Presentation slides and recording of 10/2/18 webinar.

Risk-based reimbursement contracts are the vehicle some health systems are using to move to value-based care, prompting health systems and plans to partner and share analytic tools.

On this webinar, speakers from Marshfield Clinic Health System and Milliman MedInsight discuss the top five tools they believe drive the success of their 6-year analytic partnership, which has helped mitigate risks and improve patient care.

By attending the webinar you will learn to: 

-Leverage predictive algorithms, benchmarks, and grouper technology
-Quantify cost reduction opportunities and utilization rates on potentially low value services 
-Use a cohort approach to fine tune care coordination programs for Population Health

Speakers:
-Michael Sautebin, Chief Actuary, Security Health Plan 
-Meghan Fetherston, Principal and Healthcare Analytics Consultant, Milliman

The Role of Consumer Consent in Health Information Exchange (HIE) 

The traditional one-way information transfer considered the healthcare provider as the expert communicator and the patient as passive receiver of information. Patient-centered care operates based on patients’ preferences to improve patient safety and increase patient satisfaction and participation. A mutual exchange of information ensures that both patients and healthcare professionals form a partnership. Greater patients’ participation in Health Information Exchange can lead to higher degree of trust among all types of demographic groups. Patients need to be more engaged in decisions about data exchange through HIE in order to trust the technology and the healthcare system. The right of informed choice and consent is a meaningful means to achieve the support of consumers regarding HIE. However, the process of handling informed consent has caused variety of concerns such as security and privacy risks for patients. In this study, the role of consumer consent is discussed using the literature review method.

The full paper can be downloaded below.  

Navigating Your Path to Consumer-Driven Health Plans

As employers move toward offering a consumer-driven health plan (CDHP) as part of their employee benefits, many have questions such as:

• How do employees respond to consumerism?
• Are my employees ready to assume greater control and responsibility?
• What can my company do to make the transition easier?
• Will the benefits of making the transition be worth the expense and the upheaval?

This research from Humana answers those questions and more. Over a 15-month period, researchers studied individuals representing different age groups, family structures, employment positions, and income levels. Participants remained anonymous. The findings are reliable, but due to the nature of qualitative research, they cannot be considered representative of the general population. By studying the same people over time, an evolution can be seen in employees’ attitudes, beliefs, and behavior, and employers can make note of potential obstacles to avoid.

The study findings are summarized below.

Best Practices

• Employees appreciate choice - Your company’s implementation of a consumer-driven health plan can be smoother by designing offerings with choice in mind—and by making sure each offering is distinct. You can further build employees’ confidence in their enrollment choices by helping them predict potential costs and by providing tools that can help them forecast future healthcare needs.
• Employees want to “try it on” - The ability to predict healthcare needs and costs leads to confident decision-making in choosing a plan.  Permitting employees to make use of company computers, hosting training classes, or setting up kiosks can help overcome lack of computer familiarity. Likewise, employee expectations can be made more manageable by facilitating ongoing communication or by providing employees with a “coach” that can guide them in predicting healthcare needs and selecting an appropriate plan.
• Getting results - Changes in attitude and behavior are driven by experience and the desire to contain out-of-pocket costs.  One way to enhance an employee’s sense of control over their own healthcare is to communicate year-round about the benefits that the employee has selected and how he or she has used the plan. Such communications could include an individualized statement of benefits used or year-to-date cost savings
• The need for ongoing support - A system of supportive communication can help build familiarity and boost employee confidence.
• Money matters - Consider exploring special incentives that encourage employees in the responsible use of their plan benefits.
• Planning pays off - Encourage your employees to plan ahead for emergencies and provide the tools to make planning easy.
• Transparency is necessary - When your employees understand the value of transparency in healthcare, they are likely to have much greater confidence in their ability to be smart consumers. You help facilitate this understanding by making sure employees are aware of the tools available to them and by providing training to ensure that they are able to use these tools easily and effectively.
• Keep it simple - Employees’ top priorities are ease of use and claims follow-up.  There is a desire to see their spending information presented in a familiar, user-friendly frame of reference, such as a credit card statement.  You may also wish to explore options that can help simplify claims and reimbursement.
• Consumerism meets individual needs - There may be a need to acknowledge the various temperaments and styles in which people organize information. You may need to deliver information in a variety of ways. Consider surveying your employees about their preferred methods of receiving information.

The full Humana Research Summary can be downloaded below.  

