Welcome to the Blogosphere! Voice on Population Health

The Care Continuum Alliance announces a timely new blog: Voice on Population Health.

VPH

Tracey Moorhead, President and CEO of the Care Continuum Alliance, writes today’s inaugural post. She persuasively notes the increasing importance of the full continuum of population health interventions – wellness, prevention and other approaches to improving health, reducing disease risk and raising productivity.

Bob Laszewski’s essay on today’s THCB resonated with me: 2012: A Year of Huge Uncertainty in Health Care Policy. In my 30 years in health care, I have never seen more uncertain and fluid times.

Yet in times of uncertainty and confusion, it’s important to focus on what IS certain and predictable. The need for population health approaches is one of those certainties. While care providers are recognizing the need to develop and invest in strong care management abilities, health plans are redoubling their efforts to develop these capabilities in-house.

Tracey’s first post includes a link to the CCA’s new white paper: Key Issues in Population Health Management: Key Industry Issues for 2012.  Check it out.

Is Hospital-Physician Integration Sustainable?

Reprinted courtesy of MCOL.

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Perspectives on a Selected Key Topic |     April 2011/May 2011     |   Volume Three Issue Two


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Will a material number of hospitals and their core medical staffs, that are relatively independent, evolve into highly integrated delivery systems during this decade, and why?

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William J DeMarco MA, CMC
Demarco1
President and CEO, Pendulum HealthCare Development Corporation

The great momentum brought about by government and private payers demand for more accountability is unstoppable. Rapid consolidation of hospitals and consolidation of physicians by physician groups, hospitals and now insurers will shift referral patterns and consumer preference. 1 out of 4 hospitals will fall short of providing value and close or be absorbed within 10 years.

Physicians will be offered higher prices to sell out to insurers and investors who value the short supply of PCPs and will try to control care demand by retooling the care system building ASC and small scale short stay hospital.

True clinical integration will follow for the survivors. The ability to prospectively develop clinical budgets and bundles of services will connect regional tertiary and quaternary care facilities to local hospitals so integration can be regionalized across larger populations and payer segments.

Once these delivery systems realize they need a product recognizable to individual consumers they will seek alliance with select insurers or create their own insurance company thereby achieving the true definition of integration which is to integrate financing and delivery of care.

This offers the shared savings with themselves and stabilizes patient flow and overhead to achieve value to purchasers and users of care.

We think these opportunities will be at a tipping point on a market by market basis over the next 5 years and will be a national definition of success within 8 years. We believe this will happen because already the bond rating companies are looking at physician alignment and payer alignment as factors in establishing credit worthiness of hospitals for expansion and mergers.

Benjamin Isgur
Isgur2
Director, PricewaterhouseCoopers LLP’s Health Research Institute

Integration is certainly on the rise. The notion of independent physicians may be a myth because so-called independent physicians are becoming increasingly financially tethered to hospitals. In fact fifty-six percent of physicians PwC surveyed want to more closely align with a hospital in order to increase their income. The new health reform law focuses on population health and adopts a Medicare compensation model that penalizes poor quality and rewards cost savings and electronic information sharing. Some commercial payers are also pushing this business model.

Tire Kickers Need Not Apply: 8 First Impressions of the Medicare ACO Rule

On March 31, CMS released the long-awaited “Medicare Shared Savings Program: Accountable Care Organizations” document (ACO Rule). Read the details here (strong suggestion: unless you’re working on your PhD in ACOs, start with the fact sheets).

There are many surprises. Here are eight first impressions on this 429 page tome:

  1. The bar has been set high…very high.  Tire kickers need not apply.
  2. Don’t expect to see many or any small ACOs.
  3. Patients will be confused by ACOs.
  4. Concerns over maintaining competition and avoiding antitrust are being taken seriously.
  5. CMS scores points for coordinating the ACO Rule across Federal agencies.
  6. CMS loses points for micromanagement and a controlling mindset.
  7. Possible losers — hospitals, ACO vendors.
  8. Possible winners — physicians, health plans.

The details follow.

Webinar: Beacon Communities Reshaping Landscape for HIT and Population Health

Tuesday, Oct. 26, 1-2 p.m. Eastern Time — Presented by the Care Continuum Alliance

Federally supported “Beacon Communities” are at work now defining how health information technology will support accountable, evidence-based care in communities – especially for care of chronic conditions. Backed by $235 million in federal grants, 15 communities across the country are serving as Beacon Community pilots for eventual wide-scale, performance-based use of technology to improve our health care delivery system.

