Healthcare Intelligence Network

Humana's remote monitoring pilots go beyond traditional targets of heart failure, diabetes and COPD to observe functionally challenged members, explains Gail Miller. This novel approach uses a Personal Emergency Response System (PERS) with a built-in accelerometer to monitor members challenged by activities of daily living (ADL), says the VP of telephonic clinical operations in Humana's care management organization, Humana Cares/SeniorBridge. Another pilot, a collaboration with HealthSense, places sensors around the member's home to study algorithms of normal movement so Humana can detect changes and intervene before a member's crisis. All Humana remote monitoring pilots engage the circle of care surrounding the member --- be it home health, a family member, or a spouse. Gail Miller will share more details of Humana's telephonic care management and how remote monitoring pilots will enhance care coordination during a March 19, 2014 webinar, "Integrating Mobile Health Remote Patient Monitoring with Telephonic Care Management for Improved Care Coordination Results," a 45-minute program sponsored by The Healthcare Intelligence Network.

Relationships with community organizations that support mental health as well as recovery from addiction are essential to care coordination of Medicare-Medicaid beneficiaries, notes Julie Faulhaber, vice president of enterprise Medicaid at Health Care Service Corporation (HCSC). These collaborations enable HCSC to address the needs of duals as "a whole sick person, and not just as a diagnosis," she explains, noting that duals often suffer from depression along with some physical disability. HCSC also has its own integrated team with behavioral health expertise. Julie Faulhaber will share her organization's approach to designing a care coordination model for dual eligibles and initial findings from these new programs during a March 12, 2014 webinar "Moving Beyond the Medical Care Coordination Model for Dual Eligibles," a 45-minute program sponsored by The Healthcare Intelligence Network.

Given changing reimbursement incentives and collaborative models for physicians and hospitals, Greg Mertz, managing director of Physician Strategies Group, LLC, discusses why the Congressional proposal "Better Care, Lower Cost Act" of 2014 is financially more attractive to providers than ACO models and whether he thinks it will be passed. He also deconstructs CMS' recently reported financial results for such health reform delivery initiatives as Medicare ACOs, Pioneer ACOs, and the Physician Group Practice demonstration, and weighs in on which, if any, model he considers the most sustainable. Greg Mertz helped healthcare organizations assess which value-based healthcare delivery model is right for their organization during "Physician Alignment: Which Model Is Right for You?," a February 19th, 2014 workshop at 1:30 p.m. Eastern.

There are three key benefits to prudent sharing of performance data among physicians, notes Cynthia Kilroy, senior vice president of provider strategy and business development at Optum, who suggests a four-step systematic approach for data dissemination that moves companies away from simply creating "metrics in a box." Besides the electronic health record, she recommends three other data sources to mine for provider performance metrics. Cynthia Kilroy explored the key structure, issues and challenges in these evolving reimbursement models during a January 29, 2014 webinar, "Accountable Care Reimbursement Models: Moving from Productivity to Population-Based Incentives," a 45-minute program sponsored by The Healthcare Intelligence Network.

Adventist Health's successful use of incentives to engage employees in population health sets a high bar for the program's imminent rollout to patients at Adventist-owned White Memorial Medical Center, notes Elizabeth Miller, Adventist's vice president of care management. In this interview, Ms. Miller describes the program's target population as well as the incentive that engaged 95 percent of its employees in health management. Elizabeth Miller will share the key features of the population health management program at White Memorial, the program's impact on Adventist's 27,000 employees and program rollout to its patient population during a January 22, 2014 webinar, "Managing Risk in Population Health Management," a 45-minute program sponsored by The Healthcare Intelligence Network.

With hospital readmission rates under close scrutiny by CMS, Torrance Memorial Health System launched a readmission program in early 2013 that has been recognized as a program of excellence for its innovation and impact on the community. Navigators work with patients prior to discharge from the hospital to educate them on the hospital's Care Transitions program, which includes a network of Skilled Nursing Facilities, or SNF's and one home health agency. And once the patient is discharged, ambulatory case managers keep watch on the patients after the 30-day penalty phase is over. Josh Luke, Ph.D., vice president of post acute services at Torrance Memorial Health System and founder of the California Readmission Prevention Collaborative and the National Readmission Prevention Collaborative, shared the key features of the program during "Award Winning Readmission Prevention Protocols: Navigating Care Transitions with Preferred SNF and Home Health Providers," a 45-minute webinar on January 8th, 2014, at 1:30 pm Eastern.

