Most Advanced Care Management Solution Announces Strategic Business Partnership with IBM PartnerWorld

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Most Advanced Care Management Solution Announces Strategic Business Partnership with IBM PartnerWorld

Innovative Care Management & Coordination Solution, EngageHealthIQ, set to join IBM PartnerWorld

DAYTON, OH December 4, 2014 – EngageHealthIQ, the most advanced software platform to help nurses and physicians work more optimally, is proud to announce its services will be enhanced through a partnership with IBM PartnerWorld.  

“The IBM PartnerWorld program provides EngageHealthIQ with resources that will help us find new market opportunities and scale quickly,” said Michael Pennessi, CEO and Co-founder of EngageHealthIQ.

“We are looking forward to being better equipped as we provide unprecedented, highly effective clinical management tools that can drive change across the patient population.”  

The PartnerWorld program, backed by one of the world’s most respected technology and innovation companies, includes the latest in technologies and education—all designed to enable innovative companies to thrive. Recognizing how the IT and global marketplace is changing, the membership provides a platform for scalable companies to achieve a faster path to success in this quickly-changing marketplace.  

“We’ve talked about how we are ‘redesigning’ the provider and care team relationship with patients. Providers are looking for a chronic care disease management solution like ours that provides meaningful clinical insights through a nurse-centric platform. And now, as a member of IBM PartnerWorld, we will be able to realize greater value in this point of care clinical team space,” said Pennessi.

About EngageHealth IQ 

EngageHealth IQ is suite of software services designed for physicians looking for a better way to manage patient care. As the most advanced platform to harness care provider team and patient connectivity, EngageHealthIQ fully leverages physicians through model of care and advanced workflow.

Inspired by evidence-based care management principles, and proven over time through cost optimization and quality outcomes, EngageHealthIQ supports sustainable behavior change in individuals. Learn more about how EngageHealthIQ supports the post-acute care management team as “true providers” here: http://www.engagehealthiq.com  

CONTACT:

Michael Pennessi
http://www.engagehealthiq.com
@engagehealthIQ
mpennessi@engagehealthiq.com
Phone (614) 519-2586

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4 Truths for Physicians from Dr. Paul Grundy

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4 Truths for Physicians from Dr. Paul Grundy

We spoke with Paul Grundy, MD, MPH, FACOEM, FACPM, about the fundamental change that is occurring in how physicians and patients interact. Known as the Godfather of the PCMH, Dr. Grundy is the founding President of the Patient Centered Primary Care Collaborative (PCPCC) and is IBM’s Director of Global Healthcare Transformation.

Here are the 4 must-know insights for physicians, no matter where they are in their career. 

1. The future of health relies on using the health data at our fingertips.

“For the first time in history we are going to get [and better use] data in health care,” explains Dr. Grundy. That may conjure up images of a comprehensive platform such as EngageHealthIQ, or tools like Watson, EMR or simply a patient registry. Either way, it is critical to recognize that health care has fundamentally changed, says Dr. Grundy.

New information is created not just from behaviors, but biometrics and beyond; this data should then be better aligned with behavioral support systems and the right incentives (and feedback) for robust and coordinated care. 

“I fundamentally think one of the driving forces for transformation is that we are going to have data,” says Dr. Grundy. As one of the last industries to make this shift, it’s time that doctors, too, become accountable to managing a population using the facts and data available to them. 

2. We’re now attaching data to a healing relationship, for better, more effective care. 

For practices looking to get a more accurate, ongoing picture of their patients’ health, not utilizing the data that we can collect, means we aren’t being as effective as we could be—from both a communication, and an overall care, standpoint. 

“The thing about data is that when you have data, in any industry, there is an expectation that someone is going to be accountable for that data, and that data will be acted on,” continues Dr. Grundy. It’s up to physicians their teams to better manage that data, starting now.

It’s time we see we are accountable to that data for better population health management.

“If you think of this in terms of where we are as an industry, we are fundamentally master trainers. We are trained in a way that goes back to the turn of the last century. We are trained to basically [house] that information that exists about treating patients, and use our heads as our biggest repository,” Dr. Grundy says. While that’s the model the master builder followed in the middle ages, that’s certainly changed thanks to technology and even patient expectations, Dr. Grundy says.

