Is telemedicine the new normal?

Virtually everything has changed in the past few months. The way healthcare is provided is no different. More independent physicians have moved toward telemedicine as a way to continue to see patients but to do in a safe environment. With third party payers approving certain aspects of virtual care for reimbursement, telemedicine may well become part of the new normal.

The Harris Poll conducted surveys in early 2019 and in late April 2020 that clearly show that telemedicine is becoming more acceptable among patients. Results of the first poll conducted in 2019 showed that 66% of Americans were willing to use telehealth but only 8% had actually done so.

The more recent survey was conducted online from April 27-28, 2020, and involved 2,081 adults living in the US. This survey showed that overall use of telehealth services had doubled at that point, with almost a third of Americans (32%) saying they had tried telehealth and 15% saying they used telehealth for the first time during the COVID-19 pandemic.

In addition, the survey revealed that:

  • Two in ten (19%) said they have used telehealth since the start of the pandemic – and of those, nearly 4 in 5 (79%) had not used such services prior to COVID-19 (i.e., in the last ~2 months more people have used telehealth than had ever used it before).
  • While usage (especially during the pandemic) is happening everywhere, the vast majority of telehealth users reside in suburban (44%) and urban (41%) areas, with 14% of telehealth users residing in rural areas.

When asked how they felt about using telemedicine for their healthcare services, 82% of those who had used it said they love/like it. Those who had not yet taken advantage of telehealth said they found the idea appealing. 61% of survey participants who had not used telemedicine said they like/love the idea of doing so.

Transition your practice to telehealth using Elation. Learn more here.

Telemedicine may well become part of the new normal of the COVID-19 world, as people are advised to stay home to stay safe. Many people are starting to rely on virtual healthcare services for a variety of medical issues and concerns.

The Harris Poll survey found that:

  • Prior to the pandemic, about three in ten (29%) telehealth users were using telehealth for ongoing chronic conditions; during the pandemic, chronic care accounts for 47% of use.
  • A third have used telehealth for diagnosis and evaluation of non-covid-19 conditions (30%).
  • A quarter have used telehealth for mental health therapy sessions (26%).
  • Two in ten (18%) have used telehealth since the start of the pandemic for COVID-19 related diagnosis and management.

Overall, eight in ten of those who have already used telehealth services say they are likely to use it post-pandemic.

  • Of those using telehealth during the pandemic, three quarters (76%) are very/somewhat likely to continue using these types of services.
  • More than a third (35%) of current telehealth users say they are very likely to continue using after the pandemic.

Although most third-party payers, including Medicare, are reimbursing independent physicians for various aspects of telemedicine, those insurance payments may only be temporary. In fact, Medicare is slated to end its coverage of a number of services when the COVID-19 pandemic no longer poses a public health emergency. Even private insurers could revert to only paying a fraction of the cost of traditional visits for telehealth services after the pandemic has passed.

Private insurers typically follow the lead of the federal government in such matters and, while there is broad bipartisan support for telehealth coverage, Congress would have to pass specific legislation to make some of Medicare’s changes permanent. Seema Verma, administrator of the Centers for Medicare & Medicaid Services (CMS), says that “Reversing course would be a mistake.” Approximately nine million people under traditional Medicare used telemedicine services during the early months of the crisis. Verma adds, “It was really a no-brainer for us.”

Rod Farvard
September 7, 2020

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5 tips to start Panel Management in your independent practice

Proactively managing your patients’ health will benefit them as well as your independent practice. When you implement panel management, you are taking steps to ensure that all of your patients are current on their basic preventive care. The emphasis there is on “all” of your patients, not just the patients who come into the office for an illness or a checkup. You can start panel management in your independent practice following these five tips:

  1. Use your electronic health record (EHR) to develop a database.

The database, or registry, will include details about all of your patients and their immunizations, screenings, and preventive and chronic care tests.

  1. Develop and adopt guidelines for your independent practice.

Decide on practice guidelines for preventive and chronic care services, then use those guidelines to establish target levels for health indicators. If this is your initial attempt at implementing panel management in your independent practice, you might decide to use evidence-based national guidelines created and updated by authoritative organizations.

  1. Train your staff.

Panel management is a practice-wide responsibility. Your staff, including nurses, medical assistants, and reception should be trained in panel management strategies. A successful panel management approach is adopted throughout the practice.

