4 Steps to Improving Practice Performance and Team Utilization


4 Steps to Improving Practice Performance and Team Utilization

ACO and PCMH model looks for a team-based effort to see that the right care is delivered at the right time. The successful practice transformation, one where all team members are working at the top of their license, requires center-wide commitment.

A nation-wide lecturer on PCMHs and an EngageHealth IQ Advisor, Jenene Washington, MD, MBA, Pediatrician and Medical Director, Baltimore Medical System, shares the multi-tiered approach to medical home transformation with EngageHealth IQ.

Before any gap analysis takes place, the first steps in the transformation include recruiting key people in the conversation who can champion the changes is important to the success of the overall process.

“Different practices have different goals, so bringing in these champions—these leaders and influencers—can help every organization or center on the path to success,” shares Dr. Washington, EngageHealth IQ Advisor.

Here are four initial steps she recommends for organizations to take as they gain momentum in the ability to become PCMH-designated.

1. Determine practice goals and priority of those objectives.

The primary care practice needs to be built so that the physicians, nurses, and the entire care team have enough support for their daily duties, as well as longitudinal responsibilities. “Do we have enough people to get through the day efficiently? Do we have enough people to manage patients as efficiently as we could?” These are the questions that can accelerate the process. Combined with keeping cost effectiveness and revenue gains in mind, “that’s really the first step,” explains Dr. Washington.

The next step is to identify the priority outcomes and goals for the practice. “Since each practice is unique, the focus on practice transformation may differ from practice to practice.” This is where the champions of this better coordinated care can share and cultivate the practice’s unique vision and goals with the rest of the team.

These goals could include any of the following:

·  Access for patients

· Timely communication across care continuum

· Quality of care

· Well-managed transition of care

· Ability of physicians to see more patients

· Team-based, efficient style of care

Or, they could be goals including being better prepared for patients/pre-visit planning; increased care management by nurses; referral tracking; lab tracking—the list goes on.

 “Different practices of course have different goals, and different priorities,” explains Dr. Washington. “Sometimes they really want a true care management program, or maybe it is increasing the ability of patients to access the center. The practice has to prioritize what they want, and the second component of this is really determining the ultimate staffing model desired.”

2. Analyze current workflow to better examine individual roles responsibilities.

By looking at workflows, it’s possible to see where inefficiencies exist in relation to the goals that were set. By looking at the role of all staff members, and adjusting as necessary, a physician’s time can be freed up, removing responsibilities that could be taken on by a different resource on staff.

“Another example is sometimes we can see how RN/nursing role will shift into a role where they are able to have more direct patient care. This would mean they would have more opportunities for patient education and care coordination, so in this situation, the role becomes more hands-on,” she says.

“With a nurse’s role becoming less clerical and having a direct patient care emphasis, the practice as a whole may be able to see the benefits from this in terms of reimbursement, patient compliance with treatment goals, and overall patient satisfaction,” Dr. Washington adds.

“Once you’ve prioritized, and we’ve done an assessment of our workflows—we can evaluate  where we stand with access, or how are we doing now with pre-visit planning. We can begin the process of transforming the practice one step at a time.”

From each of those goals, workflows can be created and shared.

3. Determine gaps in the practice’s framework.

Everyone on the team should be working at the top of his or her license. “Take for example a nurse who might be answering phone calls and scheduling patients; she could be working with a patient and getting reimbursed for that. That’s really what you want them to be doing, and that’s what they really should be doing, says Dr. Washington.

Ultimately, it’s a better outcome for the patient when roles or responsibilities are re-distributed in this way.

Understanding “gaps” in the workflows or processes can be as simple as asking, “Is our current model meeting the needs of our patients? Or our staff?” If not, what else needs to be accomplished, implemented, or even removed to optimize our performance?

The gap analysis includes the “what else” and outlines steps to include the missing pieces, or to remove the redundancies, in the workflow.

4. Implement improved process and procedures. 

After the workflow is determined, process improvement is where the dots are truly connected.

