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Integrating Medical Care With Behavioral Health In Pain Management

Integrating Medical Care With Behavioral Health In Pain Management

When suffering from chronic pain, symptoms affect more than just the body. Physical pain also affects mental health, emotional well-being and quality of life. Chronic pain may also cause or increase worry, anxiety, frustration, anger and depression, making the physical pain worse and hampering abilities to cope. In addition, prescription opiates,  which are commonly used to treat chronic pain, can pose a challenge for some patients, including hyperalgesia (increased sensitivity to pain) and a risk for addiction. Needless to say, physical, emotional and mental health care are connected, especially for patients with chronic pain.

That is why a whole-person, comprehensive approach is the optimal model of care treatment. Yet, despite mounting evidence that integrating behavioral medicine can offset the ongoing cost of chronic pain treatment [1], the two disciplines tend to operate in silos.

New Health Pain Treatment Center has implemented an integrated traditional medicine and behavioral health model that allows patients to experience optimal pain relief and feel empowered to more fully participate in their lives. Patients learn valuable tools and skills to help minimize or avoid opiates while practicing how to successfully navigate the mental and emotional difficulties that almost always accompany physical pain.

This is critical now more than ever since as a country we are seeing a high risk for opiate addiction in patients with chronic pain as well as the overuse of opiate medications. In our state alone, more than 22,000 Coloradans report dependence on opioids.[2]

Components of Integrated Pain Treatment

Pain treatment – like many other areas of health care – has historically operated in isolation, with different entities providing diagnosis and treatment planning, imaging, physical therapy, surgery and other services.

Under traditional models, patients are often referred to different providers for different symptoms, increasing the likelihood of incomplete and fragmented care, delays in care, gaps in communication and less-than optimum outcomes.

Almost always missing from the equation is behavioral health.

The following approach describes an integrated approach to medical care, designed to improve outcomes and patient experience, while reducing cost.

Medical and Behavioral Health Assessment

During the initial visit, a medical and behavioral health assessment helps identify the physical, psychological and social factors impacting health.

The medical assessment is a comprehensive assessment of the patient’s history of pain, followed by the initiation of therapeutic modalities. The medical history includes a detailed intake of the initial causes of the patient’s pain, the exacerbating factors of the pain over time, any previous medical and surgical interventions that have been offered or administered to the patient and an assessment of which previous modalities of treatment have been most and least successful.

In addition, the state’s Prescription Drug Monitoring Program is a valuable tool that can be leveraged to improve prescribing and protect patients who may be at risk of addiction. New Health uses the database to generate a comprehensive, three-year historical report of which pain medications the patient has tried in the past, and this report is reviewed in detail with the patient. A comprehensive physical exam is performed, and patients provide a urine sample for a toxicology screen. The medical team also makes an initial evaluation of the patient’s risk and history of addictive behaviors related to medication use.

Incorporating Behavioral Health into Treatment Planning

The behavioral health assessment is an extensive intake regarding all aspects of the patient’s mental health. It incorporates elements from the Substance Abuse and Mental Health Services Administration’s Eight Dimensions of Wellness (Figure 1).

Source: Substance Abuse and Mental Health Services Administration

The medical and behavioral assessments inform the individualized treatment plan that is developed cooperatively by the medical and behavioral health teams. Patients’ individual treatment plans may include a mix of medical interventions, which may include medication management and/or interventional treatment such as nerve blocks, or epidural steroid or joint injections. The medical team can also coordinate referrals for other treatment modalities, such as physical therapy or massage therapy, as needed. The behavioral health team coordinates behavioral health therapies, including individual or group therapy.

During therapy sessions, patients receive non-pharmacological coping skills that include: stress reduction, mindfulness techniques, dialectal behavioral therapy skills and other tools for managing pain. DBT skills and techniques may include: mindfulness or focusing skills; distress tolerance, including self-soothing using the five senses through aromatherapy, hot showers and baths, etc.; opposite action, where a person identifies the feeling he or she is experiencing and takes an opposite action; and emotion regulation (employing deep breathing, etc.).

These approaches help improve interpersonal effectiveness and increase patients’ “recovery capital” or healthy life resources. These resources may include social resources, as well as better overall health and well-being, all of which help patients move through pain successfully. Throughout treatment, medical providers should follow up on patient adherence not only to medical treatment but also to the use of coping skills and other techniques to navigate pain.

The Importance of Group Therapy

People experiencing chronic pain also often may experience diminished cognitive skills, especially as it pertains to executive functions, which may limit the effectiveness of individual cognitive therapy.  Group therapy allows patients to begin working on emotion regulation and distress tolerance, while enjoying the support of other patients with similar struggles. In a group setting, peers offer support while holding each other accountable. Group members are able to empathize and identify with each other’s challenges, which in turn helps eliminate stigma and address feelings of loneliness and isolation.[3]

Group therapy also provides an opportunity to practice and refine healthy social and relationship skills before taking them back to their family and community systems.

Medication Monitoring

Treating chronic pain is complex, and the risk of addiction must be factored in to individual treatment plans. In 2016, an estimated 3.3 million people aged 12 or older were current misusers of pain relievers, representing 1.2 percent of that population.[4]

The initial medical assessment is designed to help identify patients at risk for potential abuse, and responsible drug testing during treatment helps inform clinical decisions by providing valuable information about patients’ use of prescribed medications, non-prescribed medications and illicit substances.

