Mock Surgery day

The 19^TH Annual Mock Surgery day at Brackenridge Hospital was a huge success. Approximately 1500 people attended the event. A wide variety of groups and organizations were represented as they shared information on various topics pertaining to good health and general safety. Those who attended learned about subjects like; kidney disease, diabetes, cancer, fire safety and more. The hospital also had staff on hand to show people how to bandage wounds and even the trauma department was represented.

Vantage Outsourcing was invited to participate in the event and for the first time ever cataracts were covered. Information was shared, which answered a variety of questions, such as:

• What is a cataract?
• How does it form?
• Who can get cataracts?
• How long does the procedure take?

Along with this information, the cataract surgery was described, the surgical instruments were on hand for viewing and some of the different types of lens implants were discussed. Overall, a lot of information was provided.

Vantage Outsourcing had a great time at this public event and is looking forward to further the publics knowledge when it comes to Cataract Procedures.

Mock Surgery Day

Brackenridge Hospital in Austin, Texas is having a “Mock Surgery Day” on 2/6/10 from 8:00am-3:00pm. In the Clinical Education Center, of the hospital, there will be designated areas set up as operating rooms. Each area will reflect different surgical procedures performed at the hospital. Medical staff will be on hand to talk about what happens during surgery.

The program is designed for kids and adults alike. Scrub attire and surgical masks will be provided for visitors so they can really “get a feel” of an OR environment. The event takes approximately 2 hours to go through.

For more information please contact: Elois Currivan or see their website at (http://www.seton.net/clinical_education_classes_and_events/classes/mock_surgery)

Supporters of the project included Vantage Outsourcing whom’s Cataract Division will be assisting the hospital in demonstrating the various aspects of Cataract Surgery.

Free Webinar: Hospital-Doctor ASC Joint Ventures: A Highly Efficient Physician Engagement Tool

Title: Hospital-Doctor ASC Joint Ventures: A Highly Efficient Physician Engagement Tool

Date: Feb. 11, 2010

Time: 1:15-2:15 CST

Sponsored by: Medical Surgical Partners

Overview: The era of loose cooperation and occasional competition between hospitals and their private practice medical staff members is drawing to a close. As a result, hospitals and health systems must align with physicians to meet the demands for price, quality, efficiency and community service imposed by private payors, government and empowered consumers. Hospitals and health systems are faced with a wide range of physician engagement tools and strategies to meet this challenge.

Nearly 1,700 hospital-physician surgery center joint ventures exist in the United States. These arrangements facilitate service line development, offer market development opportunities, ameliorate the compensation needs of employed surgeons, provide a vehicle for real estate investment by non-surgeon staff, reduce the cost of care in the community, enhance access to care and care quality and are an incubator for development of physician leaders. Most importantly, such joint ventures are efficient to organize and offer a win-win situation for hospitals and physicians seeking to align the hospital’s mission and economic interests with those of its physicians.

Notwithstanding the power of ASC joint ventures, many hospital executives find them counter-intuitive because of short term loss of hospital surgical revenue.

Topics covered will include:

• Examination of the market drivers behind ASC joint ventures;
• Economic factors underlying their performance and impact on hospital operations; and
• Joint-venture structure issues central to successful hospital-physician surgery centers.

Correctly approached, hospital-physician ASC joint ventures are a powerful physician engagement tool that produces reliable results quickly and efficiently and without substantial capital and operational investment by the health system.

Speaker information:
David Thoene, Managing Partner, Medical Surgical Partners — Mr. Thoene has 27 years’ experience consulting for and developing ASC throughout the United States and was instrumental in perfecting the hospital-physician ASC joint venture model used by many major health systems and hospitals throughout the country. He has published articles in national trade journals on topics such as evaluating real estate options for surgery center development and has been a speaker at national conferences on topics related to ASC development. Mr. Thoene was the vice president of development for FSC Health and Titan Health Corp., founded the development arm of Randlett Associates Incorporated and is the founder of Medical Surgical Partners. Mr. Thoene has developed surgery center investments for physicians, academic medical centers and health systems.

Registration:
To register, click here.

#1 Priority for Your Front Office Team

A surgeon can be the best surgeon in the area or the world, for that matter. But, if his/her front office isn’t doing its job right, this expertise means nothing. It’s the equivalent of having the best quarterback on the field, but the front line can’t block, the running back can’t run and the receivers can’t catch. A team simply can’t win, with only one effective player. So how effective is your team?

