Tuesday, November 18, 2014

Turn Population Health Data into Meaningful Disease Management Strategies

Via Health IT Analytics, a FDA/CMS Summit for Payers event supporter. View the complete article here.

How can providers turn population health data into meaningful chronic disease management?

When you hear the words “population health management” chronic disease care almost immediately comes to mind, diseases such as; diabetes, asthma, hypertension, and COPD. They sap billions of dollars from the healthcare system every year, and represent an enormous challenge for providers.  From medication adherence apps to appointment reminders sent through the EHR, providers have a range of tools at their disposal to track, corral, and encourage patients to manage their own care.

How can providers leverage these technologies while employing effective management strategies that provide patient-centered, population-minded care?

Which patient engagement, adherence strategies will work?

A provider can implement all the health IT in the world, but effective chronic disease management will still rely almost entirely on the patient’s willingness to engage with their care strategies, take their medications, and show up at their appointments.  Devising patient engagement strategies that produce measurable results requires an intimate knowledge of the targeted patient population, an understanding of what drives non-adherent behaviors, and a familiarity with technologies that truly appeal to patients.

For example, the patient population that is covered by Medicaid may face much different socioeconomic challenges than a privately insured community that receives support via their employers.

Dr. Margie Rowland, Chief Medical Officer of CareOregon said, "Many of our members are very poor and have literacy issues" She added, “It’s not just about taking the right pills or coming back for appointments, but it’s making sure people actually understand their illness and understand what questions to ask, or getting help with transportation to their provider - it’s not just health literacy.  It’s literacy in general.”

Different communities require differ services. For instance a non-english speaking population may require a translation service, while a rural population could require telehealth services to eliminate long drives.

Healthcare providers should be sure to assess their patient population before committing to any engagement strategy. The pairing of data with community feedback will provide a base for future efforts.


At FDA/CMS Summit for Payers, Michael Willis, PhD, Vice President & Business Information Officer at Kaiser Permanente will discuss how information technology shows tremendous potential in helping reduce disparities by improving access and information flow as well as communication between providers and patients. Session information below:

Health Disparities Using Technology to Bridge the Divide

Health disparities continues to be a major issue for our country. As our country’s diversity has grown we have also seen a parallel increase in health disparities. This presentation will focus on the challenges associated with health disparities and how Information Technology can be used as a catalyst for collaboration and education to measurably improve the lives of individuals and their families.

Register for FDA/CMS Summit for Payers now and take $100 off the current rate when you use the code XP1917BLOG.

Register Here!

Monday, November 17, 2014

Dual Eligibles and HIT: Managing Not Just Measuring

By Nalini K Pande, JD

Why is HIT Important to Duals?

There’s an old saying in the health care quality world: “We cannot improve what we don’t measure.”   And, of course, the follow-up to that is: “how can we measure without good data?” Health Information Technology (HIT) is at the heart of one the most exciting aspects of health reform.  HIT systems are designed to collect and display data related to the delivery and care of patients.  

Dual eligibles are covered under both the Medicare and Medicaid programs and are generally the sickest and most costly beneficiaries of the Medicare and Medicaid programs.  Given this, it is essential that HIT systems, including Electronic Health Records (EHRs),  are designed to supply actionable data for the measurement of dual eligibles and ultimately, to improve the care of this unique population and reduce costs.

Where Are We Now?

The future of the nation’s health measurement and  HIT agenda is at a cross-roads.  We are still in the process of changing old systems to move us into the health electronic age.  We are also in the process of developing and endorsing measures specific to the duals population.  As we do so, there are several key issues that we must focus on to improve the care of the dual eligibles population.  One issue that stands out above the rest is how to better manage this unique population, not just measure them.  It is not enough to just collect the data.   Rather, it is what we do with this data and the measurement findings that will ultimately lead to improvements in health outcomes and care delivery for dual eligibles. HIT can capture data that is critical in improving care coordination, care transitions and disease management for dual eligibles.  We must use this information to analyze clinical trends and better engage dual eligibles as well as help providers in clinical decision support.