3.  Communication will either improve, or take away from, our ability to deliver care.

In the past, we saw system-wide innovation come in the form of the automobile. The automobile, Dr. Grundy points out, enabled physicians and their teams to reach patients (and for patients to reach care facilities) quicker, and on a much wider basis. 

And now technology is enabling this provider “reach” to patients to extend even further, across the entire care continuum, and even into patients’ homes. “There are [many forms] of communication that can occur asynchronously, and remotely with mobile. That [ability] is going to transform how we communicate in health care.” 

Engagement won’t just mean face-to-face, in-person encounters in the future. 

4. An evolved payment model rewards not just clinicians, but patients as well.

The nature of communication is changing, and a central part of that doctor-patient interaction is the underlying insurance and benefits system a patient is a part of. By and large, the majority of physicians are still in a fee-for-service model, and the majority of encounters are face-to-face, explains Dr. Grundy. “We are beginning to see that shift.” 

What’s helping drive the shift towards a more innovative model is an understanding in most people’s minds, and most medical economists’ minds, that when you pay for an episode of care in a purely fee-for-service world, the system will tend to deliver services. “When you pay for fee-for-service only, you get too much service—over-service,” he adds. Currently as much as 17 percent of physician team payments do not come from the pure fee-for-service model, a number that is set to increase in the coming years.

Why do we expect that percentage to continue to increase?

“There’s a clear understanding from both the providers and payers that pure fee-for-service has failed us,” says Dr. Grundy. Physicians moving away from the model are saying, “If I engage my patients more effectively, if I engage him and the results are better, then I am going to earn more money.”

Smarter Use of Information Can Benefit All 

Through this evolved form of engagement, we are beginning to understand the science of patient engagement and that relationship between physician and patient. When the system rewards outcomes, and more accountable care, everyone in the health care system can benefit. As we move towards this more effective model of care, how can we summarize the changes that need to take place for quality-driven choices, and better health outcomes for all? 

Fundamentally, there is practice transformation. Beyond this, practices being paid to transform to a patient-centered approach, and an insurance/benefits design that encourages an individual’s self-management and engagement with her health. 

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How Does Artificial Intelligence Support Physicians?

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How Does Artificial Intelligence Support Physicians?

Artificial intelligence allows care teams to know how--and when--to better support patients in their health journey.

Watch this video to see a glimpse of how the most advanced algorithm adapts in real time to changes in the patients' conditions and behaviors. The team of EngageHealth IQ and our partner, Experlytics, are proud to offer this healthcare AI with an unsurpassed level of sophistication.

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How to Approach Team-Based Care as a Physician

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How to Approach Team-Based Care as a Physician

Cathy Levine, Executive Director of the Universal Health Care Action Network of Ohio (UHCAN OHIO), tells us the two key factors we need to know when it comes to patient-focused and team-based care.

1. The definition of patient engagement can be thought of as a partnership.

“'Patient engagement’ or ‘patient-centered care’ is about a partnership,” says Levine.

“It’s about respecting each person as in individual, getting to know that individual. It is about meeting each patient where s/he’s at and helping the patient make progress. It’s not just better health—but a better patient experience and better health.”

“People are uncomfortable with the triple aim’s ‘better patient experience.What does that mean?”

“’Patient experience’ is more than better magazines in the waiting room, or someone smiling at you. You have to feel welcomed when you go to the doctor. It has to be a safe, trust-building, nurturing environment. For people from different racial, ethnic, and socio-economic backgrounds, they may need to encounter people who look like them for the patient to feel comfortable. The need for that kind of experience is part of why there is a movement to transform primary care.”

Given financial pressures and time limits primary care physicians have today, it is just that primary care physicians may be frustrated with some of their current constraints. 

They need practice design and financial support in creating these relationships with patients and support so they can spend adequate time with each person. And that’s also where doctor involvement with consumer groups, as well as taking advantage of clinical team support IT services such as EngageHealth IQ, enters into the picture. 

“Doctors need to reach out to consumer groups about working together to change the way doctors are reimbursed for patient visits and to get feedback on patient-centered practice design,” adds Levine.

 “We have to reinvent primary care. We have to build up primary care. The investment has to follow the words. If we are serious, let’s put the money there.”