As in football, a front office must know the drills and apply them daily. First, they need good people skills. It’s a MUST that they always put the patient first. As the saying goes, “if Mama ain’t happy, ain’t nobody happy!” How does this apply to your patients? Think about it, if your staff mishandles an issue in the front office, they’ve not only upset the patient, but the patient’s family/friends and everyone sitting in your front office, i.e. other patients and potential customers. If you can do one thing for your staff, teach them how to handle difficult situations. First, train them to live and breathe the two rule standard as an initial reaction to a disgruntled patient: “Rule #1 – The patient is always right, Rule #2 – If the patient is wrong, refer to Rule #1.” By making the patient feel that they are right, the anger and emotions surrounding the situation are diffused immediately. Second, in resolving a patient issue, take them to a private area and work through the patient’s issue in a positive manner. If a staff member has done something wrong, require that the staff resolving this issue with the patient do 4 things: (1) admit wrong doing, (2) openly acknowledge what was done incorrectly, (3) apologize for the mistake, and (4) come up with an action plan that you will implement immediately to ensure this doesn’t happen again. If your staff does this, it’s a guarantee that your patients will come back, as well as become life-long customers and most importantly, tell their family and friends of the great experience they had at your office and/or surgery center and what a top notch ophthalmologist you are.

The second most important duty of front office staff is how they treat each other. The Golden Rule is always a good place to start. This rule is “treat others, as you would like them to treat you.” If you instill this in each and every one of your people and let them know that you expect them to live this daily, your personnel issues will be minimal. In the last year, one of cataract outsourcing team members violate this rule. Rather than treat it as an isolated incident and address with only this particular staff, the supervisor gathered the entire group together the day after the episode and presented them with a one page statement. He read it out loud and had discussions with them what this meant on an individual level, as well as a team. He went over points about how our society, as a whole, has become less professional and respectful of each another. They discussed this and it was agreed that the team needs to work harder in making sure these types of behaviors/attitudes don’t permeated their work environment. They discussed how they could have handled the situation differently. In the end, the supervisor, along with each staff member, signed this document acknowledging their pledge to treat each other professionally and with the utmost respect, at all times.

Another aspect of front office service applies to your facility staff. If you haven’t already done so, you need to encourage, promote, and require your facility staff to treat your office staff with the upmost respect and view them as a key customer. In addition, they need to do the same for all surgeon users’ office staff. Your people must view these groups of people as key customers, i.e. same top notch customer service, as the staff gives the patients. Granted not all physician offices have the greatest customer service-oriented people working their front desks. But, encourage your staff to look beyond this and to keep reminding themselves that a surgeon’s staff is the gatekeeper of the facility’s patients. Again, if these key people are happy, I’ll guarantee you the facility case load will increase.

Finally, your staff needs to be dutiful in completing the tasks of scheduling, pre-certing, registering, preparing patient for surgical protocol and expectations, billing and collecting payments. However you might remind them that if poor customer service exists and/or prevails, there will be no need to pre-cert, register, etc…, as customers will be non-existent. Therefore, the #1 priority must always be customer service to both external and internal customers.

Hospitals remain unsure of future business model

BATTERED BY ONE OF THE WORST recessions in generations, many Americans are holding out hope that government initiatives can pull the country out of its economic funk. While there is room for optimism, hospitals might soon find their already-sagging bottom lines taking another plunge under new healthcare legislation.

“Our biggest concern is about healthcare coverage and extending it to the maximum number of people, but that can lead to the chronic problem of potential government underpayments,” says Richard Umbdenstock, president and CEO of the Chicago-based American Hospital Assn. “Medicare pays hospitals, on average, about 91 cents on the dollar, and Medicaid about 88 cents. If more of our patients are covered by those government programs, or some sort of public option tied to those payment rates, the result is going to be much greater financial instability for the entire system.”

It’s a perfect storm brewing across the healthcare landscape, and the economy is only one part of it, says Gary Blackford, president of Universal Hospital Services, a medical equipment outsourcing company based in Edina, Minn.

“Everyone knows that when the economy takes a turn for the worse, hospitals see an increase in the number of people who can’t pay for the services they receive,” he says. “Then, given the political uncertainty we’re experiencing, hospitals aren’t sure what their business model is going to look like in the future, so they’re frozen in place until that picture becomes clearer. Finally, hospitals have seen their percentage of Medicaid patients grow much higher at the same time states are having a difficult time meeting their reimbursement obligations.”

On the bright side, some experts believe that this difficult period has helped prepare hospitals for a brighter future by forcing them to become leaner and more efficient.

“It’s not like hospitals simply closed their eyes and continued to plow forward during this down period; they made improvements in their ability to control expenses, particularly on the labor side,” according to Gary Pickens, leader of the research and development group for the Center for Healthcare Improvement at Thomson Reuters.

MEETING THE CHALLENGE

Without many other viable options, so far, hospital executives have largely focused on cost cutting: freezing their capital budgets and cutting into their operating budgets. For the most part, experts say they’ve done a good job at that; in fact, some for-profit hospitals have posted record-setting quarter-over-quarter gains. They’ve made a solid recovery, but there is no indication hospitals have returned to business as usual yet. However, it does appear that they’ve at least weathered the storm, Pickens says.