Explains Dr. Washington, “Depending on the size of a center, a question that needs to be answered is: do you have a new policy or procedure in place to ensure that your new workflows and standards are documented to be referenced at a later date? And, in formulating a new policy or procedure, also ask: how will we measure success of the new policy? We would want to know what metrics are required and how often we will evaluate those metrics.

Whether it’s a simple reassignment of roles, or a change in workflow design, we must be prepared for change.

It’s true there are built-in efficiencies with the PCMH model adoption, but real revenue gains and an enhanced workflow are not changes that all happen overnight. 

“We’re talking about implementing change, and what you find is that even though inefficiencies are recognized, the team will have to put in extra effort to implement this change,” explains Dr. Washington. 

“Like with all change, though, it’s well worth it when you see a mediocre practice completely re-energized. It is exciting when patients notice the difference in the management of their health or the efficiency of the team; you know you are making a difference in the new model. It’s great to see people put in the effort to transform the practice, and then you see the rewards as they achieve—and even exceed—the goals they created for themselves."


How Our Health System Must Approach Technology for Better Patient Self-Management


How Our Health System Must Approach Technology for Better Patient Self-Management

With All the Buzz Around Consumer-Facing Digital Tools, What About Our Health System’s Use of Technology for Better Health Outcomes? We sit down with Dr. Kevin Campbell MD, FACC, an internationally recognized Cardiologist who is also the on-camera Medical Expert for WNCN, to discuss the issue. Dr. Campbell appears weekly on the WNCN Today morning show and is a weekly contributor on Fox News Channel and Fox Business News.

The consumer-facing, wearable health sensor marketplace continues to make headlines. And as this news coverage continues, it begs the question: what must medical leaders consider when it comes to technology coming from the provider—technology that advances care team-patient relationships, and that further involves patients in their own health?  

Even if it is “behind the scenes,” certainly this kind of data-backed, relationship-driven technology that is based on proven principles cannot be overlooked.

Here are the two key factors physicians should consider as they better understand and leverage patient-centric population management platforms. 

1. Effective physicians must be proactive instead of reactive as they embrace technology for better care delivery.   

Research has repeatedly shown how outcomes improve when patients are more engaged in their heath care.

“An engaged patient is a patient who is invested in his or her own health,” says Dr. Kevin Campbell, MD, FACC, an internationally recognized Cardiologist and on-air medical contributor for Fox News. “That could actually be due to the fact that these patients have done research online to better understand the disease process, and they come to the office better informed. It may also be that they are actively using technology to track various health indicators.”

“Whatever it might be, we know that when patients have access to more data, they actually tend to be more engaged and they also respond to making changes in their health care and in their lifestyle,” explains Dr. Campbell. 

The reason technology used in this way is effective is that patients have a greater sense of control. With this increased ability to see metrics showing how their health status is changing based on their day-to-day behavior changes, they see more reinforcement for their efforts. 

“Data leads to empowerment for these patients because it gives them some sense of control. Normally, if they are sick, they don’t have that same sense of control. They are better able to make changes in their lifestyle, and to see various health indicators change in an obvious way,” a factor that’s important for us to recognize as members of a patient’s care team, Dr. Campbell adds.

And just as patients can embrace technology, care teams and physicians also should have this mentality for enhanced, overall relationships with their patients. 

“Doctors—who are scientists after all—recognize that having data available helps us make effective, critical decisions. Many physicians are embracing technology and, as healthcare providers, see first-hand how patients are becoming more engaged as a result. Physicians in gadget-based specialties like cardiology really do seem to naturally embrace technology,” he adds, “and it is my hope, that in the near future, more physicians from a wide variety of specialties begin to engage in a more active way.”

2. Resource constraints make team-based care even more critical, even as we take advantage of technology to optimize our care process.

With primary care shortages, and more patients requiring access to care teams, technology serves and supports better quality care because it helps address those very problems. “Physicians are being asked to do more with less and as healthcare providers we must become more efficient in order to continue to provide high quality care."

