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R-E-S-P-E-C-T—“Find Out What It Means to Me”

"R-E-S-P-E-C-T find out what it means to me," are words most everyone has heard and probably sang along to at one point in their life. The popular song by Aretha Franklin, is just one of many songs that touts the need for respect.

Because HealthInsight lists "Respect" as one of its "Values in Action" that govern our relationships with one another and the communities we serve, and because of the importance of respecting each other in the workplace, I thought the topic was important enough to remind everyone what respect is, and how respect is demonstrated in and around the workplace.

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Lightning Safety in the Mountains and Beyond

Storm Clouds - Photo by Melissa J. White

There goes that thunder again! Something rare in the Southwest, thunder storms and the associated lightning became common this summer in New Mexico. It seemed every time my sister and I went hiking in the Sandia Mountains, especially above 10,000 feet, we encountered a late afternoon thunderstorm with lightning over our heads. Even though we had checked the forecast before leaving, the storms kept sneaking up on us.

What should we do? There is no sturdy shelter here unless you are near the tramway and the ski area. On one occasion, we headed into the trees and got out of the high meadow we were crossing. Although still risky, we were less exposed than being on the ridgeline or under a lone tree in the meadow. Lightning strikes the tallest object and being out in the open, and we didn't want to be the tallest object.

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Co-pays, and Discounts, and Cash Prices, Oh My!

Tablets

At HealthInsight we have an initiative, funded by Cambia Foundation, to develop a curriculum to equip newly-insured people with tools to assist them as they navigate the health care system. As someone who has received formal health care system and policy education, and one who has worked in the system for nearly 20 years, I was confident that I was an expert on utilizing and maximizing the system for my family and me. My confidence was crushed the moment I needed to fill my son's acne prescriptions.

I am on a high-deductible health plan, which is complimented by a health savings account (contributed to by both me and my employer). At the first doctor's appointment, I was more than $1,000 away from my deductible--when in-network care and prescriptions would be covered at 100 percent. My son's pediatrician was aware that I would be paying out of pocket, so he wrote prescriptions for what he thought would be the most inexpensive. When I went to pick them up from the pharmacy, the total was $312.73 for a topical antibiotic and a tube of generic Retin-A. I was shocked, but the pharmacist reassured me that I could probably stretch them out beyond a month. I caved and bought the medication.

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Building Our Skill Set for the Future

Meeting

HealthInsight operates in a demanding environment promoting improvements to a complex health care system and in the overall health of our communities. The providers we have served for decades are facing difficult challenges, including adapting to changing demands of consumers, an increased burden of disease and health care reforms that are altering both the payment for and design of their work. In this blog I've captured ideas from staff across HealthInsight as we consider how to evolve our skill set to continue to serve communities in our mission to improve health and health care.

In the past we concentrated our learning in key areas of leverage, such as applying lessons from the aviation and nuclear industries to health care processes and patient safety; using technology (initially Palm Pilots) to bring clinical decision support to the front line and focus on effective use of electronic health records (EHR) and other health information technology (HIT); promoting transparency of information on quality of care; and analyzing processes and using data to understand the dynamics of gaps in care. While those areas remain important, we want to know: Are there others?

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National Immunization Awareness Week for Adults: August 16-22, 2015

Immunization

This week is National Immunization Awareness Week for Adults. Influenza and pneumonia are vaccine-preventable diseases, yet these two diseases combined were the eighth leading cause of death in the United States in 2012, and 90 percent of the influenza deaths occurred in adults 65 and older. Nearly one in three people in the United States will develop shingles (herpes zoster) in their lifetime and there are an estimated 1 million cases each year. The risk of shingles increases as a person ages.

The HealthInsight team is working with office-based practitioners, home health agencies and hospitals in our region to improve influenza, pneumonia and shingles vaccinations among Medicare patients and those with both Medicare and Medicaid insurance. We are currently recruiting providers to join this effort. Our website contains information and the benefits to participating. We need you to help us improve immunization rates and prevent these diseases.

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A Window Into the Future? Utah Practices Share Their Medicare Accountable Care Organization Experiences

Doctor with Patients

Recently, I was fortunate to host a Utah Partnership for Value (UPV) panel featuring local clinics participating in the Medicare Shared Savings Plan Accountable Care Organization (MSSP ACO) program, a federal program that pays providers for delivering better outcomes and lowering cost as appropriate, rather than just paying for each item of service. UPV was also privileged to have a national perspective assist in the discussion, with Tom Merrill, a senior research partner with Leavitt Partners and expert on ACOs, joining the panel. These MSSP value payment arrangements started in 2012, and Utah clinics—Granger, Exodus and Revere—were able to share some of the earliest lessons and suggestions for Utah's success in this new arena of paying medical providers not just for volume of services, but for the best possible outcomes and quality at the right cost.