Still, hospitals can only cut costs and put off expenses for so long, because they must continue to purchase supplies, while the clinical equipment accumulates wear and tear. They can’t keep using the same X-ray machines and hospital beds for the next 20 years. Maintenance and new investments are a must.

“The good news is that the bond market has turned around, so hospitals are now able to get long-term financing at attractive rates,” Blackford says. “In addition, while philanthropy and charitable donations did drop—as expected in a tough economy—they didn’t drop as far as hospital executives feared they might. The public has understood the need to support the healthcare system, especially at the community level.”

Hospitals also have done a good job of managing their labor expenses. When it comes to labor costs, the two easiest (though still painful) ways are to cut wages or decrease total headcount.

“But many hospitals found a third way: reducing their labor expense per discharge by shortening the average patient’s length of stay,” Pickens says. “By getting more people through the hospital faster, they have been able to maintain their operating margins despite a slowdown in revenue growth. And our data shows that they’ve done it by more effectively managing their inpatient care, not by cutting corners. In fact, we haven’t seen any fall-off in terms of the quality of inpatient care; quality indicators such as overall mortality rates have continued to trend upward.”

Going the extra mile to improve their operations, rather than relying on instant fixes such as cutting wages or staff, should continue paying dividends into the future. Hospitals have started to adopt continuous improvement programs similar to those in other industries, such as Six Sigma in auto manufacturing, Blackford says.

“Those efforts aren’t just going to improve them financially, they’re going to improve the quality of care and patient outcomes as well, in terms of things like hospital-acquired infections, patient falls, and nurse lifting injuries,” he says. “If pressed, many executives would acknowledge that there has been a degradation in service. For example, the wait times in the emergency room might be longer, and services might have suffered a bit because all of the departments are staffed a little more thinly.”

Overall, despite the challenges, hospitals have kept a close eye on their quality and found ways to improve their operations, he says.

Umbdenstock agrees, saying that while hospitals have had to make difficult decisions, by and large, they’ve made the best they could of the situation. All hospitals provide certain services that are essential to their communities. To ensure they could continue providing those core services at the highest level of quality, some other things had to go, he says.

“Rather than trimming back on all of their services—thus running the risk of slipping on overall quality—many hospitals just offered fewer services,” he says. “For some of the high-end specialty procedures, the volume just didn’t justify continuing to offer them. People who wanted those services simply had to be referred to larger, regional hospitals.”

HEALTHCARE LEGISLATION

Despite the rhetoric and general confusion surrounding healthcare legislation, many realize the danger of low Medicare reimbursement rates. Increasing the number of patients with access to healthcare is great, but if hospitals lose money on each of them, the system will be worse than it already is.

“A good number of our federal legislators understand the problem, as evidenced by the Senate bill [which at press time was still in the debate process prior to the vote],” Umbdenstock says. “Unlike the bills in the House, the Senate is more sensitive to the problems of linking Medicare rates to a public program, and more likely to provide states with a significant role.”

With so much controversy and dissension surrounding reform, the outlook seems to change almost daily.

“Two months ago, or even two weeks ago, I would have said that healthcare reform would be—at worst—neutral to hospitals, and might even have a favorable impact on them,” Blackford says. “After all, they take care of millions of people who can’t pay for their care every year, so if they suddenly start getting reimbursed for that care, it’s going to help.

“The problem is how that reimbursement is going to be structured. If people who are currently uninsured are pushed into Medicaid, the reimbursement hospitals get won’t be enough to cover the cost of their care. The system will break. I’m very worried about the future of hospitals.”

 

Additional drug benefit possible

Though a two-tier formulary for generics and brand-name drugs was cutting edge 20 years ago, this decade has given rise to the three-tier formulary, according to Perry Cohen, president of The Pharmacy Group. He predicts the third tier will likely expand within the next 20 years.

Respondents to MANAGED HEALTHCARE EXECUTIVE’S annual survey largely indicated (39.9%) that they have a three-tier formulary plan in place. Cohen says the third tier is going to change to include specialty health benefits on top of the existing medical and pharmacy benefits.

“Specialty health benefits will deal mostly with drugs that are currently in tier four and five, because they are specialty drugs that cost perhaps $10,000 a year,” says Cohen. “So, over the next 20 years you’re going to see traditional drugs covered under a three-tier copay system, but that third tier is going to get more funky.”

A separate benefit will have to be broken off, not because of cost, but because the patients on those drugs need a lot of case management and the population numbers are small, Cohen says.

“So the incidence is really small, the drugs are expensive, and they need a lot of case management to go with it, such as tracking, use, genetic testing—and all those things are going to lead to a third category of health benefits, called specialty health benefits.”

In addition, Cohen says the market is moving from drug formulary management toward drug utilization management.

