Thursday, June 5, 2014

Medical Economics: Steinberg’s practice is textbook example of patient-centered medical home

Journal features Commonwealth Medicine physician leader

By Jennifer Rosinski
UMass Medical School Communications
June 05, 2014
Judith Steinberg, MD, MPHThe care coordination of an AIDS patient and his HIV-positive wife managed by UMass Medical School’s Judith Steinberg, MD, MPH, is a textbook example of success using the patient-centered medical home (PCMH) model, according to a cover story in the most recent issue of Medical Economics.
Dr. Steinberg (at right), clinical associate professor of medicine and deputy chief medical officer for UMass Medical School’s Commonwealth Medicine division, said that it was critical to have a behavioral health specialist immediately begin counseling the couple following their diagnosis.
That coordination would not have existed if Steinberg’s practice was not a medical home, one of 44 participants in the multi-payer Massachusetts Patient-Centered Medical Home Initiative (MA-PCMHI) sponsored by the Massachusetts Office of Health and Human Services.
“When I describe the patient-centered medical home to practices, providers, or to anyone—all of us are patients at one point or another—I like to say it’s really the way we, as patients, would like to see our care delivered,” Steinberg told Medical Economics.
“It makes such perfect sense that our care is focused on us as an entire individual, not as individual diseases or organ systems. That our care is well-coordinated and communicated across many settings and there’s an attention to quality and we are all partners in our care.”
The article, “Patient-centered medical home: Making care coordination work for your practice,” also included insight from Christine Johnson, PhD, PCMH quality improvement and transformation director at Commonwealth Medicine. She described how a physician reluctant to use care managers grew to appreciate them after they assisted in handling a complicated post-hospitalization patient. The physician said it was like “going from baggage to first class,” Johnson said.
Commonwealth Medicine is leading the development of the patient-centered medical home model and helping practices turn it into a reality. Led by Steinberg, Commonwealth Medicine has partnered with Bailit Health Purchasing LLC on MA-PCMHI. The three-year multi-payer demonstration concluded on March 31, 2014 and is in the analysis stage. Early results show 43 of 44 practices received National Committee for Quality Assurance PCMH recognition. Statistically significant improvement was shown in 11 of 22 clinical quality measures, including chronic disease management, prevention and care coordination. A complete evaluation and report is expected in the fall of 2014.

ICD-10 Medical Code Tests Yield Successful Results for CMS

The Centers for Medicare and Medicaid Services’ claims acceptance rates approached the average for normal claims, and participants were able to test the impact of errors in claim reports during the process.

The Centers for Medicare and Medicaid Services’ initial testing of updated medical diagnosis codes that will be required at health care payers and providers next year proved to be successful, according to Niall Brennan, the acting director of CMS Offices of Enterprise Management.
The updated codes, ICD-10, replace ICD-9 to bring the U.S. up to speed with other industrialized countries and allow for more specific patient diagnoses.
After several delays, the implementation of ICD-10 will be required by Oct. 1, 2015.
All entities covered by the Health Insurance Portability and Accountability Act must implement the new codes to create consistency between the health care system in the United States and other industrialized countries.
Brennan, in a CMS blog post, said testers submitted more than 127,000 claims with ICD-10 codes to the Medicare Fee-for-service (FFS) claims systems and received electronic acknowledgments confirming their claims were accepted.
There were approximately 2,600 participating providers, suppliers, billing companies and clearinghouses during the week of testing, according to Brennan.
The largest testing group was from clearinghouses, which submit claims on behalf of health care providers, Brennan said. They submitted 50 percent of all the test claims.
In the U.S., CMS accepted 89 percent of the test claims, with some regions reporting acceptance rates as high as 99 percent, according to Brennan. Medicare FFS claims system did not present any issues during the testing process. Normal claims acceptance rates average between 95 and 98 percent.
“This testing week allowed an opportunity for testers and CMS alike to learn valuable lessons about ICD-10 claims processing,” Brennan said. “In many cases, testers intentionally included such errors in their claims to make sure that the claim would be rejected, a process often referred to as negative testing.”
In the near future, the Department of Health and Human Services expects to release an interim final rule that will include a new compliance date requiring the use of ICD-10 beginning Oct. 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9- through Sept. 30, 2015.
CMS will be releasing details about plans to conduct end-to-end testing in 2015, according to Brennan.

Empowering Engagement through the Adoption of Patient Portals

Who is using your patient portal? What is the health literacy of your population? Has your organization reaped the incredible benefits of actively engaged patients? If not, the time to act is now!

Patients who have more knowledge, skill, and confidence in managing their health, and who are more adept at navigation and using the health care system, appear to incur lower costs.

According to the Robert Wood Johnson Foundation, people who are actively engaged in their health care are more likely to stay healthy, while those who lack the skills and confidence to manage their own care often require more of it and incur up to 21 percent higher health care costs.

Utilization of patient portals is also a key exercise for satisfying Meaningful Use (MU) requirements.

Now patients must participate in order for the EP to meet Meaningful Use Stage 2.
Consider these new measures for 2014:
  • More than 5% of patients must send secure messages to their EP
  • More than 5% of patients must access their health information online (via a patient portal)
Are you satisfied with your Return on Engagement?
Health engagement, and in particular bolstering activation and health literacy, delivers a win-win for individuals to achieve optimal health outcomes.If you are looking for a new and innovative approach, mHealth Games can help! Health information can confuse anyone. mHealth Games helps patients and caregivers better understand and act on health information. 

Consider the power of a universal language such as games...
A recent study from the American Journal of Preventative Medicine examined the effects of gaming on health outcomes, and video games improved 69% of psychological therapy outcomes, 59% of physical therapy outcomes, 50% of physical activity outcomes, 46% of clinician skills outcomes, 42% of health education outcomes, 42% of pain distraction outcomes, and 37% of disease self-management outcomes. 

Take the mHealth Challenge

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