Bundled Payments: Preparing for the Inevitable Shift

January 12, 2012 in by Guest Blogger | Tags: , , , , , | Leave a comment

This week’s guest post comes from Dean Farley PhD, Vice President at OptumInsight. An advocate for collaboration across all constituencies for better patient care, here he explains how payers and providers can make bundled payments a reality.

The idea of implementing bundled payments can be intimidating for any hospital CFO. But, as a way of paying providers that combines all the services needed to treat a patient, bundled payments are an inevitable step for both payers and providers as the industry heads toward accountable care.

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Good Health is a Two-way Street: Getting Patients to Hold up Their End of the Bargain

January 9, 2012 in by Guest Blogger | Tags: , , | Leave a comment

In this week’s guest post Dr. Miles Snowden, chief medical officer at OptumHealth, offers tips for stimulating patient accountability in the age of accountable care.

While payers and providers are usually in the spotlight when it comes to accountable care, the most successful models will be the ones that place a strong focus on patient accountability. More and more frequently patients are selecting doctors with the best outcomes, asking proactive questions, and taking an active role in their lifestyle and behaviors. Empowering patients with the support and tools to be responsible for and more involved in their own health is critical to improving outcomes and reducing costs as part of any accountable care environment.  In fact, Optum found that when given more information about a planned elective surgery, 1 of every 15 patients change course – either deferring, choosing a less intensive option, or changing facility or proceduralist.

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Round Two from the ED: Response to Comments on KevinMD.com

December 21, 2011 in by Dr. Mark Crockett | Tags: , , , , , | 1 comment

I appreciated all the dialogue that my recent post on KevinMD’s blog, “The emergency department in an ACO world,” has generated over the past week or so – the number of comments is a great indicator that ED physicians are not just letting this topic go by. I’ve compiled the following post to address as many as I can:

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Marketing for HIE Success…but to whom?

December 19, 2011 in by Glenn Keet | Tags: , , , | Leave a comment

In our last post of the HIE patient consent series, we described why attaining patient consent is necessary to the success of an HIE. But to the average patient — you know, the one who isn’t a hospital CIO in their downtime — the concept of an HIE can raise privacy concerns. To overcome this, healthcare organizations need to educate patients on how HIEs work, assure them that their information will remain confidential and secure, and explain to them the benefits of electronically sharing patient information via this exchange.

According to the American Medical Association and the Markle Foundation, four in five American consumers believe that using an online patient health record (PHR) would yield major benefits to them in managing their health care. In spite of this, the usage of PHRs has been very low to date, due in some part to patient concerns about privacy of their personal health information.

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Up, Up and Away! Healthcare’s Future “In the Clouds”

December 14, 2011 in by Guest Blogger | Tags: , , , , , , | 2 comments

We’re excited to welcome Anand Shroff, vice president of product management at OptumInsight, to Healthcare-Exchange. A strong advocate for advancing the use of technology in healthcare, Anand discusses the role cloud computing may play in the industry’s future.

It’s no secret that healthcare has historically been slow to adopt the latest and greatest in technology and even slower to embrace technological paradigm shifts, as evidenced by the continued presence of client-server computing in healthcare in the age of the Internet. While strides to catch up have been made in recent years – with shifts toward electronic health records (EHR), advanced health information exchange (HIE), and mobile computing devices – the world of business is changing rapidly, and the industry needs to do a better job of keeping pace.

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Physician Mind Shift: The Emergency Department in an ACO World

December 1, 2011 in by Dr. Mark Crockett | Tags: , , , , | Leave a comment

In the era of accountable care, you’ll notice that many hospitals and health systems are already driving towards more collaborative workflow. The integrated delivery network (IDN) is changing significantly, and for the better. But in high-acuity care areas, like the emergency department (ED), the challenge of treating patients more holistically in what is already a fast-paced environment is concerning for physicians evaluating the pay-for-performance model.

