Friday, May 31, 2013

Family Physicians Group Improves Patient Experience through Use of PatientPoint® Care Coordination Platform

Published: May 31, 2013 

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PatientPoint plays key role in strategic patient engagement initiative
 — /PRNewswire/ -- PatientPoint®, the leader and innovator in mobile-enabled care coordination and patient engagement solutions, today announced that Family Physicians Group (FPG), a multi-specialty group and CMS shared-savings ACO, has launched the first phase of its strategic patient engagement initiative. The initiative will improve the patient experience and strengthen patient-physician relationships of this leading managed care practice through the use of the PatientPoint Care Coordination Platform. The program supports the group consisting of more than 120 physicians across 25 NCQA PCMH Level III-accredited sites in eight Florida counties.
In April, FPG completed the first phase of implementation across all locations to automatically update patient records such as demographics, medical history and pharmacy information into GE Centricity, FPG's EMR platform, via PatientPoint electronic check-in tablets. With more than 90 percent of FPG's patient population consisting of elderly, Spanish-speaking Medicare patients, usage adoption rates are already as high as 70 percent for the intuitive and multi-lingual electronic check-in and check-out feature. PatientPoint facilitated multi-lingual preventative health screenings during the electronic check-in to trigger care gap closures with the patient and increase practice revenues. During the four months of initial implementation for FPG, more than 2,000 depression screenings were administered through the electronic check-in.
The vision for FPG is to expand and enhance point-of-care engagement by using the PatientPoint Care Coordination Platform to address gaps in care, ensure preventative screenings and increase medication adherence.  Addressing these areas pre-visit and providing additional information at the point of care allows physicians to treat their patients holistically. FPG's goal is to create an environment that supports a more meaningful visit and a stronger physician-patient relationship, ultimately resulting in better health outcomes. 
Khalid Moidu, MD, CIO at Family Physicians Group, states, "A critical component of our strategy to build and sustain new healthcare delivery models is to apply innovative technology and care coordination solutions and support strong engagement practices with care providers. PatientPoint solutions bring information together from multiple sources to engage patients in their own care and enhance care management. We are pleased with our partnership with PatientPoint and are seeing excellent results. Since the PatientPoint Care Coordination Platform is prevalidated by NCQA for medical home, we are able to achieve our goals of continuing to transform our practice and to improve patient engagement while keeping costs in check."
Recognized for innovation in patient engagement by the Microsoft Health Users Group, the Care Coordination Platform integrates with practice management software and EMRs, streamlines the clinical process at the point of care, automates outreach to noncompliant patients on behalf of the physician and reconciles gaps in care. In addition, the provider organizations gain clinical and administrative efficiencies, resulting in increased revenues and reduced care management costs. As the first mobile-enabled care coordination and patient engagement platform to be prevalidated by the NCQA for 2011 PCMH criteria, PatientPoint allows practices utilizing the platform's prevalidated functionality to gain automatic credit of up to 15 percent of total points required to achieve NCQA PCMH Level III.
"The results FPG has realized in a short period of time by using the PatientPoint Care Coordination Platform are increased proof of the impact patient engagement has on improving patient outcomes and keeping costs down," said Raj Toleti, president and founder of Coordinated Care Solutions and CTO of PatientPoint. "As a result, physicians can be more proactive in prescribing their care plans, and patients have more information and knowledge to make better decisions regarding their own care." 
FPG is using the PatientPoint solutions to address common ACO challenges such as: attribution loss, care coordination, operational burdens and cost containment. Join Dr. Moidu in a webinar on June 4 at 12 p.m. ET on "How to leverage patient engagement and retention strategies for ACOs."
About Family Physicians Group
With more than 120 physicians from Jacksonville to St. Petersburg, Orlando-based Family Physicians Group is a leader in primary care physician services in Florida. The group, which was established in 1987, has received a Patient-Centered Medical Home NCQA accreditation. Its delivery of health services focuses on a model with emphasis on the integration and coordination of care for illness prevention and management of diseases, such as diabetes, heart disease and others. For more information, please visit
About PatientPoint
PatientPoint® is the leader and innovator of patient and physician engagement solutions at the point of care. PatientPoint award-winning patient education programs and care coordination platform drive meaningful outcomes for patients, healthcare providers and program sponsors. The PatientPoint Care Coordination Platform is the first mobile-enabled care coordination and patient engagement platform to be prevalidated by the National Committee for Quality Assurance (NCQA) for 2011 patient-centered medical home (PCMH) criteria. PatientPoint serves more than 61,000 physicians across all programs and more than 570 hospitals throughout the U.S., and impacts over 456 million patient and caregiver exposures annually. Learn more
PatientPoint® Contact: Davida Dinerman/Pauline Louie Schwartz 781-684-0770

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Will missing data affect physician P4P scores?


