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The Healthcare Intelligence Network (HIN) is the premier advisory service for executives seeking high-quality strategic information on the business of healthcare.

The Healthcare Intelligence Network (HIN) is the premier advisory service for executives seeking high-quality strategic information on the business of healthcare.
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United States

Description:

The Healthcare Intelligence Network (HIN) is the premier advisory service for executives seeking high-quality strategic information on the business of healthcare.

Language:

English


Episodes

Humana Remote Monitoring Pilots Engage Circle of Care Surrounding Member

3/13/2014
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Humana's remote monitoring pilots go beyond traditional targets of heart failure, diabetes and COPD to observe functionally challenged members, explains Gail Miller. This novel approach uses a Personal Emergency Response System (PERS) with a built-in accelerometer to monitor members challenged by activities of daily living (ADL), says the VP of telephonic clinical operations in Humana's care management organization, Humana Cares/SeniorBridge. Another pilot, a collaboration with...

Duration: 00:04:26


3 Key Benefits to Prudent Sharing of Physician Performance Data

2/20/2014
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There are three key benefits to prudent sharing of performance data among physicians, notes Cynthia Kilroy, senior vice president of provider strategy and business development at Optum, who suggests a four-step systematic approach for data dissemination that moves companies away from simply creating "metrics in a box." Besides the electronic health record, she recommends three other data sources to mine for provider performance metrics. Cynthia Kilroy explored the key structure, issues and...

Duration: 00:06:03


Deconstructing Health Reform: 3 Reasons Medicare and Pioneer ACOs May Not Survive

2/20/2014
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Given changing reimbursement incentives and collaborative models for physicians and hospitals, Greg Mertz, managing director of Physician Strategies Group, LLC, discusses why the Congressional proposal "Better Care, Lower Cost Act" of 2014 is financially more attractive to providers than ACO models and whether he thinks it will be passed. He also deconstructs CMS' recently reported financial results for such health reform delivery initiatives as Medicare ACOs, Pioneer ACOs, and the...

Duration: 00:05:58


Award Winning Readmission Prevention Protocols: Navigating Care Transitions with Preferred SNF and Home Health Providers

1/17/2014
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With hospital readmission rates under close scrutiny by CMS, Torrance Memorial Health System launched a readmission program in early 2013 that has been recognized as a program of excellence for its innovation and impact on the community. Navigators work with patients prior to discharge from the hospital to educate them on the hospital's Care Transitions program, which includes a network of Skilled Nursing Facilities, or SNF's and one home health agency. And once the patient is discharged,...

Duration: 00:12:55


Managing Risk in Population Health Management

1/17/2014
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Adventist Health's successful use of incentives to engage employees in population health sets a high bar for the program's imminent rollout to patients at Adventist-owned White Memorial Medical Center, notes Elizabeth Miller, Adventist's vice president of care management. In this interview, Ms. Miller describes the program's target population as well as the incentive that engaged 95 percent of its employees in health management. Elizabeth Miller will share the key features of the...

Duration: 00:03:27


Medicare Pioneer ACO Year One: Lessons from a Top-Performer

12/18/2013
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Lauded for its care coordination service, Monarch had to overcome a few challenges when retrofitting the Naylor Transition of Care (TOC) model for the ACO --- among them insufficient patient access, patient skepticism and resource limitations. By focusing on readmissions reductions and four disease management conditions --- ESRD, COPD, CHF and diabetes --- and creating a care coordination team that included the newly created care navigator, case managers, and pharmacist, the organization...

Duration: 00:14:03


Dual Eligibles: Closing Care Gaps and Engaging Members in Self-Management

12/18/2013
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The philosophy that healthcare is local --- and therefore, care needs to be local and community-based --- forms the core of WellCare's efforts to connect its dually eligible population to health services, explains Pamme Taylor, WellCare's vice president of advocacy and community-based programs. The Tampa-based healthcare company takes a culturally competent approach to assessing duals' unique personal circumstances, ensuring their "soft landing" into WellCare's care coordination system....