Quality Models

Five years ago, Aetna and several large employers confronted Virginia Mason Medical Center in Seattle over how much it was charging for treatment of migraine, severe acid reflux and narrowed aortic valves, and other conditions. Virginia Mason, a not-for-profit hospital system that employs about 400 salaried physicians, took the message to heart.

Working with the employers and Aetna, doctors and staff began to re-engineer care protocols. For example, the system ensured back pain patients same-day access to a physical therapist and physical medicine physician and sharply reduced medically unnecessary MRI tests and physical therapy visits. From 2004 to 2007, the changes yielded a 50% reduction in lost employee work days due to back pain, almost $2 million in cost savings and high patient satisfaction scores.

Following the overhaul, however, Virginia Mason’s spine clinic was losing revenue because of fewer billed tests and services. To offset the loss, Aetna boosted reimbursement for appropriate physical therapy sessions. With the higher payments and the greater volume of patients it could handle under the more efficient system, Virginia Mason covered its costs—while payers achieved a significant net savings.

President Obama and health policy experts have specifically touted integrated delivery systems, such as Virginia Mason, Geisinger Health System, the Mayo Clinic and others, as national models for innovation. Dartmouth University researchers have found, for instance, that Mayo spends one-third to one-half less than other top hospitals to care for similar patients with equal or better results.

Geisinger has gotten so much attention from politicians that it reportedly hosted tours for more than 70 visiting payers and providers last month.

Leaders of integrated delivery systems say the model won’t work just anywhere. It’s challenging to build a culture of high quality and low costs through contractual relationships. Independent delivery markets don’t have the dynamic of salaried doctors and instead must manage the powerful fee-for-service forces.

Robert S. Mecklenburg, MD, medical director of the Center for Health Care Solutions at Virginia Mason, says his system’s experience shows how health plans and employers can benefit from collaborating with an integrated hospital-physician group. But, he adds, moving away from fee-for-service to payment models that reward better patient outcomes, higher patient satisfaction and lower costs is key.

“[Innovative providers] want to be paid for value,” he says. “That’s very important in straightening out U.S. healthcare.”

Mayo Clinic CEO Dr. Denis Cortese describes integrated systems as having high levels of physician engagement, teamwork, connectivity and greater use of industrial efficiency and quality controls. All this is hard to achieve in contracted networks.

At the same time, experts say, non-integrated systems haven’t felt the pressure—or been given the financial incentive—to change because payers have been slow to revamp payment methods to encourage coordinated delivery. The current fee-for-service model simply rewards greater volume of services.

So far, Dr. Mecklenburg says, no health plans have agreed to pay Virginia Mason based on actual patient outcomes, except on a temporary experimental basis. He believes the system should realize a positive margin when it meets its quality targets.

“You won’t get system reform without changing the reimbursement dynamics,” says Andrew Webber, president of the National Business Coalition on Health in Washington, D.C. “I’m sure the leaders of integrated delivery systems are frustrated with the current payment system.”

ALIGNMENT OF INCENTIVES

At the state level, Massachusetts, with its individual mandate, now is eyeing a shift from fee for service to bundled payments to control spiraling costs.

In line with that, Blue Cross & Blue Shield of Massachusetts continues to leverage its Alternative Quality Contract with episode-based global payments, which pushes providers to work together on improving patient outcomes and cost-effectiveness, according to Jim Conway, senior vice president of the Institute for Healthcare Improvement in Cambridge.

The alternate contract sets specific outcome measures provider groups must achieve in managing patients with chronic conditions. For the first few years, provider groups won’t face financial penalties as long as they meet the process standards, but down the line, they’ll take a financial hit if they don’t meet the outcome targets.

“It took a while for the first hospital and physician group to sign up,” Conway says. “But now a lot of people are signing up because they see this as the direction the industry is going—away from fee for service to a system that takes care of overall global health.”

In other parts of the country, Blue Cross & Blue Shield of Minnesota also has started paying providers for care of the whole patient rather than for specific services, Conway says.

Self-insured employers are testing new reimbursement approaches as well.

Members of the Colorado Business Group on Health are paying providers additional reimbursement on top of fee-for-service payment to manage the care of diabetics and other patients with chronic conditions, according to Webber. They’re using a program developed by the Bridges to Excellence industry partnership. Similarly, the Employers Coalition on Health in Rockford, Ill., is experimenting with paying providers a bundled case rate for patients with chronic conditions, using the PROMETHEUS Payment System, of which Bridges to Excellence is the operational partner.

Webber says health plans and employers should offer financial incentives to patients to get their care from integrated systems, taking advantage of emerging value-based benefit designs.

“There will be opportunities to say to patients, ‘We’re willing to reduce your premium share if you’re willing to participate in more integrated, high-performance delivery systems,’” he says. “I think more and more consumers would be willing to join more closed-panel systems if they could reduce their premium share. Then we can reward high-performance providers in two ways: with payment differentials and with more patients.”