In addition, Dr. Campbell says, “[Technology], when utilized for remote interaction between caregiver and patient, can serve to allow us to better develop relationships, to connect with patients more meaningfully, have better communication, and do so more directly, and more quickly than we have ever done before—and this is critical in improving outcomes with limited resources.”

Even if decisions and workflow design are both backed by information/access to data, and even when we have telemedicine or self-monitoring efforts in place, a strong physician and care team support system must exist if we want sustainable change to occur.

“Data collection and digital tools for patients, such as wearable sensors, Fitbit devices and others can be incredibly beneficial when used by patients between visits. But we really see a major boost in outcomes when you combine these efforts with the ‘backbone’ of the care delivery process: the patient’s health care team. This is why the team is more and more important as we look to manage chronic disease—all with less time and resources to do so,” says Dr. Campbell.

Advanced workflow designs for high-performance, team-based care takes advantage of the power of evidence-based guidelines.

Non-physician team members can manage complex care by exception; following guidelines, they can recognize when an exception to the physician’s Plan of Care requires their attention. 

Technology is optimizing the care process powerfully in this and many other ways.

A revolution in healthcare delivery is modernizing the industry for high value and truly excellent outcomes. The modern physician/CEO/leader assures her team is empowered, trained, and properly delegated to, and is well-connected to all other non-physician team members to assure the patient is “owned” and fully cared for at all times, which is consistent with evidence-based guidelines. 

With administrative costs on the rise, and with a significant shortfall of all types of physicians, the significance of the team-based approach is increasing.

“I think that we are already seeing that we have to do more with less,” says Dr. Campbell.  “We have to be more efficient. We have to be smarter about how we use our resources, and in order to do that, we really have to work together. It is essential to maintain a team based, patient centered approach and support this approach with technology.”

It is no longer adequate to have "lines of demarcation" between people on our care teams.

“We must see it as this: we have a team, people have roles on that team, and everyone is qualified for their specific roles. A patient-centric care team is the result if we practice medicine in that way—everyone on the care team contributes something, and then outcomes improve,” says Dr. Campbell.

The route to total care management that combines personalized care plans and patient engagement tools that enhance a care team and patient’s communication/relationship is possible through EngageHealth IQ’s suite of services. 

Dr. Kevin Campbell MD, FACC is an internationally recognized Cardiologist who specializes in the diagnosis and treatment of heart rhythm disorders. Dr. Campbell is the on-camera Medical Expert for WNCN and appears weekly on the WNCN Today morning show. In addition, Dr. Campbell is a contributor for both the national Fox News Channel and Fox Business News and appears LIVE on air on a weekly basis. Find Dr. Campbell on Twitter here and at his blog here.


The 2 Things Providers Should Know About Artificial Intelligence


The 2 Things Providers Should Know About Artificial Intelligence

With uncertainty in the media around the integration of informatics and personalized medicine, EngageHealth IQ examines two truths about how Artificial Intelligence (AI) can improve and support proactive, comprehensive care. Here are the two things every provider must recognize:

1. AI is not about replacing physician or care team judgment—it’s about powerfully scaling the provider’s ability to deliver high quality, useful care based on population need. 

Health statuses shift and churn over time, but advanced algorithms let us better determine two key things. First, EngageAI helps us predict an individual’s readiness for change (health velocity) so that we can better create and shape her care plan. Second, EngageAI enables us to accurately predict the cost to manage any given population.

Imagine a group of patients with severe diabetes. To address their needs, we are able to capture health data both in the clinic, as well as through a mobile application using AI. The data is then used to classify the patients in terms of their velocity toward better health. Our algorithms then monitor select key variables, enabling us to select the factors that are most important to any given patient.

EngageAI enables us to optimally merge this data with complete, real-time and individualized care

“Perhaps using the word ‘intelligence’ has mystified integration of computational learning and medicine, since we think of intelligence, in many cases, in reference to human intelligence. The two are indeed separate,” explains David Trunnell, COO/CFO and Co-founder of EngageHealth IQ. “We have a useful and powerful predictive program that’s engineered to capture, synthesize, and model data in an effective way so that patients, physicians and care teams are empowered. This is what we mean when we say ‘intelligence.’”