Qualified physicians may obtain waivers under the Drug Addiction Treatment Act of 2000 (DATA 2000), meaning they are equipped and trained to identify, as well as treat, those patients identified as having addiction issues. New Health’s physicians have obtained waivers and can prescribe buprenorphine in all its forms, including sublingual and subcutaneous. In some cases, physicians may also arrange for and provide long-acting naltrexone therapy, which blocks opioid receptors in the brain, when indicated.

Interdisciplinary Staff Meetings

To have a truly integrated approach to pain management, medical and behavioral health providers must be able to share information in real time, working together to adjust patient treatment plans to reflect patients’ progress and needs. The American Pain Society has developed a list of desirable attributes of interdisciplinary teams (Figure 2).

FIGURE 2 / Attributes of a Well-Functioning Interdisciplinary Pain Team

Source: American Pain Society

Conclusion

An integrated care model helps patients become physically, mentally and emotionally stronger so they can live happier, healthier lives. It is imperative patients receive tools and skills to help minimize or avoid opiates while learning how to successfully navigate the mental and emotional difficulties that almost always accompany physical pain. This is critical now more than ever since as a country we are seeing a high risk for addiction in patients with chronic pain as well as the overuse of opiate medications.


Newhealthservices.com

New Health provides an innovative way to help chronic pain patients become physically, mentally and emotionally stronger so they can live happier, healthier lives. Our doctors and therapists work together to formulate a treatment plan and make sure each patient’s individual physical and mental wellness needs are met. Our unique model helps minimize or avoid opiates while giving patients the tools they need to feel better and to navigate the mental and emotional difficulties that almost always accompany physical pain.

Dr. Nathan Moore, medical director of New Health, is board-certified in family and addiction medicine. He previously served as president and chief executive officer of MedNow Clinics and ARCH Detox. In that role, he oversaw the development of effective outpatient detoxification programs/protocols for opiates, alcohol and benzodiazepine use disorders. A graduate of the Duke University School of Medicine, Dr. Moore serves on the board of Practice Health and Colorado Care Providers and chairs the finance committees of both organizations.

Osvaldo Cabral has worked in addiction and mental health since 2002 and specializes in addiction treatment, dialectical behavior therapy, skills training, aggression replacement training, cognitive behavioral therapy and trauma-focused therapies. As director of integrated services, he coordinates the operations of New Health’s medical and behavioral health professionals to ensure continuity of care for New Health patients.

For more information, please contact Natalie Lamberton, vice president of business development, at 303.668.2177 or nlamberton@newhealthservices.com.


[1] Chiles, JA, MJ Lambert and AL Hatch. The Impact of Psychological Interventions on Medical Cost Offset: A Meta‐analytic Review, Clinical Psychology: Science and Practice, 6, 2, (204-220), (2006).

[2] T Manocchio. The ABCs of MAT (Medication-Assisted Treatment), Colorado Health Institute, May 31, 2017. Accessed Aug. 2018 at www.coloradohealthinstitute.org/blog/Abcs-mat-medication-assisted-treatment.

[3] Center for Substance Abuse Treatment. Substance Abuse Treatment: Group Therapy: 6 Group Leadership, Concepts, and Techniques. Substance Abuse and Mental Health Services Administration (US), TIP Series, No. 41, Rockville, MD (2005).

[4] Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration, HHS Publication No. SMA 17-5044, NSDUH Series H-52, Rockville, MD (2017).

Foundations’ Role In Creating And Advancing Policies That Prevent Disease And Promote Mental Health And Well-Being

Foundations’ Role In Creating And Advancing Policies That Prevent Disease And Promote Mental Health And Well-Being

 

    • Foundations’ Role In Creating And Advancing Policies That Prevent Disease And Promote Mental Health And Well-Being

Deaths from drugs, alcohol, and suicide are driving the first reductions in life expectancy in the United States in the past two decades.

At the same time, racial/ethnic and socioeconomic disparities in health and well-being have widened since 1980, and a number of emerging trendsthreaten to exacerbate these.

The United States still spends far more on health care than on social services compared to other Organization for Economic Cooperation and Development countries, even though research suggests social services are strongly linked to improved outcomes. And, despite how much we spend, our outcomes don’t stack up to those of other countries.

Thankfully, communities in the United States are working to push back against these trends by actively seeking better health and well-being—not just through their own actions but also by partnering with many others in pursuit of broader changes.

Foundations and their investments (for example, in grantees) often play a unique role in enabling this pursuit of better health. The functions and roles that foundations play are as varied as the communities they serve, and each foundation has a different mission, focus, and interest in policy.

Yet, despite these differences among funders, policy is the one thing that often undergirds foundations’ work across these concerted efforts to improve mental health and well-being. For instance, the financial backing of foundations often supports the innovation that started in communities. But that is not the end of the road—these efforts frequently live and die by the larger systems and policies that are needed to enable, support, scale, and sustain the work.

That said, while it is essential that foundations play a role in policy, it is often unclear how best for them to do so, and even less clear how to do so with other foundations, grantees, and partners. There appears to be a need for thoughtfully designed and tightly knit strategies that foundations can use to meaningfully affect policy. For example, consider the following case studies.

