recent slowdown in health care spending into account, those estimates come with a fatal flaw - an assumption that costs have slowed largely due to the 2007 recession. 

By comparison, Cutler and Sahni's study suggests that just over a third, about 37 percent, of the decrease could be chalked up to the recession. Instead, they say, the bulk of the decline could be attributed to factors like a decline in the development of new treatments. 

"For whatever reason, the technology that's available for treating people seems to be improving at a slower rate than in the past," Cutler said. "In recent years, there have been a number of oncology drugs that have been touted as potential blockbusters, but most haven't sold as well as expected. Other analysts have also noted that while research and development spending by pharmaceutical companies has increased dramatically, the number of new drug approvals has remained flat." 

With the passage of the Affordable Care Act, Cutler said, health care providers received new incentives to increase efficiency and reduce costly problems, such as readmitting patients soon after discharge and in-hospital infections. 

"There are a variety of different programs where we've said if you're efficient you'll be rewarded, and so that's what a lot of institutions are trying to do," he said. 

Steep out-of-pocket costs have also resulted in many people - even those who are insured - choosing to defer some treatments in the interest of saving money. 

"A typical insurance policy now has a deductible of over $1,000 for an individual, and maybe $2,000 for a family, and most people don't have that amount of cash in the bank," Cutler said. "It's a big hurdle. People look at their cost-sharing, and they say this is a lot of money, I'm not sure I can afford it, so they're cutting back on discretionary imaging, they're cutting back on elective surgeries, and on referrals to specialists that might not be covered. 

"At the same time, insurers have become a lot smarter about directing people to cheaper alternatives when you do seek treatment," Cutler added. "For example, it used to be that everyone took the branded version of a drug. Now, if you're taking the branded version of a drug, you've gone out of your way to do that." 

Ultimately, Cutler said, the question of whether earlier estimates of health care costs are correct will depend on whether insurers, providers and the public continue to work to keep costs under control. 

"Don't think of this as plate tectonics, where the Earth's crust is moving and we just need to figure out how fast it's moving," Cutler said. "We have a lot of control over this, through policies in the Affordable Care Act and Medicare and Medicaid. It's not easy -- no change is ever easy -- but if we continue to do the right things, like stressing efficiency and helping people choose less expensive alternatives, then we can make sure this trend continues."
Harvard University

Study Models Three Big Changes To Medicare

Study Models Three Big Changes To Medicare

By Ankita Rao
MAY 7TH, 2013, 3:52 PM
Lawmakers are looking for ways to tackle the growth of Medicare spending, which the Congressional Budget Office estimates will account for 24 percent of the federal budget by 2037. But some strategies to cut program costs could leave millions of beneficiaries without coverage.
A study from the Rand Corporation, a nonprofit research organization, compared the impact of three proposals that have been discussed by Congress or the White House to  curb the costs of the government health care program for seniors and the disabled. The study is published in the May issue of Health Affairs.
Here are the three policy changes the study modeled.
Means testing Part A: Medicare Part A includes coverage of care in hospitals and nursing homes, and unlike Part B (which covers doctor visits, labs and equipment), the Part A premium is the same no matter how much a beneficiary earns. The idea of making wealthier seniors pay more for Part A has been around for a long time: It was suggested by thebipartisan Kerrey-Danforth commission back in the mid-1990s.
Premium support: Premium support would give seniors a set amount of money to purchase a private or Medicare-like health insurance plan. It’s a proposal similar to the one championed by House Budget Committee Chairman Paul Ryan (R-Wis.).
Raising the eligibility age: If Medicare mirrored Social Security, the eligibility age would be 67. This proposal has been floated by both parties and has stoked heated debate. Medicare’s age requirement has not changed since the program’s inception in 1965, though life expectancy has increased by eight years in that time.
“The magnitude of savings can vary quite substantially,” said author Christine Eibner, a senior economist at RAND, about the results of the comparative study.
The researchers found that premium support and raising the eligibility age were the most effective changes to curb costs. Increasing the eligibility age, for example, reduced federal spending by 7.2 percent through 2036, compared to 2.4 percent if a premium for Part A was added. And the premium support plan resulted in the most savings after 2019 of all three options.
The savings from raising the eligibility age in the RAND study was different from earlier Congressional Budget Office estimates because the Rand authors modeled the outcome with the idea of raising the age in 2014. The government office instead assumed the age would gradually be raised and not be in full effect until 2027.
But all three scenarios had downsides and the two scenarios that produced the greatest potential savings also produced the greatest possible burden for Medicare enrollees both financially and in terms of access to health care.
In the means-tested strategy, somewhere between 2 and 20 percent of eligible beneficiaries may choose not to enroll in Medicare Part A, researchers found. For the premium support plan, the authors estimate 13 percent of seniors would forgo coverage. And raising the eligibility age to 67 also would reduce enrollment by approximately 13 percent, according to the study.