The goal of the webinar is to address

  • The fundamental nature and vision of the Beacon Community Program
  • How the Beacon Program will influence nationwide delivery system reform and be a guide-path toward developing community infrastructures
  • Other implications for the future of healthcare delivery

Why You Need to Know About Beacon Communities

“Disease Management” RIP

The Care Continuum Alliance has mercifully and wisely rebranded it’s name and eliminated the initials “DMAA”. See its press release: Care Continuum Alliance Launches New Brand for Population Health Improvement. (As a reminder, DMAA originally stood for Disease Management Association of America.)

I for one say “hurrah, and good riddance”.

Where Did the Term “Disease Management” (DM) Trip Up?

Status Report: HITPC and Workgroup Activities on HITECH Stages 2 & 3

 

OK, let me be the first to admit that today’s “just-the-facts-ma’am” post might be a little dry…but trust me, its really important stuff to know in understanding the process of how the Health IT Policy Committee (HITPC) and its workgroups are approaching formulating recommendations for HITECH Stages 2 and 3.

At this point at least two different workgroups are involved in developing recommendations for HITECH Stages 2 and 3.

  • A newly formed Quality Measures Workgroup. This group will “produce initial recommendations on quality measure prioritization and the quality measure convergence process pertaining to measure gaps and opportunities for Stage 2 Meaningful Use”. The group is chaired by Dr. David Blumenthal and held its first meeting on September 10.
  • The Meaningful Use (MU) Workgroup. Most recently, the MU Workgroup solicited expert testimony on Care Coordination (August 5) and Population Health (July 29).

Important recent HITPC and Workgroup activities are summarized below.

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.

HITECH Health IT Legislation: Opportunities for the DMAA Community

Dr. Don Storey and I spoke at the at The Forum 09 conference in San Diego earlier this week. The DMAA publication “The Continuum” had an excellent writeup of our enthusiastically received presentation. 

Here’s a copy of our PowerPoint slides…

View more presentations from vincek.

and here’s DMAA’s writeup:

Helping physicians and hospitals meet the “meaningful use” criteria for federal support for health information technology under recently passed legislation represents a keen opportunity for the population health management industry, presenters at this session said yesterday.

Vince Kuraitis, JD, MBA, of Better Health Technologies, LLC, and Don Storey, MD, of RMD Networks, presented a look at the evolution of HIT and the electronic medical records systems from a strongly proprietary model with little interoperability to new model of integrated, modular applications from various vendors sharing common languages and platforms.

How Much Health-Related Productivity Loss is Really Avoidable? And Why Should I Care??

by John E. Riedel

Study breaks new ground in calculating the "normal impairment factor."

John Riedel We know that poor health accounts for a considerable amount of productivity loss-anywhere from 1 ½ to 3 times direct medical costs.  The potential for disease prevention and disease management programs to reduce productivity loss has, for obvious reasons, caught the attention of healthcare purchasers.  But let’s be careful about making big claims to "recapture" productivity loss.  People find it tough to change health behaviors.  And, even if someone is perfectly healthy, they aren’t 100% productive 100% of the time!  (Possibly with the exception of the current reader.)

Although the association between poor health and reduced productivity is reportedly quite high, employers don’t know how much productivity loss can realistically be recaptured .  There is a need to quantify the portion of productivity loss that can be regained through health management strategies.

Without knowing that amount of impairment, employers and their population health management providers can’t set realistic objectives for their health and productivity strategies.  A recently published article in the Journal of Occupational and Environmental Medicine (Riedel et al with StayWell Health Management) sheds some light on this issue.

Medicare Health Support: 8 Takeaways on Building Better Bridges

by Thomas Wilson, PhD, DrPH and Vince Kuraitis

Engineer

What’s the right metaphor for Medicare Health Support (MHS), CMS’ major experiment with disease management for Medicare beneficiaries?  We prefer to look it as a bridge failure that presents an opportunity to improve future engineering and design.

We’ve now had the time to read, reread, and reread again the very recent report from Research Triangle Institute (RTI) — Evaluation of Phase I of the Medicare Health Support Pilot Program Under Traditional Fee-for-Service Medicare: 18-Month Interim Analysis .  Here’s a listing of our 8 key takeaway points:

  1. There’s Sufficient Evidence to Conclude "MHS Didn’t Work As Expected"
  2. Some Quality Measures in MHS Improved, Yet Outcomes Didn’t. Why?
  3. MHS Suffered Execution Nightmares
  4. Ronald Reagan Was Right — “Trust, But Verify”
  5. MHS Has Implications for the Medicare Medical Home Demo (MMHD)
  6. Be Wary of Claims from Pre-Post Studies
  7. Differences Between Medicare and Commercial DM are Dramatic
  8. The Guaranteed Savings Model is a Two Edged Sword

Let’s examine these at these one at a time.