The Hogg Foundation for Mental Health in Texas launched its Mental Health Policy Academy and its Fellows programs in 2010. Policy fellows are placed at nonprofit, government, or higher education organizations across Texas to increase individual and organizational capacity to advance mental health policy in Texas and to better engage consumers in mental health policy development and implementation. In addition, the Hogg Foundation produces a Mental Health Guide, for advocates and policy makers, to coincide with each Texas legislative session (held every two years), and the foundation follows up after each session with a summary that provides an overview of mental health– and substance misuse–related legislation filed during that session.

The New Hampshire Charitable Foundation has invested in public policy and advocacy to reduce and prevent alcohol and substance misuse—its work has included launching and supporting New Futures, a nonprofit organization that “advocates, educates and collaborates to improve the health and wellness of all New Hampshire residents through policy change.”

The W.K. Kellogg Foundation has supported policy efforts including the development, implementation, and evaluation of a Mental Health Impact Assessment tool to assess the effect of public decisions and actions on the social determinants of mental health in low-income communities. (The Robert Wood Johnson Foundation (RWJF) and the Pierce Family Foundation also support the tool.) Additionally, Kellogg has supported a mental health policy development working group focused on promotion of mental health in schools, child care, and early education. That work has been described in prior Health Affairs Blog posts.

The Lutheran Foundation formed and launched the Regional Mental Health Coalition of Northeast Indiana in 2016, which aims to improve mental and behavioral health and wellness by advocating for policy and systemic changes, developing campaigns to reduce stigma, and ensuring collaboration across government, mental health, health care, judicial, education, faith-based, and workplace communities.

And, in 2017, Trust for America’s Health (TFAH) and Well Being Trustembarked on a joint effort to advance policy solutions to the drug, alcohol, and suicide epidemics. The first product of this partnership was a report, Pain in the Nation: The Drug, Alcohol and Suicide Epidemics and the Need for a National Resilience Strategy, funded by Well Being Trust and the RWJF, and published by TFAH.

That report focuses specifically on practice and policy solutions to reduce deaths from drugs, alcohol, and suicide—ranging from expanding the use and availability of rescue drugs, sterile syringes, and diversion programs, to limiting hours and density of alcohol sales, to supporting state suicide prevention plans, to expanding social-emotional learning and mental health services in schools. The report also calls for—and provides recommendations for building—a National Resilience Strategy, which would take an effective, comprehensive, continuum approach to addressing these epidemics, from prevention and early identification, to connection to services and supports, to treatment and recovery.

What We’ve Learned

The following highlights specific actions mentioned in the report that could be taken to solve some of the problems around substance misuse and mental health. We understand that there are multiple layers of policy action required at each level—local, state, and national—and that each layer will have different types of action that can be taken.

  1. Investing in prevention and creating more resilient families and communities must be a higher policy priority—especially for foundations.

In recognition that many of the issues we face as a society around mental health and substance misuse are grounded in social factors, simply dedicating our attention to working on closing the treatment gap (which is important but is being addressed by many other organizations) is insufficient.

Well Being Trust and our grantees, including TFAH, are investigating policies that can go upstream and prevent mental health and substance misuse problems from even beginning in the first place. We will help support the investment, policies, and practices necessary to enhance protective factors and close the prevention gap.

  1. Foundations can be instrumental in helping their communities create consistent standards for identifying and treating mental health and substance misuse for multiple conditions and across community and clinical delivery settings.

Currently, there are no consistent standards for mental health and substance misuse treatment in the United States. This means that receiving care differs greatly depending on certain critical variables like insurance type, location of service, and type of clinician providing care.

One of the first steps for creating a more equitable and comprehensive system is to have consistent standards for mental health across multiple clinical settings. Foundations and grantees have a critical role to play in identifying these standards and advancing the policies that codify them in practice.

  1. We must make accessing services for mental health and substance misuse conditions easier and make services more affordable for everyone.

Utilizing mental health and substance misuse services requires access to the appropriate clinician and ability to afford the care and treatment. Sadly, both of these items remain problematic in the United States.

The country must consider novel approaches to improve access, rather than simply depending on a referral to a mental health or substance misuse clinician. Redistributing mental health and substance misuse clinicians throughout the health care system is one way to increase access.

And, when we consider that mental health and substance misuse services remain unaffordable for many people, both access and affordability will require us to rethink our strategy and develop innovative policies and solutions.

Certain populations face particular barriers to access. Blacks, Latinos, and American Indians are more likely to be uninsured. Those living in rural areas may not live near treatment and other services. And low-income residents throughout the United States face a number of obstacles to care including the potential loss of income when seeking treatment.

  1. Mental health and substance misuse benefits, services, and policies must be at or above parity for medical benefits, services, and policies.

Undergirding much of what transpires in health care delivery are the benefits that each of us carry through our respective insurer. In many cases, how mental health and substance misuse benefits have been structured make it truly challenging to integrate care in a systemic way. And, in other cases, mental health and substance misuse benefits are not even offered at parity despite federal law mandating it.

Clearly, policies can be strengthened and created to ensure that people have access to the benefits that will help them to realize their fullest potential.

  1. We must redesign how we pay for mental health and substance misuse treatment so as to prioritize prevention, team-based care, and quality and outcomes.

Currently, health care is often driven by disease and sickness. Additionally, fragmented financing keeps mental health and substance misuse services isolated. For the country to solve problems as complex as the deaths of despair, there must be a comprehensive approach that includes simultaneous clinical, operational, and financial changes. As such, alternative delivery and payment models for mental health and substance misuse should be studied, shared, and scaled by foundations. Thankfully, there are new examples emerging each day that highlight innovation in payment reform.