Modifying a popular hospital admissions risk assessment tool for its own use helps Stanford Coordinated Care to prioritize home visits for its roster of high-risk patients, all of whom have complex chronic conditions, explains Samantha Valcourt, MS, RN, CNS, Stanford's clinical nurse specialist. Stanford's HARMS-11, based on Iowa Healthcare Collaborative's HARMS-8 hospital risk screening tool, looks at individuals' utilization, social support and medication issues, among other factors, to measure a patient's risk of readmission. The resulting home visits, a critical component of Stanford's care transitions management program, help to uncover health challenges the complex chronic patient may still face, including four common medication adherence barriers Ms. Valcourt describes in this interview. Samantha Valcourt shared how Stanford's Coordinated Care uses a home visit assessment to improve care transitions post-discharge during a December 19, 2013 webinar, "Home Visits: Assessing Complex Patients Post-Discharge To Reduce Readmissions."

If payment inequities can be addressed, communication and technology tools in place in large physician multispecialty groups make them ideal candidates for a medical neighborhood, suggests Terry McGeeney, MD, MBA, director of BDC Advisors. Dr. McGeeney, who spent 13 years of his practice career in a large multispecialty group, has also seen some FQHCs and managed Medicaid programs that do a good job of linking community and social supports required in medical neighborhoods. As for engaging patients in this emerging integrated care delivery system, try explaining the medical neighborhood's value proposition for them, he suggests. Patients already get why the integrated approach is good for physicians and insurance companies but need to hear why they should buy in to team care, patient portals and other aspects of centralized care coordination. Dr. McGeeney shared his expertise in developing medical home neighborhoods during a November 20, 2013 webinar, "Medical Home Neighborhoods: Uplinking Specialists To Create Integrated Systems of Care."

Despite the migration of some Pioneer ACOs to CMS's Medicare Shared Savings Program (MSSP), expect the surge in commercial accountable care organizations to continue in 2014, predicts Steven Valentine, president, The Camden Group. In this audio interview, Valentine suggests improvements to patient handoffs, an area in which ACOs have disappointed, in Valentine's view, as well as expectations for the other much-modeled care delivery platform, the patient-centered medical home (PCMH). In both the ACO and the PCMH, Valentine anticipates specialists will be critical parts of the solution, especially when it comes to emerging payment models, quality and performance. Steven Valentine and Catherine Sreckovich, managing director, healthcare, Navigant, provided a roadmap to the key issues, challenges and opportunities for healthcare providers and payors in 2014 during an October 30, 2013 webinar, "Healthcare Trends and Forecasts in 2014: A Strategic Planning Session."

From partnering with non-traditional providers like retail clinics to targeting larger physician practices to achieve savings and boost health outcomes, watch for health plans to continue to reshape primary care delivery over the coming year, predicts Catherine Sreckovich, managing director, healthcare, Navigant. Ms. Sreckovich outlines seven ways in which payors will influence primary care, advocates for big data for both payors and providers, and comments on the longevity of the bundled or episodic payment trend in this HealthSounds interview. Catherine Sreckovich and Steven Valentine, president of The Camden Group, provided a roadmap to the key issues, challenges and opportunities for healthcare providers and payors in 2014 during an October 30, 2013 webinar, "Healthcare Trends and Forecasts in 2014: A Strategic Planning Session."

In its quest to transform 70 to 80 percent of its physician practices to a patient-centered medical home (PCMH) over the next three years, WellPoint has adopted a "meet the practices where they are" philosophy, reports Julie Schilz, director of care delivery transformation for WellPoint. Each practice is at a different place in the transformation effort and requires specialized supports, she adds. Smoothing the transformation rollout is the simultaneous participation of 500 WellPoint practices in CMS's Comprehensive Primary Care (CPC) program, whose goals dovetail with key PCMH principles --- as though WellPoint had another partner in its transformation initiative, Schilz notes. Just as important as practice support is transparency with health plan members, Schilz adds, especially when it comes to explaining the concept of the medical home neighborhood --- where care coordination is a collaboration between primary care and the specialist. Ms. Schilz shared the key features of WellPoint's transformation initiative, including results from its pilot program that have led to a system-wide rollout, during an October 24, 2013 webinar, "Aligning Value-Based Reimbursement with Physician Practice Transformation."

There's education, there's experience, and then there's the 'right stuff' --- the indefinable personality traits that earmark an individual as a change agent, collaborator and ambassador of case management, says Annette Watson, senior vice president of community transformation for Taconic IPA (TIPA), of TIPA's requirements for the RN case managers it hires for its advanced patient-centered medical homes. Then there are the not insignificant contributions of the RN case manager to accountable and patient-centered care, which Ms. Watson describes in this interview. While staff-buy-in and communication continue to challenge the embedded case manager model, the participant in CMS Innovation Center's Comprehensive Primary Care (CPC) initiative says reimbursement for embedded case management is less of an obstacle today than in the past, due to funding-friendly care models and pilots descending from healthcare reform. Ms. Watson shared how TIPA has successfully embedded case managers in an open, multi-payor community during an October 9, 2013 webinar, "Improving Population Health with Embedded Case Managers in an Open, Multi-Payor Community."