EngageAI is, therefore, a robust tool to solve specific tasks to better treat and manage disease. In many cases, it’s those with “less skill” that will be armed with the advantage of tasks that require a greater degree of skill and/or time thanks to AI.

2. AI provides greater efficiency for doctors and care/support teams.

By definition, clinical AI is the retrieval, storage, analysis and meaningful usage of various types of rich information about our health.

And despite the utilization of such intelligent systems, the patient remains at the center of the care process. 

In fact, AI improves diagnoses and reduces medication-related errors, most notably, in complex and uncertain environments. The question is often asked: has informatics been shown to improve efficiency, all while delivering greater care to each individual?

The answer is yes. In a January 2013 AI in Medicine study, clinical data was run through an artificial intelligence framework to help develop and to understand the efficacy around such complex treatment plans. The results showed AI could have improved patient outcome by 30 to 35 percent. The research also suggested that providers could have seen as much as a 50 percent improvement in patient outcomes, for roughly half of the associated costs utilizing an AI framework.

This study is just one example of where “efficiency” for patients also would mean better treatment for the patient: it translated into finding the right treatment faster, and in fewer clinic visits. Additionally, from a provider standpoint, the study was promising, with the cost per unit of outcome dropping to $189, in comparison to the existing treatment-as-usual CPUC of $497.

The ability to measure a patient's readiness to self manage, and to better share information and to access a large amount of health data has never been as possible as it is now. AI simulations have the demonstrated ability to create/approximate patient readiness and cost to manage these patients.

But information alone is not necessarily knowledge—it’s what we do with that information that matters.

If we want to continue to deliver better care, to more people, we must not wait to take advantage of intelligent systems. With intentional, patient-centric program design we provide and support, AI aids our ability to manage information related to each patient. 


EngageHealth IQ and WellPortals Partner to Help Lead Transformation of Healthcare Spurred by ACA


EngageHealth IQ and WellPortals Partner to Help Lead Transformation of Healthcare Spurred by ACA

"EngageHealth IQ and WellPortals' alliance allows us to accomplish what amounts to a ‘hat trick’ of healthcare: improve the health of the individual, improve the efficiency for the caregiver, and lower the cost of care." --David Trunnell, CFO/COO, EngageHealth IQ 

Healthcare has made a seismic shift towards wellness and patient outcomes. To meet new market opportunities, EngageHealth IQ and WellPortals are combining their individual expertise to develop robust, results-driven products that help drive wellness in large populations.

EngageHealth IQ, a provider of advanced, best-in-class software tools that allow care teams, patients, and employees to self-manage and improve their health, has announced a strategic partnership with WellPortals, a pioneer in online lifestyle modification programs for chronic diseases.

“Our current programs have the proven outcomes, workflow modifications, financial analytics and results that support how our technology improves the health of individuals, as well as the performance of an organization,” said EngageHealth IQs Co-Founder and CFO/COO David Trunnell. “Now, by partnering with WellPortals, we add a much greater breadth and depth of wellness offerings that enable easy-to-use, flexible—yet still scalable—performance-based programs for both corporations and healthcare organizations,” said Trunnell.

In a landscape where organizations continually adjust to the changing healthcare requirements, the partnership allows EngageHealth IQ and WellPortals to act on their shared vision of changing the landscape of how organizations are able to proactively handle employee wellness, and in particular, chronic disease management.

Chronic disease accounts for 75 percent of all healthcare costs. With as much as 45 percent of all Americans having at least one chronic disease, companies are endlessly seeking out ways to reverse and prevent these conditions to reduce costs and to improve individual health.

“WellPortals has a history of being an early leader, and this partnership is no different. By working together, WellPortals and EngageHealth IQ are well positioned to be the performance-based, complete solution for improving outcomes in high-risk individuals,” said WellPortalsCEO Steve Chandler.