It’s no surprise that in the world of health apps and iphones, we turn to HIT to revolutionize our health care systems and improve outcomes.  However, HIT alone is not the Holy Grail we seek.   Rather, HIT is only a tool to get us the data we need to measure and improve our patient outcomes, our clinical care, and our delivery systems.  The story cannot end with more measures and data.  Otherwise, we will simply collect a lot of good information without much action.  We must re-tool our delivery systems and health care culture so we can act on the data we capture such as changing patient care plans and engaging patients differently.  Essentially, we must focus on moving from health measurement to health management and outcome improvement.   This will take a stronger focus on analyzing the data, and measurement findings, using predictive modeling, and taking a more proactive rather than reactive approach.  Many Accountable Care Organizations and other health entities have embraced this new approach but it is far from the norm.  Can we afford to shift from measurement to management?  Many fear the cost of HIT alone is too great.   However, with duals costing Medicare and Medicaid $250 billion, can we really afford not to?

Nalini Pande, Managing Director, Sappho Health Strategies has nearly 20 years of experience in healthcare policy and reform.  She has considerable experience in Medicare and Medicaid, and emerging payment models including health information technology, accountable care organizations and patient-centered medical homes. Ms. Pande also has strong expertise in dual eligibles and the specific issues facing this unique population.  Ms. Pande is a graduate of Harvard Law School and Princeton's Woodrow Wilson School of Public and International Affairs.

Friday, November 14, 2014

Health Care Insights | Weekly Round Up

Health Care Insights brings you your weekly healthcare round up. Below you will find relevant articles on key industry topics that we thought our readers would benefit from - enjoy.

Top Stories:

CMS Says Some Providers are Obstructing Dual-Eligible Demonstration
The CMS official in charge of coordinating care for Americans covered by both Medicare and Medicaid says some healthcare providers are illegitimately trying to dissuade dual-eligible beneficiaries from participating in a managed-care initiative designed to test ways to reduce costs and improve quality. She said her agency has increased its surveillance of these providers, though she did not identify any by name.

Plans Say Duals Bring Down Star Ratings, Beneficiary Advocates Not Convinced
(Subscription Required)
As CMS looks at possible changes to the Medicare Advantage star ratings program, health plans say that poorer beneficiaries are causing lower-than-appropriate star ratings for some MA plans, though the Medicare Rights Center says that current data do not show that beneficiaries' low income is the root cause of lower quality care for those beneficiaries.

Work Group Submits Comments to CMS on Sovaldi, Breakthrough Therapy Designation Medications
The Medicaid Work Group sent a comment letter to the Centers for Medicare and Medicaid Services on the introduction of Sovaldi and other new  Breakthrough Therapy Designation medications and their potential impact on Medicaid costs.

Vitamin B Doesn't Reduce Cognitive Risk in Healthy Elderly
Lowering plasma homocysteine levels with oral vitamin B12 and folic acid does not appear to be an effective strategy for reducing memory loss and Alzheimer's risk, according to findings from a randomized, clinical trial of elderly people in the Netherlands with elevated homocysteine.

Joint Commission Report: U.S. hospitals are getting better, but there is still room for improvement
If the Joint Commission‘s assessment of a hospital is any indication – and by just about all accounts, it’s the indication – hospitals across the U.S. are improving, with more than 1,200 having achieved “top performer” status. A total of 1,224 made that cut, an increase of 11 percent from last year. The top performers represent nearly 37 percent of more than 3,300 Joint Commission-accredited hospitals that contributed data, according to its annual report.

Have a great weekend!

Tuesday, November 11, 2014

Register for the FDA/CMS Summit for Payers by Friday 11/14 to Save $300!

Attend the FDA/CMS Summit for Payers to initiate the collaboration, with top government and key regulatory bodies working closely with healthcare leadership to join forces and build an open culture of harmonization to provide efficient and affordable healthcare to all patients.

This meeting stemmed from the infamous Solvaldi case, as the FDA approved the specialty drug to go to market but with it being so expensive, it caused major problems for the CMS and health plans. No longer can regulatory bodies work in silos, it's time for collaboration!

But hurry—time is running out! Register by this Friday 11/14 and save up to $300 off the two-day rate. Or, if budgets and time are tight, choose the one-day option and attend for only $895. Be sure to use the code XP1917BLOG to save.

Register Now! 

If you haven’t already done so, download the brochure to see the full speaking faculty, including some of the most influential people in health care.

See you this December!

Friday, November 7, 2014

Health Care Insights | Weekly Round Up

Health Care Insights brings you your weekly healthcare round up. Below you will find relevant articles on key industry topics that we thought our readers would benefit from - enjoy.

Top Stories:

A Post-Election Day Certainty: New Scrutiny for the Affordable Care Act
This week’s elections ensure a new round of political attacks on the Affordable Care Act, but they also create potential opportunities to repair provisions of the law that people on both sides of the partisan divide would like to fix.

