Monday, May 13, 2013

The Real Cost of Education, Auditing and Patient Engagement: $5 PMPM

Kameron Gifford, CPC

Republican, Democrat or Independent; Provider, Patient or Payor, It doesn’t matter what side of the line you fall on – we can all agree on one thing – Healthcare Reform is as necessary as it is Inevitable. We must align ourselves for the paradigm shift that lies ahead. We can’t continue to repeat the same actions over and over again with the expectation of different results? That, by definition, is insanity.
I recently wrote an article, “Mission Critical, Target Missed: $34.1 Billion in Overpayments to MA Plans in 2012” in which I referenced a recent study that found MA plans were (on average) overpaid $2,600 per beneficiary last year. If we break that down month over month we are looking at approximately $200 per month per enrollee. What did MA plans spend that money on in 2012?
How did their enrollee’s experience of care compare to their neighbors who elected to stick with traditional Medicare? And what about the providers who took care of these patients? How did their experience of providing care to MA members compare to those patients with traditional Medicare?
It might surprise you that the answer to that question would fluctuate greatly depending on who you asked, where they lived, what type of care they needed (or provided) and what plan they were enrolled with (or contracted with) last year.
According to the Kaiser Foundation, Medicare Advantage enrollment grew by 10% in 2012, exceeding 13 million enrollees or 27% of the total Medicare population. Of those 13.1 million, only 26% of all Medicare Advantage enrollees were covered by plans that were rated as above average or excellent, and 575,000 enrollees, about 9% were in plans that were “underperforming” and received less than 3 stars.
This is our solution? A solution that is plagued with complex reimbursement systems and unsustainable costs? One in which the access to care has been severely restricted all in the name of cost reduction? A system in which patients with insurance are unable to access the care they need and as a result do not get cost saving, preventive services. A solution that is only providing average care to the majority of our seniors?
We know that the cost of care is directly proportionate to the value it provides, and to be effective, that value must be meaningful to the patient.
So how much money was invested in 2012 by Medicare Advantage plans to close traditional gaps, improve access to care and educate patients? What incentives were paid to primary care doctors who went over and above the traditional “standard of care” to coordinate, monitor, and deliver care even during those critical periods of transitions? What about on patient outreach? Who is calling the member who hasn’t reached out to their PCP after enrolling? Or, are we only reaching out to those that are over-utilizing services?
Education is the only answer to a sustainable system.
What training is mandated for HCC Coders? Why aren’t physicians being taught the underlying principles of risk adjustment instead of being asked to assign specific ICD-9 codes to their MA members? Where is the transparency that Obamacare was intended to provide?
What if the answer to our healthcare crisis isn’t in the millions of medical records we are auditing and re-auditing? What if the answer isn’t in the “missing diagnosis” codes or the “monetary penalties such as recoupments”?
But, instead in the investment of education for patients, providers and office staff? What if the answer was creating more flexibility in the delivery of care or strengthening communities to bring that sense of responsibility into our neighborhoods? What if we took the money invested in prosecuting and defending waste, fraud and abuse and redirecting it into improving access and developing mobile platforms to meet the needs of patients?
Empirical Risk Management was able to create this personalized, comprehensive, integrated care in our recent pilot program. The cost of the program was less than $5 per member per month, and the value it created extended beyond quality measures and HEDIS - it instilled a desire to make better choices.
If we can innovate for as little as $5,per member per month, I can't help but wonder where the other $195 was spent?

Lincor Solutions Launches World’s First Mobile Solution for Patient Engagement and Clinical Services

Lincor Solutions Launches World’s First Mobile Solution for Patient Engagement and Clinical Services

MEDIVista MOBILE delivers services to Apple iPad and Android devices

Lincor announces the latest addition to the MEDIVista product suite – MEDIVista MOBILE, during eHealth Week in Dublin.
MEDIVista MOBILE delivers patient services to iPads and Android wireless tablets and is a modular extension to the proven MEDIVista service delivery platform already deployed in over 20 countries and 125 hospitals. MEDIVista provides patient centric content and applications to fixed bedside terminals, improving patient outcomes and workflow for both nurses and physicians.
“Many hospitals are facing demands to develop a BYOD (Bring your own Device) strategy so patients can use their own mobile devices,” explains Lincor Solutions co-founder and CTO Enda Murphy. “Without proper management and control, this can lead to strain on the hospital wireless infrastructure. The proven MEDIVista server technology gives hospitals this control plus the ability to fully manage a potentially lucrative revenue stream.”
Richard Cooke, Lincor Solutions CEO,continues“The rise of tablet devices has led to an increased expectation from patients and their visitors that they can use their own devices while in hospital. MEDIVista MOBILE enables just that and is a world first solution for hospitals to deliver live TV, Movies on Demand, internet access and Skype to both fixed bedside terminals and mobile tablet devices through a centrally managed service. Customers new to MEDIVista also get the peace of mind that comes from having the solution underpinned by tried and tested technology designed for the hospital environment.”
About Lincor Solutions
Lincor Solutions, founded in 2003, operates internationally from corporate offices in Nashville, Tennessee, as well as Dublin and Cork, Ireland. With sales offices in Toronto, Canada, Bordeaux, France, and Vienna, Austria, the company supports the largest installed base of its type worldwide. Lincor’s MEDIVista product set is delivered through a network of channel and technology partners in Europe, Middle East, Asia and the Americas.
Lincor will be showcasing MEDIVista MOBILE at eHealth Week Booth #617
For more information, visit