The answer is yes, but maybe not as much as you may thought.
A paper by Ryan and Bao use data from a randomized controlled trial (RCT) called IMPACT (Improving Mood-Promoting Access to Collaborative Treatment) to determine if errors in physician quality  profiling are due mostly to random variation or missing data.  For this report, the authors outcome of interest is remission of depression symptoms at 6 months after the start of treatment.
The IMPACT data include both a clinical registry used by care managers in the trial to document exposure to the intervention and to track patient outcomes (“registry data”) as well as longitudinal research interviews, which independently assessed patient outcomes at regular intervals (“research data”).  The authors use both the registry and research data to to generate parameters for the simulation.
The authors describe their simulation model as follows:
To initiate the Monte Carlo simulation, we assigned each provider a true quality score and a rate of missingness, each drawn randomly from distributions shown in Table 1. On the basis of data from the IMPACT trial, we assumed a correlation between missingness and true quality that was common to all providers. Then, 200 patient-level random draws, first determining whether an observation was missing or nonmissing and then determining patient remission (conditional on missing status), were taken for each provider. We then aggregated information from these draws, calculating provider-level “observed” quality scores under one of the two conditions: (1) using remission outcomes only from patients with nonmissing data, so that profiling error was a combination of error from missing data and from random sampling; and (2) using remission outcomes from patients with both missing and nonmissing data, so that all profiling error was due to random sampling. 
The authors reached a number of findings:
  • Measuring quality using relative rather than absolute measures had lower error rates.  In fact, relative profiling approaches had profiling error rates that were approximately 20 percent lower than absolute profiling approaches.
  • Most profiling error is due to random sampling, not missing data.  Between 11 and 21 percent of total error was attributable to missing data for relative profiling, while between 16 and 33 percent of total error was attributable to missing data for absolute profiling.
There is an important caveat to these findings, however.  The reason the missing data error is so small is due to the observation that in IMPACT data, missing data were not strongly related to the remission outcome in the IMPACT data.  If patients with observations missing from the data were much more (or less) likely to experience remission, then the missing data error would have made up a much larger share of the overall profiling error.


Corporate Innovators at the cusp of the next iteration

THURSDAY, MAY 30, 2013

The more I read innovation surveys and comments from analysts and executives, the more I wonder about management thinking.  Recently Accenture published a nice survey of 519 executives in firms in the US and in Western Europe.  The survey repeats what many of us have known for years:  executives recognize the importance of innovation and are frustrated with the results.  According to the survey 93% of the executives surveyed felt their firms would depend on innovation for growth, but less than 20% believe their innovation strategy is delivering a competitive advantage.  These two critical points identify what is perhaps the most significant trap in corporate innovation:  the unrealistic expectations of return on innovation.

If we were to stop for a minute and contemplate the timescales for innovation, things might become a bit more clear.  For many firms, regardless of when the idea is generated, it will take several years to develop a new product, prepare it for launch and provide it to customers.  Then, after the launch, it may take another year or two before the new product reaches break even and begins to generate real profits.  So, from the generation of a new idea till the recognition of profits and differentiation from the new product or service, it's reasonable to expect the timeframe to span three, four or even five years for fast turn products, and even up to seven or eight years for products with longer development cycles.

Add to this the fact that many companies don't "bet the farm" when they start innovation activities, for several reasons.  First, no one wants to take on too much risk on unfamiliar and untried innovation tools and systems.  There's always an argument for "low hanging" fruit as the first innovation initiative.  Second, many firms single thread innovation activities, due to resource constraints, budgetary issues and general change management.  This means that for many organizations, their first foray into innovation is by definition a line extension.  Further, many innovators conduct serial innovation activities rather than attempt to run several innovation activities in parallel, due to the constraints mentioned above.  This means that not only are the first attempts line extensions, but due to the limited number of initiatives, few products are developed.  Add to these the fact that it can take several years for even simple line extensions to move through a tightly constrained organization, and three to five years on the CEO may be scratching his or her head, wondering where all the innovations are that they demanded and were promised.