“We say that we offer ‘wellness that makes financial sense,and its true,” said Chandler. “With a focus on diabetes, heart disease, cancer, asthma and obesity, our programs target the conditions that have the greatest impact on the cost of healthcare. The business and healthcare sectors are now recognizing the value of the reversal and prevention of chronic conditions, and our mission is to continue to deliver high-value solutions together.”

The proven model of organization health and wellness management will include:

  • Insight-driven analytics and assessments
  • Structure development, workflow modification, and habit formation
  • Education and proven behavior management techniques
  • Results-driven support and interaction
  • Rich reporting and modifications

Trunnell explains:

 “Business and healthcare leaders are looking for a tailored experience that fits their needs and what they may currently have in terms of wellness/health, a program that influences the lifestyle of their employees, and a high participation rate. We couldnt be more pleased to be able to offer this total solution that has its roots in the clinical world: a robust, yet still accessible, analytics-backed wellness program.”


Can Increasingly Data-Driven Medicine Still Drive a Patient-Centered Approach?


Can Increasingly Data-Driven Medicine Still Drive a Patient-Centered Approach?

EHRs have made data collection easier than ever, but does an increase in quality measures equate to greater value for patients? We explore how data can be used to positively shape and influence our relationships with patients across the care continuum. In the end, what gets measured is what receives attention.  

The final day of Nurses Week celebrated on Monday also marked Florence Nightingale’s birthday. As the founder of modern nursing, Nightingale was passionate about the value of nursing, including the idea of data analysis.

Now more than 100 years since her advocacy for such disease prevention, again we are examining our standards of care and how they may be improved through data.

Now more than ever, more and more data on each patient has the potential to be captured. As processes become more streamlined for facilitating this data collection, a question remains, however: in our aim to deliver excellent, patient-centered care, are we getting lost in all the measurements—in data for the sake of data?

When utilized for patient involvement, more data should not equate to more “noise”

High value care—that which has continuous improvement, and is personalized—requires data by definition in order to measure whether individuals and population outcomes are in fact high value. It’s true that what we measure over time is what’s critical, and when we have better ability to measure, in turn we will see more optimal and better indicators as a result.  

Not all data is created equal

Much of our new and increased data for clinicians must be organized if we want it to truly achieve high value care. This is the only way to utilize data to its full potential for continuous improvement.

Take for example Patient Generated Health Data. This category of data is critical to the clinician’s complete assessment of the patient: their health IQ, self-efficacy, and motivation. These, in turn, are the real drivers of creating a patient that can be fully invested in her own care process.

We’ve examined what it means to be an engaged patient before, and our position remains the same: engaged patients are those who have the tools, know-how, and motivation to be involved in their health outcome.

AI (Artificial Intelligence) measurement of health velocity enables this to happen by serving as another form of information, one that’s essential to incorporate in order to build an effective, proactive workflow. Yet another: the measurement of the highest value data indicators and interventions by the care team aimed at reversing disease. Together, when utilized appropriately, data-backed decision making improves care, recognizes individual patient preferences, improves physician efficiency, and it improves over time.

There is power in information, and using it effectively goes far beyond merely “checking boxes” to make sure we are in compliance.

Instead of “provider-centered data,” we must work for relationship-driven outcomes

Providers are the real leaders in a patient’s journey through the healthcare system.

AI enables us to better see and utilize context—a missing component in many of the purely data-driven platforms that exist today. To do this, it requires a person-by-person approach and a holistic analysis of the critical connection between provider and patient.

Providers are the ones creating and shaping the relationship with patients. Surely then, health data that’s utilized appropriately would not take away from the patient’s needs, the patient’s values, or their actual history or current behaviors. Rather, recognizing patients as partners, more robust information provides rich, ongoing context so that we can be more responsive than ever.

Data applied in this individualized, progressive manner benefits from patient values and underlying drivers of their behavior (and health).

With this in mind, we’re able to ensure patient-centered, outcome-oriented, high quality care that does the opposite of “adding to the clutter.”


