The Truven Health Blog

The latest healthcare topics from a trusted, proven, and unbiased source.

Need More Evidence that Patient Education Can Reduce Readmissions? Start Here.

By Arti Bhavsar/Tuesday, August 26, 2014
Arti Bhavsar imageAs healthcare practitioners and administrators, we are keenly aware of the complexities associated with preventing readmissions. Common questions that come to mind when tackling the readmissions dilemma include: What patient care and education interventions can we implement? Do we have a solid transition of care program? What is the cost impact to my organization, from direct costs to loss in reimbursement? Most importantly, how can we embed sustainable programs to avoid readmissions? 

Take for example the impact of medication management related issues as a factor for readmissions. In an evaluation conducted by Feignbaum, et al. at Kaiser Permanente, researchers studied factors contributing to readmissions within 18 hospitals (1).  Medication management issues impacted 28 percent of preventable readmissions and were identified as one of the top five areas for to prioritize for organizational intervention programs. Upon interviewing 189 patients and caregivers, researchers found that 32 percent of patients indicated they would have liked to have received more communication regarding their medications, and of these, 73 percent of caregivers indicated that lack of information was one of the components that lead to a readmission (1). This data, coupled with a recently published article by Mixon, et al. focusing on post-discharge medication errors, highlights a significant area of opportunity to prevent medication management related issues. The study indicates that medication errors ranging from omissions, commissions, and misunderstanding in indication, dose, and frequency were found in 50 percent of patients after hospital discharge (2). The groups most impacted were those with low health literacy and numeracy scores (2). These statistics are sobering and should make us want to re-evaluate our current approach towards medication-related patient education in order to improve our practices to reduce the risk for patient harm and eliminate avoidable readmissions. 

When creating a strategic approach to reduce medication management related readmissions and errors, organizations should consider the following areas of improvement:
  • Integrate medication handouts into Electronic Health Records (EHR) to optimize clinician work flow and enhance the patient discharge process
  • Provide patient education handouts that adhere to health literacy standards to improve patient comprehension and retention of medication management related topics with tools designed for those with greatest risk of non-compliance (low health literacy and numeracy)
  • Embed a “Teach-back Process” to validate patient and/or caregiver comprehension of the medication management related information provided
  • Provide low-literacy aids to augment learning with tools such as pill-boxes, text messages, and/or daily medication schedules
These interventions are not only meaningful for the clinical outcome improvement results they can provide, but they are also aligned with safety, regulatory standards, and compliance standards that lead to higher reimbursement payments. These incented standards range from reduction in readmissions related to medication management events, to attestation for Meaningful Use Stage II criteria for integrated patient education and improving patient satisfaction scores as evaluated by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. 

Pharmacists, physicians and nurses, it’s time to ask yourself how your organization is approaching medication-related patient education. Has your organization mobilized the medication-related experts who impact care decisions at the point of care? Do you have the opportunity to improve your work flow to make time for caregivers to exercise best practices in education on discharge? Do you know how many patients you are discharging with medication errors? These questions can help you on the journey to reduce your medication management related risk and improve your organizational approach.

Arti Bhavsar, Pharm.D.
Consulting Manager

The Newly Insured Don’t Turn into Primary Care Physician (PCP) Loyalists Overnight

By Linda MacCracken/Tuesday, August 19, 2014
Linda MacCracken imageWhen looking at the impact of the newly insured, the Philadelphia market’s experience of an 8% rise in emergency department (ED) use is notable. Moving from uninsured to insured status may happen in a day, but new health service use habits take time. The impact of the newly insured – via Medicaid expansion or private exchanges – is still unfolding.

Truven Health forecasts on the impact of the newly insured mirror the statistics noted in the Philadelphia Inquirer article, “With Health Law, ERs Still Packed.” In fact, young adults and children are more likely to use an ED when they have insurance versus when they had less insurance. Surprisingly or not, children, Millennials and young Gen Xers are not primary care physician (PCP) loyalists.

Join our webinar “What to Expect from the Newly Insured” to get highlights on what to expect, tips on how to prepare, and how to realize higher profits and deeper customer engagement.