Primary care physicians may feel the squeeze of market conditions at present, but ultimately, doctors – especially in partnership with patients - can be agents of improving health care.

2. The change required for a patient-centered approach starts with practice culture.

“If reimbursement, incentives, measures and other rules need to change, primary care providers should sit down with consumer advocates, and let’s work together on this,” says Levine.

Let’s identify our common ground. If the patient-centered medical home is going to work, the culture in the team of providers has to change. It has to be one where every member of the team is empowered to contribute to the work, and is respected for their expertise, and where the patient is now treated not as an outsider but as a partner,” she adds.

“We are talking about building relationships and building trust with patients,” says Levine.

If you have a true team-based approach, it’s not up to the doctor to do it all. “The [support team] is paid less, but they are highly trained in narrower areas, and are trained to do different parts of what needs to happen. It’s not all on the doctor. That’s part of the design of your practice.”

“The question is, are doctors trained to take every patient, where they are at, and are they able to respect that patient? Doctors need to enter into a relationship of mutual trust and respect and figure out how to move that patient to another level of partnership.”

“Keep in mind we’ve all been raised in health care system that very seldom encourages people to be partners in their health care. It’s very much a system of ‘doctor knows best,’ where you don’t question the doctor. You can’t expect patients to, overnight, learn how to be partners,” she adds.
 

"There has to be an invitation, and someone has to tell patients that the practice is changing for the better."

We also have to consider what it means to provide care to the aging population. Once again, to connect and to best influence and empower these patients, it starts with a new culture at the practice level. “The goal is for people to be healthier. Many providers don’t understand what it means to invite their patients into a partnership. That requires a big culture change.

Primary care practices must figure out effective strategies for figuring out where each patient—where she is currently in her health journey—and figure out how to move that patient along to manage their own health.

“And that’s why the patient-centered medical home is a team—you might not be the best person to build that relationship and trust, but someone else is going to be able to develop that partnership.”

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EngageHealth IQ & Wellspring Family Medicine Announce Partnership

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EngageHealth IQ & Wellspring Family Medicine Announce Partnership

EngageHealth IQ for PCP.png

An Update from Dr. Damon Daniels, MD, of Wellspring Family Medicine in Columbia, SC.

As someone dedicated to harnessing and cultivating relationships with our patients, the recent changes in health care you have likely heard of are very much top of mind for me.

Some of the news you may be aware of includes changes to your insurance, as well as cost structure and reimbursement transformation for practices and hospitals.

We are also seeing an unprecedented amount of change in patient needs and expectations.

We are proud to tell you about the proactive approach we are taking at Wellspring Family Medicine so that we can continue to offer true, patient-centric and innovative care. We are listening, and we want you to know.

Patients choose Wellspring Family Medicine knowing that they can receive compassionate care that focuses on their entire health. We believe in access to comprehensive care, quality chronic illness care, and we have a true community-facing orientation.

This has been our vision since 2007, and we will continue to be committed to this vision for decades to come.

With this vision, we recognize we have a changing demographic of patients (with an increasing number of those age 60 or older), and that we have an increasing number of people with chronic conditions. In fact South Carolina ranks 10th in the nation in the percent of population with diabetes.

Wellspring Family Medicine is in the process of transforming into a Patient-Centered Medical Home to better equip us to take care of our patients with diabetes and other chronic medical conditions. We are striving to be the primary place where our patients receive care to manage their chronic medical conditions (i.e. a medical home).

And now, our partnership with EngageHealth IQ marks another crucial step in helping us deliver the highest quality of care to our patients, as well as the entire community.

Beyond access to care, we recognize the value in using technology (and data-backed decision making) for improved care, and improved outcomes. We recognize that we also want our employees to support our broader vision as best they can, and EngageHealth IQ is helping us uniquely fulfill that goal. 

As the health care system transforms, EngageHealth IQ will be there to help us proactively “fill the gaps” both clinically and operationally. But perhaps more importantly, at its core, our partnership will serve to support the relationship we have with our patients, which has always been our highest priority.  

With the shift from payment for care delivered, to payment for patient outcomes, we are ready to embrace our new health initiatives. We are ready to continue listening to you and the community. This is important as our patient’s needs continue to change. Our team and our patients are ready to embrace change, and we want to continue to improve the health and wellness of the community in Columbia. This is why we are proudly using proven, evidence-based practices to help people better self-manage their health.