Big data: Enabling the Future of Healthcare
Everyone’s talking about the importance of big data in healthcare. Yet, as the data piles up – most of it is isolated in different silos, and health systems are struggling to turn big data from a concept into a reality. Here’s how I see it having a substantial impact on the health of populations, today and in the future.

Electronic Medical Records, Built For Efficiency, Often Backfire
Electronic medical records were supposed to usher in the future of medicine. Prescriptions would be beamed to the pharmacy. A doctor could call up patients' medical histories anywhere, anytime. Nurses and doctors could easily find patients' old lab results or last X-rays to see what how they're doing. The computer system could warn doctors about dangerous drug combinations before it was too late.

Steward’s ACO focuses patient engagement efforts on 4 percent of covered lives
According to Girard, there are two fundamental processes in healthcare, information flows and people flows. The ideal, he said, is for both processes to be happening at the right time in the right place.

Coordinated care and patient engagement
The healthcare breakthrough of the 21st century may not come in the form of a miracle drug from the pharmaceutical industry. Rather, it's more likely to emerge from the ways caregivers interact and motivate patients.

Enjoy the weekend!

Wednesday, November 5, 2014

Five Steps to Get Started with Population Health Management

Via Health IT Analytics

Below is a snippet from an article by Health IT Analytics, an FDA/CMS Summit for Payers event supporter. To view the complete article, click here. 

Building a population health management program requires a strong vision and a data-driven strategy for providing high quality, coordinated care.

Population health management encompasses a wide and varied range of activities, including care coordination, chronic disease management, health information exchange, patient risk stratification, clinical analytics, community outreach, and internal quality improvement.  With so many different ways to approach what is basically a large-scale revolution in the way healthcare organizations views their role in patient care, it’s no wonder that many providers find it difficult to know where to begin.  What are some of the ways providers can start to build a population health management program that will produce better patient outcomes without breaking the bank?
  1. 1. Clarifying goals and developing a roadmap
  2. 2. Infrastructure investments and data analytics
  3. 3. Engaging your staff members
  4. 4. Engaging your patients
  5. 5. Ensuring care coordination and follow-up
To learn more about each of the previously mentioned steps so providers can start to build a population health management program to produce better patient outcomes, visit Health IT Analytics where you can view the entire article.

Tuesday, November 4, 2014

Dual Eligibles and ACOs: A Blueprint for Success

By: Nalini K Pande, JD

Background:  Why Duals Need Stronger Focus and Attention

You may notice that when we talk about health reform, most health policy experts tend to bring the conversation back to the dual eligibles.  These beneficiaries are covered under both the Medicare and Medicaid programs and are generally sicker and costlier than Medicare and Medicaid beneficiaries as a whole.  Thus, it is no surprise that duals have been the focus of those trying to bend the cost curve.

ACOs May Be Uniquely Situated to Address Key Duals Issues

How do we improve the care of these beneficiaries while also working to reduce costs?  Accountable Care Organizations (ACOs) that take on dual eligibles, are uniquely positioned to provide effective solutions. An ACO is a group of coordinated providers in which provider reimbursements are linked to quality metrics and reductions in the total cost of care for an assigned population of patients. Given their emphasis on patient-centered, integrated care and coordinated Medicare and Medicaid benefits and funding streams, ACOs could facilitate greater quality improvements and reduce cost-shifting between programs as well as overall costs. Yet, the fundamental question still remains:  What is the blueprint for success?

Two core frameworks will need to be developed as part of a blueprint for success:
   • ROI Framework
   • Measurement Plan

Certainly additional key components will be necessary.  However, two critical components of the blueprint for ACO success are ROI (return-on-investment) and Measurement frameworks. First and foremost, a successful ROI framework is needed to ensure financial viability of the ACO structure: (e.g, hospitalization costs must be significantly reduced to pay for increased expenses in care coordination, care transitions, and care management). 

Second, a measurement framework will be needed to test improvements in quality.  Key measures should include patient-reported outcome measures, beneficiary experience, care coordination measures, utilization and cost measures, etc.

As part of this blueprint, the ACO must consider the barriers and challenges to changing the current system. How can the ACO overcome these barriers?  This will depend on whether the ACO can achieve a true culture change at three levels:
  • • at the governing level with a stronger focus on clear and attainable management goals and benchmarks with diverse stakeholder input
  • • at the clinical level with team-oriented care in order to improve care coordination and
  • • at the community level with a focus on population health and collaboration with community organizations.

Can ACOs that take on duals bend the cost curve and improve quality? This has yet to be seen.  Setting ACOs up with a blueprint for success may be just what the doctor ordered.

