We are in an age when data matters more than ever. It affects how much physicians earn, how much hospitals make (or lose) and whether treatment plans evolve based on efficacy.

Accountable Care Organizations (ACOs) are under increasing pressure to make the data work out. Whether in managing EHRs/EMRs, doing analysis of big data, working with the Medicare Shared Savings program, or handling fee-for-performance models, hospitals must be more sophisticated than ever before.

It is an almost impossible challenge for hospital administrators to manage all of these intricacies and also keep the common sense and fundamentals of "good medicine" alive. So we were inspired by some recent comments by Joel Vengco, vice president and CIO of Baystate Health in Massachusetts.

To give you a sense, Baystate Health is huge. It is a six-hospital health system with 80 medical groups, serving 900,000 patients across four counties.

And yet - when asked what the biggest challenge for Baystate Health as an ACO is, Mr. Vengco said:

"The first big hurdle is just really creating the necessary environment for collaboration across the continuum of care and the region... Everyone is responsible for that patient population... So it’s really back to the basics of collaboration, which is in many ways a fundamental principle, but is also sophisticated and complex with regard to an operation like that." 

This is definitely representative of our experience with hospitals that use ClickCare -- and those that don't. There is a lot of complex analysis that happens, but ultimately, success in an ACO setting comes down to excellent care coordination, superb healthcare collaboration, and healthcare providers across the continuum of care.

It's not easy work, but there are tools (like some telemedicine platforms) that can help. It's work that's done person by person, day by day.

 

For our best advice on creating that environment for healthcare collaboration, get our free Quick Guide:

 

 

 

 

Photo of Baystate Medical Center used under Creative Commons rights from orlandosworld on Flickr

Healthcare in the US is almost unfathomably complex. Plus, it's always changing, such that it can be very hard to notice trends in any useful way.

However, we are at an especially volatile and important moment in medicine, with the reverberations of the Affordable Care Act still playing out. Just in the past few weeks, I've noticed a few trends that I think every ACO, every hospital, and every medical provider should have their eyes on.

3 shifts in medicine that will probably impact you in the next year:

• Insurers will be demanding "more" from providers and hospitals.
  On one hand, insurers are squeezed by higher-than-expected costs of the newly insured. Many are now requesting rate increase approval from the government. As the New York Times reports, "The rate requests, from some of the more popular health plans, suggest that insurance markets are still adjusting to shock waves set off by the Affordable Care Act." On the other hand, many insurers are merging, which gives them more leverage over hospitals and providers.  The pressure to increase revenue and cut costs, combine with increased power from mergers may well add up to more demands on providers and hospitals.
• Non-traditional care contexts are becoming the norm.
  Because of shifts in what is able to be reimbursed under the Affordable Care Act, there are new delivery mechanisms being pioneered. For instance, there is a current boom in diet clinics, due to ACA reimbursement for obesity consultations and treatment. It's likely that as care outside of doctors' offices increases (with other medical providers being the ones actually interfacing with the patient), healthcare collaboration (especially using telemedicine tools) will become more important. Collaboration will need to happen more, and across the spectrum of care, in order for patients not to fall between the cracks.
• Home care is a growing segment of medicine, and we're (mostly) not doing it well.
  Data is beginning to suggest that there are more homebound people than ever before, and they're sicker. Plus, there are more caregivers who are older family members and need support themselves. This type of dynamic means that medical providers are responding, and finding ways to provide care at home. For instance, there is a growing group of geriatrics practices that make housecalls. And if those housecalls have to be made by specialists because there is insufficient technology to allow collaboration at a distance, that's going to be unsustainable. If these trends continue, we'll need to find ways for the people providing the home care to be supported by other medical providers, in efficient and effective ways.

For decades, medical providers had the luxury of ignoring macro trends. These days, however, I think that we ignore these dynamics at the peril of ourselves, our practices, and our patients. For us to act with wisdom, sustainabily, and in service of good medicine, we must act with these things in mind.

And really, that is more of a privilege than a burden.

 

To learn how iClickCare can help you adapt to these shifts, click here: 

 

Last week, the Centers for Medicare & Medicaid Services made an announcement that is really significant, but perhaps not surprising. They are launching a program that will further cement managed care and even more deeply link performance and payment -- the Next Generation ACO Model.