Linda MacCracken
Vice President, Advisory Services

Sometimes 1% Reward Can Change Behavior - Sometimes it is Not Worth the Effort

By Carol Alexander/Friday, August 8, 2014
Carol Alexander imageThree thoughts occur when reading the Medicare plan for transitioning the current physician fee-for-service compensation model to paying for the quality of their care. The first is the notion of paying, or in this case rewarding or penalizing physicians for the quality of their care. The use of the term “quality” would indicate to most that the physician has measurable clinical outcomes, or that a patient’s health improvement can be measured through the physician’s treatment plan. Although the Medicare measures have not been finalized, it appears what will be measured will be process rather than clinical outcomes. They will be measuring how the physician manages basic medical screenings, documentation, and other tasks associated with prevention quality indicators. Many physicians have been actively submitting Physician Quality Reporting System (PQRS) data for several years — particularly the larger group practices that have been encouraged to track and report the data and also gain access to the incentives associated with reporting at the time; which brings me to my second thought. 

Focusing at the group level has it merits. Larger groups will be positioned better to implement, monitor, and encourage physicians within the group to earn these incentives. Although a 1% to 2% incentive does not sound like much and may not persuade an individual physician to change behavior, a true group practice — where the whole is greater than the sum of its parts — will strive to reach the aggregate reward of 1% of Medicare payment. In a group size of 100 or more physicians of multiple specialties, 1% can be enough to gain the attention of management or physician finance committees and have them make an effort to reach and achieve these dollars to help offset other rising practice expenses. 

However, to get the attention of the individual physician, it is true that the percentage of reward or penalty needs to be much higher. We have seen many compensation plans that try to drive a different behavior through physician compensation formulas that put more than 10 percent of pay at risk; these tend to not be effective. The rule of thumb is that to achieve changes at the individual level, the incentive/risk should be greater than 15%-20%.

Lastly, the small groups will have difficulty adapting to these changes. The lack of incentive for an individual practitioner does apply here. The amount of effort needed to redesign care, track outcomes, and monitor performance internally may not be worth a 1% or 2% reward or penalty, and if too onerous can even lead to more physicians — particularly the small, independent practices — dropping out of the Medicare coverage pool.

Carol Alexander
Senior Consulting Manager

ACO Executives Struggle to Estimate Degree of Financial Risk

By Michael L. Taylor/Wednesday, August 6, 2014
Michael L. Taylor imageA recent survey found many executives of Accountable Care Organizations (ACOs) are struggling to properly estimate the degree of financial risk their organization can bear. These organizations would benefit from an actuarial assessment of the ACO population for which they are intending to provide care, but many ACOs don’t have the many types of data needed to properly estimate risk. There are two areas of risk to assess:

  • The cost implications for those patients with chronic disease: ACOs need to not only understand the costs associated with chronic diseases such as heart disease, diabetes and cancer, but also the prevalence of these diseases in the population for whom the ACO is assuming risk
  • The cost implications for those without a chronic disease, but at risk for illness due to lifestyle risk factors: A large volume of scientific literature has consistently shown that, in a given population, as the number of risk factors increase, medical cost rises.
Doctors may have this information for the patients for whom they are caring, but they won’t have the data for an entire population. It’s difficult to predict costs without prevalence data.

Obtaining the data necessary to do this risk analysis is therefore necessary, but can be tricky for ACOs. Multi-year administrative claims data can demonstrate the burden of chronic disease, although typically this data isn’t held by any single provider. Regarding lifestyle risk, many large employers use “self-reported” data from health risk assessments for this purpose, but ACOs generally do not have access to these data. There are other factors to consider to predict costs in a population. Socioeconomic factors, level of education, and ethnicity all impact medical costs, but ACOs may struggle to obtain these data as well.

Successful ACOs will need access to these data streams and the ability to analyze the data to make financial predictions and create viable business models. They will also need to factor in the cost of obtaining these various types of data to include in the models. They will then need to partner with doctors and hospital systems to provide high-quality, efficient care in order to be financially viable. It can be done – we have customers that are assembling and integrating multiple data streams, performing and monitoring the analytics, and sharing the results across their enterprises – with careful planning, close coordination, and transparent governance.

Michael L. Taylor, MD, FACP
Chief Medical Officer