April 22, 2013, 9:08 a.m. ET

Quintiles Unlocks Path for Digital Patient Engagement

New report demonstrates how the digital patient can yield efficiencies throughout the biopharma product lifecycle

RESEARCH TRIANGLE PARK, N.C.--(BUSINESS WIRE)--April 22, 2013-- 

Harnessing the power of the digitally connected patient can not only help produce enormous amounts of savings in the health care system, but can also improve patient outcomes.
Companies that can successfully engage with the digital patient will distinguish themselves and increase their probability of success according to a new report from Quintiles, "Harnessing the Power of the Digital Patient." The report explores a more modern approach to patient engagement to streamline product development, prove product value and accelerate product adoption and adherence.
Declaring this, "The Age of the Digital Patient," Quintiles tracks the evolution of patient engagement models over time and argues that the patient is at the center of today's model--a change from the more company-centric models of the past.
The report dismisses the value of "old-school" patient databases to find patients, and declares the 2.4 billion people with an internet connection as "today's database."
Core to the Quintiles Digital Patient model is the building of trusted relationships via patient communities, and the creation of opportunities for patients to engage in managing their own health. These programs range from introductions to clinical trials, to enrollment in adherence programs, to virtual studies that include collection of patient reported outcomes, medical records, lab data and device diagnostics to prove a product's value or safety--all collected directly from patients without introducing site burden.
"It's not a question of 'when' these capabilities will be available," says co-author David Coman, senior vice president Quintiles communications, "it's a question of when the industry will give itself permission to make these approaches standard. We have been preparing for 'The Age of the Digital Patient' since 2007, and have the capabilities and experience to provide transformational change today."
Quintiles digital patient experience extends back to its creation of Mediguard.org in 2007 and ClinicalResearch.com in 2009, and its completion of more than 350 custom patient programs on behalf of sponsors in its Digital Patient Unit. To date, Quintiles manages relationships with more than three million clinically profiled patients across nearly every therapeutic area.
First Patient Enrolled in Six Minutes
An example of the promise the digital patient holds can be found in an observational research study in which Quintiles recruited 425 patients with chronic obstructive pulmonary disease (COPD) from its online patient community. The first digital patient was enrolled in the study in a mere six minutes with the last patient confirmed in only nine calendar days.
59% Increase in Retention Rates
A second example can be found in a 1,255-patient women's health study in which Quintiles developed a custom communication plan for each patient in order to reduce the number of patients that become lost to follow up or drop out of the study entirely. The customized communication program kept patient engagement high and resulted in a 59% increase in the retention rate for the duration of the study.
The full Quintiles report, "Harnessing the Power of the Digital Patient, " can be accessed here.
About Quintiles
Quintiles is the world's largest provider of biopharmaceutical development and commercial outsourcing services with a network of more than 27,000 employees conducting business in approximately 100 countries. We have helped develop or commercialize all of the top-50 best-selling drugs on the market. Quintiles applies the breadth and depth of our service offerings along with extensive therapeutic, scientific and analytics expertise to help our customers navigate an increasingly complex healthcare environment as they seek to improve efficiency and effectiveness in the delivery of better healthcare outcomes.

Medicare Health Risk Assessments

Medicare Health Risk Assessment  

CMS is considering excluding from risk adjusted payment any diagnosis data collected from MA enrollee Health Risk Assessments which are not confirmed by a subsequent clinical encounter.  

CMS planned to collect flags in 2013 of these risk assessments.
Based on comments received, CMS is delaying the collection of flags until calendar year 2014.  

Further determination about exclusion of these data will be published in the 2015 Advance Notice

Audit Your Records, Before Someone Else Does

AUDIT YOUR PRACTICE BEFORE SOMEONE ELSE DOES

Medicare and Medicaid now require physicians to establish a compliance plan that can effectively detect "criminal, civil, and administrative violations."  That means you must have a plan to address key compliance issues such as billing discrepancies and appropriate coding and documentation. 

Contact ERM today for a FREE Consultation

1-877-938-9232

Schedule On-Site or On-line Training Today and Learn:

·         The basic laws involved with Medicare fraud and abuse,

·         How to identify hot areas that are often the subject of audits,

·         How to develop and maintain a workable compliance plan, and

·         The importance of documentation and frequent self-auditing.