National Nurses Week 2014: Top Quotes About Nursing


National Nurses Week 2014: Top Quotes About Nursing

In celebration of National Nurses week, here are 8 notable quotes about nursing.

1. “As a nurse, we have the opportunity to heal the heart, mind, soul and body of our patients, their families and ourselves. They may not remember your name but they will never forget the way you made them feel.” – Maya Angelou

2. “When a person decides to become a nurse, they make the most important decision of their lives. They choose to dedicate themselves to the care of others.” – Margaret Harvey

3. “Unless we are making progress in our nursing every year, every month, every week, take my word for it we are going back.” – Florence Nightingale

4. "I have an almost complete disregard of precedent, and a faith in the possibility of something better... I go for anything new that might improve the past." – Clara Barton, Educator, nurse, humanitarian and founder of the Red Cross

5. “To do what nobody else will do, a way that nobody else can do, in spite of all we go through; that is to be a nurse.” – Rawsi Williams, JD, BSN, RN

6. "Nurses dispense comfort, compassion, and caring without even a prescription." – Val Saintsbury

7. “It would not be possible to praise nurses too highly.” – Stephen Ambrose

8. “The trained nurse has become one of the great blessings of humanity, taking a place beside the physician and the priest.” – William Osler, MD


EngageHealth IQ and Experlytics Announce Groundbreaking Strategic Partnership


EngageHealth IQ and Experlytics Announce Groundbreaking Strategic Partnership

EngageHealth IQ and Experlytics have announced a first-of-its-kind partnership to deliver better diabetes care with the power of artificial intelligence supporting advanced care team software, model of care and workflow design.

EngageHealth IQ, the provider of the most advanced, best-in-class software tools and workflow consulting services to actively engage patients in personal self-management, has announced its partnership with Experlytics, the leading provider of artificial intelligence analytic tools for healthcare. EngageHealth IQ and Experlytics’ long-term, strategic partnership presents healthcare provider groups an unprecedented solution comprised of EngageHealth IQ’s nurse-centric platform with predictive functionality to drive more meaningful clinical insights for healthcare stakeholders across the care continuum.

With Type 2 Diabetes requiring a more robust and integrated approach to drive patient self-management, providers recognize the opportunity in taking advantage of a highly effective, continuous improvement solution that’s now available with this partnership. “These clinical management tools are aimed at ‘closing the gap’ in the quality of care that’s being delivered today,” explained Michael Pennessi, CEO and Co-founder of EngageHealth IQ.

“EngageHealth IQ has crafted an innovative platform for nurse care management and a broadminded yet very targeted approach to chronic care disease management. EngageHealth IQ is without a doubt a future leader in this field and we are very proud to be partnering with them,” said Lars Hard, Founder of Experlytics and ExpertMaker.

The utilization of artificial intelligence is a commitment from EngageHealth IQ to empower patients and providers with a combination of patient optimal workflow processes and state-of-the-art technology.

“Healthcare stakeholders have come to us, increasingly seeking a highly effective way to empower and drive change across the patient population. It’s more than patient education; it’s about identifying and managing an individual’s health velocity,” said Pennessi. 

“Engage and Experlytics make up the only available providers of these advanced AI solutions, in combination with the most advanced care team software, model of care and workflow design offerings.”

“Combining our artificial intelligence expertise together with EngageHealth IQ’s leading platform for patient management, we have opened new doors for clinical provider groups to get the tools they need to better address the needs of their patients,” said Mattias Paulsson, CEO & Partner of Experlytics.

“We’ve created a set of advanced mathematics algorithms to identify how patients’ needs for care vary over time. In the end, our solutions make providing the highest quality of care easier, more reliable, and less costly,” explained Paulsson, who is also a member of the EngageHealth IQ leadership team.

To see our original news release, visit here


Spotlight April 2014: We’re Now A Stakeholder in Ohio’s Chronic Disease Collaborative


Spotlight April 2014: We’re Now A Stakeholder in Ohio’s Chronic Disease Collaborative

Engage offers the roadmap and know-how to find the short- and long-term impact that local (and global) decision makers want to see when it comes to how they are treating and preventing chronic disease.