HOME TEAMS

Some health plans and employers around the country are working with provider organizations—and even small physician practices—to support the emerging patient-centered medical home model.

In the model, a primary care physician leads a team of allied health professionals to provide or facilitate each patient’s care needs, including self-care and prevention. The team uses data to proactively manage care for its entire patient population as well.

The Geisinger Health System in Pennsylvania and Group Health Cooperative, a Seattle nonprofit health plan that employs salaried doctors, have reported that their medical home pilots have reduced emergency room use and preventable hospital admissions, improved outcomes for chronic care patients and boosted patient satisfaction. They’re expanding the model to all primary care sites, but it’s costly to properly staff, train and equip practices to become effective medical homes. The practices must be adequately reimbursed to cover the extra patient management services and the forgone fees for service.

Health plans and Medicare have moved slowly on implementing the model, waiting to see evidence of cost savings and quality improvement.

“The medical home is a very important element, and we need to reward primary care doctors, because this can move us toward more integration of care,” Webber says.

Beyond the medical home initiative, Geisinger Health System has taken another step in aligning payment. The not-for-profit system, which includes three hospitals, a multispecialty group practice with 700 doctors and a health plan, is beginning to re-engineer care protocols, starting with coronary artery bypass surgery. Its payment methodology for the re-engineered services, called ProvenCare, bundles comprehensive care for the procedure at a fixed price, instead of piecemeal services and costs. Essentially, by bundling services and paying a flat rate, some risk is shifted to the provider, so it’s in the provider’s interest to deliver the best care, not more care.

Geisinger and its doctors identified 40 factors that produce the best outcomes for bypass operations and built a checklist that ensures those best practices are performed every time. Since its redesign went live early in 2006, Geisinger reports markedly improved patient outcomes for bypass surgery, including a 44% reduction in the 30-day readmission rate, a 21% reduction in patients with any complications, and a 55% reduction in re-operations for bleeding.

Geisinger similarly has redesigned care for hip replacement, interventional cardiology procedures, cataract surgery, obesity surgery and perinatal care.

Duane Davis, MD, chief medical officer of Geisinger Health Plan says Geisinger has gotten a “marketing buzz” out of ProvenCare. Employers like the fact they pay once for the product, just like for other goods and services. But surprisingly, no other health plans have taken Geisinger up on its ProvenCare guarantee deal, except for Geisinger’s own plan. Dr. Davis says he isn’t sure why that’s the case.

“That’s stupid,” says Jeff Goldsmith, a veteran industry forecaster based in Charlottesville, Va. “If a provider group is organized well enough to give you a guarantee they won’t have to readmit, I would rush to sign a contract like that. Maybe some attitudes need to change.”

Goldsmith says that health plans and provider organizations are leery about working together on global payment contracts because of the disastrous experiences with capitated contracts back in the 1990s. Many physician groups and hospitals formed joint ventures to accept these fixed-fee deals and suffered big losses. New structures aim to even out the economics with gainsharing.

WATER UNDER THE BRIDGE

However unfortunate, private practice is collapsing, and more hospitals are employing doctors and creating their own multispecialty, integrated delivery systems. That, Goldsmith says, will allow hospital systems to manage care with their employed doctors. Likewise, health plans may be ready to return to working with provider groups to manage their patient populations because current cost-control methods, such as external utilization review and patient cost-sharing, aren’t sufficient.

“I can’t tell you whether that mindset has changed and whether plans have decided they’ve run out of tricks and are ready to return to working with providers in a constructive way,” Goldsmith says.

Scott Armstrong, president of Group Health Cooperative, says, “our whole industry is in the process of trying to come up with an answer to how health plans can work with providers. How can [global payment] create alignment around common goals? We have to overwhelm the skepticism based on bad experiences in the past.”

Even beyond that, however, Geisinger’s Dr. Davis says it’s going to take time to make healthcare better and cheaper. While integrated systems like his offer important lessons, there are no “big bang” solutions. The primary care medical home is a good place for health plans to start aligning payment incentives for improved care.

“There’s a huge opportunity for the insurance industry to use its skill sets and work in partnership with the clinical side to coordinate very fragmented care,” he says. “If we don’t figure out how to do primary care and coordination better, in the long run, payers will lose anyway.”

While private-industry payers can work on reducing fragmentation, government-supported coverage continues to face budget challenges. As a result, even the highest quality, most efficient providers stand to lose further reimbursement as rates decline.

The Mayo Clinic announced early last month that its Rochester, Minn., clinic, which has treated patients from the Midwest and West, will only accept Medicaid beneficiaries from Minnesota and the four states that border it. Meanwhile, its Arizona location no longer accepts Medicare for patients seeking primary care at its Glendale facility after reviewing results from a two-year pilot project. Mayo leaders made the decisions to limit service based on the low payment rates in Medicare and Medicaid.