  1. Identify gaps in care.

When a patient is not meeting a goal or is overdue for a preventive test, they have a gap in their care. You can use your Clinical First EHR to quickly identify patients who aren’t meeting goals based on custom care management protocols, Meaningful Use objectives, or specific document tags, and easily schedule a follow-up appointment to address any potential gaps in care.

Contact us for more information about identifying care gaps as you implement panel management in your independent practice.

  1. Close those care gaps.

You and your independent practice staff can reach out to your patients to ensure they are getting all the care they need, including preventive care. Outreach panel management includes the proactive measures you and your staff take to contact patients through letters or calls between visits. Inreach panel management happens when you and your staff communicate care gaps to patients who come to your office for a visit.

Some additional points to consider as you start panel management in your independent practice are suggested by the Patient Centered Primary Care Institute (PCPCI):

  • Collaborate with your patients to get them more involved in their own care.
  • Panel management will help your practice become more efficient.
  • Your patients will enjoy a higher quality of healthcare.
  • Communication, internal and with patients, is key to your success in panel management.

Rod Farvard
April 23, 2020

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Differences between Panel Management and Care Management

While there are many common factors and benefits in the two healthcare approaches, there are also significant differences between panel management and care management. Both are proactive and are focused on improved outcomes and reduced costs for patients and physicians. The details regarding which patients are managed and how they are managed differentiate panel management and care management.

Panel Management

As the name implies, panel management involves the physician’s entire panel of patients. Aligned with the concept of population health management, panel management (as defined by the University of Washington Department of Medicine Lexicon) means that “the care team is concerned with the health of the entire population of its patients, not just those who come into the clinical setting for visits.”

The AMA explains that panel management is a “proactive approach to ensuring that all patients whom a physician or practice is responsible for receive preventive care, not just those who come in for appointments” and recommends the following approach to establishing a panel management program:

  1. Develop a registry. This registry can be maintained on the patients’ electronic health records (EHRs).
  2. Use a health maintenance template. This step can also be accomplished using EHRs, which enables the independent physician to holistically evaluate the patient population. (Check out the details here.)
  3. Adopt clinical practice guidelines. Establishing and following guidelines around preventive and chronic care services as well as target levels for health indicators is critical to effective panel management.
  4. Select and train staff to serve as panel managers. Panel management is an approach to be implemented and maintained by the entire clinical staff, working as a team.
  5. Identify care gaps. The clinical staff can use the panel’s EHRs to quickly identify patients who aren’t meeting goals.
  6. Close care gaps through in-reach and out-reach. In-reach focuses on those patients who are seen in the office on a regular basis. Out-reach is a proactive approach for patients who rarely come to the office or who have fallen out of care.

Care Management

The care management approach focuses on collaboration among multiple healthcare providers, managed by the primary care physician. As defined by the Center for Health Care Strategies, Inc. (CHCS), the goal of care management is to “achieve an optimal level of wellness and improve coordination of care while providing cost effective, non-duplicative services.” The potential for unnecessary and even contradictory laboratory and diagnostic services as well as medications prescribed by multiple physicians without coordination and oversight is significantly reduced or even eliminated with care management.

Care management also takes into consideration non-medical factors, such as social determinants of health, and engages the patients and their families in their healthcare plan. When patients are engaged in their own treatment, including preventive care measures, the quality of their outcomes increase and costs decrease for both patient and physician.

Rod Farvard
April 1, 2020

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How care management can increase your independent practice revenue

The triple aim of healthcare, as outlined by the Centers for Medicare & Medicaid Services (CMS) is better care for individuals, better health for populations, and lower cost. These are also the basic goals of a Care Management program for your patients and your independent practice. Lowering costs can also help increase your independent practice revenue.

Most independent physicians are searching for ways to increase their practice revenue. In a 2019 Physician Report, “22 percent of respondents said their practice is doing better than a year ago, 52 percent are doing about the same, and 26 percent are doing worse.” Options for increasing revenue include increasing the patient panel, which would require additional staff, and improving productivity and efficiency.

Care management enables the physician to more effectively and efficiently manage a patient’s treatment plan by coordinating with other healthcare providers to reduce unnecessary tests or office visits. While primarily a mechanism for improving the patient’s healthcare outcomes, the program also results in lower costs for the independent physician’s practice. When costs are lowered, net revenue increases.

