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Taking Back the Trail

Taking Back the Trail at Sunset

Social determinants of health, the economic and social conditions that affect the health and development of people and their communities, are an important aspect to consider when attempting to create positive health outcomes for a population. Often the effects of these conditions occur subconsciously -- patterns of healthy behaviors are set by our environments and we accept them as a natural part of our day-to-day lives.

One of the social determinants of health is having access to a safe area for outdoor recreation, where people can walk their dogs, play with their kids or run to keep fit. My neighborhood park is like that -- my family calls the park "puppy town" due to all the dogs that can be found in the park every morning and evening.

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Looking Up to Reach the Stars

Hiker

HealthInsight, like many organizations working toward the triple aim of better health care and better health at a lower cost, has recognized the need to stretch ourselves beyond comfortable goals and targets. As we work with health care providers and other community stakeholders, it will take truly innovative and transformative effort to achieve the goals we seek. Just as we ask providers of health care in our communities to transform their work to improve care and reduce cost, we also ask the same of ourselves. How can we do our work in a way that gets fundamentally different results, extraordinary results, with the same amount of funding, or even with fewer resources? We believe what is required is to step back and look at the big picture -- stepping away from the way we usually have done things to be able to imagine new ways this work can be accomplished.

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What Employers Want from Practice Transformation

Doctor with Patient

This is the last in a series of blogs that shared various health care stakeholders' views on how outpatient practices need to transform to prepare for new payment models that move away from paying for units of care to paying for quality and efficiency. Having shared what we heard from patients and providers previously, I will now share thoughts from a representative of a different health care stakeholder -- employers.

I was fortunate to discuss this topic with Brian Klepper, PhD, health care thought leader and recently appointed CEO of the National Business Coalition on Health (NBCH), which represents 4,500 employers and 35 million employees and dependents. Why do employers care about practice transformation? Because in the United States we pay more than twice as much for health care and get poorer results than other developed nations, so we are disadvantaged in the global market and have less to spend domestically on education and other important infrastructure. This pattern, while unsustainable, is very well entrenched as our fee-for-service system has incentives that lead to more care and not better care. It's hard for a health care system to make changes to itself that will reduce its bottom line. Other stakeholders, often employers, are leading the way in changing to a pay-for-value model.

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Part Two: What Do Providers Think About Practice Transformation?

Little Girl with Doctor

Last week, I shared some thoughts from members of the Provider Advisory Group (PAG) for the New Mexico Coalition for Healthcare Quality. I sat down with this group to discuss practice transformation and the impact it has in transforming care. Members provided their own opinions of practice transformation and not those of the organizations where they work. Today's blog is part two of our discussion.

Providers thought interoperable electronic health records (EHRs) could go a long way in helping with essential coordination of care. They are still seeing a lot of faxing, and things that are easily done on mobile devices are very difficult to do in a less user-friendly EHR system. They thought that doctors shouldn't spend time typing information into the system that either the patients themselves or another staff member could enter. The data needs to be there to drive change, but they thought it was the whole team's role to make sure data was accurately entered and useable. In many practices, doctors are still entering most of the patient data. Providers need to improve their processes for sharing that work with all team members. Currently the EHRs create notes that have all the criteria for coding for a visit to be paid, but the notes are often not structured in a way that captures and displays information on quality of care. User interfaces of EHRs could improve the patients' experience if the systems were easier to operate, enter data into, and to quickly view the patient's past data and create reports in formats that are easily understandable for patients.

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What Do Providers Think About Practice Transformation?

Doctor with Patient

In last week's blog post, I shared some thoughts from members of a Patient and Family Advisory Council on what practice transformation could and should include. This week I have summarized a conversation with members of the Provider Advisory Group (PAG) for the New Mexico Coalition for Healthcare Quality, who serve as expert "ears on the ground" representing practice settings. Members provided their own opinions of practice transformation and not those of the organizations where they work.

They discussed the positive and negative aspects of having more of their income linked to improved patient health outcomes and satisfaction along with cost savings. These well-seasoned health care professionals think transformed care could provide a better patient experience while allowing them to practice medicine in a way that is more fulfilling, but they also recognized that there is a long way to go before we get there.

