“The Top Ten Things You Need To Know About Engaging Patients”…and the Why

HowardrosenHi all, my name is Howard Rosen (Founder & CEO of LifeWIRE Corp), co-author of the recently published white paper report entitled “Top Ten Things You Need To Know About Engaging Patients.” You can access a copy here through the Institute for Health Technology Transformation (scroll down to “Whitepapers”.)

According to the Pew Internet and American Life Project, 88% of American adults with Internet access research health information online and 60% say Internet info influenced a decision about how to manage a health condition. Further, going online no longer is a one-way stream of information from computer to patient, but has launched into the web 2.0 reality of social networking. Patients go online to find meaningful engagements with other patients and now – not so uncommonly – with their providers. Such a trend provides opportunity for providers to distinguish themselves competitively, and more importantly, to improve the patient experience and quite pos­sibly their health outcomes.

The report is a compilation of what key health IT experts from across the United States think are the most important things you need to know about engaging patients in the digital age. There are also four key recommendations for practical action. It discusses how healthcare organizations that provide high quality outcomes for patients will be the ones who prosper under new health reform models, such as Accountable Care Organizations (ACOs) and the Patient-Centered Medical Home (PCMH). This report also explores the concerns that come with patient engagement and the advantages and strategies that should be explored.

A One in a Hundred Whitepaper: “Better to Best” Transcends PCMH, Care Coordination, Access, HIT, and ACO Payment Reform

Let me try to get you in the right frame of mind to read one of the most remarkable white papers in a long time: Better to BEST: Value Driving Elements of the Patient Centered Medical Home and Accountable Care Organizations — released yesterday by the Commonwealth Fund, Dartmouth Institute, and PCPCC.

Having been a debater in high school and then trained as a lawyer, my default mode of thinking is to be critical:

“Hey, Vince, how ya doin’? Great day isn’t it?”

“Well, …err…maybe, maybe not…actually, here’s 14 reasons why not.”

My wife and friends kindly tell me that this personal quality can be insufferable, and if you’ve ever met a lawyer you know what I’m talking about. My internal defense mechanism against my inner-critical brain is simply to turn it off — just go along for the ride and live in the moment.

To the extent that you can connect with what I’m saying, I suggest that before reading this report that you turn off the critical part of your brain.

If you’re a regular reader, chances are you’ve read individual white papers on these topics:

  • PCMH — the Patient Centered Medical Home
  • Care Coordination
  • Access to care for the un and underinsured
  • HIT — health information technology and the HITECH Act
  • Payment reform, especially as it’s been discussed around ACOs (accountable care organizations).

“Better to Best” transcends all these topics — it weaves them together, displays the interrelationships, and describes specific components of what a truly integrated health system could look like.

Getting DIRECTly to the Point: The Role of the Direct Project in Fast-Tracking Health IT Interoperability

By Rich Elmore and Arien Malec. Rich Elmore is the Direct Project Communication Workgroup leader and Vice President, Strategic Initiatives at Allscripts.  Arien Malec is ONC’s Coordinator, Direct Project and Coordinator, S&I Framework.

A patient’s health records are no longer confined to a doctor’s office, shelved inside a dusty file cabinet. With the advent of the Nationwide Health Information Network, a framework of standards, services and policies that allow health practitioners to securely exchange health data, medical records digitized to be easily shared between doctor’s offices, hospitals, benefit providers, government agencies and other health organizations, all across America.

This health information exchange is dramatically enhanced by the Direct Project. Launched in March 2010, the Direct Project was created to enable a simple, direct, secure and scalable way for participants to send authenticated, encrypted health information to known, trusted recipients over the Internet in support of Stage 1 Meaningful Use requirements. The Direct Project has more than 200 participants from over 60 different organizations. These participants include EHR and PHR vendors, medical organizations, systems integrators, integrated delivery networks, federal organizations, state and regional health information organizations, organizations that provide health information exchange capabilities, and health information technology vendors.

Will ACO IT Models Be Walled Gardens or Open Platforms?

Will ACO (accountable care organization) IT models be walled gardens or open platforms?  i.e., will ACO IT platforms focus on exchanging information within the provider network of the ACO, or will they also be able to exchange information with providers outside the ACO network? (If the question still isn’t clear, click here for a further explanation.).

“Does This ACO Thing Really Mean We Need to be ‘Accountable’”

The American College of Physicians (ACP) just released a well-reasoned and thorough position paper, The Patient-Centered Medical Home Neighbor: The Interface of the Patient-Centered Medical Home with Specialty/Subspecialty Practices.

As I’ve written before, the Big Idea behind ACOs (Accountable Care Organizations) is the notion of accountability, not the specifics of organizational structure.

The purpose of the ACP position paper is to address the gaps that exist in care coordination when a physician refers a patient to a specialist. The obvious and logical answer proposed is to develop “Care Coordination Agreements” between primary care physicians and referring specialists, and the position paper takes 35 pages to explain why and how.

