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A group of healthcare providers was recently asked, as part of a larger survey, for their top two reasons that alignment is important to a healthcare organization. Better patient outcomes and organizational stability were overwhelmingly the top responses. The survey was conducted of NEJM Catalyst Insights Council members – “a qualified group of U.S.-based clinical leaders, clinicians, and executives who are directly involved in health care delivery.”
Participants in the survey differed somewhat as to their top reasons, although “all segments of the Insights Council agree that organizational alignment is most important to achieve better patient quality outcomes.” The percentage of those saying that the top reason for alignment is organizational stability in a dynamic, changing health care marketplace were: clinical leaders (65%), executives (60%), and clinicians (48%).
Perhaps not surprisingly, more clinicians participating in the survey (26%) than those executives participating (14%) also said that organizational alignment is important for satisfaction among frontline clinicians.
When asked what is meant by the term “organizational alignment,” more than half (57%) of the clinical leaders and executives participating in the survey said that alignment is “the organization’s mission, vision, and goals…supported by governance, strategy, and incentives.” Just over a third (37%) of the participating clinicians chose this definition. Clinicians (17%) were more likely than executives (9%) and clinical leaders (7%) to say that alignment is achieved when “all functions of the organization are directed toward patient care.”
Almost all of those participating in the survey (99%) said that alignment is necessary for key stakeholders within the healthcare organizations. However, only 63% of the Council members reported that this alignment exists within their own organizations, identifying the gap as being highest among frontline clinicians and top executives such as the CEO.
The survey was conducted of 655 NEJM Catalyst Insights Council members.
Prabhat Dhar September 10, 2018Read
Electronic health records (EHRs) are replacing paper medical records as a more efficient way to maintain patient data. Independent physicians who use EHRs realize a reduced potential for errors and spend less time searching through paper files for information. The next step in the progression toward optimizing healthcare through technology is the comprehensive health record.
Many patients see more than one physician, undergo diagnostic tests, or need treatment in a healthcare facility other than the independent practice. In order for the primary physician to efficiently coordinate patients’ care, records of the external providers should also be easily accessible. That is one of the main reasons that EHRs are embracing the concept of comprehensive health records.
The Northern Arizona Regional Behavioral Health Authority, Inc., now known as the NARBHA Institute, defines a comprehensive health record as a “new term to describe records with even more information than EHRs. Further, the comprehensive health record contains “all communications related to a patient’s physical or mental health or condition that are recorded in any form or medium and that are maintained for purposes of evaluation or treatment, including records that are prepared by a health care provider or by other providers.”
Elation Health’s Collaborative Health Record provides the same coordinated information for independent physicians. Rather than waiting for phone calls or faxes, Elation’s CHR enables you to automatically share updates directly from your Clinical EHR. Other providers get immediately notified so they can take action based on the most up-to-date clinical information.
In healthcare, time can be a significant factor in patient outcomes. Efficient collaboration with all of a patient’s providers can make the difference when confirming a diagnosis or determining a treatment plan. The Elation CHR digitally link a patient’s entire care network, improving care coordination and the quality of care everyone on the team is able to provide. Working across systems, CHRS are designed to enable each provider caring for a patient the access to information needed to care for that patient properly.
Prabhat Dhar July 3, 2018Read
Documenting a patient’s medical history, visit notes, and treatment plan is an often time-consuming but always necessary part of treating that patient. There are a number of methods the independent physician can use for recording this information. Paper files are the traditional way to keep patient records. A clinical charting tool, such as that found in an electronic health record (EHR) can help the independent physician be more efficient and help ensure patient records are more accurate.
Medical records kept on paper in file folders can get lost or damaged. The independent physician searching for information within those records spends valuable time flipping through a stack of papers for the one piece of patient data that could make the difference in a diagnosis. When a specialty provider or laboratory is involved in the patient’s care, requesting and waiting for those records can create problems for both patient and physician.
An EHR’s clinical charting tool makes those records available to the independent physician and to clinical staff with the touch of a screen. Easy access to the patient’s medical history and notes input by other healthcare provides gives the physician more time to spend with the patient during the visit.
Elation Health goes one step further, providing templates for the physician to use that encourage consistent workflows across providers and staff by clearly laying out the steps and questions to be addressed. Independent physicians can export more than one template into a visit note at once to allow for more time-efficient customization. Users can include CPT codes and billing items into Elation’s templates to streamline visit note sign off. In addition, physicians can associate document tags for easier and more consistent reporting.
Another time-saver for the physician is to empower the clinical team to input a patient’s medical information into the EHR. For example, a medical assistant can use the clinical charting tool to update the patient’s record. With the assistant in the room during the visit, documenting the physician’s notes in the clinical charting tool, the physician can focus more fully on the patient, enabling better outcomes for patient and physician.
Prabhat Dhar June 12, 2018Read
Patients who are elderly, who have chronic or complex conditions, or who need specialty treatment for a one-time medical event will typically see multiple physicians. These patients may need laboratory tests, x-rays, and perhaps even stays in a healthcare facility. Coordinating this care for the highest quality outcomes for the patient requires collaboration among the healthcare providers.
Waiting for phone calls or faxes can be time-consuming and possibly even dangerous for the patient’s condition. When care is not collaborated, errors of omission or duplication can also be dangerous for the patient. Collaborating in real-time can not only save time and money but can also significantly improve the outcome for the patient.
For those patients with chronic diseases, in particular, treatment “involves changing lifestyles and navigating a complex web of treatments. Different health care professionals with different skills in different locations will need to collaborate to provide a cohesive care team.”
Electronic health records (EHRs) can play a pivotal role in facilitating that collaboration among the multiple healthcare providers treating a patient. Physicians who have access to a patient’s EHR can immediately review the patient’s medical history, lab results, and other relevant information.