It is designed for ACOs that are experienced in coordinating care. The announcement notes: “It will allow these provider groups to assume higher levels of financial risk and reward than are available under the current Pioneer Model and Shared Savings Program (MSSP). The goal of the Model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for Original Medicare fee-for-service (FFS) beneficiaries.”

Part of the announcement is the expansion of telehealth services. This further cements the use of iClickCare, not as flourish or a "nice to have", but as a routine way of taking excellent care of patients. As the American Telemedicine Association clarified: “The decision is particularly significant because under this new model, Medicare telehealth services can be covered without regard to longstanding rural and institution restrictions, requiring a beneficiary be located in a rural area and served at a health facility. For the first time, telehealth coverage will be extended to 80 percent of Medicare beneficiaries living in metropolitan areas and from any service originating site, such as their home.”

Only 15 to 20 ACOs are expected to participate, but the message is becoming increasing clear:

Reward and risk are, increasingly, being transferred to the provider.

Are we moving back to a time before Medicare existed? Of course not but it seems that there is more recognition that the provider and the patient are part of the solution rather than part of the problem. We wonder why this is being approached in such a small way, but we also recognize that it only takes the tiniest of sparks to start a bonfire that will last the whole night.

iClickCare welcomes the opportunity to help ACOs reduce risk. More than care coordination, real risk reduction requires collaboration, which is iClickCare’s core mission. The deadline for a letter of intent for the Next Generation program is May 1, 2015, just 45 days away. If you are applying, contact us and we'll explore how we can support you. 

The benefits and savings of iClickCare have existed for decades. Now, the difference is that this type of coordination of care and strategic collaboration are indispensable -- and supported by the government. Now, more than ever, is the time.

 

As telemedicine becomes more important for managing risk, coordinating care, and decreasing the costs of care, you can try iClickCare for free: 

Last weekend, I visited Philadelphia to see my daughter. As I walked along one cobblestone street, I noticed a metal plaque with four interlinking hands on some of the oldest homes. It was familiar to me, and in reminding myself of the history of these placards, I realized something fundamental about the changes in medicine.

But let me back up. In fact, let me back up to Benjamin Franklin in 1752. In response to the horrific fires in the young city of Philadelphia, Benjamin Franklin put together a “contibutionship” to take care of rebuilding after the fires. Modeled after a London firm, policyholders of this contributionship formed a mutual insurance company to share burdens in the case of fire. A contributionship member placed a medallion or plaque on the house. When a fire occurred, the paid firemen raced to the scene and put the fire out. If there was no medallion, they watched the property burn. Of course, risk was managed: there could be no trees on the property of the houses with medallions.

Capitated care, managed care, accountable care are all built on the same principle. Benefits (care) are given, but risk is shared by everyone involved. The only difference is that there are a lot more middlemen and statisticians in the healthcare system. And rather than each member paying directly, the member pays taxes or a premium to the government or insurance company.

Management of that care involves finding a better way to decrease costs. Instead of requiring no trees on the property, healthcare management focuses on efficiencies and expensive outcomes. iClickCare focuses on both the quality and savings of coordinated and collaborative care. Everyone “at risk” -- institutions, providers and patients themselves -- can contribute to the outcome by safe handoffs, time saved, and decreasing waste.

The nearly unspoken caveat is that everyone must behave differently. Not only the providers need to change, the patients need to do so as well. An excellent commentary on that piece by Christensen, Flier and Vijayaraghavan is here.

