Healthcare Intelligence Network

What constitutes healthcare quality improvement? CMS's definition of medical costs will likely coalesce around five key areas of quality improvement, say John Steele and Steve Young, managing directors for HealthScape Advisors. These CMS guidelines will impact health plans in January, when new medical loss ratio (MLR) regulations take effect. In this podcast, the advisors also describe the risk that insurers could incur on the rebate side if they don't adequately prepare for the January changes and the impact the regulations could have on consumers' medical care and choices. Steele and Young will provide an in-depth analysis of what health plans must do now to comply with the January deadline for MLRs and how this might impact health plans operationally and financially during "Minimum Medical Loss Ratios: How Health Plans Should Prepare for the January Compliance Requirements," a 60-minute webinar on July 21, 2010.

Nurse practitioners constitute a workforce already grounded in patient-centered care, explains Linda Lindeke, Ph.D., an RN and a nurse practitioner herself since 1978. Lindeke, who is also associate professor for the School of Nursing and Department of Pediatrics and director of Graduate Studies for the School of Nursing at the University of Minnesota, describes the demographics where a nurse practitioner's contributions might need clarification, explains why there's not much mention of the medical home in nursing literature and assesses the impact of the Affordable Care Act's $15 million allocation to fund 10 nurse practitioner-led clinics that will provide primary care services to the medically underserved. Lindeke will examine how nurse practitioners are being utilized in the physician practice, hospital and clinic settings to increase access to care and coordinate care for patients with chronic conditions during "The Emerging Role of Nurse Practitioners in Expanding Access, Enhancing Revenue," a 45-minute webinar on July 28, 2010.

Along with the transformation to a patient-centered medical home came an acceptance of a model that coordinates care for an entire population, not just the patients showing up each day, notes Dr. Paul Kaye, medical director at Taconic IPA. And even though the 238 Taconic physicians at 11 sites have received Level III PPC(R)-PCMH(TM) recognition from the NCQA, Susan Stuard, executive director of THINC, explains that practice transformation doesn't stop there. Dr. Kaye and Ms. Stuard described how the sharing of data across its organization is improving physician performance and value-based reimbursement levels during "Improving Physician Performance and Value-Based Reimbursement Levels Through Meaningful Data Sharing," a 45-minute webinar on June 23, 2010.

When primary care isn't available, several proxy healthcare services can sometimes fill the bill for certain conditions, helping to reduce the number of avoidable emergency room visits, explains Sara Gray, senior manager of emergency services at Kaiser Foundation Health Plan of Colorado. Ms. Gray describes two important steps hospitals can take when discharging patients to keep those patients from seeking post-discharge care in the ER, and suggests a hospital-SNF partnership to reduce preventable ER visits by SNF patients. Ms. Gray shared Kaiser's three-pronged approach to reducing inappropriate and avoidable ED use during "Reducing Unnecessary Emergency Room Visits: Strategies To Discourage Inappropriate Use and Reduce Preventable Visits," a 45-minute webinar on June 9, 2010.

As more payors test the patient-centered medical home model of care, what are the pros and cons of participation for physician practices? Dr. Marjie Harbrecht, medical and executive director of Health TeamWorks, describes the financial middle ground that is likely to satisfy payors and providers who sign on for medical home pilots and offers some additional selection criteria her organization (formerly the Colorado Clinical Guidelines Collaborative) may use in the future. Dr. Harbrecht examined how practices are recruited, selected and supported in medical home programs during "Physician Practices in the Medical Home: Recruiting, Evaluating, Supporting and Measuring the Patient-Centered Team," a 45-minute webinar on May 19, 2010.

Medicaid patients present their own unique set of needs during home visits, explain Dr. Larry Greenblatt, medical director, Chronic Care Program, Durham Community Health Network, Duke University Medical Center, and Jessica Simo, program manager, Durham Community Health Network for the Duke Division of Community Health. The duo explains the two types of patients that benefit most from home visits, the priorities of the home visit and the most common problems identified during home visits. Dr. Greenblatt and Ms. Simo will examine the features of a successful home visit initiative during "Home Visits in the Patient-Centered Medical Home," a 45-minute webinar on May 20, 2010.

In the first of several conversations with Metcare of Florida chief executives on its continuing medical home pilot with Humana, CEO Mike Earley and President and COO Dr. Jose Guethon describe Metcare's longstanding commitment to the management of care transitions for its Medicare patients, how its 10 medical home practices keep a handle on patient care in hospital settings, and the clinical and business returns that result from these efforts. Earley and Dr. Guethon will describe how Metcare practices have made the transformation to patient-centered medical homes, with an eye on maintaining the profitability of their practices, during "Patient-Centered Medical Home Transformation: 9 Key Hurdles for Physician Practices To Overcome," a 45-minute webinar on May 12, 2010.

Sharing the latest literature on the causes and prevention of hospital readmissions is Susan Shepard, the director of patient safety education for The Doctors Management Company. Ms. Shepard described the type of patient most at risk for readmission, some of the risks inherent in transitioning patients from one care site to another, and the contribution of the patient's primary physician to a successful discharge. Shepard identified key aspects of the hospital admission, stay and discharge that can reduce the likelihood of readmission during "A Coordinated Discharge Planning Approach to Reduce Avoidable Hospital Readmissions," a 45-minute webinar on April 28, 2010.

The patient-centered medical home is at the heart of Mesa County, Colorado's shared savings model, explains David West, M.D., a hospitalist, family physician and healthcare consultant from Grand Junction, Colorado. Dr. West describes how the shared savings model can be adapted across markets, including the conditions and factors that must be present for this approach to be feasible. He also shares a unique provider incentive that is keeping hospital stays of Medicare patients at less than one-third the national average, one of the factors that has the nation touting this area as a model for efficient healthcare delivery. Dr. West examined how to structure a shared savings agreement during "Shared Savings in the Medical Home," a 45-minute webinar on March 31, 2010.

The contributions of an embedded case manager to the practice quickly become evident, explains Diane Littlewood, R.N., regional manager of case management for health services, Geisinger Health Plan, which in turn bolsters physician buy-in for the program. She describes the upfront basics that help to ensure that health plan and provider expectations for embedded case management are met. Ms. Littlewood examined an embedded case manager program, from the factors that will help determine if a program is right for an organization and deciding on the placement to defining roles and responsibilities for the program, during "Embedded Case Managers: Navigating Care Transitions, Gaps in Care and Patient Compliance," a 45-minute webinar on March 10, 2010.