Telemedicine is becoming increasingly commonplace due to factors including a looming physician shortage, the healthcare reform debate, and the increasing willingness of insurance companies to pay for the practice. Universities, technology companies, and hospital systems have been experimenting with telehealth since the 1990s. And a major insurance provider—UnitedHealthcare of Minnesota—recently announced a national push to persuade its network of professionals to adopt telehealth for their patients, according to the Baltimore Sun.
The Health Information Trust Alliance announced this past week that it's developing a health IT security certification program that will help healthcare organizations determine whether IT products are HIPAA compliant and follow HITRUST's security criteria. The program will focus on products' capabilities, effectiveness, functionality, and support of security practices.
A new computer application allows emergency room doctors throughout New York State to quickly access concise guidelines for starting prompt drug treatment that can reduce the risk of becoming infected with AIDS. The guidelines come in the form of a widget developed by a team of doctors from St. Vincent's Hospital in Manhattan with financing from the state's AIDS Institute. The widgets were initially given to more than 200 emergency departments and will be distributed more widely over time.
A pathogen detecting scanner that uses a combination of mass spectrometry to determine genetic markers of organisms, a database of genetic signatures, and mathematics to identify pathogens and flag unknown organisms in fluids and tissue samples was the overall gold winner in The Wall Street Journal's 2009 Technology Innovation Awards. The winners are highlighted in this article.
If Congress passes one of the many healthcare proposals pending on Capitol Hill, public and private organizations will have to conduct more research to back it up, according to speakers at the Agency for Healthcare Research and Quality's (AHRQ) session Monday on forging a path to achieving high-quality, affordable care.
Numerous examples exist of ineffective care, said Karen Davis, PhD, president of The Commonwealth Fund. To move away from poor or ineffective care, it's important to think about how to reward results for improving that care. "We need to reward by paying the best results for patients and we need to reward proper use of resources," she said.
This could be achieved in several ways. First, one way is through payment reform that would reward quality through the use of bundled payments for the care of patients.
Also, it will be important to look at the adoption of plans—such as accountable care organizations—in which plans would be accountable for delivering successful, coordinated care. In addition, transitions in care will need to be closely examined as patients leave hospitals—making sure to reduce complications by coordinating between the hospital and primary care practice, and to prevent readmission.
David Blumenthal, MD, the national coordinator for health information technology, said more research is needed to determine the effectiveness of health information technology while it is being implemented under the current stimulus measures.
For the most part, health IT research has been limited. More documented research could help providers put their systems into practice—using it more effectively.
Public and private organizations have studied ways, for instance, to look at the value of electronic health records (EHR) or health IT systems at the individual hospital, practice, or healthcare network level, he said.
However, more research is needed to see what can be done in multiple settings to promote the use of EHRs and obtain the best value from them and to "gain the greatest value" for their health IT investments, he added.
One of the leading population health management companies announced Monday it has filed a voluntary petition under Chapter 11 of the U.S. Bankruptcy Code. LifeMasters Supported SelfCare, Inc., based in South San Francisco, CA, alleges that the costs associated with participating in Centers for Medicare and Medicaid Services' demonstration projects is a reason for the decision.
"The Chapter 11 filing is the most efficient path for the company to restructure liabilities that are a result of demonstration projects previously performed under contracts with the Centers for Medicare and Medicaid Services, " said George D. Pillari, who was named president of LifeMasters Monday.
Pillari, a managing director of Alvarez & Marsal Healthcare Industry Group, LLC, has been working with the company and its board as a restructuring advisor prior to the filing, and replaces Christobel Selecky, who has been an industry leader and longtime president and CEO of the company. Selecky will remain on the company's board of directors and will also work as a senior advisor on a consulting basis for the company.
LifeMasters has participated in three CMS demonstration projects over the past four years that tested disease management in the senior and dual eligible populations, most notably the Medicare Health Support demonstration project in which CMS reported that the disease management programs did not "demonstrate success based on CMS' study design and measurement methodologies. Because CMS didn't deem the projects successful, LifeMasters has to repay fees to CMS "earned in excess of savings generated during the multi-year projects," according to the company.
"Rather than endure a costly and time-consuming legal path to challenge CMS, we have chosen to restructure our CMS and other liabilities through the Chapter 11 process," Pillari said.
The company added that it doesn't expect disruptions in its services and believes it has "ample cash on hand to emerge from Chapter 11 as a viable health improvement company."
Imagine buying a health insurance policy for your employees that rewards not the provider for giving good care, but your workers for taking steps to stay healthy.
And if do three things: Make and keep preventive care appointments with their physicians, attend proscribed "wellness fares," and register with an online tool and fill out an electronic health record, they pay lower deductibles and lower copayments.
Welcome to SeeChange Health. The company based in San Francisco is awaiting approval from the state Department of Insurance, but expects to begin selling policies to employers with between 20 and 50 employees starting Sept. 29.
"Our business premise is that traditional insurance companies have focused on the wrong things," says SeeChange CEO Martin Watson. "They only worry about their members after they come down with a chronic illness."
And, he continues, "Most insurance companies have structured their models in such a way that they don't want you to see a doctor. They design complicated products that result in low claims. And you'll be dissatisfied with them and leave. And by the time you have a chronic problem, you will be another carrier's problem."
Watson says the company will begin selling the policies to employers in Fresno, and already has agreements with Community Health Centers and Santé Community Physicians, and a network of 2,800 doctors. "Then we'll be moving into the mid-central Valley, then to Bakersfield, and then Los Angeles and San Francisco in rapid fashion. And to Colorado next year."