Read more on Wellspring Family Medicine here


Interested in reading more about Engage's worksite wellness capabilities and platform for optimal workflow and revenue gains? Get in touch with EngageHealth IQ here.

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What to Know About the Current State of Workplace Wellness

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What to Know About the Current State of Workplace Wellness

EngageHealth IQ sat down with Jed Constantz, Chief Operating Officer at Employer Advantage Health Care Solutions. Employer Advantage is a Tennessee-based wellness and healthcare services company that specializes in working with self-insured employers with centralized populations and aging workforces. Employer Advantage not only works to reduce healthcare spending for employers, but it also focuses on improving the health of employees, increasing their satisfaction and productivity in the process.

Our Q&A session with Jed shed light on current changes and trends that are happening in the corporate wellness space, and what that may mean for us as physicians, employers, and as individuals receiving care. 

Q: Can you speak to the role of the employer in healthcare reform, and healthcare transformation today? And where does this fit in with the development of wellness programs? 

A:  Improving care management coordination at the primary care level is what is going to improve both the quality and value of healthcare delivery and services.

To support this improvement, a direct connection needs to exist between employers and primary care practices and physicians. Until that type of direct connection is made, more so than what has happened in the past, the healthcare industry will not be as effective or as efficient as it could be, and will continue to be unnecessarily complicated. 

So-called “wellness initiatives need to be embedded in a “clinically valid” primary care setting by the employer so that the patient population has an opportunity to reap the benefit of a program like EngageHealth IQ.

This will allow the insight derived from EngageHealth IQ to be clinically actionable by the patient’s primary care team.

Q: If the wellness programming can better serve people in such a clinically valid environment, is that at all threatening to an HR person? Or what impact does this have on the way things have been done in the past with an employee population?

A: It depends upon the self-interest of that human resources/benefits person. Any time roles and responsibilities are shifted to a more appropriate setting; it could be threatening to the individual or individuals who no longer serve in that role. The same thing holds true for the vendor community who, at present, find it easier to sell to the employer directly, as opposed to channeling their capability through a community based primary care practice.

Unfortunately, not all community based primary care practices are genuinely ready for this conversation or to assume this role and responsibility. Adequate compensation, as a primary care practice, is the biggest obstacle at this time, however, employers are in the best position to address and remove this obstacle.

It is the employer, the CFO, the COO, or at times the CEO, who really has to make the judgment on the value of buying wellness from primary care. Individuals at the HR level often have too many conflicts or issues that they are dealing with that impair their judgment as far as measuring the real value of this strategy. In addition, many lack the authority to make a decision to do the things that need to be done to pull the trigger on this. 

The primary care community has, historically, had trouble advocating its true value on its own behalf. Primary care has not necessarily been ready, but now models of primary care delivery have emerged that are changing their level of readiness.

In the context of EngageHealth IQ, assessing and proactively managing the risk status and risk factors of patient populations has become critical capability for the primary care practices to ensure the more effective, and more efficient, delivery of care. 

Q: What other shifts are impacting this willingness to innovate?

A: The move towards PCMH development, and more recently the growing popularity of something called Direct Primary Care, or DPC, has impacted a willingness and ability to innovate. The DPC model is where primary care practices are carving themselves out of traditional benefit plans, and are offering themselves to employers, using a per patient per month “payment in advance of care” formula. This DPC model recognizes the fact that an employer may have recently implemented a high deductible plan, and offers financial access to primary care before any of the other benefits kick in.

Q: We can see where this is going—if then, the patients decide to deny themselves of care since they have those out-of-pocket expenses. Can you tell us more about the direct primary care style practice?

A: A DPC style practice recognizes that in exchange for a membership fee, they can more efficiently offer a population of patients a wider array of primary care services, particularly preventive carewellness.

They need to be able to offer high value, high profile services to people, so that people believe that they are getting their money’s worth, and are being cared for in the most comprehensive, yet individualized, manner possible.

A growing number of employers understand there is a different breed of primary care practice emerging—and you know they are a different breed because these practices have invested in a system like EngageHealth IQ, and they can demonstrate proficiency in the use of such a system.