BONUS: Discounted Compliance Plan Guide + Template and Provider Documentation Guide

The Digital Disruption

The Digital Disruption

Medicine is destined to be the most regulated industry in the world. The current culture of healthcare in America challenges traditional business models on everything from cost to implementation to how we gather feedback about the patient experience. This paramount shift in the way we evaluate our physicians and choose our health plans further supports the need for continual innovation. In this new generation of due diligence, the entire healthcare community has become accountable not only in the state and federal courts but in the court of public opinion as well. This new arena demands strong fiscal oversight, tangible transparency and outcomes that are determined by the level of patient engagement. The old boardrooms dialogue, centered around the acquisition and internal uses of big data, have given way to new questions. Senior executives and are now asking, “How do we get our members excited about using all of this data?”

The fact that this question is now being asked by the most influential decision makers in healthcare signals the beginning of a new kind of disruption, a digital disruption.

This digital disruption will be pioneered by leaders using technology to create innovative platforms to engage patients and change behavior. The champions of the future will be determined by the individual capacity of a corporation to modify and adapt. Inventions will no longer depend on handcrafted products but instead be shaped from ideas, concepts and processes presented across multiple platforms that can be accessed from anywhere any time any place.

The health plan of the future will engage patients through digital apps that can monitor compliance, Create custom QR Codes for HEDIS Measures to allow for real time tracking, all while assessing member satisfaction with the plan, pharmacy benefits and primary care providers.

In fact, the tools themselves will have nothing to do with the digital disruption, it will be the meaningful ways in which we use these tools to meet the needs of patients. Success or failure will be contingent not on what you create but what you do with it next.

The cost of healthcare is unsustainable. First premiums were raised to try and get consumer involvement. That was followed by employing variable cost shares and quality incentives. None of which have influenced behaviors. Perhaps because all of those affect us indirectly.

Innovative platforms such as Mobile Apps and Telemedicine have been able to reach their audience in the most intimate of places. 

How are you engaging your patients? Are you prepared for the digital disruption?

Kameron Gifford, CPC

ERM Consulting Inc

www.ermconsultinginc.com

CMS has updated ICD-10 resources to reflect October 1, 2014 DEADLINE

Updated resources are now available to reflect the October 1, 2014, deadline. The CMS implementation guides, checklists, and timelines have been adapted and provide step-by-step guidance around the transitions.

• The ICD-10 implementation guides provide detailed information for planning and executing the ICD-10 transition. The downloadable PDF versions are available below:
  • Small and Medium Practices
  • Large Provider Practices
  • Small Hospitals 
  • Payers 

• Checklists and timelines with ICD-10 tasks and estimated timeframes are now available for:
  • Small and Medium Practices - Checklist and Timeline
  • Large Provider Practices - Checklist and Timeline
  • Small Hospitals - Checklist and Timeline
  • Payers - Checklist and Timeline

Medicare Fee-For-Service National Provider Call – Last Chance to Register

Thursday, April 18; 1:30-3pm ET

On September 5, 2012, CMS published a final rule that delays the ICD-10 compliance date from October 1, 2013 to October 1, 2014. Are you ready to transition to ICD-10? Now is the time to prepare. Join us to learn how to prepare in 2013 for the transition. CMS Subject matter experts will review basic information on the transition to ICD-10 and discuss implementation planning and preparation strategies. A question and answer session will follow the presentations. Learn more about the call on the April 18 call web page.  

ICD-10 Conferences

• ACP Internal Medicine Conference (April 9 – 11, 2013; San Francisco)
  • ICD-10 - Are You Ready? technology briefing; Thursday, April 11 at 10:45 am; in the exhibit hall
  • ICD-10 Implementation: A Practical Roadmap; Thursday, April 11 from 2:15 pm - 3:45 pm; Room PN 033
• The AHIMA ICD-10-CM/PCS and Computer-Assisted Coding (CAC) Summit is April 22-24 in Baltimore
  • MDCMS representatives will be at table 29. We encourage you to stop by to hear about CMS tools and resources available to help with ICD-10.  