How does a quality electronic health record (EHR) solution
improve your independent practice’s efficiency?

To further increase your independent practice revenue, you might consider adding services within your practice rather than referring patients to other specialty providers. For example, Coley Bennett, CMM, CHA, practice manager at A Plus Medical, P.C., an independent primary care practice in Tacoma Park, Maryland, suggests that embedding a behavioral health specialist in the practice makes sense since the physician has established a rapport with the patient. The independent physician’s office can serve as a resource for the patient and the additional offering can potentially increase revenue for the practice.

Reimbursement for additional services will certainly increase your practice’s revenues. A behavioral health specialist can also help diagnose and address underlying problems that could benefit the patient and the physician. Improved outcomes for the patient’s physical health conditions are typically realized when the mental health and social determinants of health are also addressed. Treating all aspects of the patient’s condition and coordinating that treatment in the most effective and most cost-efficient manner are integral to a quality care management program, which will help increase your independent practice revenues.

Rod Farvard
March 16, 2020

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What are care management best practices?

Identifying the need, developing a tailored plan, and engaging with the patient and other providers are among the best practices cited by experts and researchers for effective care management. White papers published by Health Care Transformation Task Force and the Center for Health Care Strategies, Inc. (CHCS) point to the need for care coordination, particularly for high risk patients with chronic or complex conditions.

CHCS cites that fact that “Across the country, innovative states are implementing programs that provide ‘high touch’ care management for targeted groups of beneficiaries.” The organization’s research identified a number of best practices for care management, including:

  • Stratification and triage by risk/need
  • Integration of services
  • Designated “care home” and personalized care plan
  • Consumer engagement strategies
  • Provider engagement strategies
  • Information exchange among all stakeholders
  • Performance measurement and accountability
  • Financial incentives aligned with quality care.

The Health Care Transformation Task Force, in its paper titled Developing Care Management Programs to Serve High-Need, High-Cost Populations, states that “Effective care management programs will utilize both qualitative (physician- or patient-reported information) and quantitative (claims, electronic data) resources to identify high-need, high-cost patients.” The paper adds that care management best practices “will take a holistic, person-focused and family-centered approach to health including its behavioral, social, and physical aspects.”

Coordinating care for a patient includes consideration of the patient’s social determinants of health, involvement on the part of the patient as well as the patient’s family in the decision-making process, and physician engagement and communication with the patient as well as the patient’s other healthcare providers. As the Task Force explains it, “Best practice models of care management will emphasize care coordination across providers and have robust primary care capabilities at their center.”

Utilizing an effective electronic health record (EHR) to collaborate enables the providers to communicate with the patient and with each other, and, more importantly to automatically share updates directly from the Clinical EHR. Other providers get immediately notified so they can take action based on the most up-to-date clinical information.

The Task Force emphasizes that “Care management programs should be structured in a way that best suits the patient demographics and available resources of the provider organization, and care managers should work to engage patients and caregivers in creating the care plan and managing a patient’s health.”

Rod Farvard
March 4, 2020

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What are some useful care management tools?

Implementing an effective care management program requires planning and the right tools. The independent physician who sees a need to implement a comprehensive care management plan must first consider the factors involved for the practice as well as for the patients. Useful tools will enable the provider to then develop and maintain a care management plan that reduces costs, reduces or eliminates unnecessary visits and procedures, and provides a higher quality of care.

Useful care management tools include:

A pre-visit planning checklist

AAFP recommends this tool to “identify potential care gaps and otherwise better prepare for an upcoming patient appointment.” The checklist can be completed by a medical assistant or another member of the independent physician’s clinical staff who initially meets with the patient to gather a history and a list of additional healthcare providers treating the patient.

A patient-centered care plan

As described in an NEJM Catalyst article, a patient-centered care plan “encourages the active collaboration and shared decision-making between patients, families, and providers to design and manage a customized and comprehensive care plan.”

 

Learn more about how Elation Health can help you develop your patient-centered care plan.

 

Patient diaries

Records kept by the patient regarding exercise, food intake and voiding, and the timing and description of symptoms can aid the provider in determining the appropriate strategy and coordination of care. Patient diaries can become a valuable tool for an effective care management plan.