NCQA tracks plateau in quality yet increased reporting of measures

As if it weren’t bad enough news that healthcare costs continue to spiral upward, the benchmark quality report for 2009 from the National Committee for Quality Assurance (NCQA) reveals that quality has stalled somewhat. In fact, the report examined the link between the cost and quality of care and found little or no connection between the two.

“The State of Health Care Quality: 2009″ report examined quality data submitted by 979 health plans across the country that collectively cover 116 million Americans, a 9% increase over 2008’s sample.

“Hundreds of health plans have made the commitment to measure and report on the quality of care provided to their members. Those plans have made remarkable progress in improving care,” said Margaret E. O’Kane, president of NCQA. “But they can’t do this alone. It’s time for all plans and providers to step up to the plate and do the right thing for their members.”

The stagnation of quality came as a disappointing surprise after a decade of improvements and was seen in all areas of healthcare—private coverage, Medicaid and Medicare.

“The status quo is unacceptable,” O’Kane said during a press conference last month. “Overall, the [quality] gains are pretty small, particularly among the most vulnerable populations,” as plans serving Medicare and Medicaid patients failed to show noticeable improvement in many key quality measures for the third consecutive year.

Among the notable areas in which quality has stalled:

Only 46.4% of people taking anti-depressant drugs are monitored by their physicians;

34.1% of children prescribed medications for attention deficit hyperactivity disorder are seeing a doctor for follow-up care;

Half of patients previously hospitalized for mental illness see a physician for a follow-up visit;

45.3% of people are receiving colon cancer screening at the appropriate age; and

Only 42.6% of patients with alcohol or drug dependency are get treatment for the condition.

Despite those disappointing results, there were several bright spots. Among them were a 12% increase in the provision of beta-blocker drugs to Medicare patients who had a heart attack within the previous six months; nearly across-the-board high-quality care for asthma patients; and substantial gains in smoking-cessation efforts in the Medicaid population.

“Sometimes, a plateau is just a place to get your bearings and figure out what your next strategy is going to be, and that’s the kind of plateau I think this is,” O’Kane says.

The need to get healthcare quality back on the path to improvement is dramatic, however. NCQA says that if all health plans were able to perform as well as the top 10% of plans did, the United States would realize fewer deaths and save at least $12 billion in medical costs and lost productivity every year. If every American were able to receive care that matched the quality of that provided by those plans in the top 10%, the number of lives saved would range between 165,000 and 272,000 annually.

Where those saved lives come from might depend on geography; the New England region had the highest-quality health plans, while the South Central region of the United States came in last.

“Every American deserves to have quality care, and a diabetic in Alabama shouldn’t get poorer care than a diabetic who lives in New Hampshire,” O’Kane says.

Turning Data Into Insights: The Power of a Centralized Data Warehouse

Have you ever asked your information technology (IT) group for the answer to a question, only to receive an inadequate response (or no response at all)? It’s hard to fault the personnel. IT departments in the healthcare world are all too often over-tasked and understaffed. Typically, they are too busy with daily operations and systems maintenance to deal with requests that fall outside their normal duties. Items found on the chopping block often include marketing initiatives and/or requests for business intelligence.

To remain competitive in an increasingly competitive healthcare industry, organizations need high-level answers and in-depth insights — about patients, about the physicians they work with or the physicians that refer to them. How can you get the information you need to make key decisions on a day-to-day basis?

For many healthcare providers, the solution is a centralized data warehouse that stores a wide range of electronic information, from patient records to marketing data. As providers throughout the country look for ways to optimize American Recovery and Reinvestment Act (ARRA) funds earmarked for healthcare IT, this is the perfect time to take a close look at data warehousing and the benefits it provides.

The components of a data warehouse

If your organization is like most, you compile massive amounts of data but do very little with the information. By centralizing all of your data in a single place, you’re in a position to extract insights that can be valuable in many areas, including patient retention, reactivation and acquisition. Most data warehouses include the following:

» Patient records

» Inbound marketing data, including call centers and Web sites

» Donor and fundraising data

» Physician information

Every day, healthcare professionals use science as the basis for medical care and treatment, yet the vast majority of organizations are only beginning to infuse science into marketing efforts, market planning processes and in driving answers to key business questions. Just as data can drive better medical decisions, it can lead to greater effectiveness and efficiency in other organizational functions.

Who are your patients?

One of the biggest benefits of a centralized warehouse of data is the incredibly accurate picture it provides of your patient base. Many healthcare executives presume that they have a clear view of their patient population, only to be surprised by what the data reveals.