Health Plan’s Secret Sauce is Social Media

Health Plan’s Secret Sauce is Social Media

Health Plan's Secret Sauce is Social Media

Jacqueline Fellows, for HealthLeaders Media , April 17, 2013

Every industry, including healthcare, has been trying to figure out a way to get the most out of social media in general, and Facebook, specifically. The real winners are, of course, consumers because myriad online ads, coupon sites, and Facebook posts drive prices lower.

Hospitals and health systems trying to compete in this space can't win a price war, but they may win on patient engagement. Unfortunately, the results are soft, at best, as the strategy generally revolves around hoping someone comments on a Facebook post about a wellness goal, such as losing weight, managing stress, or quitting a tobacco habit.

Magellan Health Services, a specialty managed healthcare provider, seems to have hit upon an effective way to not only engage patients, but also change the behavior that is contributing to patients' health problems. And they're doing it with social media.

In 2012, Magellan launched a pilot project with a "large health plan in the Northeast" aimed at reducing the readmission rates of members who had been admitted to a hospital for substance abuse. In addition to a phone call after being discharged from the hospital, health plan members were invited to join a social media site that looks, feels, and functions like Facebook, but is tailored specifically for them.

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"The people we're engaging on this [website] we probably never would've gotten on the telephone," says Laurie Gondek, senior vice president of product innovation at Magellan. "You have people who want to engage in many different ways. Some, with their providers… and then there are those who prefer to start out online."

Though the pilot project has ended, the site is still being used by Magellan and for the company's health plan customers who buy it under a private label to brand the site how they want. Gondek says she is seeing a lot of interest from Blue Cross Blue Shield plans and others who are interested in the site's potential for bridging care gaps and for chronic conditions.

"We've started to talk to ACO's and other entities that are looking for ways to have the medical practitioners have something in their toolbox that has some behavioral components to it for those individuals who do not want to see behavioral practitioners or specialists. We've got some ACO's we're working with in California and some in the southeast," she says.

The way it works is patients sign in with their usernames (it can be whatever the patients choose) and then check in with an emoticon to indicate how they're feeling. There are 28 different emotions a user can choose from, ranging from happy to in pain. The small icons are also color coded red, yellow, or green. The color is important and can serve as an SOS signal of sorts. For example, if a user checks in as being "in pain," which is red, then everyone in that user's support group—the Facebook equivalent of friends—is notified and they can jump to offer support. Friends can then comment, and also hit the equivalent of a "like" button, except the statements are empathic, ranging from, "I relate," to "I feel like that too" (sic).

Patients can also choose which groups pertain to them, such as depression or alcoholism, and they'll be connected with other patients in a social media forum that offers what traditional support groups do not—anonymity. There are also real meetings online as well as webinars with doctors or other medical experts, explains Gondek.

"What's interesting is as these individuals start out online, they are signing up for the online meetings and the talks with the expert, so we're achieving a kind of a mixed model with them being able to enter with their preference. When we say, 'We have a national expert talking about eating disorders today at noon, would you like to join?' They join, and then they ask them questions."

In the pilot project, which included 1,000 patients, Gondek says the effort generated a 20% engagement rate.

"If you look at a traditional coaching program where we are fortunate to get engagement of 2 to 3% using a telephonic model," says Gondek. "By reaching out to these individuals with a welcome home call and an invite to the program, we achieved 20%, which, that's pretty high—double what we thought it was going to be."

Gondek also says that once patients engage with the program they're more apt to take a phone call from a coach, if needed.

And while the hard data from readmission rates is still a few months off, Gondek is optimistic.

"I had a goal of reducing it [the readmission rate] from 2 to 5%, and it's a little too soon to tell, but some of our numbers are looking very promising. We're thinking we're going to save somewhere between $1,000–$2,000 per individual, which is pretty significant."

Gondek says Magellan is running with its early success in substance abuse readmission rates and including other conditions such as eating disorders, chronic pain and autism, among others.

"It's HIPAA-compliant; it's got experts [and] we're monitoring the site. I really think that we could find something here that could be super helpful that would keep costs down. We actually see this as having tremendous power in a number of ways."