The philosophy that healthcare is local --- and therefore, care needs to be local and community-based --- forms the core of WellCare's efforts to connect its dually eligible population to health services, explains Pamme Taylor, WellCare's vice president of advocacy and community-based programs. The Tampa-based healthcare company takes a culturally competent approach to assessing duals' unique personal circumstances, ensuring their "soft landing" into WellCare's care coordination system. Care managers at the heart of WellCare's multidisciplinary team, conducting a comprehensive needs assessment with each Medicare-Medicaid beneficiary and driving the resulting care plan, ensuring duals' complex care needs are met at the most appropriate time and level. Ms. Taylor shared Wellcare's strategies for meeting members' needs with community-based partnerships and engaging duals in self-management of their care during an October 2, 2013 webinar, "Dual Eligibles: Closing Care Gaps and Engaging Members in Self-Management."

Lauded for its care coordination service, Monarch had to overcome a few challenges when retrofitting the Naylor Transition of Care (TOC) model for the ACO --- among them insufficient patient access, patient skepticism and resource limitations. By focusing on readmissions reductions and four disease management conditions --- ESRD, COPD, CHF and diabetes --- and creating a care coordination team that included the newly created care navigator, case managers, and pharmacist, the organization has improved patient compliance, reduced negative drug interactions and hospital days and improved patients access to community services. During "Medicare Pioneer ACO Year One: Lessons from a Top-Performer," a September 18th webinar at 1:30 pm Eastern, Colin LeClair, executive director of ACO for Monarch HealthCare, shared first year lessons from its Medicare Pioneer ACO experience, how it evolved in year two and the impact on its organization's participation in other accountable care organizations.

A patient might expect a reminder about a missed colonoscopy during a primary care visit, but during a trip to the dermatologist? Providing health plan members with "consistent and ubiquitous reminders" via multiple touchpoints in their healthcare journey is one of Kaiser Permanente's key population health management strategies, reports Jim Bellows, PhD, senior director of evaluation and analytics for Kaiser Permanente. Another is the vigorous use of registries --- more than 50 in all, at last count --- even for relatively rare diseases. Dr. Bellows defines the criteria for registry creation, expands on the choice and availability of patient touchpoints and explains the evolution of other Web-based PHM tools in use by Kaiser Permanente. Dr. Bellows shared his organization's approach to population care and population health management during a July 31, 2013 webinar, "Managing Population Health with Integrated Registries and Effective Patient Touchpoints."

When tracked within its electronic medical record, key interventions like transitional care coaching and an expanded Patient Health Questionnaire not only improve the care provided to John C. Lincoln ACO's population but provide a clearer picture of the accountable care organization's performance, note Karen Furbush, business consultant, and Heather Jelonek, chief operating officer of the John C. Lincoln Network ACO. Additionally, the ACO's Physician Advisory Network, made up of its leading physicians, tracks patterns and trends within the ACO and helps the care team to adhere to best practices in evidence-based medicine. Monthly webinars with the physician advisory network and its EMR specialists provide opportunities for evaluation and training in these best practices. Karen Furbush and Heather Jelonek shared how the John C. Lincoln Network ACO has modified its reporting process, from workflow changes to customizations within its EMR to improve performance results during a July 17, 2013 webinar, "Performance Quality Measurement and Reporting for Accountable Care," a 45-minute program sponsored by The Healthcare Intelligence Network.

When health coaches employ motivational interviewing during patient encounters, expect upticks in medication adherence, weight loss, HbA1c levels and overall engagement, notes Alicia Vail, RN health coach for Ochsner Health System. Ochsner's eight health coaches focus on patients with diabetes, hypertension and obesity who have come to their attention by way of physician referrals, health screenings and pre-chart reviews. In this podcast, Ms. Vail describes how Ochsner Health System incorporates health coaches in its clinic structure and describes the benefits that result from the coaching intervention. Alicia Vail and Bill Appelgate, executive director of the Iowa Chronic Care Consortium, shared how an evidence-based health coaching focus drives returns in a value-based payment delivery system during a June 19, 2013 webinar, "Health Coaching's Value in Accountable Care and Medical Homes."

Primary care and the patient-centered medical home offer a great opportunity for health coaches to become allies with patients in improvement of their health, notes William Appelgate, executive director of the Iowa Chronic Care Consortium. Individuals with the highest health risks should be given priority, but those on the cusp of a serious health event also merit coaching assistance, he says. For providers new to the coaching conversation, Appelgate shares three benefits of incorporating health coaches in the care process --- including the upping of their 'outcomes game.' Bill Appelgate and Alicia Vail, RN health coach for Ochsner Health System, shared how an evidence-based health coaching focus drives returns in a value-based payment delivery system during a June 19, 2013 webinar, "Health Coaching's Value in Accountable Care and Medical Homes."