Q: What should we know about how some employers are moving to on-site clinics? 

A: There are nearly 1,000 employers throughout the country who have gone the direction of implementing on-site clinics. Typically, they are offered in a limited fashion, and they might be viewed as a source of cheaper primary care, not necessarily more effective primary care.

For those employers that have adopted the on-site strategy, the thinking is in the right direction, but the on-site clinic itself isn’t typically as effective as real primary care. Some on-sites are trying to create their own EngageHealthIQ-like capabilities in an attempt to become more effective.

Rather than reinvent the primary care wheel, employers should consider if there is an opportunity to work with local community-based primary care practices, it may be more efficient and better for the community.

When this happens, it changes the nature of local community based primary care practices for the betterment of the entire community. 

Q: You talk about effectiveness, as well as bettering the community as a whole. Can you connect the dots for us with this and the corporate wellness programming?

A: That’s where the embedding of a clinically valid risk assessment tool, such as EngageHealth IQ, is a perfect example of what primary care practices can do to interact with a person long before the onset of care, and treatment relating to some kind of chronic illness…Wellness programming, at the primary care level can be built on the four “health status” pillars of stress, exercise, diet and sleep. 

The use a tool like EngageHealth IQ can help the practice better understand the needs of the patient, the behaviors of the patient, the mindset of the patient, so now they can intervene early enough and often enough with different types of service offerings. The health education and the literacy of patient—in terms of the health care system—can prevent downstream healthcare spending, which more clearly illustrates the value of primary care, when it is well-structured.

That is really the message we are trying to bring to employers. 

Q: What else would be important for an employer to know—one that recognizes the benefits of a primary care practice that uses EngageHealth IQ for an individualized, comprehensive program they can offer employees?

A: The employer who understands these dynamics, better than most, can recognize, “I can meet the burden of providing first dollar coverage for preventive care in a more selective way, by establishing arrangements with these correct primary care practices”—not all primary care. 

They can see the need for a relationship with a select community of primary care practices that they choose to work with.

Employers owe it to themselves, to their employees, to be more directly involved in this, and when shopping for that correct primary care, they need to look for capabilities like EngageHealth IQ embedded inside that practice.

This represents a type of evaluation standard, because otherwise that primary care practice will talk a good game, but not truly be able to deliver it for that employer’s covered individuals.

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What We Can Learn From the US’ Healthiest States

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What We Can Learn From the US’ Healthiest States

Examining states in the US that have the highest health ranking (as determined by the UnitedHealth Foundation’s Health Ranking study,) we can see that these states also have people who are healthier across every stage of life. For these “healthiest states,” chronic disease prevalence is lower, as well as smoking rates and obesity. 

Why is it that some states can do this very well in terms of health, and other states we see failing in their pursuit of better health outcomes?

This question was answered by Ted Wymyslo, MD Chief Medical Officer at the Ohio Association of Community Health Centers.

“Government, schools, people, employers—they are all looking at it through a different lens and in states that are improving in health measures, they are working together to have a greater collective impact in their region,” explains Dr. Wymyslo. “Those that are passive in their approach have poorer outcomes and health rankings. Others see you can positively impact and empower people’s behavior.” 

Intentional Systems to Empower Patients—And Care Teams

Hawaii, Vermont, Massachusetts, Connecticut, Colorado and Minnesota are just a few states leading the way when it comes to health.

“Those that are doing well have sought out to build around the idea of community health. For instance, in the schools, they have intentionally built health not only into the academic curriculum, but changes have been integrated into the lunch menu, safe routes to school, school gardens, and other areas. It could also be workplace wellness programs, addressing good nutrition and promoting exercise…It’s things such as bike paths, or ensuring the capability of having easy access to safe playgrounds, as other examples,” Dr. Wymyslo says.

The lessons learned from the communities who have changed the lives of people living there?

“They make a conscious decision. It does not happen by accident.”

A United Community Backed by Access to Key Data

Perhaps the most valuable lesson Dr. Wymyslo points out is what we can learn from the best practices stemming from those states. “None of this is accidental. If we expect health to improve, it’s a cultural choice to make these interventions.” Whether it is primary, secondary or tertiary prevention, all “parties” affecting health need to come together, especially to avoid the complications that can occur when disease happens.

Where can a misstep occur for those communities ready to evolve?