Going Forward

While investing in evidence-based practices and programs—as many foundations are currently doing—is critical to improving health and well-being, a comprehensive, scalable, and sustainable approach requires a greater focus on local, state, and federal policy solutions. Through their grant making, foundations can help change policies or regulations that have implications for health and well-being, as well as influence the direction of government funding in this arena.

In addition, foundations must go further. They need to take risks and be willing to fail.

Government cooperation (and grantmakers’ funding) is, in most cases, critical to having the population-level impacts necessary to close the prevention gap. Yet, government is often required to fund models with an evidence base, which might not always be the most innovative approaches.

At the same time, philanthropies have more leeway to take risks and can put themselves on the line to reduce the risk inherent in certain programs (for example, needle exchange) for government and other foundations. As such, we have to be willing to fail. Not every innovative program is scalable—what works in one town might not work in another town. But we must share our lessons learned—and move forward in a meaningful way together.

Further, to truly move the needle, we must be policy-influencers and advocates. Foundations can harness the power of our endowments through impact investing—using our knowledge of the financial world to ensure that everyone can realize their fullest potential.

It is critical that foundations invest in cutting-edge policies, learn from the case studies highlighted above, and develop novel strategies to engage in this work. Such investment is fundamental to improving mental health and well-being in a comprehensive, scalable, and sustainable way.

This blog post is based on a presentation by the authors at the Grantmakers In Health annual conference, in June 2018, in Chicago.

Healthcare Reform Across State Lines Exploring differences by state

Healthcare Reform Across State Lines Exploring differences by state

Healthcare Reform Across State Lines Exploring differences by state

 

A recent webinar examined how different providers approach the opportunities and challenges
brought by the Affordable Care Act (ACA). Industry leaders in Florida, Massachusetts, Mississippi,
New Jersey and Pennsylvania shared their views. Below are highlights.

 

Visit our Healthcare Reform Across State Lines webinar replay for more insights.


ACCESS VARIES SIGNIFICANTLY STATE-BY-STATE

Each state interprets the ACA in its own way, driving provider strategy and impacting coverage,
rates and costs. Massachusetts decided early on to maximize access via state health reform.
Access in some other states has been more challenging, with physicians not accepting
Medicaid or Federal Exchange beneficiaries. For Florida, one solution has been proactively
negotiating out-of-network rates for unique services.


EARLY ADOPTER STATES SEE COST BENEFITS

Massachusetts’ early adoption of Medicaid expansion in 2006, plus coverage expansions that
served as a precursor to the ACA, have seen reductions in uninsured individuals and lower costs:

 

  • Per capita health spending growth is lower than the U.S. generally
  • Expansion enabled preventative care and reduced per-member per-month costs when
    compared to other states
  • Insurance participation is more stable than in other parts of the country

STRATEGY/TECHNOLOGY INNOVATION

  • Massachusetts’ early healthcare expansion allowed it to focus on costs and prices as far
    back as 2008. By 2012, its strategy focus was reducing expenditure and encouraging
    alternative payment methods
  • In Mississippi, over 60 hospitals came together to form MississippiTrue, the first
    multi-provider plan in the state
  • Innovations have also emerged in response to the Mississippi Telemedicine Parity Act,
    which mandates that all health insurance and employee benefit plans must provide r
    emote care

UNCERTAIN STATE AND FEDERAL REIMBURSEMENT

Some states have taken pre-emptive measures to cope with a lack of clarity. For example,
53,000 Mississippi residents rely on the Federal Exchange for their health insurance.
There’s uncertainty over whether Cost Sharing Reductions (CSR) will end, which could
increase premiums by 25% in 2018. In response, the state has taken a number of measures:

 

  • It’s allowed exchange providers to submit two sets of rates, one assuming CSR continues,
    and one assuming it doesn’t
  • It has issued waivers to ensure the continuation of coverage through 2018 and to curb
    increases in rates for children under 14


 

ONGOING CHALLENGES

 


A key challenge for providers nationwide is the uncertain outlook for the ACA.
The House of Representatives passed the American Health Care Act (AHCA) to
“repeal and replace” the ACA. It is estimated to achieve more than $100 billion
in Medicaid reductions by 2027.
Being informed and formulating strategies is now more important than ever.

KEY TAKEAWAYS

  • Each state interprets the ACA differently, impacting strategy, coverage and costs
  • Challenges have led to strategy and technological innovation
  • Uncertain state and federal reimbursement, and regulatory changes to the ACA
    make being informed more important than ever

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Insights into Risk-Based Reimbursement

Insights into Risk-Based Reimbursement

Healthcare leaders discuss impact and opportunities

Bank of America Merrill Lynch

 

Five technologies set to transform the healthcare industry

Five technologies set to transform the healthcare industry

Five Technologies Set to Transform the Healthcare Industry

Written by John Hesselmann, Specialized Industries Executive, Global Commercial
Banking at Bank of America Merrill Lynch