Actionable Intelligence at the Point of Care can Help Prevent Physician Burnout

It’s no secret that today’s physicians are expected to do more with less—less than complete patient information, less time to spend with each patient, fewer resources in general—all while delivering high-quality, cost-effective care to an increasingly value-focused and highly regulated consumer marketplace. The stakes are high, and many of these factors can lead to burnout.  Furthermore, administrative hurdles such as completing prior authorizations and addressing "sticker shock" concerns at the pharmacy also contribute.  

The good news is that physicians have access today to EHR-integrated prescription drug price transparency and prior authorization tools, which work together seamlessly to create an optimal experience for patients, pharmacists and physicians while helping to prevent or relieve physician burnout.

With actionable patient intelligence delivered to the point of care, physicians see how much a medication will cost their patient based on their specific health plan coverage. Together, physicians and patients can use this information to choose the drug option that is both medically appropriate and most affordable. And if a prior authorization is required, it can be completed electronically, and in most cases while the patient is still in the doctor’s office.

The full article can be viewed at the following link.  

It’s Time to Put Away the Puzzle: Improving Patient Safety by Enhancing Medication Management Accuracy

The NCPDP SCRIPT CancelRx transaction plays a critical role in medication management. A CancelRx Request message is sent to the pharmacy when a prescriber discontinues a medication in the Electronic Health Record (EHR) system, thereby providing a crucial piece of actionable intelligence that is distinct from other new e-prescription (NewRx) orders.  This transaction plays an essential role in prescribers’ workflows, as they expect timely receipt and efficient processing of their electronic medication orders, including cancellation orders, to ensure optimal patient care.  Unfortunately, this critical tool is currently underused.

The full article can be viewed at the following link.  

The original journal literature associated with this article can be downloaded below.  

Effects of Integrated Telehealth- Delivered Cognitive-Behavioral Therapy for Depression and Insomnia in Rural Older Adults

We examined the effects of integrated cognitive-behavioral therapy for depression and insomnia (CBT-D + CBT-I, respectively) delivered via video conference in rural middle-aged and older adults. Forty patients with depressive and insomnia symptoms were randomized to receive either 10 sessions of CBT-D + CBT-I or usual care (UC). Patients in the integrated CBT condition were engaged in telehealth treatment through Skype at their primary care clinic. Assessments were conducted at baseline, post treatment, and 3-month follow-up. CBT-D + CBT-I participants had significantly greater improvements in sleep at post treatment and 3-month follow-up as compared with the UC participants. The Time X Group interaction for depression was not significant;participants in both the CBT-D + CBT-I and UC conditions showed a decrease in depressive symptoms over time. Although integrated CBT benefits both depression and insomnia symptoms, its effects on depression are more equivocal. Further research should consider expanding the depression treatment component of integrated CBT to enhance effectiveness.

The full article can be downloaded below.  

Financial incentives to encourage value-based health care

This paper reviews the literature on the use of financial incentives to improve the provision of value-based health care. Eighty studies of 44 schemes from 10 countries were reviewed. The proportion of positive and statistically significant outcomes was close to 0.5. Stronger study designs were associated with a lower proportion of positive effects. There were no differences between studies conducted in the United States compared to other countries; between schemes that targeted hospitals or primary care; or between schemes combining pay for performance with rewards for reducing costs, relative to pay for performance schemes alone. Paying for performance improvement is less likely to be effective. Allowing payments to be used for specific purposes, such as quality improvement, had a higher likelihood of a positive effect, compared to using funding for physician income. Finally, the size of incentive payments relative to revenue was not associated with the proportion of positive outcomes.

The full paper can be downloaded below.  

Connecting your medical data could be the next big payoff

An article focused on creating accessible and integrated patient data.  This holistic approach fulfills value-based care goals and helps promote overall patient health and wellness.  

The full article can be viewed at this link.  

Gulshan, Peng, and Coram, 2016

In this evaluation of retinal fundus photographs from adults with diabetes, an algorithm based on deep machine learning had high sensitivity and specificity for detecting referable diabetic retinopathy.

June 14, 2018 press release from the American Medical Association.

The promise of augmented intelligence (AI) in spurring technological innovation in medicine has generated growing interest among health care stakeholders. It also has spurred a range of concerns about the novel challenges in the design, implementation, and use—especially how AI will be incorporated into the practice of medicine and affect patients. With those varied perspectives, the American Medical Association passed its first policy addressing AI at its Annual Meeting, adopting broad policy recommendations for health and technology stakeholders on this issue.