The answer: a crucial underpinning must be in place for these relationship-driven practices, and that’s the ability to have access, and to harness meaningful data about patients on an ongoing basis. 

When primary care physicians, care teams, and other practitioners can utilize data around a patient’s health IQ, self-efficacy, current state of health and even motivation—the result is powerful. 

Being able to take such timely and robust data attached to each patient, and share that data with the others in the care continuum is where the power—or opportunity—is really unlocked, shares Dr. Wymyslo.

This data is now an influential driver that directly backs modern care delivery, helping mine, identify, better filter, and keep track of information on a daily basis. Data is used in artificial intelligence for better outcomes, rich trend analysis, actionable registries that help determine key indicators, as well as for determining the best plan for a patient based on those variables. And while most can agree how this information is what helps us track quality parameters, not to be forgotten is how this data also should help communication and continuity of care. 

“Care coordination is making sure everyone is on the same page. The primary care doctor has to ultimately be the one that is responsible for housing that information for many different uses. And that’s why we can call it the medical home—it is the home to all the information about the patient and their health,” says Dr. Wymyslo.

It is available! It is where information is ultimately managed, accumulated, and accessible…for anyone who can utilize it, and this includes the patient.”

Shaping Relationships with Patients for More Personalized Care

This change is about systematizing our health care delivery to make it more efficient, and to fully support clinicians who are managing more patients, with less time. This process and evolution means all players must come together in order to deliver care that is more comprehensive and personalized. 

“That is the real value of being able to exchange information,” Wymyslo asserts. “…We can finally all be on the same page, allowing patients and providers to make better health decisions because the total health picture is available to all the decision-makers.”

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Value-Based Care’s Foundation is Primary Care

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Value-Based Care’s Foundation is Primary Care

For the general population, we need to both educate, and bring back the focus, to primary care.

In a recent AMA Wire article titled “What specialty physicians need in new models of care,” it was reported how the CMS plans to test new care delivery and payment models with specialist physicians. 

“The AMA has been working with specialty societies,” the article reports, “to identify ways patient care can be improved while health care spending care be reduced through new payment models.” While many specialists certainly have unique obstacles and needs, it seems that the CMS would simply be reinventing the wheel with such an initiative.

The Foundation for Patient-Centric Care Management Still is Primary Care

It’s true that specialists must be integrated strategically within any high functioning framework. However, the AMA’s specialty-specific reimbursement model has absolutely no mention of an emphasis on primary care. 

Specialty physicians do often deal with very medically complex patients. Additionally, they likely feel that they are being held accountable for patient outcomes that they cannot easily influence. And, it is true that having a reimbursement structure that does not keep this in mind is not equitable for specialty physicians. 

Looking Forward, Let’s Work to Integrate Specialists for Better Outcomes for All Parties

A major component of an adopted reimbursement model must be an integration element, one that benefits all parties involved. Specialty physicians, in this setup, could consider adding an element that includes integration and communication with the primary care physician. 

This kind of organized, planned and improved way to exchange information is one of the care management support offerings that EngageHealth IQ provides. 

One example of such an advanced workflow strategy is hardwiring the Specialist Nurse with the Primary Nurse Care Manager. Combined with additional revenue opportunities through Transition Care Management (in which the physician can bill the TCM code as well as other services by auxiliary staff), a “high functioning” model should be able to support Complex Chronic Care Coordination. And that’s a reimbursement opportunity for the Primary Care Physician that’s long overdue.

These opportunities will allow for better coordination by Primary Care Physicians and the Specialist point nurses in addition to appropriate reimbursement opportunities for the practice at large. Although currently available, future, and needed reimbursement opportunities, may overlap for many centers.

Ultimately, this “integration element” of a reimbursement model would require specialty physicians to involve primary care physicians in what you could call “shared medical decision making.” Ultimately, the outcomes would include lower costs. In addition, it’s true that it would require patients without a primary care physician who are receiving specialty care to be established with a primary care physician in order to receive that ongoing specialty care.

Taking a Step Back and Looking at the Big Picture 

We’re now faced with the opportunity to reduce silos of care for those only receiving specialty care. Performance measures in the model, in the future, would track how well specialty physicians integrate their care within the context of a primary care patient centered model.