So what did they say? Not surprising was the value of capturing and sharing data from electronic health records, knowing about the kinds of patients and conditions represented in a practice, communicating to others about the care delivered, and locating a patient's medical information wherever they seek care. Data helps providers understand patient needs so they can assist them more efficiently. It was also no surprise that the data that Medicare provides these clinics, as they participate in the MSSP ACO, shows them places where they need to develop new processes. For instance, one clinic is now addressing their post-acute care relationships and communication.

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Identifying the Tipping Point and Meeting Stakeholders Where They are is Critical to Success

Handshake

People have been asking me what the catalyst or tipping point was that motivated the employers in our community to lead and establish the New Mexico Coalition for Healthcare Value, the new employer led multi-stakeholder organization. I have given the question much thought and I believe it has to do with collaborative leadership, creating community ownership and meeting stakeholders where they are. Let me be clear this takes time and does not happen overnight. The other major ingredient I believe, is to provide something that stakeholders find of value, something that helps them, as we call it "the value add" and can also be seen as meeting them where we are.

Now don't get me wrong, there is no doubt we wouldn't have had the success of being able to transition to the new organization without having had another critical ingredient , a strong backbone organization; in our case that organization was HealthInsight, who was working on the Robert Wood Johnson Foundation (RWJF) Aligning Force for Quality Initiative (AF4Q) at the time. Having the backbone organization allowed us to move quickly in the early days of the AF4Q initiative, which allowed us to focus on the task at hand instead of focusing on building or sustaining the organization in the very beginning. We were able to focus on the initiatives, show some early positive results, and that success then provided the synergy and energy for moving ahead at full speed. This also created a sense of pride and success from which we were able to build. HealthInsight was necessary to incubate, grow and nourish the community collaborative, much as we do our children, but ultimately there comes a time when they are ready to leave the nest and go out on their own. I think the role of a backbone organization is critical but we must also keep in mind that if we are successful, those collaboratives or initiatives will take on a new life and eventually move out of the umbrella of the backbone organization. This is an especially critical concept to understand both for funders, as well as for the backbone organizations. To be successful there is also a need for a long-term strategic vision and committing for the long-term in initial funding, in order to allow the foundational work to be done and supported.

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The Powerful Gift Health Care Providers Have In-hand: A Family’s Experience of Interaction with the Health Care System During End of Life

Nurse with Patient

I have previously blogged about my mom, who developed Alzheimer’s disease and was placed into a dementia care facility in 2011 at the age of 71. I still remember the day that I had to have the gut wrenching discussing with my dad and siblings to remove mom from her home and place her in the care of a dementia facility for the safety of both of my parents. This discussion occurred after several 911 calls, since my elderly father could no longer control some of mom’s agitated and sometimes aggressive behavior. We even had a false start where everything was set up for mom to be transferred and at the last minute my dad decided he could not do it. A week later, mom again had major behavioral problems and dad relented. The admission of mom started a three- plus year journey for our family where we would have a large number of touch points with the health care system.

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Building a High-Rise One Conversation at a Time

Board Meeting

I recently had an interesting conversation with my husband about discipline and not in the way you might think. Thankfully, our two boys are now young adults and no longer need much guidance. Instead, we spoke about how good communication requires discipline.

My husband has been a plumbing contractor for 30 years and has served on many new high-rise construction teams where disciplined communication is not only critical, it's valued. One of his favorite projects was constructing a local high-rise, known as Mandarin Oriental, a CityCenter hotel with residential condominiums on the Las Vegas Strip, and it wouldn't be standing today if it weren't for the disciplined communication between him and the hundreds of other men and women who helped build it.

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Health Care Changes: The Concerns of Physicians in Today’s Environment

As a quality improvement organization, HealthInsight and its contractors and partners are committed to improving health care and the delivery of that care. Sometimes it may be hard to understand why not all providers are excited about the changes taking place. I recently attended the American Medical Association's annual meeting in Chicago. Here are some of the concerns I heard from physicians:

Some providers are resistant to ICD-10, electronic health records (EHRs), e-prescribing and meaningful use. Many of the physicians did see value in the changes mentioned, although to be sure, they saw the least value in ICD-10. Physicians definitely see value in EHRs, but they do not like the manner in which they feel they are being forced to use them. Most physicians saw EHRs as improving communication and in making documentation clearer, and as a tool to improve communication between doctors and patients. However, they are very upset the government did not take early steps to be sure that EHRs could easily communicate with each other, government and insurance companies.

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