So as these concepts become even more crucial for us all to move towards sharing the burden of disease, managing risk, decreasing costs, and providing good care, these are the definitions that will be crucial:

• Capitated care:  By the head. The payment for insurance to care for a member for a fixed fee per year.
• Managed Care:  Adding tools such as approvals for procedures, a panel of physicians, and occasionally rationing of services. Remember the rule about trees in the contributionship? HMOs have those kinds of provisions.
• Accountable Care Organization:  An organization which pays by capitation or fee for service, but adds penalties and rewards based on quality measures from the Centers for Medicare and Medicaid Services.
• Managed Medicaid:  A healthcare payment system by states which enrolls the poverty stricken in a capitated plan. Payments to providers can be fee for service or capitated.
• Prepaid Health Plans:  Same as above. Prepaid group practices developed from 1930 through 1960.
• HMO (Health Maintenance Organization):  A prepaid health plan but based on the Health Maintenance Organization Act of 1973. Payment for services is only made within the network of the plan after referral from a primary care provider.
• PPO (Preferred Provider Organization):  A prepaid heath plan in which the patient is able to make self referral within and without of the network of the plan.
• EPO (Exclusive Provider Organization):  A hybrid of HMO and PPO. The patient selects the provider without a primary care referral, but the care must be exclusively within the network of the plan.
• BPCI (Bundled Payments for Care Improvement):  Not prepaid, but retroactively paid services to groups of providers to force alignment of incentives. A managed care program with retroactive payments instead of prospective payments. 

When all is said and done, though, medicine should come down to a partnership with the provider and the patient. The doctor, the nurse, the aide and the therapist are a team with the patient and for the patient. Any system will only work when it is also really bought into by the patient. For as Benjamin Franklin said when referencing fighting fires: “an ounce of prevention is worth a pound of cure."

 

Tools like iClickCare can support a Managed Care system by improving the way that coordination and collaboration happen. See how iClickCare can work for your organization with a free 2-week trial:

I live in a beautiful rural area, which is great -- unless you are trying to grow a vegetable garden.

It seems like the country would be perfect for vegetables, but I've found that when gardening where I live, wildlife becomes a daily battle, with deer seizing upon produce with the stealthy precision of Navy SEALs. I had always seen more proficient gardeners with pro-built custom fencing solutions and felt that I obviously couldn't choose one of those. I could build that myself! It's just a little fencing and I could see what they were trying to achieve with each component. Plus, the all-in-one solution cost $600.

Anyone that's ever tried a home improvement project knows where this story is headed: $540 of materials, nine days of work, and three trips to Home Depot later, I had tried to replicate the all-in-one solution, cut myself with the fencing, had to return all the materials, and eventually just bought the all-in-one solution.

Now, the DIY version is not always worse. I make bread and cheese at home, and my wife sews. But usually the cobbled-together solution is better when you don't care as much about the outcome as the process. For instance, when you include the books, materials, and resources that I've bought to make my homemade bread, it certainly doesn't come out cheaper than the stuff from the bakery. But I love the process, so it makes sense to do.

Every day, we're under increasing pressure to cut costs while improving outcomes: more and more is demanded, with fewer and fewer resources. In that context, many people have come to us looking for ways to save money on care coordination tools, platforms, and protocols. You know that you really need an efficient solution to prevent readmission and manage care of your patients, but you don't want to waste resources.

So when is an all-in-one system worth it? And when does it make sense to create your own care coordination system?

 

These are some of the common functions that Accountable Care Organizations and managed care organizations tell us they need in a care coordination platform (whether telemedicine or not):

• Make your information technology network very secure and impenetrable from the outside. Be sure that files on the network cannot be seen by everyone.
• Find a way to prevent transmission of pictures or taking of pictures. (We have found this to be a frequent answer, and while secure, does little to coordinate care.)
• Use a checklist so that nothing gets dropped.
• Enable both provider-to-provider communication as well as patient-to-provider communication.
• Send secure messages between providers
• Archive unique cases for teaching to medical students and residents.
• Create a patient portal so they can understand the course of treatment and engage in options.
• Integrate with EMRs and EHRs
• Manage admissions and discharge.

These are all functions that can be handmade, homemade, or patched together using existing tools. So when hospital systems and managed care organizations come to us to ask, we always tell them the same thing: if you're excited about the process of piecing together your own care coordination / medical collaboration / telemedicine system, then go for it! But if you're looking for the most efficient and effective outcome,  you may be better off with the pro-built system (iClickCare is one option) that has it all included already. Just as I would have been with the vegetable garden fencing. 

 

If you've been doing cost comparisons of telemedicine systems for care coordination, maybe our guide to one all-in-one system can help:

 

 

 

 

Image courtesy of hardworkinghippy on Flickr, used under Creative Commons rights.