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Value-based care worsens physician burnout, and what to do about it


Mount Sinai hires Lumeris to boost population-health management

New York City-based Mount Sinai Health System is diving deeper into population health by choosing  St. Louis-based Lumeris to help improve its population-health- management initiatives.

Lumeris’s approach revolves around value-based care.  Nigel Ohrenstein, the company’s senior vice president for Northeast and national accounts, explained to Med City News that  Lumeris’s technology lets providers better manage the health of certain patient populations by  bringing together clinical and financial data to give providers a more complete picture of each patient.

“Our approach is about more than just clinical improvement. It’s about helping healthcare organizations to navigate the transition to the new business of value-based care,” he said.

Niyum Gandhi, Mount Sinai’s executive vice president and chief population health officer, said:

“As we rapidly embrace value-based care as a system, continuously improving our efficiency and quality to improve the overall health of our community is a critical priority. Mount Sinai has identified innovative collaborators to help support us in this journey, and we believe Lumeris can accelerate our ability to effectively and responsibly manage large populations in risk-based models.”

“They had already launched population health initiatives, which had been effective, but they wanted to go further, faster,” Mr. Ohrenstein told Med City News.

He said that Lumeris’s platform is already being launched  at Mount Sinai,  adding that it’s meant to aid the 150,000 patients now managed in risk-based contracts. Mount Sinai plans to double the number of individuals it  covers under value-based arrangements.

To read the Med City article, please hit this link.


3 possible ways to get over value-based-care obstacles

This Medical Economics article by Thomas J. Van Gilder, M.D., chief medical officer and vice president for informatics and analytics of Transcend Insight, provides possible ways to get over three value-based-care obstacles, which are listed as:

“Physicians are missing relevant data.”

“Tedious reporting requirements clash with physician training and expertise.”

“Physicians lack comprehensive point-of-care tools.”

Dr. Van Gilder concludes:

“As we transition to a new and better system under value-based care, there are bound to be bumps along the way. There is a risk that the shift will increase the paperwork (or ‘clickwork’) burden—at least in the beginning. Initially, as new systems are implemented, efficiency may not increase as much as expected.

“But before writing off the need or avoiding making the effort to change, we need to realize that not every physician or group will settle upon the same model. In addition, there are a growing number of solutions to fit the different sizes and shapes of healthcare delivery.

“With change comes new beginnings, and we have a tremendous opportunity to ease the transition and ultimately reduce the paperwork burden reduce the reporting burden, and even reduce or improve the documentation burden. 

“If we align incentives so that everyone is working towards mutually agreed upon goals, then the journey becomes less one of measurement and more one of innovation and clinical autonomy. We can lighten the load and, in doing so, liberate all care team members to focus on doing what they do best: delivering high-quality, value-based care.”

To read the article, please hit this link.


Marrying lean strategies AND value-based care


CEO David J. Bailey, M.D., CEO of Nemours Children’s Health System, writes that while value-based care is essential to achieve better patient medical outcomes, new payment models on their own aren’t enough. Nemours runs hospitals and clinics in Middle Atlantic states and Florida.

Dr. Bailey concludes:
“The changes necessary to transform the health of any population are simple: Embed healthful behaviors from birth, reward care efforts for outcomes rather than volume, and provide patients with the ability and tools to truly engage in their own health. But implementation is exceedingly complex. We believe that value-based care, implemented using lean principles and in conjunction with an ongoing, community-wide effort to address social determinants of health, can reduce health spending and deliver on the promise of better health, for children and for all.”

Hospitals hiring lawyers to help patients


For Kaiser Health News

Every Friday, Christine Crawford has a counseling session at a clinic at New York City’s Mount Sinai Health System as she moves ahead with plans for gender-transition surgery later this year. In addition to the many medical and psychosocial issues, there are practical ones as well. So, Crawford was thrilled when a Mount Sinai representative said they would assign a lawyer to help her legally change her name to Christine.

The lawyer filed her name-change petition with the court and helped Crawford, 56, with other steps, such as notifying her former spouse and publishing the name change in the newspaper. She gave Crawford information about what she needed to do to make the change official with organizations such as the Social Security Administration and the  state Department of Motor Vehicles.

Perhaps best of all, when Crawford graduated with a master’s degree in social work last month, her diploma had her new name on it.

“[The lawyer] was able to expedite the petition and the court date,” Crawford said. “She was a godsend.”

As healthcare systems continue to shift toward becoming comprehensive medical homes for patients,  providers are increasingly incorporating lawyers into the team of professionals who are on hand to help people at no additional charge to patients.

Roughly 300 healthcare systems, children’s hospitals and federally qualified health centers have set up these programs, said , co-director of the National Center for Medical-Legal Partnership at George Washington University in Washington, D.C.

