Entries in Thayer, Claire (118)

Friday
Jan292016

How Value-Based Care Ties to Physician Performance

By Claire Thayer, January 28, 2016

A recent survey by the Deloitte Center for Health Solutions finds that over the next 10 years, physicians expect as much as 50% of their compensation will be directly tied to value-based care (VBC). Developing accountability as well as physician support are essential components of VBC payment models. The Deloitte survey highlights these key factors in protecting physicians’ financial interests:

  • 61% Limits to total financial risk exposure
  • 46% Equitable, performance-based distribution of bonuses from shared savings
  • 43% Ability to help set performance goals

Political and technical challenges exist in accurately measuring physician performance. In measuring physician quality, the Agency for Healthcare Research and Quality points out that resolving the issues listed below is critical to getting the consistent and valid results necessary for public reporting:

  • Rules for attributing patients to individual physicians
  • Methods for aggregating data from different sources
  • Methods for creating composite scores
  • Calculation of benchmarks and assignment of peer groups for comparing physician performance
  • Processes for auditing/validating results

These and other issues on how value-based care ties to physician performance were the focus of a recent MCOL infographoid, highlighted below:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Thursday
Dec172015

Accuracy of Health Provider Directories

By Claire Thayer, December 17, 2015

Health plans participating in the federal exchange program (think Obamacare) and Medicare will be required in 2016 to monitor and maintain online directories.  CMS online directory requirements stipulate that health plans are to communicate with their contracted providers for updates on their ability to accept new patients, changes to street address or phone number, along with any of changes affecting availability to patients.

Penalties will be assessed for inaccuracies discovered in the online provider directory – and the assessment may be steep --up to $25,000 a day, per beneficiary for Medicare Advantage plans, and up to $100 per day for those covered under the federal exchange program.

A recent study into the availability of providers in the Medicaid Managed Care program found that 43% were not participating in the Medicaid managed care plan at the listed location and could not offer appointments and 35% of providers could not be found at the location listed.

These and other issues on maintaining accurate information in provider directories was the focus of a recent MCOL infographoid, highlighted below:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Sunday
Dec132015

List of Chronic Diseases for Young Adults – Add Mental Health!

By Claire Thayer, December 13, 2015

When we think about chronic conditions, we typically think about chronic diseases such as cancer, heart disease, diabetes, etc. But rarely is mental health thought of as a chronic condition. According to data in the 2014 National Survey on Drug Use and Health (NSDUH), 11.9 percent of young adults aged 18 to 25 received mental health services in the past year

It’s interesting to note that 42.3 percent of young adults who received mental health services in the past year are receiving prescription medication as their only mental health service.

A recent Health Affairs blog, The Forgotten Chronic Disease: Mental Health Among Teens And Young Adults, identified 5 primary barriers in obtaining needed mental health treatment:

  • Stigma
  • Inadequate screening by primary care providers
  • Trouble finding treatment
  • Failure to implement evidence-based therapies
  • Slow implementation of research findings

Additional information:

The CBHSQ Report, Substance Abuse and Mental Health Services Administration (SAMHSA). December 8, 2015.

The Forgotten Chronic Disease: Mental Health Among Teens And Young Adults. Health Affairs Blog. October 1, 2015.

Mental Health Myths and Facts. MentalHealth.gov U.S. Department of Health & Human Services.

Wednesday
Nov182015

The Impact of Inaccurate Patient Data 

By Claire Thayer, November 18, 2015

Matching of patient records to the correct person is of utmost importance in terms of patient safety and quality of care, yet gets complicated when organizations share their records electronically either with different EHR platforms or across multiple healthcare systems as well as when patients use different settings to receive their care.   The Patient Identification and Matching Initiative, sponsored by the Office of the National Coordinator for Health Information Technology (ONC), focused on identifying incremental steps to help ensure the accuracy of every patient’s identity. A few of the key findings outlined in the ONC’s  Patient Identification and Matching Final Report report suggest:

  • Standardized patient identifying attributes should be required in the relevant exchange transactions.
  • Any changes to patient data attributes in exchange transactions should be coordinated with organizations working on parallel efforts to standardize healthcare transactions.
  • Certification criteria should be introduced that require certified EHR technology (CEHRT) to capture the data attributes that would be required in the standardized patient identifying attributes.
  • Certification criteria that requires CEHRT that performs patient matching to demonstrate the ability to generate and provide to end users reports that detail potential duplicate patient records should be considered.

Also referenced in the extensive 85+ page ONC report: One-fifth of CIOs surveyed by College of Healthcare Information Management Executives (CHIME) indicated that at least one patient in the last year suffered an adverse event, due to mis-matched records. While exact cost impact is hard to gauge, one health system reported that poor patient matching is associated with an operational cost of fixing a duplicate record at $60. The overall impact of inaccurate patient data was the focus of a recent MCOL infographoid, highlighted below:

 

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Tuesday
Oct202015

Transitioning payer reimbursement from volume to value

By Claire Thayer, October 20, 2015

Moving away from traditional reimbursement models based on volume to those aligned more closely with outcomes, cost and quality is easier said than done, but has over-whelming industry support.  Earlier this year, Modern Healthcare spoke with committee members of a new Health Care Transformation Task Force (made up of providers, insurers and employers) who pledged collectively to shift 75% of its members' business into contracts with incentives for health outcomes, quality and cost management by January 2020.

The U.S. Department of Health and Human services has jumped on board the value reimbursement trend as well, setting a goal of tying 30% of traditional fee-for-service Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50% of payments to these models by the end of 2018.  A Deloitte study found that 72% of surveyed health executives said that the industry will switch from volume to value. The Case for Value-Based Care was the focus of a recent MCOL infographoid, highlighted below:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.