A survey by Neilsen Strategic Health Perspectives and the Council of Accountable Physician Practices (CAPP), found that only 49 percent of the 30,007 respondents said that their physicians could share information about their health and were aware of medical-history information before an appointment.
Among other rather depressing findings, summarized below by FierceHealthcare:
“Thirty-seven percent of patients diagnosed with multiple chronic illnesses –one of the groups that can benefit most from care coordination–reported they had follow-ups or care management, just slightly higher than 36 percent of patients overall.”
“The study also found that only a third of patients have access to 24/7 care like weekend or evening hours, access to urgent care in the same system or other off-hours access like telephone lines.”
Susanne Madden writes in Physicians Practice on why physicians need to join clinically integrated networks. She concludes:
“Many smaller practices and organizations are floundering as the healthcare market changes around them. Requirements for data reporting, care coordination, patient follow up, and so on, in order to meet new market and contracting demands is becoming too costly and cumbersome to support. Many smaller groups have little leverage in the market to secure good contract terms with both payers and hospitals that are building ACOs and limiting employee benefits to narrow networks —so coming together under these structures is a good way to share the load.
“Being part of a larger network of high performing (that is, ability to meet market quality metrics) providers improves leverage, minimizes participation costs, and allows for data to be managed centrally; which can help with CMS reporting, commercial payer pay-for-performance compliance, and patient tracking and management, for example. It is expensive to manage to metric-driven contracts, so utilizing CIN data mining across EHRs from multiple vendors helps to reduce that burden substantially. And if you can’t manage to the data, you can’t take advantage of performance initiatives and may be facing payment penalties in the months to come.
So if you are an independent physician, you may want to see what options are available to you to partner up with larger physician groups, hospitals, or health systems that can help you thrive in the big data market. Now is the time.
Modern Healthcare reports:
“Managing large patient populations within value-based reimbursement models is placing new demands on clinical support staff to improve patient care coordination. Case managers, social workers and pharmacists today are working alongside primary-care providers with shared responsibility for making sure a patient’s care is well-managed.
“It’s created the need for software programs that go well beyond the typical electronic health record. San Francisco-based Acupera is seeking to meet this emerging need with a software platform that recognizes that care coordination requires a team-based approach.
“Its care-management software uses a complex algorithm that automatically converts data drawn from multiple data sets into a sophisticated care plan for each patient that can be used by both clinical and nonclinical staff, many of whom have limited experience with traditional EHR systems. Acupera is betting that, eventually, functions integral to population health management will be prompted by software and performed automatically.”
Researchers found that an alternative payment model in Massachusetts meant to encourage overall healthcare coordination for mentally ill patients didn’t improve overall health-system coordination for these people, or improve care quality, but it’d didn’t hurt their access to care either.
Researchers looked at claims data in 2006-2011 to examine whether the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract affected mental-health service use, mental-health care spending, total spending and quality of care.
Last week, the Centers for Medicare and Medicaid Services released its 2014 Actuarial Report on the Financial Outlook for Medicaid.
The report is making headlines because the actuaries estimate that for 2014 the newly eligible Medicaid expansion population had costs greater than the non-newly eligible Medicaid population.
But, Emma Sandoe writes in Health Affairs, “While we still do not have final figures on how much new Medicaid enrollees spent on medical care in 2014, we do have evidence—including a recent study by Naderah Pourat and co-authors published in the July issue of Health Affairs—that primary care and care coordination can help reduce the initial care costs of Medicaid enrollees entering the healthcare system for the first time.
“After all, evidence suggests newly eligible Medicaid beneficiaries are healthier and less costly than the current Medicaid population. However, when negotiating their managed care contracts, many states estimated that the newly eligible would cost more in the first year than non-newly eligible individuals. This approach was based on the theory that the first newly eligible people to enroll would be those previously locked out of the insurance market, quickly entering the healthcare system with pent up demand. Additionally, they would be sicker and would require more healthcare services.
“But it doesn’t have to work that way. Pourat and colleagues show how, several years ago, California found a way to reduce the cost of newly insured Medicaid beneficiaries entering the healthcare system for the first time: care coordination.”