In today’s ED, patients may enter with a chronic condition that could be better managed by a primary care physician (PCP), but because ED physicians are incented to treat sick people in a fee-for-service model, they continue to take these patients on instead of referring them outside the ED walls. If instead both ED and primary care physicians operate as part of a team of care givers that are incented to ensure patients stay healthy and avoid hospital admissions and readmissions, they are headed in the same direction in terms of focusing on better patient outcomes vs. reimbursement dollars.

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Net Positive: Providers Put on their Payer Hats Deploying and Relying on Actuarial Services

November 28, 2011 in by Guest Blogger | Tags: , , , , , , , , | Leave a comment

For this week’s guest post we welcome back Joel  C. Hoffman, Senior Vice President with OptumInsight Payer Solutions.

Evaluating and managing population risk has traditionally been the payer’s role in the health care system. But as providers become increasingly accountable for populations, they will need to be equipped with many of the same competencies that payers have been relying on for years. This includes the right technology to capture both clinical and claims data, but also the ability to analyze and transform these data into actionable information that affords the delivery of high quality, efficient health care and ultimately real population health — that’s where actuarial services come in.

There’s a reason why actuaries are known for incessant number crunching, data collection and manipulation (along with the occasional pocket protector) — it’s a complicated field that first requires extensive training and then plenty of experience to practice effectively. Our team of over 175 actuaries, who are engaged on a daily basis to do this work, are hearing excitement, but also understandable caution from providers looking to assess and understand both the risk and the financial benefits of setting up any of a variety of accountable care models. Many providers — including some already approved for the more advanced CMS Pioneer ACO — just don’t know where to begin, so we’ve pulled together these tips for how to wear the “payer hat” when evaluating populations and assessing risk:

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Kid in a Candy Store – My first week at The Optum Institute

November 21, 2011 in by Carol Simon, PhD | Tags: , , , , , | Leave a comment

It’s been one busy week! As director of the newly launched Optum Institute for Sustainable Health, I’ve been presenting our first set of findings at the The World Congress 2nd Annual Leadership Summit on Accountable Care Organizations (ACOs) in San Diego, flying all over the country to meet with providers, and on the phone with health care reporters who’ve been interested in our study – everyone from HealthLeaders to Healthcare Finance News to USA Today. Who needs sleep, right??

In my more than 20 years in health care, the Optum Institute is the most exciting organization I’ve been lucky enough to lead. As someone with a true passion for health care, I’m like a kid in a candy store. Our job is to be an authoritative source of information on trends in the marketplace – especially new collaborative care models – and a resource for folks who are working to make healthcare sustainable. We’ll do that by conducting research, monitoring trends, working with leading experts around the industry to keep a finger on the pulse of all things accountable care, evaluating what works and what doesn’t, and helping develop best practices to propel our industry forward in the development of Sustainable Health Communities.

To kick things off right, we went big, surveying 1,000 US-based physicians, 400 hospital executives, and 2,000 health care consumers to get a sense for how each group views this inevitable evolution of care, and to identify the most immediate opportunities for positive change. Some of the results surprised us and others were in line with our expectations, but here my favorite highlights:

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Taking it to the Web for System-Wide Satisfaction Improvements

November 16, 2011 in by Guest Blogger | Tags: , , | Leave a comment

Donna Woelfel, Clinical Applications Manager at PeaceHealth in Bellingham, WA, discusses how she and her team tackled the communication and efficiency challenges of its health care system.

With the industry moving toward new models of collaborative care, one thing is clear: hospitals and health systems are under the microscope to improve efficiency, communication and quality across departments, facilities and regions. At PeaceHealth, implementing technology to improve patient throughput was one goal, but ultimately we aimed to move the needle on patient, family and employee satisfaction and quality of care across our facilities.

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Final CMS ACO Regs: More Hits than Misses?

November 9, 2011 in by Todd Cozzens | Tags: , , , , | Leave a comment

Like many folks in the healthcare industry, the “light reading” that has graced my nightstand over this past week or two has consisted of 700 pages of the Department of Health and Human Services’ Final Rule on Medicare Accountable Care Organizations (ACOs). Overall, the changes from the draft proposal, aimed at nudging providers away from a fee-for-service model and into one of shared savings and risk, are both substantial and encouraging, with a number of key improvements in three key areas:

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