By linking your patient records with information from external databases, you can develop a precise picture of who your patients really are, including the demographic, financial and behavioral characteristics that set them apart from other patients in a market that you currently serve. You can also understand the differences between your “best, average and worst” patients and “best, average and worst” referral sources, whether it be system-wide, facility specific or within targeted service lines/specialties.

In addition, by having all of your patient records in one place, you can capture information at every touch point — from pre-op visits to surgeries, from phone calls to Web interactions.

Turning raw data into marketing insights

Once you have all of this information, what can you do with it? A data warehouse provides benefits in many areas:

Acquire new patients and new referrers. Once you know the profile of your best patients and best referral sources, you can examine your markets of service (or future interest) for people that “look” just like them. As a result, you’ll know exactly who should receive your marketing messages and who should not. The more targeted your prospect list, the greater your return on investment (ROI).

Retain your best patients. You’ll know who your best patients are, based on metrics and evaluation methods that are important to you. This will allow you to optimize your efforts to have them come back when next they may need your services.

Maximize marketing dollars. By truly knowing the target patient population and the target referral sources that you are after, your media plans will have less waste and higher return.

Minimize patient churn. Analysis of data can be useful in predicting those patients that are likely to churn. This proactive information allows you to have strategies in place to communicate with these patients before you lose them.

Develop long-lasting patient relationships. Once you attract new patients into your network of care, it is critical to convert them to life-long patients. Data warehousing allows you to drill down and filter information to yield valuable “business intelligence.” For example, you’ll know how much you’re spending on patient acquisition, and how long it will take to break even on new patients. You’ll also know how much annual revenue comes from top-tier patients and the average patient value at different stages of the patient relationship.

Ease the burden on your IT department. In most healthcare organizations, the IT department is simply not equipped to perform the level of analytics needed to solve for marketing, market planning and business intelligence questions. By outsourcing this work to experts, you can enable your staff focus on what they do best while gaining the insights that you need.

For healthcare systems, the time is now.

As networks of all shapes and sizes continue their EMR conversions, the benefits of housing all pertinent information in a singular location will become increasingly evident. Those proactive providers that factor a data warehouse into their current and long-term processes will remain on the leading edge of the industry – and far ahead of the competition.

Ken Rabinoff-Goldman, DC, is vice president of Buxton – HealthCareID and is responsible for business planning, market development and sales focusing on superior site selection, targeted marketing and other strategic planning tools for the healthcare industry. Having served patients at his private practice in Albany, N.Y., for 22 years, Rabinoff-Goldman contributes greatly to Buxton’s executive medical experience by helping understand the needs of clients in the healthcare field.

Deeper data points revealed in health risk assessments

The employee health risk assessment (HRA) remains a powerful tool for employers, but uncertainty over incentive guidelines and frustration over participation rates can stall even the most innovative programs. The goal of an HRA is two-fold.

HRAs provide employees with measures of their current health status and future health risks as well as actions they can take immediately to improve health. Additionally, employers can use the HRA information—aggregated and de-identified—to develop a wellness strategy.

“Most employers recognize that you can’t manage what you do not measure,” says Michael Taitel, vice president, Alere Center for Health Intelligence. “If you are trying to manage the health of your population, you can’t achieve that goal unless you have the data that shows the prevalence of health risks, chronic conditions, and absenteeism and presenteeism rates in your population.”

More data can be better when it comes to health measurement. Alere offers a Health and Productivity Assessment (HPA), which analyzes the effects of specific health problems on work performance and absence.

“For example, we ask them to indicate if they are missing work because of a health condition,” Taitel says. “In another series of questions, we ask them to rate and compare their performance to other employees. So simply looking at risks alone only gives part of the picture.”

For example, many HRAs assess the presence of depression.

“We understand that depression plays a key role in an employer’s productivity losses, as well as overall benefit costs, so we believe it is an important component to study,” Taitel says.

Another feature of an effective HRA includes a link into personal health support interventions so that employees may be steered into programs that can provide assistance. Employees who require assistance may also be identified for contact by a health coach or for participation in special wellness or prevention programs.

DRIVING PARTICIPATION IN HRAS

According to “Wellness Programs, Survey & Sample Series,” published in February 2009 by Brookfield, Wisc.-based International Foundation of Employee Benefit Plans, only about 14% of employers have indicated participation rates in HRAs above 75%, while 18% of employers indicated participation rates of 51% to 75%.

Bryce Williams, director of prevention and wellness at Blue Cross Blue Shield of Massachusetts (BCBSMA), believes that best-in-class participation begins at 80%.

“When [80%] of a population completes an HRA, the data becomes more meaningful and informative to future program strategy,” Williams says.

LURING EMPLOYEES WITH CASH

Incentives are the most popular tool to encourage participation, and there are a number of carrot-and-stick approaches, according to Carl R. Mowery, managing director of SMART Business Advisory and Consulting LLC, a business advisory services firm based in Devon, Pa.

