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Care Providers & Care Coordination
The 6th Thing to Watch in the Medicare ACO Regulations
Health care lobbyists and advocates are bracing for six pages of the health care reform law to explode into more than 1,000 pages of federal regulations when the Department of Health and Human Services releases its long-delayed accountable care organization rules this week. Politico
What should you be looking for as you snuggle by the fireplace this weekend reading the draft ACOÂ regs?
Rob Lazerow writes a helpful article listing 5 Things to Watch in the Medicare Shared Savings Program Proposed Rule. […]
The Crucial Distinction Between âAccountable Careâ and ACOs
While in Philadelphia earlier this week, my colleague Dr. David Nace presented me with a print copy of McKesson Relay Health’s newest whitepaper — Providing Accountability: Accountable Care Concepts for Providers.  I felt honored as he handed it to me and confided that it was one of only six copies in print. I took time to read it carefully on the long flight home.
The whitepaper is a great overview of accountable care and ACOs (Accountable Care Organizations). It’s a quick and easily digestible read.
However, there is one […]
Is Economic Credentialing A Tool for Primary Care to Lead ACOs?
Is economic credentialing â the use of economic factors such as loyalty and utilization rates in the physician credentialing process â a potential tool for primary care physicians to lead ACOs?  and reestablish the vitality of primary care in American health care?
Keith Wright and Gregory Drutchas’ incisive article Economic Credentialing: A Prescription To Secure Shared Savings Under Accountable Care provides useful history and context about economic credentialing:
For many years, the use of economic factors by hospitals in making medical staff credentialing decisions […]
Complimentary Webinar â An Impending Marriage: Electronic Health Records (EHRs) and Care Management Software
Webinar Title: An Impending Marriage: Electronic Health Records (EHRs) and Care Management Software
The presentation will be geared at practicing clinical case managers in health plans, hospitals, disease management companies, and similar organizations:
Describe market forces driving integration of EHRs and care management software.Â
Review care management software survey data and stimulus funding for EHR adoption.Â
Describe a 3 stage framework for the evolution of EHRs and care management software.Â
Characterize benefits to patients and impacts on care manager responsibilities.
The event is sponsored by HealthSciences Institute […]
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.).
MGH Medicare Disease/Care Management Demo Shows Home Run Results!
Medicare has (finally) recently released a report showing home run results for a disease/care management demonstration project!
Evaluation of Medicare Care Management for High Cost Beneficiaries (CMHCB) Demonstration: Massachusetts General Hospital and Massachusetts General Physicians Organization (MGH)
Remind Me Again About the CMHCB Medicare DemoâŚ
The CMHCB started in 2005. My recollection is that the demo requirements were extremely similar to the Medicare Health Support (MHS) project, with a few exceptions: 1) Applicants had to include direct care providers (delivery systems, physicians) in their program design, 2) patient populations […]
âDoes This ACO Thing Really Mean We Need to be âAccountableââ
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 Metrics: One Can of Worms that NEEDS to be Opened
âTrack who is on a care team â and share info with the patient.â
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 […]
Hospital Readmissions Avoidance âProgramsâ â Vendors and Hospitals Not All On the Same Wavelength
Last week I attended and participated in an excellent conference â the National Reducing Hospital Readmissions Forum sponsored by World Research Group.
One of my main take aways is to observe a simple â yet huge â difference in mindset between hospital executives and vendors.
Over the past few months I’ve heard many vendors with diverse health care offerings talking about building readmission avoidance âprogramsâ that they want to sell to hospitals. Their idea here is to put together a soup-to-nuts offering of technologies and services […]
Megatrend Spotting: Health Plan Role of Having âBest Data About YOUR Medical Conditionsâ is Up for Grabs
Who has the most comprehensive data about YOUR clinical conditions?
For most people, the answer today is âyour health planâ, but itâs not at all clear that health plans will continue to have this role in the future.
As physicians and hospitals adopt EHRs, itâs 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 […]