Electronic health records (EHRs)

Care management plans involve gathering, maintaining, and monitoring patient data. The EHR is a useful tool for the independent physician as well as for the patient. The NEJM Catalyst article details the need for technology, particularly when encouraging patients to fully participate in their own healthcare management. EHRs provide patients with “24/7 online portals that let patients schedule appointments, get information about their condition and care instructions, review lab results and doctor’s notes, and pay bills at their convenience.”

EHRs, such as Elation’s Clinical First solution, enable the provider to maintain a more comprehensive and longitudinal patient record. Independent physicians can take advantage of this useful care management tool to quickly identify patients who aren’t meeting goals based on custom care management protocols, Meaningful Use objectives, or specific document tags, and easily schedule a follow-up appointment to address any potential gaps in care.

Rod Farvard
February 14, 2020

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What are the benefits of care management?

While care management is typically thought of as an effective healthcare approach for patients, independent physicians and their practices can also realize benefits from implementing such plans. Ranging from improved finances to higher quality outcomes, the positive results of care management can be seen in a number of areas.

Care management brings together the patient, the primary care provider, specialty providers, and the patient’s family and caregivers to coordinate care for the best possible outcomes for that patient. Care management particularly benefits those patients with chronic or complex conditions who see multiple providers and require diagnostic or laboratory services in addition to medications.

The Department of Health and Human Services (HHS) states that “by 2030, 25 percent of the U.S. population will be 60 and older, and 19 percent of the population will be 65 years of age and older. At least 90 percent of those 65 and older now have one or more chronic conditions.” Further, HHS explains that if the health-related needs of this population are not met appropriately, through enhanced clinical and community coordination, that “may increase the risk of developing chronic conditions, reduce an individual’s ability to manage these conditions, increase health care costs, and lead to avoidable health care utilization.”

Care management delivers benefits to the aging population and those patients with chronic conditions by:

  • Reducing treatment costs
  • Reducing the rate of hospitalizations
  • Eliminating unnecessary and redundant testing
  • Managing medications to prevent adverse interactions
  • Involving the patient’s family and community to boost emotional well-being
  • Ensuring the primary care physician maintains a complete picture of the patient’s overall health
  • Enabling the provider to properly manage all care, improving outcomes for the patient

In its publication, Health Plan Innovations in Patient-Centered Care: Care Management, the Alliance of Community Health Plans examines a number of case studies that demonstrate reduced emergency room visits and hospitalizations, reduced costs for the provider in treating the patient, and improved “health status and health-related quality of life” for patients included in care management programs. Costs are significantly reduced by proactively coordinating care among the healthcare providers and engaging patients to be more involved in their own healthcare program.

The bottom line for patients and providers is that care management, by enabling the primary care physician to provide more efficient and coordinated healthcare, improves outcomes and reduces costs for all involved.

Rod Farvard
February 5, 2020

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What is Care Management?

Focused on the patient and involving an entire team of providers, care management is, in the simplest of terms, collaborating to improve outcomes. More than care coordination, however, care management is an episodic approach that also more effectively manages population health. The goals of care management programs include reduced costs, reduced hospitalizations and emergency room visits, and increased patient satisfaction.

AHRQ defines care management as a “fundamental vehicle for managing the health of populations,” adding that care management “is organized around the precept that appropriate interventions for individuals within a given population will reduce health risks and decrease the cost of care.”

AAFP outlines some of the activities involved in a care management program:

  • Patient education
  • Medication management and adherence support
  • Risk stratification
  • Population management
  • Coordination of care transitions
  • Care planning

(Learn how to coordinate care more effectively with Elation’s Collaborative Health Record.)

Why is care management necessary? Many patients see more than one provider, particularly those with chronic or complex condition. Ensuring that all patients understand the full spectrum of their diagnoses and treatment plans, are on appropriate medications, and have support throughout their healthcare programs will make a significant difference in their outcomes. A report published by the Robert Graham Center states:

On average, Medicare patients see seven physicians at four practices. A staggering 75% of hospitalized patients are unable to identify the clinician in charge of their care. Nearly 20% of Traditional Fee-For-Service (FFS) Medicare beneficiaries are re-hospitalized within 30 days of discharge, and half of those patients failed to see their primary care provider (PCP) in the interim.

Care management is one of the five key functions of patient-centered medical homes (PCMH). The PCMH is focused on the continuing care of the patient, rather than simply treating one condition for a limited period of time.