Elation’s Collaborative Health Record (CHR) closes the care gaps for multiple healthcare providers treating the same patient. The CHR decreases duplicative testing and enables providers to avoid medication errors with uninterrupted communication. The timely sharing of patient information helps ensure that care is as efficient as effective as possible.
Providers can automatically share updates directly from the Clinical EHR. Other providers are immediately notified so they can take action based on the most up-to-date clinical information. In addition, each physician has visibility into the patient’s complete care record for more accurate reporting on clinical quality measures and compliance for value-based reimbursement.
With the CHR’s intuitive search bar, it is easy to make sure the problem list, medications, lab results, and notes are always kept current. Ensuring that medical information is up to date and accurate, using an EHR to collaborate, can dramatically improve the outcomes for the patient.
Prabhat Dhar May 22, 2018Read
Communication and engagement can help independent physicians overcome many of the challenges associated with bundled payment programs. The Centers for Medicare & Medicaid Services (CMS) has implemented two bundled payments, Bundled Payments for Care Improvement (BPCI – a voluntary bundled payment program) and Comprehensive Care for Joint Replacement (CJR – a mandatory bundled payment program). These programs are part of the CMS move toward value-based care and require physicians to more proactively plan and follow up on their patients’ care.
Rather than reward and reimburse independent physicians for the quantity of patient visits, which can also create fragmented plans that are not coordinated between providers, CMS is moving toward a focus on the quality of a patient’s total care. Towards this end, “bundled payments can align incentives for providers – hospitals, post-acute care providers, physicians, and other practitioners – allowing them to work closely together across all specialties and settings.”
Many independent physicians have expressed their concerns about how to make the bundled payment programs work for their practices. The key is engaging patients, which has the added benefit of improved outcomes for the patient, and maintaining communication with the patient and other providers during the entire care episode.
Proactively and creatively engaging with the patient throughout the care process can help the independent physician plan for the patient’s needs more effectively and more efficiently. Using technology such as electronic health records (EHRs) can also assist the physician in understanding the patient’s complete medical history, coordinating with other physicians and healthcare facilities treating that patient, and communicating with the patient before and after visits.
As a recent MedCity News article points out, “there are countless interaction points where providers can engage patients in their own care to lower costs, improve outcomes, and enhance experiences.” Patient engagement is the key for independent physicians’ success with the bundled payment programs.
Prabhat Dhar May 14, 2018Read
The core premise of Accountable Care Organizations (ACOs) is to “assign responsibility for a population of patients to health care providers, with payments depending on the cost and quality outcomes for that population,” as described by Managed Care. Participating in an ACO is voluntary for providers; however, the Centers for Medicare & Medicaid Services (CMS) has identified savings programs in which ACOs can share.
An ACO is formed by a group of independent providers. The ACO may find, though, that it needs to find new partners to fill a gap in medical service capabilities. When building partnerships with independent physicians, an ACO should consider a number of factors. While ACOs offer incentives for quality healthcare, they must “recognize the needs of their assigned populations and work to provide comprehensive care management across the spectrum of provider types.”
Recent research published in Managed Care suggests that “ACOs need a framework for evaluating potential partners that will help risk-bearing providers establish the partnerships that will enable them to achieve their goals.” That framework includes seven “high-value” elements to look for in potential partners:
The research involved interviews with ACO representatives as well as entities representing several different types of healthcare providers. Additionally, an expert panel was convened to “evaluate the framework and help prioritize provider types to evaluate.”
Managing care appropriately and in line with the move toward value-based care requires coordination across providers of different types and specialties. An ACO that can build effective partnerships with independent physicians based on the framework identified in the research “may allow providers to expand their influence throughout the delivery system as they begin to work across locations and episodes of care to manage population health.”
Prabhat Dhar April 11, 2018Read
The Centers for Medicare & Medicaid Services (CMS) defines Accountable Care Organizations (ACOs) as “groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.” The goal of an ACO is to coordinate care, “avoiding unnecessary duplication of services and preventing medical errors.”
There are currently 171 physicians-only groups that make up 30% of the total ACOs. That number has increased from 134 in 2016. Physicians have also joined with hospitals and other facilities to form 324 ACOs, or 58% of the total.
The American Medical Association (AMA) reports that “Of the 432 MSSP ACOs operating in 2016, 31 percent generated shared savings with 45 percent of physician-only ACOs generating shared-savings, compared to only 23 percent of the 226 hospital-based ACOs.” In addition, CMS has launched a new Advanced Alternative Payment Model (APM) for physicians, which “limits downside risk for participating practices while also allowing them to collect a lump-sum bonus previously available only to those who assumed more risk.”
AMA also notes that “Physician-only accountable care organizations (ACO) … have significant flexibility to contract with allied providers to build the ACO’s network as a new enterprise.” The association points out some key takeaways regarding physician-only ACOs, including:
Physician-only ACO numbers are on the rise, as independent physicians participating in ACOs are realizing greater benefits in terms of shared savings, improved quality of care, and lower costs.
Prabhat Dhar March 29, 2018Read
Since the expansion of our blogs almost a year ago, we’ve been constantly looking for ways to continue to keep independent physicians and the healthcare community at-large informed and in the know about some of the most impactful areas of healthcare.
With care management being a growing area of interest among physicians and healthcare administrators, we’re excited to launch a blog solely focused on bringing information to you that can help reduce care gaps and improve care coordination.
From chronic disease management to independent physician associations (IPAs), and even accountable care organizations (ACOs), we’re dedicated to posting timely and relevant information to empower care managers at all levels to administer high-quality, coordinated care.
Nick Dealtry March 14, 2018Read