The future of healthcare will streamline the way we diagnose and treat health problems. We are already seeing signs of that today: from patients who receive diagnoses and treatment at home via
telemedicine and heart-monitoring wearables, to artificially intelligent therapists diagnosing
PTSD in veterans. Innovation in healthcare can decrease our
dependency on physician availability. To that end, we’re seeing emerging technologies that
deliver diagnoses directly from an app, such as MobileODT, a mobile cancer screening tool,
and Biomeme, which aims to conduct genetic testing for certain diseases within an hour.
Investors should be aware of the innovation set to transform the healthcare industry in the
next few years. Here are five areas expected to undergo tremendous growth:
1. Robotic Surgery: According to WinterGreen
Research, annual sales of robotic surgical
assistants are expected to rise from $3 to
$20 billion over the next five years. While the
notion of a robotic surgeon seems frightening,
it may actually be safer. Robot-assisted surgery
is typically faster and smoother, making
more precise incisions and reducing blood
loss. Currently, the machinery costs a million
dollars or more, however, the advancements
are expected to trim healthcare costs due to
reduced patient stay and aftercare.
2. Genomics: According to MarketWatch, the
international genomics market is estimated to
grow from $12.5 billion in 2015 to $20 billion
in 2020. Advanced genetic testing can help
people discover whether they have inherited
diseases so they can begin treatment before
symptoms occur. Advanced gene editing
has the potential to fight cancer and other
diseases by altering genetic instructions at
the cellular level. Genetic Engineering and
Biotechnology News reports that in the next
10 years it will be possible for every new baby
to have their genome sequenced and stored
with other health records.

Bank of America Merrill Lynch

HOW TODAY’S M&As ARE PREPARING HEALTHCARE ORGANIZATIONS FOR A NEW FUTURE

HOW TODAY’S M&As ARE PREPARING HEALTHCARE ORGANIZATIONS FOR A NEW FUTURE

HOW TODAY’S M&As ARE PREPARING HEALTHCARE ORGANIZATIONS
FOR A NEW FUTURE

Brent McDonald
Head of Healthcare Strategic Advisory,
Managing Director
Bank of America

In the face of seismic industry shifts, challenging
regulations, and constant uncertainty in Washington,
providers are reshaping the healthcare
landscape themselves by entering into strategic
mergers, acquisitions, and partnerships. Today’s
deals are reflective of the times, says Brent
McDonald, head of healthcare strategic advisory
and managing director at Bank of America Merrill
Lynch. “Most providers who are looking to merge
are focused on achieving powerful and costly
objectives such as transitioning to a value-based
payment model, growing a population health initiative,
and improving clinical integration,” notes
McDonald. “They are seeking partners with the
right combination of capital, infrastructure, intellectual
property, and technology.” McDonald discusses
the benefits of integration and how providers are
structuring today’s complex M&As.
What types of strategic partnerships
are common in the current
healthcare climate?
Brent McDonald: We are seeing mergers that
have clear built-in synergies. Oftentimes, the two
organizations don’t just mirror, but rather they
complement each other in strategic ways. When
they merge, it becomes one plus one equals three,
allowing them to more effectively meet the Triple
Aim. For example, one hospital may have spent
more time developing an urgent care network, a
freestanding emergency room, or a micro-hospital
network, while the other recruited and invested in
developing a network of high-acuity specialists.
It’s common to see an urban or academic medical
center that has invested in tertiary subspecialists
integrate with a successful community hospital that
is associated with more primary care physicians.
And it isn’t necessarily that they have economies
of scale available, but they are a very complementary
clinical fit. Partnering with an organization that
has built scalable competencies makes it easier
to justify the execution risk of integrating. If you
merge with a hospital that has spent the time and
resources on a clinical integration network that is
already functioning with the governance, accountability
measures, and physicians in place, then you
don’t have to take on that risk in building your own
network, which could fail.
What are the primary financial benefits
in a merger or acquisition?
McDonald: Overhead is still the most straightforward
and nonclinical financial economy of scale.
Organizations formed through a merger or acquisition
can expect to gain efficiencies in accounting,
human resources, revenue cycle, supply chain, and
other back-office services. These deals also allow
you to spread the cost of investment in health
information technology and population health over
a broader set of hospitals and a larger net revenue
base. Moreover, there may be clinical core competencies
that benefit the two parties post-merger,
including complementary service lines and geographic
ambulatory access points.
What do leaders hope to gain clinically
when entering into a new partnership?
McDonald: Quality is always top of mind. Without
quality and a reputation of quality, your earnings
and growth will suffer, as well as your ability to
reinvest and continue to be a high performing
organization. That being said, when considering a
partnership today, providers are often looking for
specific clinical competencies. For example, having
expertise in case management and physician
integration, as well as having advanced technology
is desirable. Simply having an electronic medical
record (EMR) isn’t enough anymore. How you use
the EMR to make a difference in providing care
is important to a potential partner. An organization
that has mature physician integration and is
advanced in how it uses its EMR system to impact
care likely has physician leaders who have worked
through the data sets to create best practices,
and has clinical care decision matrices embedded
in the medical record, which enables greater standardized
care.
“Without quality and a
reputation of quality, your
earnings and growth will
suffer, as well as your ability to
reinvest and continue to be a
high performing organization.”
How are mergers and acquisitions
helping organizations meet advanced
population health goals?
McDonald: Achieving population health requires
an investment, and if you are precarious from a
balance sheet or a profit-loss perspective, meaning
you don’t have enough margin to reinvest in the
hospital, then you won’t be able to execute on key
initiatives. Infrastructure and technology are the
two critical components that make up the backbone
of population health. They allow a hospital to
measure clinical information and present cohesive
and timely information back to its clinicians. Both
of these competencies require heavy capital investment
and know-how. Having a strong internal
framework and state-of-the-art IT are not something
that smaller, community hospitals can generally do
alone—typically, because they don’t have sufficient
margin to invest in such initiatives across their
subscale network. For example, if a community
hospital is trying to create a center of excellence
in a clinical service line, they may have trouble in
areas such as recruiting the key specialists and
subspecialists. A larger partner will typically have
the technology, case management, and a better
4 Bank of America Merrill Lynch I Sponsored Material
pipeline of doctors. Our Bank of America Merrill
Lynch analysis reflects that there is a correlation
between scale (or size) of an organization and higher
investment-grade credit ratings.
The goals of MACRA include radically
shifting payment models from fee-forservice
to value-based payment. How
does a merger or acquisition support
and accelerate this shift, as well as
help an organization bear
downside risk?
McDonald: MACRA adds more complexity, which
will probably cause more physicians to organize into
larger groups. Clearly, being able to handle value-based
payment is a different way of practicing.
It requires different skill sets. But, the model is still
being shaken out. Will it be hospitals, physician-organized
super groups, or a hybrid of the two that
will be best positioned to transition physicians to
value-based care? We still don’t know.
In the meantime, a traditional independent physician
practice that has to rely on a high volume of
patients just to keep their office open does not
have a lot of excess capacity in their day to deal
with changing payment and care models. It is an
almost impossible task for independent physicians
to influence the health of their patients when they
leave their office and go to the hospital or to an
urgent care center. It requires competencies they
don’t have to compete in this advanced care and
payment system, including an optimized EMR and
the ability to undergo a care redesign. Therefore,
it is difficult to manage downside risk. You will be
more successful having scale and leverage for
these considerations and, also, for weathering the
unexpected revenue ebbs and flows of value-based
care. In a merger or alignment with a larger, capable
organization, physicians become part of a
larger entity that has a sophisticated EMR and
other advantages. These advantages include case
managers and other staff who are available specifically
to follow and enhance that patient’s journey
across different care environments. A larger system
can track someone who visits the ER, making sure
they receive the right follow-up care, do not have
an unnecessary hospital readmission, and have
a positive experience with their provider and the
healthcare system.
Improving the patient experience is
important in a merger or acquisition.
As organizations come together, how
can they address common challenges?
McDonald: There are betterment and integration
hurdles in this area. Most hospital systems are
constantly working toward a better position when
it comes to improving the patient experience. To
get there requires having the right skills to invest in
all of the resources you need. On the other hand,
mergers are disruptive and patient satisfaction
can be damaged as you integrate to a new culture
or platform. It’s important to have a plan for key
patient perception areas such as scheduling, registration,
and medical records. You need a unified
approach when integrating the patient experience.
For example, patients will be frustrated if the process
is disorganized and they have to register three
times in a visit to the hospital. It requires vigilant
attention to get this right.
Bank of America Merrill Lynch

