Healthcare Intelligence Network

By Healthcare Intelligence Network

What's Healthcare Intelligence Network about?

The Healthcare Intelligence Network (HIN) is the premier advisory service for executives seeking high-quality strategic information on the business of healthcare.

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Healthcare Intelligence Network episodes:

03.13.2014
Humana Remote Monitoring Pilots Engage Circle of Care Surrounding Member
Humana's remote monitoring pilots go beyond traditional targets of heart failure, diabetes and COPD to observe functionally challenged members, explains Gail Miller. This novel approach uses a Personal Emergency Response System (PERS) with a built-in accelerometer to monitor members challenged...
03.07.2014
HCSC's Community Behavioral Health Links Essential to Duals Care Coordination
Relationships with community organizations that support mental health as well as recovery from addiction are essential to care coordination of Medicare-Medicaid beneficiaries, notes Julie Faulhaber, vice president of enterprise Medicaid at Health Care Service Corporation (HCSC). These collaborations enable HCSC...
02.20.2014
3 Key Benefits to Prudent Sharing of Physician Performance Data
There are three key benefits to prudent sharing of performance data among physicians, notes Cynthia Kilroy, senior vice president of provider strategy and business development at Optum, who suggests a four-step systematic approach for data dissemination that moves companies away...
02.20.2014
Deconstructing Health Reform: 3 Reasons Medicare and Pioneer ACOs May Not Survive
Given changing reimbursement incentives and collaborative models for physicians and hospitals, Greg Mertz, managing director of Physician Strategies Group, LLC, discusses why the Congressional proposal "Better Care, Lower Cost Act" of 2014 is financially more attractive to providers than ACO...
01.17.2014
Award Winning Readmission Prevention Protocols: Navigating Care Transitions with Preferred SNF and Home Health Providers
With hospital readmission rates under close scrutiny by CMS, Torrance Memorial Health System launched a readmission program in early 2013 that has been recognized as a program of excellence for its innovation and impact on the community. Navigators work with...
01.17.2014
Managing Risk in Population Health Management
Adventist Health's successful use of incentives to engage employees in population health sets a high bar for the program's imminent rollout to patients at Adventist-owned White Memorial Medical Center, notes Elizabeth Miller, Adventist's vice president of care management. In this...
12.18.2013
Medicare Pioneer ACO Year One: Lessons from a Top-Performer
Lauded for its care coordination service, Monarch had to overcome a few challenges when retrofitting the Naylor Transition of Care (TOC) model for the ACO --- among them insufficient patient access, patient skepticism and resource limitations. By focusing on readmissions...
12.18.2013
Dual Eligibles: Closing Care Gaps and Engaging Members in Self-Management
The philosophy that healthcare is local --- and therefore, care needs to be local and community-based --- forms the core of WellCare's efforts to connect its dually eligible population to health services, explains Pamme Taylor, WellCare's vice president of advocacy...
12.18.2013
Improving Population Health with Embedded Case Managers in an Open, Multi-Payor Community
There's education, there's experience, and then there's the 'right stuff' --- the indefinable personality traits that earmark an individual as a change agent, collaborator and ambassador of case management, says Annette Watson, senior vice president of community transformation for Taconic...
12.18.2013
Aligning Value-Based Reimbursement with Physician Practice Transformation
In its quest to transform 70 to 80 percent of its physician practices to a patient-centered medical home (PCMH) over the next three years, WellPoint has adopted a "meet the practices where they are" philosophy, reports Julie Schilz, director of...
12.18.2013
Healthcare Trends and Forecasts in 2014: 7 Payor Strategies That Will Reshape Primary Care
From partnering with non-traditional providers like retail clinics to targeting larger physician practices to achieve savings and boost health outcomes, watch for health plans to continue to reshape primary care delivery over the coming year, predicts Catherine Sreckovich, managing director,...
12.18.2013
Healthcare Trends and Forecasts in 2014: Expect Surge in Commercial ACOs to Continue