To rise to the challenge of non-compliant patients, providers should ask how they can work together to empower patients toward self-management rather than why patients are non-adherent in the first place, suggests Alicia Goroski, MPH, senior project director for care transitions for the Colorado Foundation for Medical Care (CFMC). CFMC coordinates the work of state-based Quality Improvement Organizations (QIOs), who have been working with hospitals and community providers to improve care transitions and reduce readmissions. In this interview, Ms. Goroski describes some of the interventions focused on patients, providers or both groups that have not only lowered key Medicare readmission rates but also reduced participants' overall admission stats. Ms. Goroski shared lessons learned from the 14 communities that participated in the CMS care transition demonstration project and details on program rollout to over 12 million Medicare beneficiaries in 400 communities during a May 22, 2013 webinar, now available for replay "Patient Engagement and Provider Collaborations Across the Healthcare Continuum to Improve Care Transitions."

A core desire to create a single population-focused model of care for all Medicare beneficiaries, rather than multiple payor-driven approaches, drives Atrius Health's participation in the CMS Pioneer ACO program, explains Emily Brower, executive director of accountable care programs at Atrius Health. The success of the Atrius ACO hinges on several preferred partnerships it has cultivated, including a collaboration with skilled nursing facilities, as well as outreach by population health managers, who guide patients in the management of chronic illness and prevention. Ms. Brower shared the first year lessons from its experience as a Medicare Pioneer ACO and how the program is evolving in year two during a May 9, 2013 webinar, "Medicare Pioneer ACO: Case Study on Atrius Health's Focus on the Triple Aim," now available for replay.

There are two key mistakes healthcare companies make when adopting social or mobile technologies, explains Andrew Dixon, senior vice president of marketing and operations, Igloo Software. Dixon describes what's driving the aggressive growth of interactive patient care communities and suggests how responsibility for social strategy --- which he defines as both an internal and external communications strategy --- should be assigned. Dixon discussed the key elements of an effective social strategy, along with and best practice guidance from healthcare social strategies having a bottom line impact during a May 1 2013 webinar, "Healthcare Social Business Strategy: Driving Adoption with Social, Mobile and Cloud Technologies," a 45-minute program sponsored by The Healthcare Intelligence Network.

Low scores on patient outcomes measures within the CMS Star Quality ratings program --- metrics CMS weights most heavily in its assignment of stars --- can typically be traced to poor provider and member engagement, notes Joseph Johnson, vice president of L.E.K. Consulting. Johnson suggests ways to enlist support from these two stakeholder groups, and describes how MA plans should prepare for the possible display in 2014 of CAHPS care coordination ratings along with with its star scores (though the care coordination ratings will not be factored into star ratings). Johnson shared tactics to improve quality ratings as well as insight into the future direction of the CMS Star Quality program during an April 16, 2013 webinar, "A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings," a 45-minute program sponsored by The Healthcare Intelligence Network.

The initial goal of Cullman Regional Medical Center's "Good to Go" program was to reduce readmissions. But CRMC didn't anticipate the effect that recording discharge instructions and sharing them with patients via phone and computer would have on the patient experience. Cheryl Bailey, CRMC's vice president of patient care services, talks about the unexpected benefit of the award-winning initiative, the minimal investment required to get "Good to Go" off the ground, and planned expansion for the initiative that is bridging the patient communication gap. Ms. Bailey, along with Joshua Brewster, director of care management at Regions Hospital, a HealthPartners hospital, shared the key features of their care transition management programs during an April 24, 2013 webinar, "Care Transition Management: Strategies for Effective Patient Handoffs," a one-hour program sponsored by The Healthcare Intelligence Network.

Since the idea of payment bundling was first introduced 10 years ago, justification for the episode-based reimbursement model has shifted from quality and innovation gains to its proven ability to reduce the total cost of healthcare, notes Jay Sultan, associate vice president and chief product portfolio architect for Trizetto. Healthcare entities testing bundled payments should keep two key factors in mind when trying to engage physicians in the model, Sultan adds, describing the type of message most likely to foster provider support. And finally, Sultan also identifies the major decision primary care must make now that CMS has introduced bundled payments for care coordination tasks. Sultan provided perspectives on the emerging bundled payment trend during a March 13, 2013 webinar, "Moving Forward with Payment Bundling," a 45-minute program sponsored by The Healthcare Intelligence Network.