Engaged Patients Cost Less

Engaged Patients Cost Less

Marianne Aiello, for HealthLeaders Media , April 17, 2013

It's safe to say that practically everyone reading this article would be an engaged patient. It would be hard not to, being in the industry that we are. While this is beneficial to us personally, I wonder if it skews our views of how many patients are truly engaged and what the value of that engagement actually is.

This question is something I've been thinking about a lot lately as I prepare for the second surgery to repair the damage I did to my left thumb in a gruesome vegetable-chopping incident. (If you're sick of me harping on about this since November, just think of how tired I am of dealing with it.)

During my pre-op phone screen for my coming out-patient surgery, the RN rattled off a list of preparations and rules I had to follow before arriving for my procedure; track down and wash with a particular antiseptic soap three days prior, don't eat anything after midnight the day before, take this medication the morning of but not that, acetaminophen is okay for pain but no ibuprofen or aspirin, etc. 

I dutifully wrote all of this down and, of course, am following it to the T. But what about the people who don't? I can think of several happy-go-lucky (that's putting it kindly) friends and relatives who would easily brush off most of these instructions, who wouldn't bother trekking to three different pharmacies before they found the correct antiseptic.

There are also the varying levels of health literacy to consider. I had to ask the RN on the phone to clarify a few things for me, including the scientific name of the antiseptic, which she had spat out as if it were a common item for the everyday person. Had I not felt empowered to ask, I would not have understood or followed that particular instruction.

Spacey, disinterested, and low-health literate patients are out there, in abundance. Some patients do the best they can and still fall short. Others simply 'go with the flow,' essentially relinquishing responsibility for their care to others.

Improving communication with these types of patients is something healthcare marketers should focus on. And it's more than just good medicine—it can improve costs.

A study in the February issue of Health Affairs looked at the role that patients play in determining health-related outcomes. Researchers found that patients who were more knowledgeable, skilled, and confident about managing their day-to-day health had healthcare costs that were 8% lower in the base year and 21% lower in the next year compared to patients who lacked this type of confidence and skill.

These savings held true even after adjusting for patient differences, such as demographic factors and the severity of illnesses.

Furthermore, engaged patients with the same chronic illness had lower healthcare costs than their less-engaged counterparts; less-engaged asthma patients had 21% higher costs than the most engaged patients. With high blood pressure, the cost differential was 14%.

"There is ample evidence that the behaviors people engage in and the health care choices they make have a very clear effect on both health and costs, positively and negatively," the study authors wrote.

"The most innovative healthcare delivery systems recognize this and see their patients as assets who can help them achieve the goals of better health at lower costs. From this point of view, 'investing' in patients and helping them to be more effective partners in care makes good sense."

Dave deBronkart, a.k.a. e-Patient Dave, also talks about the value of engaged patients in his most recent Forbes column, says "Let patients help." In the article, he describes how being an engaged and informed patient when diagnosed with stage-IV kidney cancer improved his outcome and possibly even saved his life.

The question for marketers, then, is how can we most effectively invest in patients in a way that fosters higher levels of engagement? The Health Affairs study authors offer two suggestions:

1. Build into every step of the care process a meaningful role for patients and their families.
2. Tailor and customize care in a way that helps patients acquire the knowledge and skills they need to effectively manage their health.

I've seen some organizations tackle these steps by creating easy-to-understand brochures and literature for patients to take with them after their hospitalization. Some take the next step of a follow-up call to make sure patients understand the instructions and are following them. And many hospitals, like the one where I'm receiving my care, check in with patients before their procedure.

While these are all likely effective, it seems to me that hospitals need to move away from fostering incident-based engagement and toward patient-based engagement. Patients should be engaged in their health and healthcare at all times, not just when they are having surgery or contract an illness.

It's up to marketers, working with physicians, administrators, and patients, to figure out what that balance is.

CMS-HCC Model - Live Education from ERM Consulting

ERM'S PROPRIETARY EDUCATION MODEL

Return on Investment -  over 300%

Empirical Risk Management has identified a methodology to improve the quality of care while focusing on compliance to positively affect change within a managed care population.