The pairing makes sense in many ways. Legal issues all too often can cascade into problems with bad medical outcomes. Lawyers might file for an order of protection from a violent spouse, help appeal an insurance claim denial or get involved in child custody, guardianship or power of attorney issues.

For Care Connections at Lancaster General Health/Penn Medicine, in Lancaster, Pa., housing problems are a key area that requires legal expertise. The four-year-old program provides comprehensive primary care services for people with complex health and social needs, especially patients who are frequently hospitalized, said Dr. Jeffrey Martin, managing physician for the program.

For someone with severe asthma and other chronic medical conditions, “it’s hard to use inhalers and take 16 other medications if you’re living in the back of a car or on someone’s couch,” he said.

When someone is fighting eviction, has problems with federal housing subsidies, suffers a utility shutoff or has poor housing conditions, Care Connections staff call on Catherine Schultz. She is a legal aid lawyer with MidPenn Legal Services, which has a contract to work on such cases for Lancaster General Hospital.
Schultz worked to get the woman a federal housing subsidy and apply for Social Security disability benefits, then appeal the administration’s denial of benefits. They’re awaiting the results of the appeal. Martin described the case of one patient, a licensed practical nurse in her mid-30s who was diagnosed with multiple sclerosis. She lost her job because she could no longer work, and then her car was repossessed. She stopped taking her medications and couldn’t make it to her medical appointments.

In fee-for-service medicine, a hospital’s work was considered finished once patients were discharged, Lawton noted.

But health care has shifted toward value-based care that focuses on outcomes and avoiding preventable hospital readmissions. Now, “you are accountable for patients beyond the four walls of the hospital, and you have to think creatively about how to create stability for them,” Lawton said.

With that in mind, many health care systems are focusing on medical-legal partnerships that target patients who are high users of services.

“Once upon a time, the attitude of the provider was, ‘It’s not my problem that you have mold in your apartment,’” said Emma Kagel, manager of medical-legal partnerships at Denver-based Centura Health System. “‘I’m just going to keep pumping you full of steroids and give you an inhaler.’” That attitude doesn’t work with value-based care, she said.

Funding is always a problem for these programs where demand far outstrips supply. They are frequently staffed by legal aid attorneys under contract to the  providers. Some programs use private-sector lawyers working on a pro bono basis.

Mount Sinai, whose program is just getting off the ground, is taking a hybrid approach. In addition to a grant from the Manhattan District Attorney’s Office to provide child and family law services, the hospital partnered with law firms and other organizations to provide transgender and end-of-life legal services on a pro bono basis.

Sena Kim-Reuter, president of the Mount Sinai Medical Legal Partnership, said she’s focused on identifying gaps in patients’ needs where she can offer assistance. “There’s no way to handle all of it,” she said.


Survey: Value-based care, M&A’s to march on

Lazard’s Global Healthcare Leaders Study finds, among other things:


  • “Non-traditional pricing models may transform healthcare more than science over the next decade: almost half (47%) of healthcare C-level executives cite the adoption of value-based or risk-sharing pricing models as transformative over the next 5-10 years, compared to 38% who cite scientific breakthroughs.
  • “The survey results suggest strongly that the move to value-based care in the U.S. will take place even under a new administration in Washington. Among U.S. healthcare executives surveyed after last year’s presidential election, 55% said they expect the majority of U.S. healthcare payments will be value-based before 2020.
  • “Almost one-third of respondents in medical devices/tech/diagnostics and in healthcare services believe that non-traditional competitors will have a transformative impact on the industry in the next three to five years.
  • “Healthcare executives most frequently cited M&A, industry partnerships and collaborations, including with non-traditional competitors, as enabling the transformation of the industry over the next 5-10 years.
  • “More than half of respondents expected an increase in acquisitions of public companies over the next 18 months, and more than two-thirds expected an increase in private company acquisitions.”


Insurers unlikely to recoup much of unpaid risk-corridor payments


Sanford Health Plan,  the insurance unit of Sioux Falls, S.D., Sanford Health, has  sued the U.S. government to recoup unpaid payments under the risk-corridor program set up under the Affordable Care Act. However, they’re unlikely to get their money.
Sanford  is asking that the Feds pay nearly $9 million in overdue risk-corridor payments for 2014 and 2015. A complaint  that it filed in the U.S. Court of Federal Claims says that CMS has so far paid Sanford Health Plan only 15.1 percent of the amount that it owes.

Modern Healthcare reports that “Sanford Health Plan is the only insurer owned by a hospital system that has sued over the missing payments, which were meant to offset major losses during the first few years of ACA implementation. But it’s far from being the only provider-sponsored plan with an unpaid risk-corridor tab. Driven largely by the movement toward value-based care, many health systems entered the insurance space. Several have been successful, but the move has been difficult for many.”