Despite the migration of some Pioneer ACOs to CMS's Medicare Shared Savings Program (MSSP), expect the surge in commercial accountable care organizations to continue in 2014, predicts Steven Valentine, president, The Camden Group. In this audio interview, Valentine suggests improvements...
12.18.2013
Medical Home Neighborhoods: Uplinking Specialists To Create Integrated Systems of Care
If payment inequities can be addressed, communication and technology tools in place in large physician multispecialty groups make them ideal candidates for a medical neighborhood, suggests Terry McGeeney, MD, MBA, director of BDC Advisors. Dr. McGeeney, who spent 13 years...
12.18.2013
Home Visits: Assessing Complex Patients Post-Discharge To Reduce Readmissions
Modifying a popular hospital admissions risk assessment tool for its own use helps Stanford Coordinated Care to prioritize home visits for its roster of high-risk patients, all of whom have complex chronic conditions, explains Samantha Valcourt, MS, RN, CNS, Stanford's...
07.31.2013
Managing Population Health with Integrated Registries and Effective Patient Touchpoints
A patient might expect a reminder about a missed colonoscopy during a primary care visit, but during a trip to the dermatologist? Providing health plan members with "consistent and ubiquitous reminders" via multiple touchpoints in their healthcare journey is one...
07.19.2013
Performance Quality Measurement and Reporting for Accountable Care
When tracked within its electronic medical record, key interventions like transitional care coaching and an expanded Patient Health Questionnaire not only improve the care provided to John C. Lincoln ACO's population but provide a clearer picture of the accountable care...
06.13.2013
Motivational Interviewing by Ochsner Health Coaches Drives Results in 4 Key Areas
When health coaches employ motivational interviewing during patient encounters, expect upticks in medication adherence, weight loss, HbA1c levels and overall engagement, notes Alicia Vail, RN health coach for Ochsner Health System. Ochsner's eight health coaches focus on patients with diabetes,...
06.12.2013
Health Coaching's Value in Accountable Care and Medical Homes
Primary care and the patient-centered medical home offer a great opportunity for health coaches to become allies with patients in improvement of their health, notes William Appelgate, executive director of the Iowa Chronic Care Consortium. Individuals with the highest health...
05.31.2013
Medicare Pioneer ACO: Case Study on Atrius Health's Focus on the Triple Aim
A core desire to create a single population-focused model of care for all Medicare beneficiaries, rather than multiple payor-driven approaches, drives Atrius Health's participation in the CMS Pioneer ACO program, explains Emily Brower, executive director of accountable care programs at...
05.31.2013
Patient Engagement and Provider Collaborations Across the Healthcare Continuum to Improve Care Transitions
To rise to the challenge of non-compliant patients, providers should ask how they can work together to empower patients toward self-management rather than why patients are non-adherent in the first place, suggests Alicia Goroski, MPH, senior project director for care...
04.25.2013
Healthcare Social Business Strategy: Driving Adoption with Social, Mobile and Cloud Technologies
There are two key mistakes healthcare companies make when adopting social or mobile technologies, explains Andrew Dixon, senior vice president of marketing and operations, Igloo Software. Dixon describes what's driving the aggressive growth of interactive patient care communities and suggests...
04.11.2013
Care Transition Management: Strategies for Effective Patient Handoffs
The initial goal of Cullman Regional Medical Center's "Good to Go" program was to reduce readmissions. But CRMC didn't anticipate the effect that recording discharge instructions and sharing them with patients via phone and computer would have on the patient...
04.11.2013
A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings
Low scores on patient outcomes measures within the CMS Star Quality ratings program --- metrics CMS weights most heavily in its assignment of stars --- can typically be traced to poor provider and member engagement, notes Joseph Johnson, vice president...
03.12.2013
Moving Forward with Payment Bundling
Since the idea of payment bundling was first introduced 10 years ago, justification for the episode-based reimbursement model has shifted from quality and innovation gains to its proven ability to reduce the total cost of healthcare, notes Jay Sultan, associate...
02.15.2013
Health and Wellness Incentives: Positioning for Outcome-Based Rewards