https://www.bofaml.com/content/boaml/en_us/home.html

Automation to Optimize Receivables In A Changing Payment Landscape

Automation to Optimize Receivables In A Changing Payment Landscape

Key Bank

Adoption of  fully electronic transactions varies significantly according to Key Bank’s white paper “From Crawl to Walk to Run”. From Streamlining business processes with new tools abounding, there are five questions CEOs should ask about their current payment management strategies. You can also educate the healthcare consumer with five strategies for improving patient relations in the front office.

Look for best practices for communicating with patients about prices, billing and payments. Ultimately, you will be able to lower the cost of staff time formerly devoted to largely fruitless pursuit of mostly small balance accounts after the procedure is completed.

Learn more about how to do this from Key Bank in the link below:

Automation to Optimize Receivables Healthcare White Paper

Thanks to our sponsor, Melissa Whitmer, Senior Vice President, Healthcare Banking, Key Bank, for providing the above white paper.

Melissa can be reached at:
720-904-4250 (Office)
303-931-2404 (mobile)
melissa_whitmer@keybank.com

 

SIM Recruits Final Cohort, Helps Practices Integrate Behavioral and Physical Health

SIM Recruits Final Cohort, Helps Practices Integrate Behavioral and Physical Health

SIM recruits final cohort, prepares practices for success with APMs

Sustainable healthcare reform requires new skills and a different understanding of how practices articulate their unique value to succeed in alternative payment models that reward the value (not volume) of care delivered. The Colorado State Innovation Model (SIM), which is recruiting for its third and final cohort, helps practices integrate behavioral and physical health, use data in actionable ways and retool processes to provide team-based, patient-centered care. One example of how this federally funded, governor’s office initiative helps practices prepare for success with alternative payment models (APMs): SIM practices have a “glidepath” with the new Health First Colorado APM.

SIM practices that are designated primary care medical providers don’t have to submit quality measures for the first year of the Medicaid APM and get full credit on the Medicaid APM point scale. Please encourage primary care practices to apply for the last SIM cohort by Jan. 19 to get the coaching and support they need to succeed in APMs, deliver whole-person care and use data more effectively: http://bit.ly/sim3application.

 

Why hospitals need to do more than just pen a sexual harassment policy

Why hospitals need to do more than just pen a sexual harassment policy

Even among the majority of practices that have a policy, current training methods are too passive, MGMA experts say.

Beth Jones Sanborn, Managing Editor, Healthcare Finance News

According to a recent MGMA stat poll, more than 80 percent of healthcare organizations have a sexual harassment policy. However, experts say just having a policy isn’t enough. It all comes down to training and enforcement.

