Care Transformation Center Blog

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

What 100+ providers told us about the path to value-based care

Dennis Weaver, MD, MBA September 22, 2016

A few weeks ago we launched the Pop Health Pop Quiz to help our members understand where they fall on the path to value. We asked 12 questions on the current status of each organization's value-based care contracts, care transformation strategies, network alignment, IT, and financial management capabilities.

Over 100 people from 87 provider organizations took the survey, and they were able to immediately see whether their organization was a skeptic, intender, builder, advancer, or committed in relation to population health management.

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The crucial diabetes metric you might not be focused on

Rebecca Tyrrell September 20, 2016

Although every organization manages patients with diabetes, many programs fall short of achieving key cost and quality goals. HbA1c metrics in particular receive a lot of attention—and for good reason—but low diabetic retinal exam rates suggest a need for a more comprehensive approach to disease management.

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2 strategies to help prescribers reduce drug diversion

by Colleen Keenan September 16, 2016

Prescription opioid abuse has led to enormous healthcare costs—by one estimate totaling $14.85 billion in inpatient charges in 2012 alone. Hospitals and health systems are becoming increasingly responsible for these costs as they take on risk-based contracts. Thus, they must be vigilant about taking steps to reduce prescription drug abuse and misuse.

One proven strategy for curbing the prescription opioid abuse epidemic is for providers to consult with Prescription Drug Monitoring Programs (PDMPs) before they write a prescription. PDMPs are state-run electronic databases that track the prescribing and dispensing of controlled prescription drugs to patients. 49 states and one U.S. territory, Guam, now have operational PDMPs. However, providers often do not use them because they can be tedious and time-consuming to access. Health system leaders have the opportunity to benefit both their local community and reduce population health costs by removing the barriers to PDMP use, which they can do by following these two key strategies:

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Train PCPs on the behavioral health skills they need most

by Tracy Walsh and Clare Boczon September 14, 2016

Integrating behavioral health services into primary care has been shown to significantly improve patient outcomes and reduce overall cost of treatment. But taxing workloads and resource constraints in the primary care setting can make it difficult for care teams to get started.

To most efficiently and effectively use limited care team time, a physician task force at Baptist Health Medical Group, called the Empowerment Team, applied a unique three-step solution. First, they used an evidence-based framework to identify the practice-specific barriers primary care teams faced in delivering behavioral health services. Next, the team surveyed providers throughout the medical group to gauge the impact of each barrier. Lastly, the program champions mapped these barriers to targeted training opportunities.

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The 6 key components of an effective care transition process

Rebecca Tyrrell September 7, 2016

While the post-discharge process and readmissions prevention are by no means new concepts, increased regulatory scrutiny, financial penalties, and enhanced data transparency and accountability measures have prompted a renewed focus on improving care transitions.

Many population health leaders are now expanding transition management to tackle additional avoidable cost opportunities such improving medication reconciliation processes, monitoring medication use, bolstering patient engagement, and incorporating non-clinical risk factors into ongoing patient management. To capture these opportunities, organizations must deploy finite care management resources against a tailored set of care delivery and care coordination services.

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Staff for care management today, without financial regrets later

John Johnston, CPA, MHA September 1, 2016

The traditional, inpatient-oriented model of case management, discharge planning, social services, and utilization review (UR) does not cut it anymore—because practically every new payment model is designed to place providers at risk for patient outcomes across the entire episode of care.

In addition to carrying inpatient-oriented resources, hospitals are now compelled to invest in new care management staff, often housed outside the hospital with a focus on coordinating care across the continuum. But accounting for productivity and ROI of a more complex staff and—more important—operationalizing these workforce "assets" in a coordinated manner pose new challenges for hospital leaders.

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How NorthShore is integrating genetic testing in personalized care plans

by Dan Hood August 30, 2016

The World Health Organization estimates that 60% of factors impacting health and quality of life are correlated with lifestyle.

Successful population health managers acknowledge this fact and use data on non-clinical and psychosocial risk factors to customize treatment plans that reflect the day-to-day reality of their patients. NorthShore University HealthSystem in Evanston, Ill., is transforming that traditional framework by integrating patients' genetic information within their care plans.

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To invest, or not to invest: The full story on IV automation

by Molly Stein August 25, 2016

Recently, we were surprised to hear from several members who have "mothballed" expensive investments in IV automation technology. These investments ended up unused and unwanted after they failed to demonstrate obvious value to the organization. But still we hear from other organizations trying to decide whether to invest in these very same technologies. So what's the story?

A number of institutions have found that IV room workflow systems and IV robotics systems can improve patient safety and reduce hospital costs. As drug costs rise and health care organizations seek to show value, many institutions are looking at IV technology systems to help them reach their goals. However, implementation challenges rightfully give organizations pause when considering investment.

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