• Education and Training to Providers and Patients
• Auditing and Compliance in accordance to OIG Standards
• Implementation and Monitoring of Initial Health Assessments and Annual Preventive Services
• HEDIS and Star Improvement Programs

Contact ERM for all of your education and training 

 877-938-9232 or 

Visit them online at: www.ermconsultinginc.com

2014 Medicare Advantage Final Call Letter

Announcement of Calendar Year (CY) 2014 Medicare Advantage Capitation 
Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter

4/1/13


Key Changes from the Advance Notice:

Growth Percentages: Attachment I provides the final estimates of the National MA Growth
Percentage and the FFS Growth Percentage and information on deductibles for MSAs.
Calculation of FFS Rates: In 2014, we will begin transitioning to a methodology in which the
historical claims data are adjusted to reflect the most current hospital wage index and physician
geographic practice cost index. More information on this methodology change is provided in
Attachment III, Section C. For CY 2014, the blend between the repriced and non-repriced AGAs
will be done based on a 50-50 split.
CMS-HCC Risk Adjustment Model: We will implement the updated, clinically revised CMS-HCC
risk adjustment model proposed in the Advance Notice with the following differences: (1) we will
not adjust the denominator and (2) we will blend the risk scores calculated using this model with the
risk scores calculated using the 2013 CMS-HCC model, weighting the risk scores from the 2013
CMS-HCC model by 25 percent and the risk scores from the 2014 CMS-HCC model by 75 percent.
We include in this Announcement the final version of the updated, clinically revised model,
including community, institutional, new enrollee, and C-SNP new enrollee segments. The
relative factors for 2013 CMS-HCC model can be found in the 2013 Announcement.
PACE Model: We will continue to use the same risk adjustment model for PACE paymentsthat
we have used in 2012 and 2013.
Normalization Factor for the CMS-HCC Model: Because the normalized risk scores from the
2014 and 2013CMS-HCC models will be blended, there are two normalization factors for 2014.
They are:
• 2013 CMS-HCC model: 1.041.
• 2014 CMS-HCC model: 1.026.
Normalization Factor for the PACE Model: The final normalization factor for the PACE
model is 1.085.
Normalization Factor for the RxHCC Model: The final normalization factor for the RxHCC
model is 1.030. 3
Frailty Adjustment: The 2014 frailty factors for PACE organizations are the same frailty factors
posted in the 2013 Advance Notice. There are two sets of FIDE SNP frailty factors for 2014; we
will calculate frailty scores using the frailty factors associated with the 2014 CMS-HCC model
and using the frailty factors associated with the 2013 CMS-HCC model. The FIDE SNP frailty
factors associated with the 2014 CMS-HCC model are finalized in this Announcement. The
FIDE SNP frailty factors associated with the 2013 CMS-HCC model are posted in the 2013
Advance Notice. CMS will separately calculate frailty scores for FIDE SNPs using each set of
factors and blend the two frailty scores in the same manner as the 2014 risk scores. These
blended frailty scores will be used both to determine a FIDE SNP’s eligibility for frailty
payments and, if eligibility is met, for payment.
MA Enrollee Risk Assessments: In response to comments received on the proposed policy for
MA Enrollee Risk Assessments, CMS is delaying the collection of “flags” for these assessments
until 2014 dates of service. We will propose and finalize a policy on the extent to which
diagnoses from 2014 Enrollee Risk Assessments will be used to calculate risk scores for payment
year 2015 in the 2015 Advance Notice and Rate Announcement.

For more information, the entire notice can be viewed at: http://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2014.pdf

TOP 10 HCC's

This list identifies the most commonly submitting HCC's.