With ACA reforms underway, thecase manager is fast becoming a major player in the patient-centric, qualityover volume healthcare mindset, taking on more standardized, collaborative approaches to care coordination and its changing delivery systems. But as crucial as case managers are to the evolvinghealthcare landscape, they also need to realize that they are, in many ways,the new kids on the block. Embedded casemanagers in particular need to understand that how they relate to theirprofessional partners is one of the most important keys to their success, explains Teri Treiger, president of Ascent Care Management. Here she shares her views on this and other aspects of the industry, including the opportunities for home-based care and how case managers can maximize the use of technology to manage patient care plans. Teri Treiger provided perspectives on the changing healthcare landscape for case management and care coordination during "The Role of Case Managers in Emerging Care Delivery Models," a February 21, 2013 webinar.

Outcomes-based rewards have a place in an overall incentives offering, notes John Riedel, president, Riedel and Associates Consultants, Inc., but despite the growth in these offerings, companies should keep their incentive options open. To maximize effectiveness, programs should include something for all: simple items like gift cards and tee shirts for sign-on, progress-based rewards to move individuals along, and outcomes-based incentives for individuals who take their health seriously. Reidel examines the staying power of extrinsic incentives and suggests eight questions companies should ask themselves to determine whether they've truly constructed a culture of health for the population they serve. John Riedel shared the key strategies in sustaining a health and wellness incentive program and moving toward outcome-based results during "Health and Wellness Incentives: Positioning for Outcome-Based Rewards," a February 4, 2013 webinar, now available for replay.

Physician-hospital organizations have been around before, but it's the emphasis on quality that sets today's PHO apart from the 80's version. In PHO 2.0, where healthcare value is favored over volume, clinical integration of participating physicians is a prerequisite, agree Greg Mertz, director of Healthcare Strategy Group, and Travis Ansel, its manager of strategic services. In this interview, they talk about the essential first steps of PHO creation and the perennial challenges of physician engagement and clinical leadership in this emerging collaborative model. Greg Mertz and Travis Ansel explored the key contractual elements to consider when creating a PHO during a January 23, 2013 webinar, "Physician Hospital Organizations: Developing a Collaborative Structure for Shared Savings Agreements," a 45-minute program sponsored by The Healthcare Intelligence Network.

SCAN Health Plan's Interdisciplinary Care Team for dual eligibles is a diverse multiprofessional group encompassing many geriatric specialists, explains Dr. Timothy Schwab, chief medical officer of SCAN Health Plan. Dr. Schwab describes some of the challenges of risk stratification in a dual eligible population, and details case management support for the percentage of dual eligibles that require support for disabilities. Dr. Schwab shared his organization's strategic approach to serving the dual eligible market during a December 6, 2012 webinar, "Care Coordination for Dual Eligibles: A Results-Oriented Approach," a 45-minute webinar sponsored by The Healthcare Intelligence Network.

A presidential election, more post-ACA milestones and a remodeling of healthcare funding and delivery will no doubt make for an exciting year ahead in healthcare. In this preview of their October 17, 2012 strategic planning session for healthcare executives, Dennis Eder and Hank Osowski, managing directors of Strategic Health Group, and Steven Valentine, president of the Camden Group, predict the direction of physician reimbursement, trends in ACO administration, the technology to embrace in the year to come, and the industry's response to a softened demand for service. Eder, Osowski, and Valentine presented during the Healthcare Intelligence Network's ninth annual "Healthcare Trends and Forecasts in 2013: A Strategic Planning Session" presentation, a 60-minute webinar on October 17, 2012, now available for replay.

Enhanced reporting and efficiency, significant reductions in readmissions in congestive heart failure patients and added leverage at contract negotiation are just a few advantages Bon Secours is deriving from its EHR-based data collection tools, explains Robert Fortini, vice president and chief clinical officer at Bon Secours. Fortini talks about the health system's shift from home-grown methodologies to the sophisticated IT knowledge base powering its population health management program, resulting in data that has a "compelling" effect at contract time. Robert Fortini drilled down on Bon Secours' tools and protocols for data analytics during an October 3, 2012 webinar, now available for replay, "Improving Population Health Management Through Effective, Efficient Data Analytics," a 45-minute webinar sponsored by The Healthcare Intelligence Network.

Integrated health coaching's person-centric approach to health behaviors across the entire health risk continuum aligns with many of the key principles of post-ACA care delivery models like the patient-centered medical home and the accountable care organization (ACO), explains Dr. Dennis Richling, HealthFitness chief medical and wellness officer. Dr. Richling and HealthFitness Vice President of Service Delivery Kelly Merriman describe the population presenting the greatest opportunities for integrated health coaching, the key to discerning participant values during the coaching intervention, and the art of 'appreciative inquiry' --- an essential coaching skill that helps to define an individual's 'exceptionality.' Dr. Richling and Kelly Merriman presented during "Integrated Health Coaching: The Next Generation in Health Behavior Change Management," a 45-minute webinar on September 20, 2012, during which they shared key features of HealthFitness' integrated health coaching program, from how participants are assessed and assigned to coaches to the program's impact.