“Some employers have even required employees, as a condition of participation in the healthcare program, to complete an annual health assessment,” Mowery says. “Others will give discounts on premiums for those who complete a health assessment, and others will provide cash or gift certificates to the employees.”

The Equal Employment Opportunity Commission (EEOC) issued an informal opinion letter stating that requiring employees to participate in an HRA may violate provisions of the Americans with Disabilities Act (ADA). However, HIPAA had earlier outlined a recommendation that noted the incentive can’t be greater than 20% of the cost of the health plan. Most employers are currently following the HIPAA guidelines.

Much discussion has taken place on how to apply incentives for completing HRAs. The company can opt to pay cash or the incentive may be tied to reduced health insurance premiums.

“The important thing to keep in mind is that incentives do not have to be costly,” says Taitel.

In CIGNA’s experience, its clients with the best overall HRA completion rates have offered a reduced premium or cash payment.

“Incentives play an instrumental role as a mechanism to engage individuals to participate in HRAs and in other programs designed to improve lifestyle behaviors,” says Emelia DeMusis, CIGNA product manager. “Levels of participation in HRAs have been found to vary significantly depending on the type of incentive that is used to motivate participation.”

While DeMusis says that optimal participation rate is obviously 100%, she believes that “even at levels below 100%, such as 20% to 40%, there can be medical savings.”

WALKING THE TALK

Participation is greater when it is supported by management and when it is linked to a more comprehensive intervention, specifically when it becomes an instrument used to help shape the corporate culture.

Incentives are a useful tool, but the best thing employers can do to encourage participation is ensure there is organizational commitment to the process, Alere’s Taitel says.

“Top leaders must become wellness champions,” he says.

In fact, in a peer-reviewed study Taitel led last year, researchers found that the strongest predictors of HRA completion are the monetary value of incentives and the employer’s level of communication and organizational commitment.

In the study, organizational commitment was a metric that included communications, the level of employee involvement through committees and internal champions, and visible executive management leadership support through advocacy, program participation and allocation of resources.

“Perhaps the most important finding was that the higher the organizational commitment, the lower the incentive cost needed to be,” Taitel says.

BSBSMA’s Williams agrees. Communicating with employees in advance of an HRA launch can ensure employees have a clear understanding of what data from their HRA will be shared with their health plan and their employer, he says.

CASE IN POINT

Visible senior management support, an engaging wellness platform and meaningful data have been demonstrated at SPS New England (SPS), a Salisbury, Mass.-based construction services company with 211 subscribers.

Under SPS’s wellness program, which is offered through BCBSMA, employees who elect to participate receive a higher contribution (up to 20%) from the company on their health insurance premiums depending on several wellness factors. SPS’s goal is 100% participation, says the company’s CEO and chairman, Wayne Capolupo.

Participation includes completing the BCBSMA online HRA, as well as being individually screened for tobacco use and three health metrics (BMI, blood pressure and cholesterol) and setting goals to maintain or improve those metrics over the coming year. BCBSMA wellness consultants work with SPS to run analytics on the HRA data and identify population health risks, which inform future interventions.

“SPS’s company contributions to health insurance premiums are based not only on employee participation but also on whether employees meet the health goals they set for themselves,” Capolupo says. “In the long run, it is our hope that by focusing employees on their own health issues and high-risk behaviors, and providing services to attenuate those risks, that employee wellness will improve and lost time and claims will be reduced. As a result, SPS’s health insurance premium will be reduced.”

DIG DEEPER

Historically, HRAs were mortality based and data didn’t go far. Today, data analytics get more mileage out of HRAs.

“Analysis of HRA data at the population level is used to support client decision making by analyzing how current health risks impact future health status, costs, productivity and disability, by identifying the most appropriate health strategies to support a population and by monitoring health status and health changes over time.” CIGNA’s DeMusis says.

By employing the University of Michigan HRA and Trend Management System, CIGNA is able to forecast costs and health status, use targeted improvement strategies and recommend the optimal outreach method to engage individuals, according to DeMusis.

But, in today’s economy, can employers afford to implement full-scale HRAs? Overwhelmingly, experts believe employers can’t afford not to implement an HRA as part of an overall wellness program.

“These programs can help employers reduce turnover, increase productivity, improve employee health and help potentially high-risk individuals from becoming future high-cost claimants,” says SMART Consulting’s Mowery.

HRAs typically cost just pennies per member per month. It’s a small investment with high potential for return.

However, there’s no real ROI for an HRA alone, according to Taitel, who asserts that the value of an HRA comes in measuring the changes in health risks over time. Large employers can link HRAs to claims data to see actual changes in costs.

However, the real key is link HRAs back to meaningful interventions. To secure true value, employers must take the information and use it to build tailored and useful health and wellness programs.

Tracey Walker is a senior editor with Advanstar Communications.

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