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What Do Patients Think About Practice Transformation?

Doctor taking notes

One of the many programs that the Centers for Medicare & Medicaid Services (CMS) created to "strengthen the quality of patient care and spend health care dollars more wisely" is the new Transforming Clinical Practices Initiative. HealthInsight has joined with the Kansas Foundation for Medical Care, MetaStar, the Pittsburgh Regional Health Initiative, Stratis Health and partners in each of our communities to apply to become a Practice Transformation Network to provide assistance to clinicians across a 10-state region. One of the many ways we are preparing for this work is by having conversations with members of our communities to better understand their thoughts and needs around transformed care.

I gained new insight into what the care transformation process means to patients when I talked with a group of patient advocates about what transformed care would look and feel like to them. Members of this Patient and Family Advisory Council (PFAC) convene to offer an educated perspective to bring empowerment, respect and inspiration to the design and delivery of health care systems. I started the conversation by describing the gradual shift from fee-for-service to pay-for-value models of reimbursement and a corresponding shift in how outpatient practices might deliver care as they seek to provide the highest quality and most efficient care.

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Unlocking Patient Self-Management: the Employment Effect

Doctor with Patient

When I am not working as a medical director with HealthInsight, I am a part-time family physician in a community-based clinic in Salt Lake City. Last week, I was lucky enough to see a long-time patient, a man that has multiple chronic conditions, including high blood pressure, anxiety, depression and asthma. He cares for his chronically ill wife, and has been intermittently employed since I have known him. During our appointment, I was pleasantly surprised how well he was doing, considering all that is going on in his life.

Eighteen months ago, his chronic conditions were not managed. He was in the emergency department at least once a month, was experiencing significant stress, and was unable to pay for some of his more expensive medications. He fell into a health care coverage gap, unable to pay for insurance and not disadvantaged or ill enough to be disabled or on Medicaid. The Federally Qualified Health Center programs were doing what they could to help him, but it was not enough.

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Accomplishing Goals by the Power of Motivation

Woman

We all have goals that we want to accomplish, but unfortunately we don't always find ourselves motivated to pursue those goals. The ability to motivate ourselves to work on our goals is often the greatest factor in whether or not we succeed.

As a regional health improvement collaborative and a quality improvement organization, our work involves not only motivating ourselves but also motivating our stakeholders and clients to help them reach their goals of better patient care and patient engagement. There are many techniques to help improve motivation, for yourself or when coaching others.

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Shared Nationwide Interoperability Roadmap: The Journey to Better Health and Care

The Shared Nationwide Interoperability Roadmap

I have to admit, I am a self-described health information technology (HIT) geek. I recognize that health IT may not be interesting to most people, but for those of us entrenched in the field of health care system transformation - it is fascinating!

Recently, the Office of the National Coordinator for Health IT (ONC) published the Shared Nationwide Interoperability Roadmap. I found this one-page depiction of where we are currently and where ONC envisions this nation going as very readable and digestible. The infographic provides some excellent statistics that just a few years ago seemed unreachable: 94 percent and 78 percent adoption of electronic systems in nonfederal acute care hospitals and physician offices, respectively; and 62 percent of hospitals electronically exchanged health information with providers outside their system. These are excellent markers!

In fact, the HIT landscape has changed significantly from 2004 when President Bush laid out his vision of widespread electronic health record (EHR) adoption. He stated, "the federal government must create the incentives for health care providers involved with the federal government to use medical records, and in doing so, will go a long way toward introducing IT, information technology, into a part of medicine that desperately needs it."

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The Importance of Transparency in Health Care

Stethoscope with money

Imagine yourself in a supermarket, under some considerable distress. You are hosting a big party and you have waited until the last minute to stock up on the necessary provisions. You find yourself in the middle of a long aisle with half a dozen shelves on each side, stacked with hundreds of nondescript goods. Unlike a typical grocery, there are no labels; you are unable to compare the quality of products. Even more troubling, the prices are nowhere to be found.

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