Outcomes-based rewards have a place in an overall incentives offering, notes John Riedel, president, Riedel and Associates Consultants, Inc., but despite the growth in these offerings, companies should keep their incentive options open. To maximize effectiveness, programs should include something...
02.15.2013
The Role of Case Managers in Emerging Care Delivery Models
With ACA reforms underway, thecase manager is fast becoming a major player in the patient-centric, qualityover volume healthcare mindset, taking on more standardized, collaborative approaches to care coordination and its changing delivery systems. But as crucial as case managers are...
01.21.2013
Physician Hospital Organizations: Developing a Collaborative Structure for Shared Savings Agreements
Physician-hospital organizations have been around before, but it's the emphasis on quality that sets today's PHO apart from the 80's version. In PHO 2.0, where healthcare value is favored over volume, clinical integration of participating physicians is a prerequisite, agree...
12.06.2012
Care Coordination for Dual Eligibles: A Results-Oriented Approach
SCAN Health Plan's Interdisciplinary Care Team for dual eligibles is a diverse multiprofessional group encompassing many geriatric specialists, explains Dr. Timothy Schwab, chief medical officer of SCAN Health Plan. Dr. Schwab describes some of the challenges of risk stratification in...
10.26.2012
Improving Population Health Management Through Effective, Efficient Data Analytics
Enhanced reporting and efficiency, significant reductions in readmissions in congestive heart failure patients and added leverage at contract negotiation are just a few advantages Bon Secours is deriving from its EHR-based data collection tools, explains Robert Fortini, vice president and...
10.26.2012
Healthcare Trends and Forecasts in 2013: A Strategic Planning Session
A presidential election, more post-ACA milestones and a remodeling of healthcare funding and delivery will no doubt make for an exciting year ahead in healthcare. In this preview of their October 17, 2012 strategic planning session for healthcare executives, Dennis...
09.18.2012
Integrated Health Coaching: The Next Generation in Health Behavior Change Management
Integrated health coaching's person-centric approach to health behaviors across the entire health risk continuum aligns with many of the key principles of post-ACA care delivery models like the patient-centered medical home and the accountable care organization (ACO), explains Dr. Dennis...
09.14.2012
Population Health Management: Achieving Results in a Value-Based Healthcare System
Before shifting from a disease-focused to population health management (PHM) approach, healthcare organizations need to do their homework, advises Patricia Curran, principal in Buck Consultants' National Clinical Practice --- from researching the population's culture to examining its patterns of healthcare...
07.27.2012
Bending the Cost Curve with a Commercial Value-Based Payment Contract: A Case Study from Advocate Physician Partners
A value-based contract between Advocate Physician Partners (APP) and Blue Cross Blue Shield of Illinois (BCBSIL) has reduced inpatient admissions and emergency room visits and has bent the cost curve after its first year. In this interview, Dr. Carrie Nelson,...
07.27.2012
Patient Engagement in the Patient-Centered Medical Home: A Continuum Approach
Although the healthcare industry is well-acquainted with the patient-centered medical home, the model is still quite new and novel to patients, notes, Jay Driggers, director of consumer engagement at Horizon Blue Cross Blue Shield of New Jersey. In this interview,...
07.11.2012
Reducing Avoidable Medicaid ER Visits With a Community Partnership Approach
Anxiety caused by the wait for a non-urgent appointment or lack of awareness that they are assigned a primary care physician are just two barriers to appropriate ER utilization by a diverse Medicaid population, explains Laura Linebach, director of quality...
07.11.2012
The Patient-Centered Medical Home: Lessons from a Statewide Rollout
Nurse educators provide essential support to physician practices in Florida Blue's rollout of a statewide patient-centered medical home, explains Barbara Haasis, RN, CCRN, senior clinical lead for Florida Blue's quality reward and recognition programs. They help practices meet key disease...
07.11.2012
Advanced Illness Care Coordination: A Case Study on Aetna's Compassionate Care Program
Aetna's Compassionate Care Program is a case management initiative that specifically targets health plan members with advanced illness, focusing on improving the quality of care they receive. As a result, explains Dr. Joseph Agostini, senior medical director of Aetna Medicare,...
07.11.2012