Chronic disease is the cause of two out of every three deaths in Ohio. That’s more than all other causes combined. Figures such as these are in part why EngageHealth IQ is now a part of the Ohio Chronic Disease Plan and Chronic Disease Collaborative.

Ohio’s Plan to Prevent and Reduce Chronic Disease is aimed at improving the policies, systems and environments that are related to chronic disease outcomes and health behavior change.

The Ohio Disease Collaborative focuses on the following, among other priorities:

·      Providing data to inform, prioritize, deliver and monitor programs and population health

·      Improving the delivery and use of healthcare services in order to prevent disease, detect diseases earlier and manage risk factors.

·      Ensuring those with or at high risk for chronic diseases have access to community resources in order to best manage their disease or risk factors

These priorities are very much aligned with EngageHealth IQ’s mission. And although we’re changing lives on a global basis, the plan reminds us of the extent to which we’re working to improve delivery of care and population-based prevention right here in the Midwest. 

A question the coalition has for Ohio healthcare systems is this:

As a healthcare provider, are you taking advantage of the evidence-based population health strategies…to improve your patients’ overall health and wellness and prevent future disease and disability?

While this occurs, several practices in Ohio have been selected to participate in a pilot project aimed at improving access to quality health care at lower cost, the Comprehensive Primary Care Initiative (CPCI). Participating practices’ physicians will be rewarded when better coordination of care with patients occurs. In exchange for resources aimed at helping them to do this, patients will see the benefits of longer and more flexible hours, EHR use, and individualized, enhanced care, including access to dedicated health coaches, in some cases of the pilot project.

Now more than ever, there’s opportunity for a better way to support physicians and care teams.

There’s a better way to raise the quality of care. There’s a better way to have seamless, truly coordinated care for people. 

Engage is providing the roadmap for practices making the transition. 

The Ohio Chronic Disease Collaborative reveals that 60 percent of people living in Ohio have one of the following chronic diseases or clinical risk factors: arthritis, asthma, cancer, high blood pressure, high cholesterol, chronic kidney disease, COPD, diabetes, heart disease, and stroke. Additionally, about 40 percent of people living in Ohio have two or more chronic diseases. These figures can be daunting, but they show the opportunity that a patient-centric, robust platform can have for each patient that enters a system.  

The Collaborative is looking at a variety of sectors, including action that can be taken in communities, schools and universities, healthcare systems, worksites, as well as governments.

With the goal of preventing and reducing the burden of chronic disease for all Ohioans, EngageHealth IQ is proud to now be a contributing member of this new and necessary initiative. 


What Payers Considering ACO Models Must Know


What Payers Considering ACO Models Must Know

A fundamental shift and support system is proven to be critical as organizations look to align payment incentives and reform care delivery.

As organizations shift from the reactive, visit-based care, many questions have come up around the implementation of the PCMH model. In particular, much discussion has occurred around the related provider payment reform changes.

Care Team Support is Key to Enhancing Care Coordination

We know it is vital for the patient-centered medical home to be able to lean on its care teams for execution. High functioning care must focus on having the patient truly be a contributing member of that care team.

The PCMH needs to be the "foundation" for effective, relationship-based care management. Care management needs to be provided by on-site, PCMH employed clinical providers/care team members.

These are the real patient advocates. 

Research has also supported that patients actually do have higher satisfaction at a primary care practice which has adopted the PCMH model along with lean process changes and payment reform.

Digging Deeper: The PCMH and ACO 

A recent Journal of General Internal Medicine published an article on the topic at large, examining how the PCMH model should evolve in order to keep pace with health care payment reforms. In particular, it examined the "shared savings" approach used by many accountable care organizations.

The article, published online this month, included a suggestion to promote integration of PCMHs and ACOs that read as follows:

ACOs could invest in PCMHs by hiring more primary care providers, expanding office hours, developing information technology and care coordination infrastructure, supporting coaching and learning collaboratives, and dedicating resources to urgent care.