Access of care and true integration across the medical neighborhood with specialists is a vital indicator, and driver, of better health outcomes and lasting success for practices.

It’s not to say that specialty physicians shouldn’t have the opportunity for greater flexibility or risk protection, but as the foundation for total care management, primary care must simply not be overlooked. 

Partnering with physicians, EngageHealth IQ brings clarity and integration to a practice through the following tools:

·      Analysis of active panel of patients (to determine appropriate desired “mix” of patient profiles)

·      Projections for care provider team staffing to see greater returns

·      Team productivity and its implications for optimal revenue and utilization

·      EngageProfit: a proprietary ROI tool for financial analysis, revealing an optimal staffing model, also further enabling a center’s physicians to focus on higher acuity patients 

Interesting in learning more? Get in touch with us today.

 

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An Interview with Amy Gibson of the PCPCC: On Improving Patient Experiences through The Medical Home

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An Interview with Amy Gibson of the PCPCC: On Improving Patient Experiences through The Medical Home

“It really comes down to relationships.”

This is how Amy Gibson RN, MS, and Chief Operating Officer at The Patient-Centered Primary Care Collaborative (PCPCC) describes the foundation of the Patient-Centered Medical Home (PCMH) model of care. “It’s about a strong, trusted partnership between the primary care team and an individual. Whoever is a member of that team—whoever is anchored to that primary care center, and who is working alongside patients and their family—that is really what makes for an effective PCMH model,” she adds. 

The PCPCC is helping change the game when it comes to health care, advocating an effective health system that’s founded on primary care and the PCMH.

From experts to thought leaders, the PCPCC works to educate and to advocate individuals, stakeholder groups, partners, medical professionals, and even Congress on the PCMH. Each year, the PCPCC collects and disseminates information as it relates to medical homes, including best practices and innovative strategies. We talked with Amy Gibson about how we can go about actually defining the “medical neighborhood” as we go forward.

Gibson explains how the PCPCC has adopted a broad definition. “[The medical neighborhood] is really connecting everyone who is impacting the health of an individual patient. It’s the caregivers, or the families—it is not just your traditional health care, or medical services in that way. It could be YMCAs, faith-based organizations, child care, schools, workplaces even.”

In this way, the PCPCC recognizes that an individual’s unique “medical neighborhood” is a reflection of all the facets of health for that specific person, at that specific point in his or her life. “It’s what makes sense for that individual patient, however they see fit, or what they see as a part of their team…so the ‘medical neighborhood’ for them embraces that,” adds Gibson. 

So then, what might define an effective PCMH within that patient’s unique medical neighborhood?

That’s where the relationship-driven structure comes in. These strong relationships between clinician/care teams and patient provide a framework for which people can create and better set themselves up for true behavior-based changes that result in better health outcomes.

And in terms of those desired outcomes, we know the evidence is strong that when patients have a trusting relationship with their health professional, they are then more likely to embrace overall goals related to their health. “Of course these goals have to be the patient’s goals, not just the provider’s goals,” says Gibson.

That being said, there’s a bit of misunderstanding about patients in terms of care delivered through a medical-home approach at times. 

“One of the biggest misconceptions, and its really more of an assumption, can come from healthcare providers,” says Gibson. “Some have taken the stance that patients do not, or would not, want care from any one other than their doctor.”

Research has shown, however, quite the opposite to be true: patients want team-based care, and they want to be interfacing with a variety of experts to better their care and get that community-based support.

For those centers looking to become PCMH-designated, the process is certainly an evolution, Gibson points out. Often times, that evolution starts with a focus on the idea of access for patients. And often, one of the first things centers are able to see as a result of this evolution is in fact a cost savings as it relates to that improved access. 

“We see decreased ER utilization for primary care-related purposes, decreased readmissions to practice due to better transitions, and that increased access to primary care in general. Those are just some of the early-on wins in medical homes in terms of cost savings,” explains Gibson.

While cost savings may be seen in the short-term, it’s also valid that quality indicators—while they certainly change over time—typically take longer to see evidence of, but they do improve. 

