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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

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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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Sepsis: A Quiet Killer

patient in hospital bed

Several months ago, I attended a conference where a mother and father spoke about their son's tragic battle with sepsis. Their experience left an impression with me that I will never forget. In 2012, their 12-year-old son, Rory Staunton, received a scrape on his arm during a basketball game. The scrape became infected and Rory received a slow diagnosis of sepsis, which eventually led to his death. The Rory Staunton Foundation was created in his honor as a way to help the fight against sepsis.

In addition to hearing about Staunton's experience, I also have two close friends who have battled sepsis. I visited both in the intensive care unit during their battle with this devastating infection. At one point, they were hardly recognizable because of inflammation.

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Trading Places: Lessons Learned by a Caregiver Who Became a Patient

Doctor with Patient and Family

Recently, I was admitted to a hospital for the first time in my adult life. While I'd experienced hospitalization (and subsequent follow-up visits with specialists) from the caregiver/advocate point of view, I had not actually been a patient before. This gave me a new perspective on both roles.

I learned that I'm much more anxious as a caregiver than as a patient. Surprisingly, as a patient, I found that I was able to wait and see what the tests revealed without focusing on "what if" scenarios. As a caregiver, I am much more nervous and always thinking about how to prepare for the various possibilities.

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The Perfect Patient

Doctor with patients

A recent article in JAMA told the story of an Ivy League educated woman in her early 30s, well insured, a native English speaker, health savvy, with no medical history -- for all intents and purposes the "perfect" patient -- who went to a hospital emergency department for lower abdominal pain. A questionable mass in her colon was discovered on a CT scan. After three days in the hospital she didn't know whether the mass was cancerous or not, and she had not received information about the next steps for diagnosis and treatment at the time of discharge. She spoke up when the nurse handed her the discharge instructions and asked to speak to her physician again. No clear answers were provided. She left the hospital confused with no obvious follow-up plan. Her abdominal pain didn't get better, but it also didn't get worse. So she did what was easiest: nothing at all. Her negative experience discouraged her from further interaction with the health care system. Three months later, she still had not sought follow-up medical care.

What makes a seemingly ideal patient so disillusioned that she neglects her own care?

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New Mexicans Step Up for Health Care Value

New Mexico Coalition for Healthcare Value Logo

HealthInsight New Mexico joined nine other stakeholders in New Mexico as founding members of the New Mexico Coalition for Healthcare Value, a new not-for-profit organization that includes private and public employers, health care providers, insurers, and one of the state's largest retiree health care organizations. The focus of this organization is to provide a neutral forum to discuss ways to improve value and transparency in health care in the state.

The coalition was formed as a result of the momentum generated by the Robert Wood Johnson Foundation's Aligning Forces for Quality (AF4Q) grant that had been operating in New Mexico over the past six years. Employers in New Mexico were interested in sustaining the efforts of the AF4Q initiative and were a driving force behind forming the new organization.

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Delivering Widespread Improvement in Health Care through Learning and Action Networks

Participants taking notes

There are many ideas, interventions and literature on evidence-based practices that have been effective in delivering quality care. However, the challenge is sharing these practices among health care providers to make the care experience better for every patient. How can providers share their experiences and learn from others' experiences to improve care instead of reinventing the wheel or continuing ineffective practices?

HealthInsight is convening Learning and Action Networks (LANs) as a forum that brings together stakeholders, providers and improvement experts in an "all-teach, all-learn" model that encourages peer sharing, rapid testing of change ideas, and support for adaptation and spread of successful improvements. The goal of a LAN is to bring providers and community partners together to:

  • Create a forum for sharing of best practices
  • Develop an action plan to overcoming barriers and problems for improving quality processes and outcomes, demonstrated through quality measures
  • Offer resources to providers to assist in improvement efforts (such as webinars, clinician tool kits, meetings and best practice advice from successful clinicians and facilities, along with subject matter experts)
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