Before shifting from a disease-focused to population health management (PHM) approach, healthcare organizations need to do their homework, advises Patricia Curran, principal in Buck Consultants' National Clinical Practice --- from researching the population's culture to examining its patterns of healthcare usage and cost trends. In this interview, Ms. Curran describes the four key research areas, as well as some of the barriers encountered along the road to population health management. She also predicts what the no- or low-health-risk populations can expect in a population health management world that spans the health risk continuum --- from incentives to provider and payor contact. Patricia Curran presented during "Population Health Management: Achieving Results in a Value-Based Healthcare System," a 45-minute webinar on September 26, 2012, during which she shared the types of population health management programs and how these programs can produce tangible results in terms of improved outcomes and costs savings.

Although the healthcare industry is well-acquainted with the patient-centered medical home, the model is still quite new and novel to patients, notes, Jay Driggers, director of consumer engagement at Horizon Blue Cross Blue Shield of New Jersey. In this interview, Driggers describes what's at stake when moving from a reactive provider model to a proactive model. Driggers will present during "Patient Engagement in the Patient-Centered Medical Home: A Continuum Approach," a 45-minute webinar on August 22, 2012, during which he will describes some of Horizon BCBS's novel consumer engagement tactics that involve everything from smartphone apps to telemonitoring.

A value-based contract between Advocate Physician Partners (APP) and Blue Cross Blue Shield of Illinois (BCBSIL) has reduced inpatient admissions and emergency room visits and has bent the cost curve after its first year. In this interview, Dr. Carrie Nelson, APP's medical director for special projects, describes how APP's eight-year clinical integration of 4,000 physicians and 10 hospitals has laid the groundwork for this value-based contract. Dr. Carrie Nelson presented during "Bending the Cost Curve with a Commercial Value-Based Payment Contract: A Case Study from Advocate Physician Partners," a 45-minute webinar on July 18, 2012, now available for replay, during which she shared lessons learned from the first year of implementing the value-based contract between APP and BCBSIL.

The use of a disease-specific approach to improve health outcomes and self-management for patients with diabetes is utilized by 77 percent of organizations, according to HIN's 2011 survey on diabetes management programs. In this podcast, Melanie Matthews shares key metrics from the survey, including the role of the case manager, the use of incentives, the staff member responsible for diabetes management and the greatest challenge associated with the control of diabetes. Also, Kathy Brieger, Hudson River HealthCare chief operating officer, describes HRHC's four-pronged approach to weight management for the 3,400 adult patients it serves.

Aetna's Compassionate Care Program is a case management initiative that specifically targets health plan members with advanced illness, focusing on improving the quality of care they receive. As a result, explains Dr. Joseph Agostini, senior medical director of Aetna Medicare, these patients get more of the type of care that they want and spend less time in the hospital. Patient satisfaction with the program is high, he says, which reflects the strong bond between Aetna members and nurse case managers. In this interview, Dr. Agostini explains the key elements of the Compassionate Care program as well as some of the challenges the case managers may face in the management of advanced illness. Dr. Joseph Agostini presented during "Advanced Illness Care Coordination: A Case Study on Aetna's Compassionate Care Program," a 45-minute webinar on June 13, 2012, now available for replay, during which he shared the key features of the Compassionate Care Program at Aetna, along with the impact the program has had on healthcare utilization and quality outcomes.

Nurse educators provide essential support to physician practices in Florida Blue's rollout of a statewide patient-centered medical home, explains Barbara Haasis, RN, CCRN, senior clinical lead for Florida Blue's quality reward and recognition programs. They help practices meet key disease metrics within Florida Blue's performance scorecards, and can direct providers to both internal and external resources to help them resolve patient issues. Ms. Hassis also explains why providing after-hours access is a prerequisite for practices in the medical home program as well as the case manager's contribution to this program. Barbara Haasis presented during "The Patient-Centered Medical Home: Lessons from a Statewide Rollout," a 45-minute webinar on May 10, 2012, during which she shared how the health plan transitioned from the Recognizing Physician Excellence (RPE) program to a medical home model.

Anxiety caused by the wait for a non-urgent appointment or lack of awareness that they are assigned a primary care physician are just two barriers to appropriate ER utilization by a diverse Medicaid population, explains Laura Linebach, director of quality improvement at L.A. Care Health Plan. As part of a health plan-hospital collaboration with a goal of reducing non-acute ER use by children ages 1 to 19, L.A. Care Health Plan has launched a Nurse Advice Line and developed a range of materials to educate parents about appropriate use of the ER. Ms. Linebach describes these tools as well as a metric in L.A. Care Health Plan's pay for performance program that measures group providers' appropriate resource use. Laura Linebach presented during "Reducing Avoidable Medicaid ER Visits With a Community Partnership Approach," a 45-minute webinar on May 9, 2012, during which she shared the inside details on how the health plan worked with the hospital to target avoidable ER use and results from the initiative.