Nalini Pande, Managing Director, Sappho Health Strategies has nearly 20 years of experience in healthcare policy and reform.  She has considerable experience in Medicare and Medicaid, and emerging payment models including accountable care organizations and patient-centered medical homes. Ms. Pande also has strong expertise in dual eligibles and the specific issues facing this unique population.  Ms. Pande is a graduate of Harvard Law School and Princeton's Woodrow Wilson School of Public and International Affairs.

Friday, October 31, 2014

Health Care Insights | Weekly Round Up

Health Care Insights brings you your weekly healthcare round up. Below you will find relevant articles on key industry topics that we thought our readers would benefit from - enjoy.

Top Stories:

How The Upcoming Elections Might Shift The National Health Care Landscape
Here’s a solid prediction about next Tuesday’s elections: They’ll be crucial to the future of universal health care in America — or at least its near-term future.

Health Care Catches Data Fever
The United States is arguably in the midst of a health care crisis, but there is hope on the horizon and it involves learning how to make sense of big data. Over at Communications of the ACM, Oak Ridge National Laboratory (ORNL) shares how it is helping the health care industry benefit from patient data using the power of graph computing.

CFOs Feel Powerless When It Comes To Managing Healthcare Costs, Poll Finds
With U.S. enterprises spending more than $620 billion each year on healthcare costs, and nearly half of all Americans receiving their coverage through their employer, it’s no surprise that four out of five chief financial officers (CFOs) across all industries are feeling the pressure. In fact, nearly all CFOs (97%) believe that employers must “step-up” to the plate to help fix the broken healthcare system.

Omidria™ Granted Pass-Through Reimbursement Status from CMS
Omeros Corporation (NASDAQ: OMER) announced today that it has received transitional pass-through status for its lead product Omidria™ (phenylephrine and ketorolac injection) 1%/0.3% from the Center for Medicare & Medicaid Services (CMS), the federal agency that administers the Medicare program.

Health Groups Aim to Grow Pharmacists’ Care Delivery
Community Care of North Carolina (CCNC), GlaxoSmithKline (GSK), and the University of North Carolina (UNC) Eshelman School of Pharmacy have collaborated to generate new approaches to care delivery through pharmacists that will lower medical costs and improve health outcomes.

Have a great weekend!

Wednesday, October 29, 2014

The Medicare Congress Brochure is Now Available | Register Now to Save $600

The 12th Annual Medicare Congress was designed with you and your team in mind—covering Medicare and Dual Eligibles from A-Z. Make sure you join us this February 3-5 in New Orleans!

Let us help you navigate through the evolving landscape so you can increase reimbursement with stronger Star ratings, build relationships with provider networks to improve quality of care, meet the clinical needs of dual eligibles to attract and retain new members— and much more!

What’s new at Medicare Congress 2015:
• C-Level Sound Off
• Patient Advocacy Group Panel
• Think Tank Roundtable Luncheon
• Town Hall Round-up
• And more!

Register now and SAVE $500 but use the code XP2007BLOG and take an extra $100 off – total savings of $600! Register here.

PLUS! Dual Forum and Stars University are back by popular demand. Click here to learn more.

Tuesday, October 28, 2014

Rising Drug Costs

Welcome to this FDA/CMS Summit for Payers podcast.

Below is a teaser from our podcast with Bill Winkenwerder, Former CEO, Highmark Inc.

How should manufacturers determine drug prices and what consideration should there be?

Bill: Well, certainly manufacturers need to recover their costs – their investment in R&D – and it’s important that they make a profit. Nobody can be in business for any period of time without being able to make a profit. Now, more recently – especially with respect to certain manufacturers that have brought very expensive medications to the market – have been criticized and have been identified as charging too much. That’s the common perception, but I see the immediate evidence that the prices for these medications – given the relatively small population of people that would benefit from them – that there is a serious over-charging that’s going on. But, certainly we need to sit down and talk and determine if there is a better way to arrive at the price. What is a fair price? What is a good, market-based price? That’s what this Conference is about.

To see more from Dr. Winkenwerder, download the complete podcast here.

Download the updated event brochure here. 

Bill will be joining us at the FDA/CMS Summit for Payers in Washington D.C. for his closing keynote address "An Industry Perspective: Payment Policy for Clinically Valuable But Very Expensive Pharmaceuticals" on Friday December 12th.

Register now to save an extra $100 off the current rate with the code XP1917BLOG.

See you in Washington D.C.