Watson says the idea with SeeChange is to find problems early to get them managed when their conditions are more inexpensively controlled, rather than wait until conditions worsen.
Initially, enrollees will have a 70%-30% plan in which SeeChange will pay 70%, along with a $2,000 deductible.
"But when a member completes those three things, the plan changes to 80%-20%, and the deductible drops to $1,000." And if through the process a disease is diagnosed, out-of-pocket expenses will be waived.
"Here's where we're greedy capitalists," Watson says. "We know that the medical cost with say stage one diabetes is much less than a stage three. We know we can save a lot of money if we can keep you at stage one."
Watson says his company is adequately capitalized with $40 million, and has an expanding number of provider contracts.
Comedian Tracey Ullman always closed her show by telling her audience: "Go Home." But if she were a hospital provider discharging her patients, she might add, "And we're going to do everything possible to keep you there."
As federal payers consider reducing or eliminating payments to hospitals if their patients must return for care in 30 or 60 days, California researcher Jan Eldred went looking for programs with creative transition solutions, so discharged patients can remain safely out of the hospital.
Colorado Foundation for Medical Care and Partners in North Denver
Visiting Nurse Service of New York in New York City
Boston Medical Centers for Disease Control and Prevention.
St. Luke's Hospital in Cedar Rapids, IA
Summa Health System in Akron, OH
John Muir Health in Walnut Creek and Concord, CA
HealthCare Partners Medical Group in Torrance, CA
Sharp Rees-Stealy Medical Group in San Diego, CA
Blue Shield of California
"Hospital readmissions can be significantly reduced using straightforward strategies that are inexpensive compared to hospital care," says the report. According to findings from some of the demonstration projects she included, up to half of all readmissions can be prevented.
The report was published by the California HealthCare Foundation and was written by Susan Baird Kanaan.
"New Medicare rules are coming, and everyone knows they're coming," which will reduce payments to hospitals whose patients must be readmitted within 30 or 60 days, acknowledges Eldred, the foundation's senior program officer who selected the nine programs from about 20 innovative health system strategies.
"We want organizations to know that there are health systems out there that have figured out how to do this already, and that there are things they know do work. They don't have to come up with something from scratch.
"That's the premise on which this report was prepared. We want organizations to know that there are programs that have figured how to do this, to keep patients from having to return to the hospital," Eldred says.
Eldred's report listed four stages of care that allow for effective intervention to reduce readmission:
Preparation for discharge, a process that can start even as they are being admitted, to make sure hospital staff is aware of the home environment.
Hand-off to the outpatient physician.
Medication reconciliation to make sure new prescriptions are filled and that patients are not falling back on their old medication routines.
Home visit and/or phone call, daily or weekly for the first 30 days.
Some of the innovative programs were launched as long as four years ago by organizations grappling with capitated rates in their health plans while others tackled the problem as an experiment. In all cases, however, leaders said the most important goal was to improve care.
The strategies used in the study include student nurses who make home visits, discharge planners who text the physician that a patient is returning home and needs an appointment, and electronic talking scales that electronically transmit weight and other information daily back to the provider.
Other creative solutions that keep costs down, as well as keep patients in their homes, use discharge advocates who coordinate home care with the hospital team and arrange for follow-up appointments.
"Our program has shown incredible results," says Jerry Penso MD, associate medical director of the Sharp Rees-Stealy Medical Group in San Diego, which has 150,000 patients. "We reduced heart failure admissions by over 25% for all of Sharp Rees-Stealy, and the return on investment is $7 to $1."
Mike Kern MD, senior vice president and medical director for the John Muir Physician Network in the San Francisco Bay Area, says daily visits to patients' homes each of the four weeks after hospital discharge has reduced readmissions dramatically there as well, from an estimated 25% to 10-13%.
Kern says that often when elderly patients are discharged from the hospital, they go home and feel insecure. "They will call 911 not because they need readmission, but because they're scared. And that's the only thing they know how to do. And I don't blame them.
"And when they get to the emergency department, the ER's gut reaction is to throw the book at them, work them up, and they're on their way to the inpatient ward," Kern says. "That's often an over-the-top, wasteful way to do it" when many of their issues can be so much more effectively managed at home.
In Eldred's report, many of the included programs have common elements. "Medication reconciliation is critical," Eldred says, "because patients may have medicines at home that interact with the ones they received in the hospital. Someone needs to reconcile all those medications so patients know what they should be taking and what they shouldn't."
Another common strategy is to use nurse trainees or other health professionals to make daily visits to the patient's home, at least for the first few days to make sure they are following the prescribed regimen.
And a third effective tool was to make sure hospital staff engages patients and families to play active roles in managing their health needs.
A study published April 2 in the New England Journal of Medicine found that nearly one in five Medicare beneficiaries were re-hospitalized within 30 days, and on the whole, unplanned Medicare readmissions cost the federal government $17.4 billion.
Senate Finance Committee Chairman Max Baucus (D-MT) has announced that he will propose an overhaul of the nation's healthcare system that addresses GOP concerns such as blocking illegal immigrants from gaining access to subsidized insurance, urging limits on medical malpractice lawsuits, and banning federal subsidies for abortion. Under the plan, as many as 4 million of the 46 million people who are currently uninsured would be required to buy coverage on their own, without government help.
Two of the three Republicans in a small group trying to forge a bipartisan compromise on healthcare have requested numerous major changes in a proposal drafted by the chairman of the Senate Finance Committee. The Republicans, Senators Michael B. Enzi of Wyoming and Charles E. Grassley of Iowa, have catalogued their concerns in documents sent to the chairman, Senator Max Baucus, Democrat of Montana.