Notably, these improvements in care and in quality indicators are seen with chronically ill patients, the most costly of patients. “Medical homes show improvements with diabetes and hypertension, as two examples. Those are big ones. The [medical homes] often carve out a particular portion of their population, and then they are able to really deliver better care to that segmented group. Even with ‘first out of the gate’ efforts, they see the result of a better way to care,” Gibson says. And this can happen in a variety of ways, with a variety of payer mixes.

One thing is becoming clear: team-based care is the way to improving health care.

It’s about improving patient quality and satisfaction, reducing costs, and improving the health of populations.

 

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EngageROI: The Care Management Revenue Opportunity for Fee-for-Service Reimbursements

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EngageROI: The Care Management Revenue Opportunity for Fee-for-Service Reimbursements

Introducing EngageROI, a proprietary Care Management Revenue/ROI Modeling tool by EngageHealth IQ that reveals potential missed revenue opportunities in the existing FFS reimbursement environment, created specifically for PCPs and PCMHs. 

EngageROI: Helping you recognize available revenue by adhering to specific CMS policies  

With many more patients walking through the doors of medical practices/clinics across the nation, the question remains: How will we handle the influx of new patients and have a healthy bottom line? 

“We speak with physicians every day and they are frustrated,” explains David Trunnell, EngageHealth IQ COO and Co-Founder. 

“They are committed to delivering excellent care, and they are straining to find ways to handle the increasing non-clinical burdens placed on providers. Add to that burden the increase in insured Americans, plus the growing shortage of primary care physicians, and you have a terrible mismatch in supply and demand. These physicians simply ask that they be fairly compensated for the increasing work they do!" 

“We are pleased to help physicians discover how to increase productivity and revenues while extending total care management to their sickest patients,” says Trunnell.

 “These modern physicians are managing differently–appropriately–and better. They are empowering their non-physician staff to deliver more, and better care. This leverages the physician to do higher acuity work. And it empowers the staff to perform at the top of their licenses and certificates–for greater career satisfaction,” explains Trunnell.

“You cannot imagine the passion and opportunity for excellence this creates for staff. And just imagine how much more satisfied the high risk patients feel.”

EngageROI: The Care Management Revenue Opportunity for Fee-for-Service Reimbursements that PCP’s and PCMH’s Might Be Missing Out On

EngageROI: The Care Management Revenue Opportunity for Fee-for-Service Reimbursements that PCP’s and PCMH’s Might Be Missing Out On

EngageROI: The Solution to Successfully Transition to P4P

The EngageProfit Model also directly supports the transition from fee-for-service to pay-for-performance for PCPs and PCMHs, helping them consider how to better utilize practice-embedded nurse care managers. These nurse care managers, employed by the practice, help absorb the surge in demand, deliver total care management, all while generating revenues.  

With CMS financial penalties for excess readmissions, hospital-based practices can now financially justify an acceleration to total care management.

Leading medical practices are taking advantage of the nurse care manager/care team’s scope of practice to generate additional revenues and to free up the physician’s time, and all under the patient plan of care. These practices empower all clinical staff, including the patient for a full care team. 

All clinical staff perform at the top of their license/certificate to achieve maximum outcomes with this approach.

“PCP’s and PCMH's are saying to us, ‘This is the direction I need to go in to best manage the concerns I had about staffing, productivity, and reimbursement,’” says Michael Pennessi, EngageHealth CEO and Co-founder.

EngageProfit is a staffing and billing roadmap and allowing them to shape their specific care teams, generate new revenues, and position themselves to comply for pay for total care management services. A light bulb goes off, and we have care management labor justification right in front of their eyes.”

Practice embedded care teams consisting of a combination of RN/LPN’s, LCSW’s, MA’s, and administrative staff—are all managed so that team members are empowered to absorb the responsibilities that fall within their scope of practice. 

The EngageHealthIQ Solution is the foundation of the most advanced patient engagement and evidence based care today. With EngageHealthIQ, all care team providers are high performance in delivering evidence based care for maximum outcomes, the Triple Aim. “By providing a general direction for a range of possible ROI’s up to 30 percent for primary care practice team, on top of transition care financial penalty avoidance, and worksite wellness program revenues, EngageROI is a real game-changer,” says Trunnell.

Get in touch with us today for more information. 

*An in-depth analysis must be done based on your state's regulations, on your specific practice, including payer mix, current staffing patterns, number of registered patients, and patient stratification/profile analysis. 

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