Healthcare Intelligence Network

Health IT is extremely important in improving an organization's communication and prevention strategies, says Ewa Matuszewski, CEO of Medical Network One. In this podcast, Matuszewski also comments on how health IT supports the joint principles of the PCMH and describes how her health IT tool of choice can be a stepping stone to further implement IT within an organization. Matuszewski, along with Dr. James Crawford, senior vice president for laboratory services and chair of the department of pathology and laboratory medicine at North Shore-Long Island Jewish Health System, presented case studies on the use of health IT in the medical home and its impact on care access, quality and cost during a May 28, 2009 webinar, Wiring the Medical Home: Healthcare IT to Power a Patient-Centered Model.

Implementing an EHR into your organization is not the same as implementing a patient-centered medical home (PCMH) model of care, according to Dr. James Crawford, senior vice president for laboratory services and chair of the department of pathology and laboratory medicine at North Shore-Long Island Jewish Health System. To be a PCMH, the practice workflow has to change as well. In this podcast, Dr. Crawford discusses the key process change that has to accompany the adoption of health IT by a medical home as well as health IT's impacts on care coordination and findings from the PCPCC's survey of physician practices on their use of health IT in support of the medical home model. Dr. Crawford, along with Ewa Matuszewski, CEO, Medical Network One, presented case studies on the use of health IT in the medical home and its impact on care access, quality and cost during a May 28, 2009 webinar, Wiring the Medical Home: Healthcare IT to Power a Patient-Centered Model.

Health claims are still scrutinized during risk stratification, but today's analysts examine these data points through a slightly different lens, explains John Harris, chief wellness officer and senior vice president for Healthways. Harris explains why the focus has shifted from ICD-9 coding patterns to the financial trends evident in the claims, and what accelerating or decelerating costs reveal about an individual's health status. Harris, along with Dr. William Vennart, vice president of medical management and national medical director with CareAdvantage Inc., described how their organizations have approached health risk stratification, from how individuals are identified for stratification purposes to the effectiveness of risk stratification programs during the webinar, Reducing Acute and Chronic Care Costs Through an Effective Health Risk Stratification Model.

Predictive modeling and health risk stratification can help providers identify members for case management and disease management interventions, says Dr. William Vennart, vice president of medical management and national medical director with CareAdvantage Inc. These methods ensure that patients receive treatment for their chronic conditions early on and, in turn, reduce unnecessary utilization and lower acute and chronic care costs. Dr. Vennart, along with John Harris, chief wellness officer and senior vice president for Healthways, described how their organizations have approached health risk stratification, from how individuals are identified for stratification purposes to the effectiveness of risk stratification programs during the webinar, Reducing Acute and Chronic Care Costs Through an Effective Health Risk Stratification Model.

Nightly data mining has helped Vanderbilt University and Medical Center identify and make contact with high-risk high-volume patients, explains Dr. Dexter Shurney, which has vastly improved patient outcomes and closed care gaps. But the medical director of Vanderbilt's Employee Health and Care Plan would like to see even more data put in front of physicians at the point of care --- especially regarding certain patients with no claims history. Dr. Shurney describes these "bombs waiting to explode," as well as the impact of the patient-centered medical home (PCMH) model of care on disease management and why wellness and prevention services may be the best responses to individuals with comorbidities. Dr. Shurney, along with Dr. Ariel Linden, Dr.P.H., M.S., president of Linden Consulting Group, examined how disease management programs can continue to prove their worth and new developments in disease management that are netting results during The Strategic Ongoing Role of Disease Management in the Healthcare Continuum: Achieving the ROI.

Aetna's practice of sending its providers periodic "care considerations" --- detailed clinical data that identify opportunities to improve care --- has been formalized in its patient-centered medical home (PCMH) pilot with Partners in Care (PIC), explains Dr. Don Liss, the regional medical director of Aetna's mid-Atlantic region. PIC providers' engagement with the care considerations is now a factor in the pay for performance aspect of the pilot. Dr. Liss shares some short-term indicators that demonstrate that the PCMH is working as well as the long-term view for medical home ROI, which can vary greatly for payors and providers. Dr. Liss, along with George Chedraoui, healthcare leader with IBM and immediate past president of Bridges to Excellence, shared different viewpoints --- the healthcare payor and purchaser --- and their strategies for achieving an ROI from the medical home during, Medical Home Metrics and Measurements for Achieving ROI.

IBM spends about $2 billion a year on healthcare for its 500,000 employees but doesn't believe it's getting its money's worth from the current system, explains George Chedraoui, healthcare leader with IBM and immediate past president of Bridges to Excellence. Chedraoui explains why IBM is banking on the patient-centered medical home (PCMH) --- with its focus on disease prevention and wellness --- to deliver this value, what impact $19 billion in health IT incentives will have on physician practices, and why it will take more than technology to transform a physician practice into a medical home. Chedraoui, along with Dr. Don Liss, regional medical director for the mid-Atlantic region of Aetna, shared different viewpoints --- the healthcare payor and purchaser --- and their strategies for achieving an ROI from the medical home during, Medical Home Metrics and Measurements for Achieving ROI.

According to Paul Terry, Ph.D., president and CEO of StayWell Health Management, when evaluating health coaching and population health programs, it is rare to see a return on investment in a program's first year, but generally by the second and third years, ROI begins to build. In addition to discussing ROI trends, Terry evaluates the value of self-reported data and the impact health coaching can have on an organization's productivity, presenteeism and absenteeism, and also gives some benchmarks for ROI in health coaching. Terry, along with Dr. Craig Nelson, director of health services research for American Specialty Health, described the measures to look at when evaluating health coaching and population health programs and provided case studies of how they are actually using these measures to demonstrate a health management ROI during a March 25, 2009 webinar, Calculating the Health Coaching ROI: Models and Results.

According to Dr. Bruce Bagley, the cornerstone of PQRI is quality improvement, and any bonus payments physicians receive for reporting efforts are just that --- by-products of the process. Dr. Bagley, medical director of quality improvement for the American Academy of Family Physicians, also shares his views on the value of patient registries and other healthcare IT for PQRI, and advises physicians who may be frustrated by their PQRI experiences. Dr. Bagley, along with Betsy Nicoletti, consultant, Medical Practice Consulting, LLC, described how PQRI can provide physician practices with a great start on registries and measurement and reporting and provided practical hands-on PQRI coding and auditing strategies during a March 18, 2009 webinar, Physician Quality Reporting Initiative in 2009: How To Avoid Submission Errors and Improve Reimbursement.

According to Dr. Agostino Villani, when it comes to pain management, the doctor-patient relationship far outweighs the pain treatment itself. Dr. Villani notes that patients who experience quality doctor-patient relationships are much more successful in their management of pain than those who do not. In part 2 of this interview, the internationally recognized expert on chronic pain, CEO of Triad Healthcare, Inc., and author of "Pain is Not a Disease," further discusses the physician-patient relationship, measuring the outcomes of pain management and med school curricula on pain management.