The Truven Health Blog

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

Planning Strategies to Bridge Fee-For-Service and Value-Based Care

By Linda MacCracken/Monday, September 30, 2013
Linda MacCracken imageIn today’s market, providers planning for service reconfiguration are focusing on several areas: physician networks, outpatient networks, payer risk initiatives, acute care provider partnerships, and pre-/post-acute care provider partnerships. Driven by healthcare reform, the provider delivery system is rapidly consolidating and contracting in new ways. With the new risk and value-based reimbursement incentives, hospitals and health systems have to develop comprehensive care networks that will provide the right care, at the right price, in the right setting.

So how do providers begin to bridge fee-for-service and value-based care? With strategic planning. In fact, strategic planning has never been so important. Being willing to make new connections and take risks will be hallmarks of a successful planner.

Using the same approach to strategic planning and involving the same planning stakeholders won’t work under healthcare reform. Planning processes need to be more flexible, frequent, and adaptive to ensure that hospital leaders have a strategy for acquiring and delivering care through partnerships.

How can hospital planners get started?
  1. Engage a larger group of internal stakeholders in the strategic planning process, such as physician leadership; fiscally aligned physicians via the physician-hospital organization (PHO) or employed group practices; and senior clinical and operational leaders.
  2. Prepare capacity for the arrival of the newly insured.
  3. Coordinate the outpatient network with the strategic business plans.
  4. Leverage performance best practices.
  5. Establish provider partnerships with pre- and post-care delivery providers.
  6. Assess payer risk initiatives by episode-driven care.
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Linda MacCracken
Vice President, Advisory Services

How Hospital Pharmacy Can Integrate Technology to Impact HCAHPS Scores

By Tina Moen/Friday, September 27, 2013
Tina Moen imageQuality care and finance. The balance of these essential elements holds the key to the future of how we provide healthcare. Multidisciplinary care is more important than ever in caring for patients, and looking at the whole picture is the best way to care for the whole patient. The Centers for Medicaid and Medicare Services (CMS) agrees. How your hospital scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is becoming increasingly important, especially since under the CMS Value Based Purchasing (VBP) program,
reimbursements are partially based on those scores.

How can pharmacists use their expertise to impact patient satisfaction and boost HCAHPS scores?

HCAHPS wants to know, if during the hospital stay, did the patient receive new medication? If so, how often did staff tell the patient what the medicine was for, and did staff describe possible side effects in simplified terms?

Pharmacists can directly impact these questions by combining clinical expertise with technology. We can make every reasonable effort to:
  • Explain to our patients why they are taking new medications – when prescribed, at first dose, and at discharge.
  • Use clear wording to help patients understand why they are taking a medication and what they can possibly expect as a result.
  • Give them patient-specific medication handouts and discharge instructions.
  • Make ourselves available to patients and to staff, to answer medication related questions.
And with technology, we can ensure we are educating our patients by scaling our efforts and making our available manpower more efficient. One of our clients, Arkansas Methodist Medical Center, is using Micromedex® Pharmacy Intervention to set alerts to remind their clinical pharmacists which patients are on new medications, develop protocols with simplified terminology for all pharmacists to follow uniformly, and then track their progress. View the video to see how they are making this work for them.

As pharmacists, we can also leverage Micromedex clinical decision support, embedded within the Pharmacy Intervention solution, or accessible via the 2.0 platform, to access the talking points within the Clinical Teaching section. Clinical Teaching highlights the most pertinent medication information and serves to inform clinicians on what patients need to know about medication use, safety, and side effects.

Lastly, we can use Micromedex Patient Education, as a standalone or embedded in the hospital EHR, to provide high-quality, evidence-based, consistent education to our patients. Health education resources are written in simple to understand language, an active voice, and at a 5th to 7th grade reading level. Patient-specific handouts and discharge instructions can be printed, and also made available to your patients via a patient portal and email.

Using Micromedex Solutions, we can compare internal benchmarks, which can be captured and quantified, to customize how pharmacy can improve care for patients. With these trusted solutions, we can make sure that the pharmacist and patient have all of the knowledge necessary to make informed decisions while aligning directly with HCAHPS standards. Well-honed tools help us adapt to the dynamic nature of the practice of pharmacy and no doubt solidify a blueprint for future regulatory and value based reimbursement programs.

Tina Moen, PharmD
Chief Clinical Officer

Defined Contribution Plans – More Choices and More Risk for Employees

By Michael L. Taylor/Friday, September 27, 2013
Mike Taylor imageThe recent announcement by Walgreens of its intention to move its employees to a private exchange may be evidence of a trend for large employers. Moving employees to a private exchange is a big step – companies have been moving retirees to this type of plan for years, but not many have offered this option to their active employees. Most large employers provide health insurance to their active employees today, but that may change. Plans in which the employer provides a fixed dollar amount for insurance and the employee picks the plan and pays the rest of the cost are called “defined contribution” plans.

Defined contribution plans should cause employees to take more “ownership” in their healthcare choices. Employees have generally had insurance options, but the options were provided by the employer. It’s fairly easy for an employee to pick from relatively few plans. In this new approach, employees are likely to have many more options from which to choose. Employees will need to understand the types of plans being offered, and which plan best fits their needs. They will need to assess the financial implications of their plan choice, and understand which doctors and hospitals are in the network they are choosing.

