The following is the first of a series of guest blogs from Senscio’s trusted advisors and thought leaders in the field of healthcare. We hope you find these articles stimulating.
by Nicholas Toumpas, Principal Consultant at Karitsa Consulting Services, LLC, former New Hampshire Director of Health and Human Services
Over the past several years, we have seen an increasing awareness of the need for evolution of Medicaid-funded healthcare from traditional “fee for service” to accountable outcome-focused care. Through the help of technology, coaching, and improved protocols, in New Hampshire we have been able to drive this care from being clinic/hospital-based, to community based, and ultimately to in-home care and support. This has resulted in better outcomes, lower costs, and improved population health, while reducing the burden on physicians.
We see the largest impact of this transition in patients with complex chronic conditions, such as CHF and COPD, as well as with patients with substance abuse and mental health conditions, who need ongoing attention and support. These two populations account for the majority of Medicaid expense.
We recognize that it can be tragic to require patients to visit a clinician every time they have an element of an exacerbation under the historical fee-for-service model. Beyond cost, it causes a cumulative negative effect on their condition, and misses the ability to catch “early warning” signals of health issues between visits. Technology, integrated with coaching and community-based care, is a tremendous workforce multiplier for the healthcare system. A service such as Sensico System’s Ibis is an ideal platform to deliver this new model of care.
In my state of New Hampshire, we have received a Federally funded “waiver” to prove the efficacy of innovation in the delivery of care to Medicaid patients. We continue to drive towards choices for independence to keep patients in-home rather than in institutions. We have embarked on a program to create demonstrable results that we improve “triple aim” results through the integration of primary care and community. To this end, we have been granted $150 million to incentivize the demonstration of an integrated delivery approach. This will be an iterative approach, where we will be moving to an outcome-based model, removing the financial risk to clinicians to implement this innovation, and proving the effectiveness. Once we show success in a small population pilot, we will continue to expand, with the hope that we can transform our delivery system. Our expectation is that ultimately, the combination of community support and coaching, along with the integration of technology, will bring us one step closer to a more effective healthcare system for those with the most urgent need.
We look forward to making these improvements by leveraging care and technology to improve our healthcare system for better outcomes, lower costs, and healthier populations.
In the age of technology, chat bots, and electronic charting, the healthcare industry is seeing radical changes in its approach to patients. While these technologies are providing new ways to provide care, they may also be missing an important aspect of quality care.
In the age of social media and data mining, leveraging predictive models for better outcomes has become paramount for many organizations. That is true for healthcare professionals relying on mined data of actual patients to improve provider decisions.
Data gathering is the easy part. There is often so much that it can become overwhelming. That’s why data mining in the healthcare industry must be strategic. The key to being able to use the reams of data now available in the actual care of the patient is to have the data contextualized into “actionable information” in a real-time manner. This enables meaningful and relevant insights to be applied to the standards of care for the individual and for populations. Here are a few tips on how to start turning data in action.
The drive to transform the healthcare system from a volume based, fee-for-service structure to a value-based, “focus on outcomes” structure has been underway for several years. Escalating costs and imbalances between levels of care have jump started the movement to reform the health care payment system.
One of the first efforts in this arena has been the Accountable Care Organization (ACO) model. Pursuing this model has been a step in the right direction. Some ACOs have shown considerable progress in finding ways to deliver good health care while reducing costs. At the same time the model has demonstrated the many challenges in transforming health care.
By Bill Anderson
Readmissions are on everyone’s mind in the acute and post-acute care space, and people with chronic health conditions are 1.5 times more likely to be re-hospitalized within 30 days, 4 times more likely to have an emergency room visit, and cost 5.5 times more for annual care than those without complex or chronic health conditions. And the high costs of admissions—the financial costs—are where Senscio and our Ibis technology provide extraordinary value to primary and acute care providers.
By Piali De
Health Affairs released a Health Policy Brief in September on “Rebalancing Medicaid Long-Term Services and Supports.” The brief announced that instead of focusing on institution-based care, Medicaid is shifting to support community-based care and long-term care options. The driving factor in this shift is the desire to provide “true balance” for beneficiaries through a “comprehensive and flexible community-based long-term services and supports program.” This, the brief argues, will be a more humane and cost-effective approach to our current health care system.
By Piali De
During last week’s roundtable conference, I had the opportunity to engage with a variety of influential and thoughtful individuals on the topic of providing care for people with the most complex health concerns. I want to thank those participants for joining with me in what became a rich conversation on this topic that we all care about and for their immense contributions to the discussion.
By Bill Anderson
Circus tightrope walkers worry about three things when they are performing. The first is the knots that hold their rope firmly above ground and keep it taunt. The second is the balance bar they use to steady their walk when things get unstable. Finally, they rely on the knowledge that the net below them is strong enough to catch them in the event of a fall. Faults in any of these three things can mean life or death for the circus performers.
By Piali De
This summer marked the 50th anniversary of the passing of the Medicaid and Medicare bills. Both government programs have transformed the delivery of healthcare in this country and have worked to eliminate abject poverty and homelessness. Before Medicare, old age and poverty went hand in hand; people over the age of 65 with healthcare complications were often unable to afford private health care and were forced to either rely on family members for support or go without care.
By Simon Trussler
Historically, clinicians have had very limited visibility into how patients with chronic conditions were doing in home or institutional care settings; they tracked patients’ status mainly during office visits or as a result of acute episodes. Preventive care and education initiatives, together with outbound nurse calling programs, could help reach the at-risk population in between visits, but they lacked the up-to-date patient data required for precise targeting of the most vulnerable population.