EngageHealth IQ provides the platform, the workflow design implications, and the model of care support for the ACO, PCMH and primary care embedded nurse care manager to do just that—with a focus on customized implementation.

Across a variety of settings, EngageHealth IQ supports medical homes to best improve how care is delivered and how providers are paid.

Although there may be alignment between many of the underlying purposes of the PCMH and ACOs, the article's authors made assertions around the idea of physician payment in each model of delivery system reform. Saying that the PCMH "can serve as a lynchpin of ACOs," the authors concluded what many already believe: that ACOs would need to support the PCMH model within their organizations.

To read the article in its entirety, visit here.


Millennial Team Members and Patients—What You Need to Know


Millennial Team Members and Patients—What You Need to Know

There are 80 million people making up the 18-34 year old segment today, putting our youngest adult generation at the same size as the Baby Boomer generation. Looking forward, it’s vital to know how the beliefs and behaviors of Millennials (which will make up 50 percent of the working population by 2020) will help influence and shape healthcare institutions, as well as the way we deliver care.

Here are 4 must-know truths about Millennials impacting the way we should approach both patients and team members that fall into this category. 

1. Millennials value health.

If you promised to make a Millennial’s life happier, healthier, and more productive, you would have a winning product with Millennials. That’s due in part to how much Millennials value their health, and the idea of being in control of their health. Millennials see technology as one way to improve, track and compare their heath on an ongoing basis, which is different than other generations.

Millennials enjoy quantifiable data regarding their health status, and they often seek out information that can help them better understand their health, whether that be apps or wearable technology. Because of this, any institution incorporating worksite wellness must not just think in terms of the future—but for today—if they want to meet the expectations of this generation.

For physicians, it’s best to keep things concise and in simple terms when speaking to a Millennial about their health. A Millennial is likely someone who seeks information in a simplistic, and in a way they view as being transparent. Just like with older patients, taking time to ask for questions and avoiding jargon greatly improves the physician-patient communication process with 18-34 year-olds.  

2. Millennials see technology as the natural way to create and implement programs.

As the so-called first generation of “digital natives,” Millennials are unlike other generations in that they do not view technology as a barrier or something they have to adapt to. Instead, it’s all they’ve ever known, and it’s the way they choose to seek out, filter, and share information.

“Millennials have it in their DNA to understand how data can actually drive decision-making and this genuine relationship-building. At times, that’s not as true with other generations. It’s not just about the data for us at Engage, it’s about the workflow impact and the patient as a whole—and that's someone who is a multifaceted, complex person. Millennials typically have no issue picking up on this. It just seems engrained in their nature,” explains Engage Co-Founder and CEO Michael Pennessi."

3. Millennials see the current healthcare system as flawed.

Not only do Millennials take their health seriously, but they have high expectations when it comes to the healthcare system at large. They hope for a revamped system: one where the patient is truly at the center, and one where treatments are highly accessible. For the digitally-savvy Millennial, they also seek easy-to-understand answers about their health, and that might just mean being able to digest it and access this information in a digital format.

Generally speaking, they look for a system that would be widely accessible and would reflect a community’s core values. In a nurse-centric, physician-led atmosphere, this kind of vision for healthcare can be achieved.

4. Millennials seek authentic communities and team-based organizations.

Just like how other generations value flexibility, Millennials also want to be measured on high quality output—an idea that’s consistent with Engage’s vision of better quality of care ultimately being delivered to patients. Millennials also value efficiency and team-based organizations in general.

Being a part of an organization that is purpose-driven, and/or shows them loyalty, is significant to them; this is what gets them truly engaged. To them, trust is an element built from information coming from their community itself—something that has to be taken into consideration for physicians and medical leaders alike.

Despite the burden many are facing financially, research confirms that Millennials are very optimistic about the future. With increased opportunity for the delivery of care to greatly improve in the coming years, they have good reason for this optimism. Knowing their beliefs in terms of health can help drive engagement for both care team members and in how we approach them as patients.