From the tiny acorn mighty oaks grow

There's absolutely nothing wrong with incremental, controlled experiments to test new philosophies and methods, and the innovation results we are seeing now are simply the first harvest of careful innovation activities.  What will be telling for future innovation is whether or not executives recognize the fruit of their planting, and decide to extend and expand the activities, and hopefully accelerate them, or deem the whole activity a failure.   The limited supply and constrained result of innovation activities to date is entirely predictable.  After all, the vast majority of corporations have spent 30 years building highly efficient business processes, cutting costs and eliminating risk and uncertainty.  Over the last few years some executives have planted tenuous innovation programs or activities that have trouble grafting on to the efficient working and activities of modern streamlined business models.  It's not unreasonable or shouldn't be unexpected that the first innovation harvests are small.  But, as the old saying goes, mighty oaks grow from tiny acorns.  All it will take is time.

Compare these results to the people who examined the possibilities of some of our most important inventions.  After the luster of manned flight by the Wright brothers wore off, I'm sure there were many people who argued that the plane only flew a couple of hundred yards and could barely carry a single person that distance.  A good horse could cover the same ground in less time!  What those naysayers failed to see, and what corporations are at risk of today, is that the first harvests are always thin, but continued investment and development can lead to far greater results and outcomes. 

From furtive experiment to critical capability

Corporate innovation is simply in its initial phases, in many cases as furtive, inexpensive experiment in one small corner of the business, underfunded and poorly resourced.  Expecting miracles from this small experiment is unreasonable, but not surprising.  Executives are realizing that while their organizations are exceptionally efficient, they cannot cut their way to growth and differentiation.  Innovation is vital because it adds to the top portion of the income statement, rather than cutting away at the bottom end.  What's important now is a continued investment, a growing investment and engagement in innovation, to shift the concept from a furtive experiment tucked away in a corner to a central, critical, consistent capability.  Just as a few Six Sigma "black belts" entered organizations years ago and now dominate corporate philosophy and thinking, innovation is a nascent experiment that must be expanded and must become a cultural phenomenon.

Many writers and analysts, this one included, hold up Apple as the arbiter of good innovation practice.  What people forget is that Apple was near bankruptcy in 1997, and had no other choice but to cut product lines and develop new innovation strategies for survival.  Today, Apple progressed through a series of innovation maturity phases, and is a relatively mature innovator.  Of course they should be good at innovating.  Apple has had almost 15 years of innovation experience to build on.  When executives look at Apple and wish their organizations could innovate like Apple, they fail to see the challenges, investments and time it took for Apple to become a viable innovator. 

Out of sight of the shoreline

The real question for many corporate innovators is this:  now that the first attempts have demonstrated some limited benefit, will they take the next step and expand their innovation efforts?  Will they define larger opportunities, provide more resources, funds and time?  Will they shift innovation activities from the periphery to the center of their organization?

Early sailor never sailed out of sight of the shoreline, because they lacked navigational skills and weren't sure what was out in the deeper ocean.  Sailing near the shoreline was safer but ultimately limiting.  It was only when they took the next step that new lands were discovered.  The same analogy applies for corporate innovation.  Small attempts have been made and they've been moderately successful.  More significant results await if the resources are available and if the organization continues to develop innovation skills and capabilities.  

Many corporate innovators stand at the cusp of important decisions.  In one direction is additional investment to build innovation capabilities and expand the breadth and depth of innovation projects.  In the other direction is the safe and familiar efficient business model, where cutting costs and achieving greater efficiencies lie.  Successful firms will recognize that both capabilities are required, and will invest in developing and maturing an innovation capability.  These firms recognize that corporate capabilities don't grow overnight, and investment is required for multiple years before significant results are achieved.  Many executives will blanch at the investment and decide to "acquire" innovation by purchasing smaller, more nimble competitors or seeking out third party technologies, not realizing the bidding war that will unfold as the number of firms choosing these options increases.