SCGhealth Blog

Effective population health management relies on patient engagement and the right tools

Wednesday, March 25, 2015

By: Scott Kraft

The entities that fund health care services – primarily federal and state governments and private insurance companies – are increasingly looking for new ways to take health care expenditures to quality results.

They’re demanding that the providers of health care services know more about their patient populations, be more proactive at managing health conditions and avoid providing repetitive, needless services.

New entities such as Accountable Care Organizations (ACOs) and new Shared Savings Programs are pushing the notion of population health management – the idea that a whole group of patients can be managed at the best cost to the best outcome – and holding health providers responsible for delivering.

Excuses such as patients not being invested in their own health aren’t being accepted either.

It will take new technology really influence the results, and the reality that many physician practices are starting to realize is that electronic health record (EHR) systems, while adept at helping to create documentation and manage individual patient encounters, aren’t always as effective at producing timely data on entire subsets of patient populations.

Population health management technology is centered on three key areas. First, helping the provider community to keep closer tabs on patient populations and engage with their most at-risk patients to help drive better compliance.

Second, giving the patients new tools and technology – much of it web-based – to help them better track their own health through metrics and data.

Finally, connecting the patient-centered data and efforts to the health providers in a way that doesn’t overwhelm the provider with useless data, but gives physicians and entire health care teams access to critical data quickly.

One example of a company driving rapid advances in population health management on the provider side is Ft. Lauderdale-based SRG Technology. The company’s population health management tool, TopCare, can be configured by health care providers to collect and sort data based on the entity’s own goals when it comes to managing a patient population.

As a result, if a physician group is looking to achieve a certain objective for a patient population, such as diabetics, the population health management tool will pull in patient data from multiple places – the electronic health record system, a practice management system, laboratory results or data – and push the patient toward the right solution based on the intensity of the intervention needed.

Not every patient needs an interaction with a physician, for example. A patient who needs guidance on screening services could be directed to a nurse or even a member of the front office staff to reach out and make contact.

Patients who need more aggressive interventions will be assured of getting more time with the physician, because the system is set up to better manage the flow of data to ensure those patients don’t fall off of the radar screen.

The physician practice is better equipped to avoid the scenario where the most compliant, engaged patients are coming into the office too much, but the practice’s patient population isn’t optimally managed because some patients have fallen through the cracks.

Patient engagement is key
As important as the physician piece is, getting tools into the hands of patients that better position them to successfully achieve their goals is a critical part of success.

That’s where companies such as Get Real Health come in. The Rockville, Md.-based company is focused on getting the right tools into the hands of patients to encourage them to better manage their own day-to-day health, then get the patient produced data into the hands of physicians and other providers to drive better interventions.

Patient engagement is the key to population health management – if you can’t reach the patients, efforts are going to be useless, believes Robin Wiener, president and founding partner of Get Real Health.

The company’s patient engagement platform, InstantPHR, was recently ranked as the best patient engagement tool in the market by Chilmark Research.

Wiener relays how the company uses analytics, in one example, to get a large group of diabetics age 35-50 into an electronic management program that includes phone reminders and alerts.

Patients are able to input data as well. No phone calls are needed, but the patients can be better managed based on the data they’re providing, rather than just being given information and not seeing results.

In one patient cohort, Get Real Health started with patients with an average A1C reading that was more than 10 – about seven is average – and glucose levels in the 190 range, a sign of very poorly managed patients who didn’t really understand diabetes, Wiener says.

The patients were given glucometers that fed results directly into the company’s patient portal and directly to the doctors, with the critical readings and information highlighted for the provider, Wiener adds.

There are really two success stories here. First, getting that higher level of patient engagement and response. Second, the patients were producing a lot more data, which helped them to get an intervention before they reached a health crisis and also created a more meaningful data set to work with then just having the patient show up in the office two to three times a year.

Patients were also given contextual information about their results. Patients with high blood sugar would get content about the health implications of high blood sugar readings, while patients with low blood sugar might get an alert to drink some orange juice or about what could happen if their blood sugar continued to drop.

The engaged patient will be a key step in meaningful use stage 3, and giving patients simple alerts and reminders via phone are a fast, easy way to engage, Wiener says, noting that the patients in the program saw their A1C levels return to normal ranges and have generally stayed in that range.

While electronic health record systems are doing a better job of slicing and dicing data then they used to, it is still very hard for them to produce the data in such a way that the provider knows what to do with it, Wiener says.

CMS proposes to update, improve Medicare Shared Savings Program

Sunday, December 14, 2014

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule intended to strengthen its Medicare Shared Savings Program (MSSP) for participating accountable care organizations. (ACOs). 

The program, created by the Affordable Care Act, provides incentives for providers to band together to coordinate care for Medicare beneficiaries in the fee for service program. Participating ACOs agree to be held accountable for improving the health and experience of care for individuals and improving the health of populations while reducing the rate of growth in health care spending. If they are successful in meeting the performance and savings benchmarks, they receive a share of the savings achieved. 

There are currently two types of ACOs in the program. One provides one-sided performance risk model that doesn’t penalize the ACO for not meeting the savings benchmarks but also pays the ACO a smaller percentage of the money saved. The other is a two-sided performance risk model that pays the ACO a greater percentage of the savings to the Medicare program if the benchmarks are met but penalizes the ACO if it performs poorly. ACOs that enter the MSSP in the one-sided track must eventually move to the two-sided model.

The proposed rule, issued December 1, 2014 incorporates lessons learned from experience in implementing the program as well as guidance issued since CMS’ first rule on the MSSP in 2011.  It would tweak the existing program in several ways, including:

  • ACOs would have more time to transition from the one-sided model to the two sided model

  • ACOs in the more risky, two sided model would not incur penalties for six years, although they’d also receive 40 percent in any earned shared savings in the latter three years, rather than the 50 percent in the first three years. Currently penalties kick in after the first three years.

  • The two sided performance risk model would be made more attractive, such as allowing more use of telehealth services.

  • A “track 3” model would be created to spur more providers to form ACOs and participate in the program.

  • There would be more emphasis on primary care services and performance based risk assessments; there would also be alternative methods of benchmarks.

  • The program would streamline data sharing and reduce administrative burdens.  

“Our intent is to encourage continued and enhanced stakeholder participation, to reduce administrative burden for ACOs while facilitating their efforts to improve care outcomes, and to maintain excellence in program operations while bolstering program integrity,” the proposed rule states.

There are currently more than 330 ACOs participating in the MSSP in 47 states, covering 4.9 million Medicare beneficiaries. In the first year of the program, 58 of them had spending below their benchmarks, saving Medicare $705 million and earning shared savings payments of more than $315 million.  Another 60 ACOs in the MSSP were below their benchmarks but not enough to earn shared savings, according to CMS’ announcement.

ACOs come in many different forms, including physician-led ACOs, payer-led ACOs and hospital/physician partnerships. Many ACOs do not participate in the MSSP. ACOs in the MSSP need to comply with CMS’ specific terms but do receive some breaks from compliance with the Stark self-referral law, the anti-kickback statute, the civil money penalties law and the antitrust laws. 

More physicians may be considering joining ACOs as a way to preserve or increase their revenue streams in light of the transition from fee for service and volume based care to coordinated care and value based programs. However, ACOs’ financial terms, infrastructure, data sharing requirements, exclusivity obligations, and governance vary greatly.  

CMS is accepting comments on the rule until Feb. 6. 

Here is the proposed rule:

Read the announcement:

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