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Community paramedicine in value-based care



Paramedics on bicycles in Los Angeles.

Kenneth W. Kizer, M.D.,  is an expert on the expanding potential of community paramedicine. As a former director of the California Emergency Medical Services Authority, he wrote the regulations for paramedicine in the state.  More recently, he has become a  thought leader in population health — and an advocate for community paramedicine in value-based care.

Hospitals & Health Networks recently interviewed him.

Among his remarks:

“Community paramedicine is an important component of population health management and the new emerging value-based health care economy because it fills gaps in the typical health care delivery infrastructure that are especially relevant to value-based payment.

“The focus of CP programs varies widely — from paramedics providing directly observed treatment for tuberculosis patients at their homes to providing transportation to health care facilities other than emergency departments and many other concepts.”

“The programs that respond to the 9-1-1 superusers hold a lot of promise for better utilizing scarce emergency care resources, including ambulances and hospital emergency departments. We know that in many communities some people call 9-1-1 multiple times per week when what they really need is help with basic primary care or other support services. Many of these persons may be homeless or have mental health needs or other problems that are not always better managed in the ED.”

“Another type of program that I think is going to prove to be very helpful is one that provides follow-up care after a hospital discharge or an ED discharge. These programs serve patients before they can get in to see their usual provider or — probably more often — until they can establish a relationship with a regular health care provider.”

To read the whole interview, please hit this link.


Population health in a community hospital ACO

An article in Health Affairs asks:

“{W}hen it comes to actual operations, what does ‘population health’ look like in an ACO, particularly in ACOs led by community hospitals? Do ACOs see their role in population health management as caring for their patient populations as a whole? Patients in their catchment areas? In their communities? And how do those views ‘sync’ with the care delivery and partnership approaches that hospital-based ACOs are actually using?”

“But when ACO leaders were asked what sorts of community health programs and services they were either employing or planning to employ within six months, the top three answers were, instead, related to care coordination, chronic-disease management, and health education.

“Similar to the aforementioned reasoning, this suggests that many ACOs may be taking a ‘walk before they run’ approach, establishing basic ACO infrastructure first before tackling more targeted community needs. It also implies that an additional focus may be needed on helping ACOs to expand their view—and services—beyond their current patient population.

“Likewise, while 71 percent of ACO leaders are either offering, or plan to offer, integrated physical and behavioral health services … fewer than 25 percent believe their ACOs will have adequate numbers of behavioral health staff to meet their populations’ needs.”

To read the Health Affairs article, please hit this link.

Lack of preventive care poses fiscal danger to hospitals


Robert Ostrowsky, the head of RWJBarnabas Health, in New Jersey, says that lack of preventive care in some communities could end up deeply damaging hospitals.

“It’s not easy because no one is willing to pay for that right now, meaning I don’t get reimbursed by insurance companies to keep somebody healthy and the government doesn’t seem to want to pay us to keep someone healthy,” Mr. Ostrowsky told the Asbury Park Press.

“They all prefer to pay us when someone gets sick and they want us to spend less when that person is sick. That’s where the concentration has been. But an ounce of prevention. If they would take X number of dollars and say, ‘Here, use it to keep people healthy,’ actuarially, that will show you eventually spend less on sickness care.”

But then, as  Ron Shinkman wrote in FierceHealthcare noted:
“It’s simply easier for providers to write a prescription than deploy a complex exercise or lifestyle regimen that might improve health and reduce pain. Some other unsettling forces from the business side of healthcare also play a role. Most notably is Purdue Pharma looking the other way on potential abuse of its OxyContin painkiller, marketing it based on the dubious claim its effects lasted for 12 hours, increasing the risk of abuse, and also taking a significant period of time to reformulate its pills to make them less likely to be abused.”

Mr. Shinkman continues: “Ostrowsky is right. Lack of proactivity on population health is not only making more Americans sick and keeping them out of the workforce, it makes them more likely to lash out against the only institutions that could play a role in their being healthy again. It is a negative feedback loop that could have disastrous consequences for the population and hospitals if it is not aggressively addressed.”

To read the article in the Asbury Park Press, please hit this link.

To read Ron Shinkman’s commentary,  please hit this link. 

IBM, Siemens announce population-health venture


IBM and Siemens Healthineers have created a venture to  offer population-health-management services and other tools to hospitals, health systems, integrated-delivery networks and other healthcare organizations.

The five-year agreement is aimed at combining IBM Watson Health’s computerized healthcare applications with Siemens Healthineers’ experience working with hospitals and health systems on clinical workflows, services and digital health technologies, the companies said.

Hospitals & Health Networks reports that: “Siemens Healthineers will offer IBM’s value-based care analytics and reporting and patient engagement tools, and will also provide consulting services to support providers in their transition to value-based care. IBM Watson Health has expanded its range of services in the past several years, mainly through acquisitions and partnerships, and this partnership seems to be a move more toward having its platform implemented.”