Geisinger Health Plan reduced the relative risk of all-cause 30-day readmissions by 44 percent compared to a matched control group using an interactive voice response (IVR) system developed by AMC Health. The IVR system targeted patients who were at high risk for readmissions following a hospital discharge. Care managers identified those complex patients that were at high risk for post-discharge complications that could lead to a readmission, explained Dr. Maria Lopes, chief medical officer at AMC Health. The IVR system makes one call per week for four weeks, using branching logic to identify issues with medication adherence, PCP follow-up, and complications, as well as a risk and falls assessment. The program is integrated into the care management workflow to make this impact, she added.

When looking for new hires for its embedded case management program, Bon Secours Health System looks for critical thinking skills and previous roles that are transferable, such as work with chronic disease patients, explains Irene Zolotorofe, administrative director of clinical operations at Bon Secours. Zolotorofe also describes the importance of matching personalities when placing a case manager in a physician practice, how to build a trusting relationship between an embedded case manager and the physician and Bon Secour's embedded case manager training process. Irene Zolotorofe will present during "Recruiting, Training and Case Load Management Strategies for Embedded Case Managers," a 45-minute webinar on May 3, 2012, sharing the process that Bon Secours has established for recruiting, selecting and placing an embedded case manager in their practices, along with details on case load management, tools used by case managers, benchmarks for measuring effectiveness and much more.

The use of nurse-only health advice lines to reduce avoidable ER visits is up 10 percent over 2010 levels, according to HIN's second annual survey on reducing avoidable emergency room use. In this podcast, Melanie Matthews shares key metrics from the 2011 survey, including program availability, health advice line use, new benchmarks on contributions from health coaches and health educators in this area and the biggest barrier to program launch. Also, Dr. Mina Chang describes the methodology behind Ohio Medicaid's interventions to encourage appropriate ED utilization by this population.

In its 15-year existence, Highmark's Quality Blue physician pay for performance program has evolved from one strictly based on clinical measures to a payment model shaped by practices' needs, explains Julie Hobson, Highmark's manager of provider engagement, performance and partnership. Hobson describes how feedback from physicians resulted in its Best Practice quality improvement project, what CMS's recently announced stage 2 proposal for meaningful EHR use means for Quality Blue, and some lessons Highmark has learned about engaging physicians in pay for performance. Julie Hobson presented during Physician Pay-for-Performance: Refining the Bonus Structure To Meet Market Realities, a 45-minute webinar on March 22, 2012, during which Hobson will describe how Highmark's Quality Blue physician pay for performance program has evolved to meet today's healthcare market realities. Hobson will share new developments slated for 2012 to reflect meaningful use requirements; the bonus scoring algorithm currently in place that rewards physicians across the measure set and how this algorithm will change in 2012 to reflect market developments; and much more.

While telephonic sessions were the primary vehicle for health coaching in the last five years, Internet-based face-to-face coaching incorporating motivational interviewing techniques is one of the directions the industry will be taking going forward, says Melinda Huffman, partner in Miller and Huffman Outcome Architects, co-founder of the National Society of Health Coaches, and a cardiovascular clinical specialist, writer and author. Mobile applications will also become more widely used, enabling health professionals to quickly access their patients' personal records, and coach via internet-based in-person calls. There will also be a move toward standardizing health coaching in terms of definition, education, and training and skill validation, Huffman says.

With more than 100 case managers working in seven regional offices, Arkansas Blue Cross Blue Shield (BCBS) embraces any tools that can elevate care delivery and efficiency and reduce paperwork. Karen Black, RN, HIPAAP, HIA, Arkansas BCBS quality improvement coordinator, describes how an early interest in computers helped to drive development of two Web-based tools supporting Arkansas BCBS case managers today, the potential for these tools to support other areas of the company, and how one tool from the centralized portal is helping to standardize transitions of care for Arkansas BCBS members. Karen Black will present during Leveraging Case Management Tools and Technology to Improve Outcomes, a 45-minute webinar on April 11, 2012, during which Black will share how the Arkansas BCBS tools repository was developed, how it fits into the case manager's workflow and the key features that are directly attributed to improvements in patient care delivery.