In a PCMH, the primary care physician is able to engage the patient, to ask pointed questions, and to observe changes or signs that may need further exploration by a specialty provider or diagnostic lab. Care management enables that physician to also manage patients’ visits and treatments outside the primary care office, ensuring that the overall care plan is appropriate and effective.

Rod Farvard
January 28, 2020

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5 tips to start care management at your independent practice

An effective care management program will help your independent practice reduce costs and improve outcomes for your patients. How do you get started on such a program? There are some important elements involved in implementing and maintaining a quality care management program. Here are five tips to get yours started:

Develop working relationships with specialty providers

Patients who benefit the most from care management tend to have chronic or complex conditions. They see multiple physicians, which is one of the biggest reasons they need you to manage their care. Implementing a quality care management program in your independent practice requires establishing a positive and productive working relationship with those specialty providers.

Train staff

Your clinical staff will become instrumental in your patients’ care management. In fact, the Agency for Healthcare Research and Quality (AHRQ) suggests that “in value-based payment models, alignment of clinic staffing with the needs of patient populations may be the most cost-effective approach.” Rather than creating a new position for the care management role, train current staff in workflow and communication strategies that will optimize the positive outcomes for your patients.

Implement guidelines for population health management

The AMA emphasizes that “population health success is closely tied to a shift from reliance on the physician to making the best use of everyone’s skills at a practice.” Guidelines for your team would include identifying patients who would benefit from care management. Take into consideration not only their medical conditions and diagnoses but other factors, such as social determinants of health to establish care management for your specific patient population.

Establish your practice as a patient-centered medical home

For the patient who sees multiple providers, coordinating that care from a home base can be critical to the quality of the patient’s healthcare outcomes. Establishing your practice as a patient-centered medical home (PCMH) is an integral part of developing and maintaining a care management program. The PCMH is focused on the continuing care of the patient, rather than simply treating one condition for a limited period of time. In a PCMH, the primary care physician is able to engage the patient, to ask pointed questions, and to observe changes or signs that may need further exploration by a specialty provider or diagnostic lab.

Take advantage of available technology

Effective care management in your practice is facilitated through options available in your electronic health record (EHR) technology. The EHR enables you to quickly identify patients who aren’t meeting goals based on custom care management protocols. Collaborating with other providers is also made more efficient through a progressive patient record that allows physicians to effortlessly collaborate and coordinate care.

Rod Farvard
January 21, 2020

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What you need to know about the Medicare Shared Savings Program (MSSP) performance results

A data activation platform company, Innovaccer, recently compiled data regarding the performance of Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP). The organization’s report, State of the Union Report for Medicare ACOs, details the results of a proprietary algorithm Innovaccer used “to look at the quality, performance, utilization and expenditure data for every region in the U.S., based on the performance of Medicare ACOs participating in the MSSP in program year 2017.”

The study found that ACOs participating in the MSSP have generated $1 billion in savings since their inception. Going forward, the report adds that “adoption of value-based care models is expected to account for 59 percent of healthcare payments by 2020, as the healthcare industry uses value-based care to address these high-cost utilizers.”

As rising healthcare costs are of concern to patients as well as providers, researchers identified the top measures that contribute the most to healthcare expenditure per capita. Nine of the fifty-three parameters affecting the performance of ACOs were found to “the most significant.” Those included: long-term care hospital discharges; COPD or asthma discharges; skilled nursing facility discharges; emergency department visits; MRI events; unplanned admissions for patients with chronic conditions; use of imaging for low back pain; use of statin therapy; and controlling high blood pressure.”

Social determinants of health were also factored into the ACO performance data, “showing the vulnerability of all the states across the U.S. against the social factors affecting their populations.” The study found North Dakota to be the least vulnerable to social determinant factors and Hawaii to be the most vulnerable. Social determinants of health include socioeconomic factors, education level, economic environment, job opportunities, and social supports.

As of July 1, 2019, ACOs may participate in the Shared Savings Program for agreement periods of at least five years, under one of two tracks: the BASIC track (which includes a glide path for eligible ACOs), or the ENHANCED track, which offers the highest level of risk and potential reward. ACOs participating in the BASIC track’s glide path may begin under a one-sided model and progress through incremental levels of increasing risk and potential reward.

Nick Dealtry
October 17, 2019

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