This move to exchanges might lead to employees developing a better understanding of how their plan works, and how expensive healthcare in the U.S. has become. Ideally, with employees understanding the cost of care, they will not only engage in more healthy lifestyles but also ask more questions about the need for certain services and procedures, thereby trimming their individual costs and in aggregate pushing overall costs down. Employees cannot be expected to make clinical decisions such as which blood test or x-ray is needed, but they should be expected to ask appropriate questions. They should want to know:
  • Why do I need this test?
  • What is the risk of having (or not having) the test?
  • How will the test result change my treatment?
  • How much will the test cost?
  • Where is the best location to have the test done?
  • Does my doctor own the testing equipment for the test being recommended?
Asking these questions will help employees become more educated about healthcare choices and hopefully lead to better healthcare decisions for them. That is good, but let’s recognize the extent of the financial risk being shifted over to employees. Should the employer subsidy become a fixed amount, and if healthcare costs increase over the years, the employee will shoulder a growing proportion of the cost burden.

The benefit of a defined contribution plan for employers is they can “cap” their costs; for employees, the question is whether they will also benefit. The answer is, “It depends…..”

Michael L. Taylor, MD FACP
Chief Medical Officer

Population Health Analytics: The Devil Is Truly In the Details

By Grant Hoffman/Friday, September 20, 2013
Grant Hoffman image“Population Health” is an oft-discussed topic, but the definition is variable depending on the vantage point of the presenter. Likewise, “Population Health Analytics” attempts to measure and improve an array of risk-bearing, clinically-integrated activities, ranging from aggregate risk analysis to predictive interventions at the point of the care.

Regardless of your particular turf, some common challenges lurk behind the application of analytics to these business challenges. The roadblocks stem from the fundamental fact that the data sources on which you depend for decision-making were not captured with cross-encounter analytics in mind. Source IT systems such as EMRs, billing systems, and electronic prescribing solutions were constructed to accomplish transactional goals for siloed provider organizations, not to support improved outcomes and cost control across the patient care continuum.

 We’ve identified three areas of focus to help you avoid pitfalls: 
  • Anticipate information-sharing challenges: Technical integration of data isn’t the hard part. The tough stuff is setting the trust conditions for authentic multi-stakeholder data sharing and governance.
  • Navigate the context of data creation: Operational processes obscure analytic classification of data, terminology standards are variable, and information arrives at different periodicities. Amidst this noise, reliable prediction, reporting, and alerting all require an “analytically-aware” implementation of data streams and measures.
  • Start with analytics you can take action on: Massive projects get everyone excited, but a moon launch isn’t necessarily your first step. Work backwards from where you have operational capacity to make improvements (basic quality measures across the continuum of care? risk and disease prevalence? alerting and interventions?) and focus your attention on a set of trusted measures to get you there.
Watch our four-part video series on population health analytics.

Two Minutes on Population Health Analytics
Two Minutes on The Importance of Trust in the Data
Two Minutes on Data Necessary for Population Health Analytics
Two Minutes on the Barriers to Integrating Population Health Data

Grant Hoffman
VP, Clinical Integration

Insurers Limiting Numbers of Providers? That’s How the New Healthcare Model Is Supposed to Work.

By Michael L. Taylor/Thursday, September 19, 2013
Mike Taylor imageA Los Angeles Times article published over the past weekend seemed in some ways to imply that consumers who choose smaller-sized provider networks through the new California health insurance exchange could have problems gaining access to their doctors — which would contradict the intent of the Affordable Care Act.

But the fact that insurance plans are limiting network size to give healthcare consumers affordable options is a rational, direct intent of reform — and an example of natural market forces at work. The reason it may feel uncomfortable to some, though, is that it is a different approach to healthcare than the model we’ve seen in the U.S. in the past.

In a fee-for-service environment, it has long been in the best interests of insurers to have networks that were as wide and all-inclusive as possible. The focus of the old model was on more — more providers involved, more services performed.

Now, the focus in a value-based model is to provide the best care at the best price. Therefore, insurers are reaching out to different target audiences with different plan products. And one of the ways an insurer can meet the needs of a consumer who wants high-quality care at the lowest-possible cost is to offer a limited-network plan.

That’s logical — and no different for the newly eligible consumers, really, than the conventional health plan consumers (who are currently insured through their employers) who must make choices based on cost and in- and out-of-network options.

The aim of the health insurance marketplaces is not only to cover more Americans, but to also offer choice and competitive pricing. As the Times article stated, there are 12 different insurers offering plans through the California exchange. Consumers can choose, more than ever before, the price point they are comfortable with for their situations.

Of course, it will be important for both exchanges and insurers to use data and analytics to stay on top of consumer satisfaction and provider capacity, and to evolve offerings as needed.

In the meantime, as the federal exchange information site states, consumers are urged to “compare plans based on what's important to you, and choose the combination of price and coverage that fits your needs and budget.” Those decisions don’t have to be made in the dark, either. With one exchange marketplace application, consumers can compare coverage options side-by-side.

Michael L. Taylor, MD FACP
Chief Medical Officer