COPD $3112

496 COPD

493.20 Asthma w/chronic COPD (Chronic Obstructive Asthma)

491.9 Chronic Bronchitis

492.8 Emphysema

CHF $3198

428.0 CHF

425.4 Primary Cardiomyopathy (Ischemic is not an HCC)

402.91 Hypertensive Heart Disease w/heart failure

Vascular Disease $2465

443.9 Peripheral Vascular Disease

443.81 PVD in other diseases (diabetes)

453.40 Acute DVT

440.0 Atherosclerosis of Aorta

441.4 Abdominal Aortic Aneurysm

Cancer $1622-$8213

All malignant neoplasm’s including Melanoma but not skin cancer

All secondary malignant neoplasm’s –

Highest HCC if site is documented $17,753

Ischemic Heart Disease $2215

411.1 Unstable Angina

Specified Heart Arrhythmia $2285

426.0 Complete AV block

427.31 Atrial Fibrillation

427.81 Sick Sinus Syndrome

Diabetes $1264 - $3962

·         all diabetes (250.XX) and most of the manifestations

Ischemic or Unspecified Stroke $2067

436 CVA

434.91 Unspecified cerebral artery occlusion, w/infarction

Angina/Old MI $1903

413.9 Angina

412 Old MI

Rheumatoid Arthritis & Inflammatory Connective Tissue Disease $2699

714.0 Rheumatoid Arthritis

710.0 SLE

Physicians and providers should report all diagnoses that impact

the patient's care, and ensure that these diagnoses are accurately

documented in the medical record. This includes the main reason for

the episode of care, and all co-existing, acute or chronic conditions,

and pertinent past conditions that impact clinical evaluation and

therapeutic treatment.

Compliance is no longer an optional expense in healthcare

 As of February 28, 2012, health plans and all down-stream entities must ensure regulatory compliance through due diligence and oversight activities.

The Office of Inspector General 2013 Work Plan reiterates these objectives.

2013 HHS Work Plan

Encounter Data—CMS Oversight of Data Integrity (New)

We will review the extent to which MA encounter data reflecting the items and services provided to MA plan enrollees are complete, consistent, and verified for accuracy by CMS.  In 2012, MA encounter data reporting requirements will expand from an abbreviated set of primarily diagnosis data to a more comprehensive set of data.  (One Time Notification, Pub. 100-20, CR 7562.) Prior CMS and OIG audits have indicated vulnerabilities in the accuracy of risk adjustment data reporting by MA organizations.  (OEI; 00-00-00000; expected issue date:  FY 2014, new start)

Risk Adjustment Data—Sufficiency of Documentation Supporting Diagnoses 

We will determine whether the diagnoses that MA organizations submitted to CMS for use in CMS’s risk-score calculations complied with Federal requirements.  We will review the medical record documentation to ensure that the documentation supports the diagnoses submitted to CMS.  Payments to MA organizations are adjusted on the basis of the health status of each beneficiary.  (Social Security Act, §§ 1853(a)(1)(C) and (a)(3).)  MA organizations submit risk adjustment data to CMS in accordance with CMS instructions.  (42 CFR § 422.310(b).)  (OAS; W-00-09-35078; W-00-10-35078; various reviews; expected issue date:  FY 2013; work in progress)

Risk Adjustment Data—Accuracy of Payment Adjustments

We will determine whether CMS properly adjusted payments to MA plans on the basis of the results of its data validation reviews.  Risk adjustment data validation is an annual process of verifying diagnosis codes.  (42 CFR §§ 422.308(c) and 422.310(e).)  The process affects payments to MA plans.  CMS contracts with Quality Improvement Organizations (QIO) or equivalent contractors to verify whether diagnosis codes are supported by medical record documentation.  (OAS; W-00-12-35554; various reviews; expected issue date:  FY 2013; work in progress)

Provision of Services—Compliance With Medicare Requirements

We will review MA organizations’ oversight of contractors that provide enrollee benefits, such as prescription drugs and mental health services.  We will determine the extent to which MA organizations oversee and monitor their contractors’ compliance with regulations and examine the processes they use to ensure that contractors fulfill their obligations.  MA organizations are accountable for the performance of the entities with which they contract.  MA organizations that delegate responsibilities under their contracts with CMS to other entities must specify in their contracts with those entities provisions that the entities must comply with all applicable Medicare laws, regulations, and CMS instructions.  (42 CFR § 422.504(i)(4)).

Compliance is no longer an optional expense in health care. 

Empirical Risk Management provides comprehensive solutions to reduce liability and improve outcomes.