Medication adherence rates for patients enrolled in a collaborative program developed by the University of Pittsburgh School of Pharmacy, Highmark, RiteAid and CE City, a technology company, was significantly improved and continued to improve over time compared to a control group, according to Dr. Janice Pringle, director of the program evaluation research unit at the University of Pittsburgh School of Pharmacy. Dr. Pringle describes the intervention, which takes a patient-centered approach to pharmacy visits combined with motivational interviewing by the community pharmacists to improve adherence rates. Dr. Pringle also shares how the collaborative has evolved following its first year results, as well as her recent appointment to CMS' Innovation Advisors Program. As part of her focus on the Innovation Advisors Program, Dr. Pringle will be working with RTI to develop pay for performance models for the community pharmacist program.

Though adult mental health patients, substance abusers and children and adolescents may face different behavioral health issues, there's a common reason behind their frequent hospital and ER visits, explains Jay Hale, LPC, CEAP, director of quality improvement and clinical operations at Carolina Behavioral Health Alliance. Hale's organization uses a set of telephonic case management protocols to reduce avoidable inpatient and ER use by these populations. He describes some of the barriers telephonic case managers might face during member outreach, red flags that indicate a physician visit is warranted, and the role of primary care providers in the member's care continuum. Hale will present during a March 7, 2012 webinar, Telephonic Case Management: Protocols for Behavioral Healthcare Patients, during which he will share the case management protocol developed by his organization, including using scripts and surveys to assess patients' engagement in the treatment process and identify patients at-risk.

Hudson River HealthCare (HRHC) takes a team approach to disease management in the 3,400 adult patients with diabetes it serves, explains Kathy Brieger, RD, CDE, HRHC's chief operations officer. Ms. Brieger describes the multiple levels of care available to patients served by the HRHC Diabetes Collaborative, a four-point strategy for weight management that targets the most challenging aspect of managing diabetes, and HRHC's upcoming trial of telepsychiatry at selected FQHCs. Ms. Brieger presented during "Diabetes Management in the Medical Home," a 45-minute webinar on January 26, 2012, providing the inside details on HRHC's diabetes management program and the program's impact on its diabetic patients. Brieger shared how to: identify and assess patients for diabetes management, including an analysis of literacy and learning and social barriers that could impact outcomes for complex patients; train staff and report quality data to drive further performance improvement; and much more.

The mapping between ICD-9 and ICD-10 code sets will have two major impacts on healthcare, predicts Dennis Winkler, ICD-10 technical program director for Blue Cross Blue Shield of Michigan, which has created a roadmap for the transition that it is sharing with the industry. Winkler describes where health plans should be on the ICD-10 timeline at the start of 2012, and defines the two major challenges the health plan expects to face as it enters the testing phase of the transition. Dennis Winkler presented during, "Mapping the Way to ICD-10 Readiness: Blue Cross Blue Shield of Michigan's Approach," a 45-minute webinar, during which he shared BCBS of Michigan's mapping strategy along with other organizational readiness tactics for ICD-10. Winkler addressed: BCBSM's six dimensions of neutrality and how the BCBSM plan incorporates these aspects into ICD-10 readiness; working with external vendors and constituents; ICD-10 systems testing and training; and more.

When healthcare providers and health plan case managers join forces in the physician practice, the end result is "care completion," explains Dr. Randall Krakauer, medical director for Aetna Medicare. In his second HealthSounds interview, Dr. Krakauer describes how the meshing of complementary patient data and knowledge from payor and provider improves the "completion factor" of care that is ordered and provides feedback on the impact of this care. Dr. Krakauer will be presenting during the November 30, 2011 webinar, "Demonstrating the Value of the Embedded Case Manager for the Medicare Population," during which he will share the strategy supporting Aetna's embedded case management initiative, along with results from the program relating to healthcare utilization and member satisfaction.

HIN's fifth annual survey on the patient-centered medical home (PCMH) recorded the highest PCMH adoption levels to date, reports Melanie Matthews in this benchmarks podcast. A substantial number of medical homes expect to participate in an accountable care organization (ACO); Ms. Matthews also shares key metrics from the 2011 survey, including time required for medical home conversion and the PCMH effect on medication adherence and patient satisfaction. The survey also identified an impressive jump in the embedding of case managers in medical homes. Dr. Bruce Nash, senior VP of medical affairs and CMO for CDPHP, where embedded case managers are at the heart of CDPHP's clinical transformation, describes what sets his program apart from other medical home pilots.

While hospitals might find CMS's pure Medicare bundled payments initiative too restrictive, it won't prevent them from addressing their costs in a bundled payments fashion, predicts Steve Valentine, president of The Camden Group. In advance of HIN's eighth annual industry forecast, Valentine weighs in on the expected growth of bundled payments, a surprising new trend in case management, why the proposed ACO rule disappointed, and the industry segment where accountable care is thriving. Steve Valentine will be back to illuminate key trends and opportunities for healthcare in the coming year during a November 2, 2011 webinar, "Healthcare Trends in 2012: A Strategic Industry Forecast."