In another disillusioning example, Scott & White Health Plan, run by Dallas-based Baylor Scott & White Health system, left the federal insurance marketplace this year based in part on almost $23 million in unpaid risk-corridor payments, a system spokeswoman told the news service.

Modern Healthcare reported that some insurers participating in the exchanges “never expected to receive the risk-corridor payments. They didn’t budget the payments into pricing and ended up being fine.”

“They look very smart in hindsight,”  Emily Wadhwani, a director at Fitch Ratings, told the news service.

The CMS owes insurers  about $8.3 billion to cover risk-corridor losses in 2014 and 2015.

But, the news service reports, “a victory in February for Moda Health may give insurers some hope. A federal claims judge ruled the Justice Department owes the insurer $214 million in payments as part of its participation in the program, saying the government ‘made a promise’ to insurers.”

It doesn’t look as if the Trump administration will help the insurers.  House Republicans’ 123-page American Health Care Act didn’t even mention the program, which expired at the end of last year.

To read more, please hit this link.

Shift to value-based care must include medical training


The new  emphasis on value-based care, managing populations and chronic diseases means that medical education must be reimagined.

A panel of physicians gathered during a morning session at the SXSW Conference  in Austin to discuss the need to redesign medical curriculum. That starts with a realization that “the competencies physicians need to be good healthcare providers and leaders are different now than they were 10 or 20 years ago,” said Susan Cox, M.D., executive vice dean for academics, chair, department of medical education, Dell Medical School, at the University of Texas at Austin.

Among the needed changes:

  • More and more patients need to know how much something will cost and physicians must provide them with this information, including offering them information on finding cheaper treatments.
  • Medical students need to be educated   about health insurance, underinsured versus uninsured, co-pays, and co-insurance and must be able to inform  patients on comparative values.
  • The students need to embrace shared decision-making. Greater interaction between providers and patients is required to adequately manage  conditions.
  • Finally,  much more emphasis should be placed on  training future physicians to address the  broad-based health challenges of their communities, including working with social-service and other nonmedical organizations.

To read a piece on this in Hospitals & Health Networks, please hit this link.

The value of shared clinician-patient decision-making in the ED


“There is tremendous potential for driving value-based care in the emergency department through shared decision-making,” wrote Edward Melnick, M.D., assistant professor of emergency medicine at the Yale School of Medicine, and Erik Hess, M.D., associate professor of emergency medicine and research chair for the Department of Emergency Medicine at the Mayo Clinic, in a Health Affairs blog post: “As we continue to build incentives for value-based care into our healthcare system, we should not leave the ED out.”

The post reported on the value of decision-aids to encourage shared decision-making during a randomized control trial at six EDs across the U.S.  The pilot program used a decision aid, “Chest Pain Choice,” developed by Dr. Hess and his research team. Chest pain, a frequent cause of patient visits to the ER, often leads to unnecessary admissions. So Dr. Hess’s team wanted to know what would happen if clinicians took the time to inform patients of their options.

The results, they write, were increased patient engagement and a reduced number of  what turned out to be unnecessary hospital admissions for cardiac testing. Doctors Hess and Melnick see this as a “multibillion-dollar opportunity” to reduce waste in the healthcare system. The findings were so promising that the researchers are developing decision aids to discuss CAT scans for people with minor head trauma.

To read more, please hit this link.

Going beyond HCAHPS to improve patients’ experiences


William Maples, M.D.,  chief medical officer of Professional Research Consultants and the executive director of the Institute for Healthcare Excellence, writes about how to go beyond Hospital Consumer Assessment of Healthcare Providers and Systems  criteria to improve the patient experience. Among his observations:

“A patient who feels listened to and genuinely cared for is a more compliant patient. A caregiver who feels trust and mutual respect at work will function at his or her highest level. But you won’t find either of these measures on the HCAHPS survey.”

“Unfortunately, due to financial incentives associated with HCAHPS and a growing focus on value-based care, we tend to equate patient experience with HCAHPS. In doing so, we have departed from a richer assessment of how patients actually experience care. We’re missing part of the story.”

“Measuring true patient experience and care value is more complex. Metrics must also include assessment of teamwork, communication, and the connection between patients and caregivers. The quality of the relationships creates the environment and culture of the workplace, which permeate all aspects of the patient experience.’

“In addition to HCAHPS, providers should examine other factors shown to be important to patients:

  • “The care team’s genuine concern and compassion.
  • “The amount of time caregivers spend with patients.
  • “The level of respect shown to patients.
  • The ability of caregivers to listen to patient questions and concerns.
  • “The ability of caregivers to communicate and work as a team.

“We need to focus on the quality of our interactions with patients. Do patients feel truly cared about, listened to and respected? Are we taking enough time to answer their questions? The most positive patient experiences arise from workplace cultures that understand the value of the patient relationship, and build teamwork, communication and processes that strengthen our engagement.”

To read more, please hit this link.

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