A simplified way of thinking about Care Coordination Agreements is that they recognize that coordination of care is a team sport, that specialists are part of the team, and that this paper proposes rules of the game about how primary care physicians and specialists should play together on behalf of their common patients.

However, there’s a great big CAVEAT buried in the position paper.  I don’t doubt the earnestness of the authors, but I do take this caveat as a Freudian slip recognition that not all specialists will be eager to play on the team and to play by the rules:

Care Coordination Metrics: One Can of Worms that NEEDS to be Opened


“Track who is on a care team — and share info with the patient.”

That’s just one of the summary recommendations coming from expert testimony given in a recent public hearing on how to improve care coordination through the use of health information technology. The Meaningful Use workgroup and Quality Measures workgroups are now wrestling with how to translate this recommendation into meaningful use criteria for HITECH Stages 2 and 3.

Seems like a good idea — simple, straightforward — perhaps even obvious. The EHR (electronic health record) could be a great tool for keeping care team members in the loop and on the same page about a patient’s care.

But then I thought about this for a few minutes, and the complexities started dawning. This seemingly simple recommendation — “Track who is on a care team and share info with the patient” — is the proverbial can of worms.

The State-of-the-Art of Care Management Software: Disconnected


Care management software is intended to help patients make critical connections across the health care delivery system.  Today it’s used primarily by 3rd party care managers who are typically either employed directed or indirectly by payers. While not surprising, the state-of-the-art of care management software is that it continues to function as disconnected islands of information.

The  2010 Health Information Technology Survey (available at no charge) provides an insightful yet sobering snapshot of care management software. The study was sponsored by TCS Healthcare Technologies, the Case Management Society of America, and the American Board of Quality Assurance and Utilization Review Physicians.

The study consists of answers from 670 respondents who chose to fill out to a web based survey; most respondents are direct care managers. 

The results are further broken down by subcategories of care management:  case management, disease management, utilization management, nurse triage, independent review organization, pharmacy benefits management, and behavioral health.  Variability among these subcategories should be considered directional given that the respondents are self-selected. The study doesn’t portend to be methodological rigorous, yet it’s a tremendously useful glimpse into the realities of care managers and the software they use.

Here are some key conclusions (mine) based on findings shown in Table 5A.  The numbers reflect the percentage of care manager respondents who indicated that their software provided specific capabilities.

Megatrend Spotting: Health Plan Role of Having “Best Data About YOUR Medical Conditions” is Up for Grabs

Who has the most comprehensive data about YOUR clinical conditions?

For most people, the answer today is “your health plan”, but it’s not at all clear that health plans will continue to have this role in the future.

As physicians and hospitals adopt EHRs, it’s foreseeable that clinical data about patients will be far more available and accessible.

Will patient data become:

  • A jockeying point for control and business advantage between health plans and care providers,
  • A collaborative opportunity to optimize clinical care and care coordination, or
  • Both?

Overview: Here Come Stages 2 and 3 of HITECH!


We’ve spent the past year creating the MU (meaningful use) requirements for Stage 1 of the HITECH act.  As shown by the diagram above, Stage 1 focuses on Data Capture and Sharing. Now it’s time to begin to focus on Stage 2 (Advanced Clinical Processes) and Stage 3 (Improved Outcomes).

The current generation of EMRs (electronic medical records) were designed primarily to assist care providers with clinical documentation, billing, and maximizing revenues. They were not designed to enable care coordination and optimize population health.  

This essay is the first in a new, ongoing series that will highlight:

  • Design and metrics for Stages 2 and 3 of the HITECH act
  • Companies and care providers developing and using applications targeting Stage 2 and 3 MU objectives

This first essay will provide an overview of what we’ve seen in Stage 1 and what we might expect in Stages 2 and 3.

Medicare MAPCP Medical Home Demo: CMS Kicks Sands in the States’ Faces

by Jaan Sidorov, MD and Vince Kuraitis

The Medicare MAPCP (Multi-Payer Advanced Primary Care Practice) demo promised to be Medicare’s Biggest Change in 40 Years

…but the emerging reality isn’t living up to the promise.

In this post, we’ll discuss:

  1. The Promise
  2. An Overview of the MAPCP Demo
  3. Our Main Takeaway: Emerging Reality Suggests Medicare Will Be a “Difficult” Partner
  4. Conclusion: Think Twice Before Signing Up

1) The Promise

The sandbox metaphor was first used by the National Academy for State Health Policy:

For the 10 or more states that are active stakeholders in multi-payer medical home initiatives, the promise of Medicare getting in the sandbox with them and playing (a.k.a. paying) is an exciting proposition. The addition of Medicare as payer to some of these state initiatives may be the critical tipping point that results in widespread primary care delivery system reform in states by involving more practices, payers and patients.