H&HN added that Anil Jain, M.D., vice president and chief medical officer for 
IBM Watson Health, said, in the news service’s words, “the alliance is about much more than gaining access to Siemens Healthineers’ deep pool of clients. ‘The experience and expertise they have in how hospitals operate and how their various workflows exist at health systems’ is a key part of the partnership, Jain said.”

To read the H&HN article, please hit this link.


17 success stories in population health


This Becker’s Hospital Review discussion of 17 hospitals and health systems with unusual and effective population-health initiatives is well worth the time to study. They have all reported success in improving population health

To read it, please hit this link.

Geisinger dramatically expanding geographical reach of its insurance


Danville, Pa.-based Geisinger Health System and Bethlehem, Pa.-based St. Luke’s University Health Network have agreed to extend Geisinger health plans to almost 50 Pennsylvania counties.

“The systems will share population and value-based payment model data and create a sponsored Medicare Advantage product to provide recipients access to services not covered under traditional Medicare and Medigap plans. In addition, more than 10,000 St. Luke’s employees will be placed on Geisinger’s health plan, effective Jan. 1,” reported Becker’s Hospital Review.

The development is one of the more dramatic demonstrations of hospital systems expanding insurance offerings to achieve the  cost efficiencies and customer loyalty that some systems see  as needed in the developing value-based world of healthcare.

“When you get to the heart of it, we are two organizations focused on taking the best care of patients and we’re excited to partner with a healthcare system that aligns with our vision and values,” said David Feinberg, M.D., Geisinger president and CEO. “Geisinger is thrilled to expand the scope of our relationship with St. Luke’s to advance population health, improve quality and provide better access to care.”


To read the whole story, please hit this link.

Population health: Partner with Uber?


Uber driver on his way to customer.

Nick van Terheyden, M.D.,  chief medical officer of Dell Healthcare Services, writes in Becker’s Hospital Review that population health must, of course, focus on primary care. But his specific suggestions include:

On data analysis, he cites:

“A western Massachusetts integrated health system includes in their risk algorithms factors such as distance from a patient’s home to a primary-care provider and availability of transportation and family support. Their thinking is that if you live too far from a clinic or don’t have transportation or family support, you are less likely to get regular care.”

“This is just one example of the kind of challenges we face in population health. It’s going to be as much about social support as it is about medical intervention. Income, location, health literacy, family support and a dozen other factors will have far more power over outcomes than anything that happens in the exam room.”

“….I wrote about high-value primary-care providers, those who got stellar outcomes with only about half the per-capita healthcare expense as other practices. These primary-care teams (and they are teams, not just physicians) exhibit significant cultural differences from other practices, starting with a laser-like focus on patient needs that go beyond diagnoses and medications. When they invest in technology, they choose carefully….”

“Notably, all of these practices make sure their physicians have mobile access to the electronic health records of their patients. That means a physician on call will have all the information needed to help a patient and to make good care decisions. ”

“Physicians  {should} take their own after-hours calls most of the time, making use of mobile access to the EHR to ensure all knowledge of each patient’s condition is available for decision-making.”

“Transportation is also a barrier for many patients, and some healthcare systems are partnering with Uber to get patients to checkups. While the cost may not always be covered I’m willing to bet the data will quickly show the payoff from this will justify the expense of providing the transportation.”

“But telehealth, remote monitoring and even free rides with Uber won’t make a lasting difference unless they are part of a culture that cares more about patient convenience than provider convenience.”

To read Dr. van Terheyden’s entire essay, please hit this link


Texas Health, Aetna to create insurer



Aetna and Texas Health Resources, a big nonprofit hospital system serving the Dallas-Forth Worth area, will create a jointly owned heath-insurance company for North Texas to address, among other things, population-health issues.

It will be the first such venture in the region between a major insurer and a major health system and include fully integrated care teams and administrative services to reduce redundancies and streamline the patient experience.

This is Aetna’s second joint venture with a nonprofit health system. The first was its pact with Inova Health System in Northern Virginia, signed in 2014.

The new health plan will combine Aetna’s “coverage expertise, case- management capabilities and analytical insights with Texas Health’s provider network and population-health management tools,’’ HealthcareDive reported.

Building a population-health practice in small steps


A small physicians group may find the prospect of  trying to succeed in population health daunting, especially when attempting to compete with large physician groups and health systems. But this piece in Physicians Practice provides some useful advice on how to build a population-health practice with small, incremental steps.

Finding a better path to population health


This HealthAffairs piece looks at “milestones on the path to population health.”

The authors “propose two objectives to better shape the path toward population health: (1) connecting the patients who would most benefit from health care and supportive services—such as those with undiagnosed chronic conditions—to appropriate clinical and community resources; and (2) developing strategies to address diseases with high quality-of-life (morbidity) burdens, not just those with high mortality burdens. A truly integrated population health platform, meanwhile, would move further beyond these milestones to more fundamentally address determinants such as education, poverty, and exposure to trauma.”

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