Healthcare Performance Benchmarks: Diabetes Management
The use of a disease-specific approach to improve health outcomes and self-management for patients with diabetes is utilized by 77 percent of organizations, according to HIN's 2011 survey on diabetes management programs. In this podcast, Melanie Matthews shares key metrics...
04.19.2012
Geisinger Reduces All-Cause 30-Day Readmission Rates Through Remote Monitoring Program
Geisinger Health Plan reduced the relative risk of all-cause 30-day readmissions by 44 percent compared to a matched control group using an interactive voice response (IVR) system developed by AMC Health. The IVR system targeted patients who were at high...
04.12.2012
Second Annual Benchmarks in Reducing Avoidable ER Use: Pain Management Driving 'Ultra Utilizers'
The use of nurse-only health advice lines to reduce avoidable ER visits is up 10 percent over 2010 levels, according to HIN's second annual survey on reducing avoidable emergency room use. In this podcast, Melanie Matthews shares key metrics from...
04.12.2012
Recruiting, Training and Case Load Management Strategies for Embedded Case Managers
When looking for new hires for its embedded case management program, Bon Secours Health System looks for critical thinking skills and previous roles that are transferable, such as work with chronic disease patients, explains Irene Zolotorofe, administrative director of clinical...
04.02.2012
Physician Pay for Performance: Refining the Bonus Structure to Meet Market Realities
In its 15-year existence, Highmark's Quality Blue physician pay for performance program has evolved from one strictly based on clinical measures to a payment model shaped by practices' needs, explains Julie Hobson, Highmark's manager of provider engagement, performance and partnership....
04.02.2012
Leveraging Case Management Tools and Technology to Improve Outcomes
With more than 100 case managers working in seven regional offices, Arkansas Blue Cross Blue Shield (BCBS) embraces any tools that can elevate care delivery and efficiency and reduce paperwork. Karen Black, RN, HIPAAP, HIA, Arkansas BCBS quality improvement coordinator,...
04.02.2012
Health Coaching Trends for 2012
While telephonic sessions were the primary vehicle for health coaching in the last five years, Internet-based face-to-face coaching incorporating motivational interviewing techniques is one of the directions the industry will be taking going forward, says Melinda Huffman, partner in Miller...
03.02.2012
CMS Innovation Panel Looks to Medication Adherence as Potential Delivery Innovation
Medication adherence rates for patients enrolled in a collaborative program developed by the University of Pittsburgh School of Pharmacy, Highmark, RiteAid and CE City, a technology company, was significantly improved and continued to improve over time compared to a control...
02.21.2012
Diabetes Management in the Medical Home: A Diabetes Collaborative Takes Team-Based Approach
Hudson River HealthCare (HRHC) takes a team approach to disease management in the 3,400 adult patients with diabetes it serves, explains Kathy Brieger, RD, CDE, HRHC's chief operations officer. Ms. Brieger describes the multiple levels of care available to patients...
02.21.2012
Telephonic Case Management: Protocols for Behavioral Healthcare Patients
Though adult mental health patients, substance abusers and children and adolescents may face different behavioral health issues, there's a common reason behind their frequent hospital and ER visits, explains Jay Hale, LPC, CEAP, director of quality improvement and clinical operations...
12.20.2011
Mapping the Way to ICD-10 Readiness: Blue Cross Blue Shield of Michigan's Approach
The mapping between ICD-9 and ICD-10 code sets will have two major impacts on healthcare, predicts Dennis Winkler, ICD-10 technical program director for Blue Cross Blue Shield of Michigan, which has created a roadmap for the transition that it is...
11.23.2011
Demonstrating the Value of the Embedded Case Manager for the Medicare Population
When healthcare providers and health plan case managers join forces in the physician practice, the end result is "care completion," explains Dr. Randall Krakauer, medical director for Aetna Medicare. In his second HealthSounds interview, Dr. Krakauer describes how the meshing...
11.17.2011
Fifth Annual Medical Home Benchmarks: PCMH Stepping Stone to ACO
HIN's fifth annual survey on the patient-centered medical home (PCMH) recorded the highest PCMH adoption levels to date, reports Melanie Matthews in this benchmarks podcast. A substantial number of medical homes expect to participate in an accountable care organization (ACO);...