The poll conducted on December 12 analyzed 1,237 responses. Of those who responded, 84 percent said their organization had a policy that specifically addresses sexual harassment. Of the remaining 16 percent, 12 percent said their organization had no policy and four percent weren’t sure whether they had one.

[Also: Why hospitals can’t ignore their ‘Harveys’, must create supportive culture for reporting sexual harassment]

MGMA also asked how training was delivered to staff. The most common method was through a new employee orientation and an annual repetition of the training, often via online training at staff meetings that also includes an assessment, test or role-playing exercise.

Other respondents said the policy was only outlined in the employee handbook.

[Also: California medical board president under fire over business deal following sexual misconduct vote]

Simply having a policy just doesn’t cut it, said Judith Holmes, cofounder of the Compliance Clinic and an expert cited by MGMA. She cautioned practice leaders to “take a serious look at handling harassment” as the number of EEOC complaints and charges mounts, not to mention the numerous high profile figures and organizations that have come under an unwelcome spotlight amidst sexual harassment allegations in recent months.

She said now is the time to draft and implement policies, and that hospitals and practices must train employees on how to handle complaints and get a clear picture of what happens when you don’t take such steps.

“It’s going to be harder for that practice to defend a lawsuit if they can’t show that they had a policy, that they applied it, that they trained people on it and they followed it,” Holmes noted.

She suggested that the best training is usually accomplished by bringing in an outside expert, especially one that really understands the law surrounding harassment, and doing a separate training for upper management, supervisors and physicians that hones in in on how to properly and responsibly handle these types of investigations.

Handling a report the wrong way can make for a toxic work environment that can resonate with other staff and even patients.

“Ongoing bad behavior, it can just devastate a practice in the long run with high turnover, low morale — and if you think patients don’t sense the tension, you’re wrong,” Holmes said. “They see what’s happening underneath often, and you may not know you’ve lost patients to this kind of underlying stress and tension that your staff feels because there are all these problems going on that no one’s addressing.”

Another MGMA expert and member, consultant Will Latham, cautioned practice leaders to look out for behavior not just that violates policy, but also actions that impact staff morale. That includes degrading comments, inappropriate jokes, profanity, yelling, lack of cooperation or refusal to follow protocols and spreading nasty rumors.

It’s not okay to explain these behaviors away with excuses of stress, heavy workloads or past bullying. The presence of disruptive behavior, Latham said, is because it’s been tolerated in the past.

In addition to confronting the behavior when it happens, the hiring process can be an opportunity to stop a problem before it starts. Evaluating candidates thoroughly and gauging their willingness to accept and support an organization’s culture can help establish that zero-tolerance approach from the start, Latham said.

Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com

No Repeal. No Replace. How About We Agree to Amend?

No Repeal. No Replace. How About We Agree to Amend?

 

Dea Robinson, FACMPE
Independent Healthcare Consultant
Doctoral Student
Colorado State University
Organizational Learning, Performance & Change
dea_robinson@live.com
drobinso@colostate.edu

“NO REPEAL. NO REPLACE. HOW ABOUT WE AGREE TO AMEND?”

Either way, “Obamacare” will most likely change in the near future and while there have been speakers, debates and numerous articles on what could happen, there are other factors that are being neglected.  To this point, let’s just go with what the last speaker, T.R. Reid said at the last Denver Medical Study Group meeting.  T.R. predicted that the US healthcare industry will end up with a single payer system.  And, to my point, regardless of what the system is from a leadership and administrative lens for healthcare, business as usual is, well, business.

Healthcare is personal, and healthcare is a business and this is where we have a rub.  Some forget that choosing a plan to offer employees affects the person making the recommendation and choice and must balance the decision within the parameters of an accountable budget to owners or a board of directors.  One fiscal reality is as healthcare expenditure continues to rise, we see employees who ‘work for benefits’.  So, instead of working for a paycheck, workers are working for healthcare coverage.  Just imagine if workers did not work for benefits, and instead worked because they wanted to and healthcare coverage was just as normal as having a latte on Monday morning.  A recent Health Affairs  blog provides a good overview of Obamacare and the differences between the two plans, but let’s suspend some of the unknowns for some knowns  We know the Baby Boomer generation and Generation X will continue to consume more healthcare services as they age, and the next generation (Millennials) will continue to push the healthcare consumer needle into places we haven’t been before that will require healthcare leaders to consider different staffing, utilization, and reimbursement models.  As we continue with our suspended unknown mindset, let’s discuss what we know.

Generational forces.  In a recent MGMA Stat poll of 1,487 respondents that asked the question regarding telehealth services, 74% of medical practice administrators respondents reported their personal physicians did not provide this type of service, but were willing to use the service (49%) if offered.  Of note, the MGMA data provided earlier was not stratified so we could not soft test respondent demographics in the respondent sample, but this is the kind of information needed for forward thinking healthcare leaders need to consider.  The next generation of healthcare consumers are the Millennial generation, a cohort birthed when the internet was implemented (born between 1981 -1995).  This group of individuals defines their generation by technology use (Hershatter & Epstein, 2010).  It is possible that the demand for telehealth services has not matured in practice because the patients most comfortable with this practice do not constitute most of healthcare patients -yet.

