Care Transformation Center Blog

The insights, tools, and resources you need to take on population health management

How co-locating with the police can reduce avoidable ED use

by Tomi Ogundimu and Petra Esseling June 23, 2017

One in eight emergency department (ED) visits is associated with a behavioral health issue. These visits are not only costly to the system, they are often unnecessary and preventable.

A key driver of many of these visits is the shift away from providing services in psychiatric institutions to providing them in community-based settings—but limited funding for community-based programs has left individuals with behavioral health problems struggling to access care.

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2 strategies for engaging patients to boost medication adherence

by Rebecca Tyrrell and Samantha Freedman June 21, 2017

Of the 187 million Americans who take at least one prescription medication to treat acute or chronic illnesses, about half—93.5 million individuals—don't take their medication as prescribed.

The reasons for non-adherence are complex and highly variable. They include poor patient-provider communication, cost and access barriers, inadequate knowledge about a drug and its use, concerns about side effects, complex regimens, and simply not being convinced of the need for treatment. Moreover, adherence for a single individual may vary over time because of changes in condition, symptoms, personal circumstances, and many other factors.

Given the prevalence of non-adherence, prescribers and other care team members must assume greater responsibility for understanding and discussing potential barriers to medication adherence in order to choose treatment regimens likely to be followed. Here are two strategies providers should adopt.

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How UUHP saved $9.4M and avoided 7,000 ED visits—in just one year

Austin Weaver, MBA June 15, 2017

In an era where many health care organizations are struggling to reduce costs while still improving quality of care, University of Utah Health Plans (UUHP) has been able to successfully do both. We sat down with Joe Mercado, an Advisory Board population health consultant who has worked closely with UUHP, to find out how they did it. 

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The illnesses that never happen: A pathway to prevention

by Akram Boutros, MD, president and CEO of The MetroHealth System, and Robert Musslewhite, chairman and CEO of The Advisory Board Company June 15, 2017

In health care policy circles we often focus too much on Washington and not enough on the promising innovations already happening on the ground, in our communities.

Many locally-driven innovations are quietly transforming the lives of patients by better integrating care and even preventing sickness in communities across the country.

In Greater Cleveland alone, we have ample stories to tell.

An 11-year-old girl with asthma visited the emergency room 74 times in a single year. Now, her attacks have all but ended.

A young boy lived in a home with lead and the risk of nerve damage, kidney problems, and permanently reduced IQ. Today, he's healthy, thriving at school, and living without that threat.

A senior citizen who had struggled to control her diabetes and hypertension risked even greater health problems. Now, she’s making steady progress through a healthier diet.

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How Mercy Health overhauled its approach to care transitions—and cut ED visits by 30%

by Rebecca Tyrrell and Darby Sullivan June 12, 2017

Up to 90% of a patient's health status can be attributed to non-clinical factors such as employment status, social integration, and access to safe housing and healthy food. However, typical care transitions programs often fail to identify these types of challenges, which can be particularly problematic for complex, fragile patients.

Mercy Health System, a three-hospital, 566-bed community teaching health system in Southeastern Pennsylvania, tackles this challenge in an innovative way: Their population health leaders developed a multidisciplinary care transition support program consisting of a licensed social worker and a community health worker (CHW) to provide supplemental social services to patients with complex needs.

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Use measures, metrics to tell your story before someone else tells it for you

Zachary Hafner, MBA June 1, 2017

Health care is rife with measurement. For both providers and payers, the time, effort, and resources dedicated to collecting and reporting data are exorbitant. While most reporting requirements are well intentioned, the proliferation is not adding value and—in some circumstances—does more harm than good. 

Health care is already complex. All the measurement adds layers of complexity and bureaucracy. And the expense is considerable. A study published last year in Health Affairs showed that physicians and staff members in four types of practices (primary care, cardiology, orthopedics, and multispecialty) spend, on average, 15 hours a week per physician dealing with quality measures—which works out to about $40,000 annually per physician and $15.4 billion total.

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3 ways CMS is incentivizing community partnerships

by Tomi Ogundimu and Darby Sullivan May 30, 2017

Inspired by growing evidence that partnerships with community-based organizations can improve health outcomes and decrease care costs, the Center for Medicare and Medicaid Innovation is providing funding to health care organizations to participate in its Accountable Health Communities Model.

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Reflecting on ACO success: Kindred Healthcare and the Silver State ACO

by Jared Landis and Keerthi Bandi May 18, 2017

Kindred Healthcare is a strategic owner and partner in the Silver State ACO, a Las Vegas-based MSSP Track 1 participant that generated shared savings in 2015.

We recently sat down with Kindred's Drew Sheinen, Vice President of Strategy and Network Operations, and Linn Billingsley, Division Vice President of the Las Vegas Integrated Market, to discuss the lessons they've learned through ACO participation. 

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