What's Healthcare Intelligence Network about?

Download our free app to listen on your phone

Healthcare Intelligence Network episodes:

Humana Remote Monitoring Pilots Engage Circle of Care Surrounding Member

HCSC's Community Behavioral Health Links Essential to Duals Care Coordination

3 Key Benefits to Prudent Sharing of Physician Performance Data

Deconstructing Health Reform: 3 Reasons Medicare and Pioneer ACOs May Not Survive

Award Winning Readmission Prevention Protocols: Navigating Care Transitions with Preferred SNF and Home Health Providers

Managing Risk in Population Health Management

Medicare Pioneer ACO Year One: Lessons from a Top-Performer

Dual Eligibles: Closing Care Gaps and Engaging Members in Self-Management

Improving Population Health with Embedded Case Managers in an Open, Multi-Payor Community

Aligning Value-Based Reimbursement with Physician Practice Transformation

Healthcare Trends and Forecasts in 2014: 7 Payor Strategies That Will Reshape Primary Care

Healthcare Trends and Forecasts in 2014: Expect Surge in Commercial ACOs to Continue

Medical Home Neighborhoods: Uplinking Specialists To Create Integrated Systems of Care

Home Visits: Assessing Complex Patients Post-Discharge To Reduce Readmissions

Managing Population Health with Integrated Registries and Effective Patient Touchpoints

Performance Quality Measurement and Reporting for Accountable Care

Motivational Interviewing by Ochsner Health Coaches Drives Results in 4 Key Areas

Health Coaching's Value in Accountable Care and Medical Homes

Medicare Pioneer ACO: Case Study on Atrius Health's Focus on the Triple Aim

Patient Engagement and Provider Collaborations Across the Healthcare Continuum to Improve Care Transitions

Healthcare Social Business Strategy: Driving Adoption with Social, Mobile and Cloud Technologies

Care Transition Management: Strategies for Effective Patient Handoffs

A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings

Moving Forward with Payment Bundling

Health and Wellness Incentives: Positioning for Outcome-Based Rewards

The Role of Case Managers in Emerging Care Delivery Models

Physician Hospital Organizations: Developing a Collaborative Structure for Shared Savings Agreements

Care Coordination for Dual Eligibles: A Results-Oriented Approach

Improving Population Health Management Through Effective, Efficient Data Analytics

Healthcare Trends and Forecasts in 2013: A Strategic Planning Session

Integrated Health Coaching: The Next Generation in Health Behavior Change Management

Population Health Management: Achieving Results in a Value-Based Healthcare System

Bending the Cost Curve with a Commercial Value-Based Payment Contract: A Case Study from Advocate Physician Partners

Patient Engagement in the Patient-Centered Medical Home: A Continuum Approach

Reducing Avoidable Medicaid ER Visits With a Community Partnership Approach

The Patient-Centered Medical Home: Lessons from a Statewide Rollout

Advanced Illness Care Coordination: A Case Study on Aetna's Compassionate Care Program

Healthcare Performance Benchmarks: Diabetes Management

Geisinger Reduces All-Cause 30-Day Readmission Rates Through Remote Monitoring Program

Second Annual Benchmarks in Reducing Avoidable ER Use: Pain Management Driving 'Ultra Utilizers'

Recruiting, Training and Case Load Management Strategies for Embedded Case Managers

Physician Pay for Performance: Refining the Bonus Structure to Meet Market Realities

Leveraging Case Management Tools and Technology to Improve Outcomes

Health Coaching Trends for 2012

CMS Innovation Panel Looks to Medication Adherence as Potential Delivery Innovation

Diabetes Management in the Medical Home: A Diabetes Collaborative Takes Team-Based Approach

Telephonic Case Management: Protocols for Behavioral Healthcare Patients

Mapping the Way to ICD-10 Readiness: Blue Cross Blue Shield of Michigan's Approach

Demonstrating the Value of the Embedded Case Manager for the Medicare Population

Fifth Annual Medical Home Benchmarks: PCMH Stepping Stone to ACO