How to get paid and for what.  A shift in technology-driven healthcare requires a shift in mental models for healthcare system leaders to let go of old payment models for physicians and staff leading to more knowledge work.  The payment models in place today are still predominantly based on a per patient or RVU model combined with hours spent in an office.  We may always have a bricks-and-mortar place for patients to go and I think this is a good thing, but here is the challenge.  Could we starting to think creatively on how to use RVU’s and hours worked as part of reimbursement instead of the only metrics of production?  I have had numerous private discussions with colleagues over the ‘value’ issue in healthcare.  Typically, the conversation ends with submission to what HHS will decide what value will be, or what the hospital decides it will be, and so on.  What is value in your healthcare system?  What do your patients value and are you rewarding the right people or teams?  Typically, the answer is, yes, but if you can’t measure it, it doesn’t exist.  I get it and my response is look to ‘patient experience’ for some ideas and your internal medical staff for the other half of value.  Are you rewarding poor behavior because RVU’s are high but no one wants to work as a team because of the culture in your organization?  Let’s also not forget that patients typically file malpractice claims based on how they were treated by the physician, not the medical outcome.  What is value for your patients, employees, physicians, and staff?

Patient record disconnectedness.  Given the mobility telehealth delivery provides, services can be delivered from any global location and this trend will challenge tightly held ways of working for providers.  Are you ready to manage people you don’t see?  Are you ready to pay people you don’t see when healthcare services happen in a cloud?  And, are you ready to assess effectiveness and outcomes of virtual medical teams?  Baby Boomers have done some great things for healthcare delivery.  They insist on living longer and doing more as they age and their lifestyles reflect expectations of their health.  A few years ago, I heard Atul Gawande, MD talk about healthcare complexity and one of the takeaways from his talk was about the challenges of systems.  He claimed one of the biggest challenges to healthcare is the complexity of systems to ‘talk’ to one another.  While some of the biggest advances have been in technology; alternatively, some of the biggest obstacles to care and customer service are also the result of technology.

I recently observed an orthopedic surgeon dictate into his Dragon dictation system and it was one of the most painful displays of human-technology interaction I have experienced in a long time. (Full disclosure:  I was a medical transcriber for many years to put myself through college and it is a struggle not to grab the keyboard and just type the words.)  He had great coping skills, however, as administration had provided a little stuffed animal to squeeze and throw in the air when his ‘Dragon’ didn’t work.  And then, when the dictation system started to transcribe his words, his computer shut down to restart and install new software.  Sound farfetched?  This is the kind of ground-level, front line frustrations that can prevent us from moving forward to providing the right care, at the right time.

Obamacare will morph and change, but we have things we can address now in a proactive way to move the healthcare needle on our own.

CIVHC’s PLAINTALK BLOG 5.24.17

CIVHC’s PLAINTALK BLOG 5.24.17

VOICES ON VALUE RSS FEED

Plaintalk Blog: Quality Matters – How Do You Know if The Health Care You’re Getting is Good?

Deciding where to get health care is a pretty big deal. But, unlike most other big-deal purchases, today’s industry doesn’t allow us to comparison shop.

When you’re getting ready to buy a new car, the price point is only one of the things you take into consideration. You likely research the safety ratings of the vehicle, how many miles per gallon it gets, the size of the engine, how much horsepower it has, and whether the cup holders are big enough to secure your coffee mug. All of these factors combine to help you to determine the quality of the car and decide how to spend your money.

Determining quality in health care isn’t so simple. In 2001, the Institute of Medicine published a report called Crossing the Quality Chasm, where they defined – for the first time – the different components of quality health care:

  • Safety: avoiding injuries to patients from the care that is intended to help them.
  • Effectiveness: providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit.
  • Patient-centered: providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.
  • Timely: reducing waits and sometimes harmful delays for both those who receive and those who give care.
  • Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy.
  • Equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

Great. These are definitely things that make up good health care…but how do we know if they are being done? Measuring patient safety isn’t exactly the same as measuring miles per gallon.

The Agency for Healthcare Research and Quality (AHRQ) identifies three types of quality measures:

  • Structural Measures – the tools used to provide care
    • Whether the health care organization uses electronic medical records or medication order entry systems.
    • The number or proportion of board-certified physicians.
    • The ratio of providers to patients.
  • Process Measures – the ways care is provided
    • The percentage of people receiving preventive services (such as mammograms or immunizations).
    • The percentage of people with diabetes who had their blood sugar tested and controlled.
  • Outcome Measures – the impact of care provided
    • The percentage of patients who died as a result of surgery (surgical mortality rates).
    • The rate of surgical complications or hospital-acquired infections.

Even better! These examples could be really helpful when trying to decide where to get treatment. Yet, here’s the catch: most of these measures are not readily available for folks on the street trying to get health care. According to AHRQ, industry professionals use these measures in four ways:

  • Program Management – Overseeing key functions to ensure that program goals are met and resources are used efficiently.
  • Accountability – Demonstrating achievement of identified goals.
  • Quality Improvement – Devising and tracking the impact of targeted interventions designed to improve health services.
  • Reporting Results – Reporting to a variety of stakeholders and other audiences.

Bummer. While all of these are valuable ways to use quality information, there are many out there who would love to use these measures to help choose the place to spend their health care dollar.

But, there’s hope! Organizations across the nation are working to make public-facing quality reporting a reality. CIVHC, and others like us, are developing ways to show quality information next to cost data so regular folks are empowered to choose high value care and take charge of their health care journey.