Improving Population Health with Embedded Case Managers in an Open, Multi-Payor Community

12/18/2013
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There's education, there's experience, and then there's the 'right stuff' --- the indefinable personality traits that earmark an individual as a change agent, collaborator and ambassador of case management, says Annette Watson, senior vice president of community transformation for Taconic IPA (TIPA), of TIPA's requirements for the RN case managers it hires for its advanced patient-centered medical homes. Then there are the not insignificant contributions of the RN case manager to...

Duration: 00:08:36


Healthcare Trends and Forecasts in 2014: Expect Surge in Commercial ACOs to Continue

12/18/2013
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Despite the migration of some Pioneer ACOs to CMS's Medicare Shared Savings Program (MSSP), expect the surge in commercial accountable care organizations to continue in 2014, predicts Steven Valentine, president, The Camden Group. In this audio interview, Valentine suggests improvements to patient handoffs, an area in which ACOs have disappointed, in Valentine's view, as well as expectations for the other much-modeled care delivery platform, the patient-centered medical home (PCMH). In...

Duration: 00:08:13


Medical Home Neighborhoods: Uplinking Specialists To Create Integrated Systems of Care

12/18/2013
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If payment inequities can be addressed, communication and technology tools in place in large physician multispecialty groups make them ideal candidates for a medical neighborhood, suggests Terry McGeeney, MD, MBA, director of BDC Advisors. Dr. McGeeney, who spent 13 years of his practice career in a large multispecialty group, has also seen some FQHCs and managed Medicaid programs that do a good job of linking community and social supports required in medical neighborhoods. As for engaging...

Duration: 00:06:16


Home Visits: Assessing Complex Patients Post-Discharge To Reduce Readmissions

12/18/2013
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Modifying a popular hospital admissions risk assessment tool for its own use helps Stanford Coordinated Care to prioritize home visits for its roster of high-risk patients, all of whom have complex chronic conditions, explains Samantha Valcourt, MS, RN, CNS, Stanford's clinical nurse specialist. Stanford's HARMS-11, based on Iowa Healthcare Collaborative's HARMS-8 hospital risk screening tool, looks at individuals' utilization, social support and medication issues, among other factors, to...

Duration: 00:06:28


Medicare Pioneer ACO: Case Study on Atrius Health's Focus on the Triple Aim

5/31/2013
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A core desire to create a single population-focused model of care for all Medicare beneficiaries, rather than multiple payor-driven approaches, drives Atrius Health's participation in the CMS Pioneer ACO program, explains Emily Brower, executive director of accountable care programs at Atrius Health. The success of the Atrius ACO hinges on several preferred partnerships it has cultivated, including a collaboration with skilled nursing facilities, as well as outreach by population health...

Duration: 00:09:02


Patient Engagement and Provider Collaborations Across the Healthcare Contin

5/31/2013
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To rise to the challenge of non-compliant patients, providers should ask how they can work together to empower patients toward self-management rather than why patients are non-adherent in the first place, suggests Alicia Goroski, MPH, senior project director for care transitions for the Colorado Foundation for Medical Care (CFMC). CFMC coordinates the work of state-based Quality Improvement Organizations (QIOs), who have been working with hospitals and community providers to improve care...

Duration: 00:05:42


Care Transition Management: Strategies for Effective Patient Handoffs

4/11/2013
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The initial goal of Cullman Regional Medical Center's "Good to Go" program was to reduce readmissions. But CRMC didn't anticipate the effect that recording discharge instructions and sharing them with patients via phone and computer would have on the patient experience. Cheryl Bailey, CRMC's vice president of patient care services, talks about the unexpected benefit of the award-winning initiative, the minimal investment required to get "Good to Go" off the ground, and planned expansion...

Duration: 00:05:01


A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings

4/11/2013
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Low scores on patient outcomes measures within the CMS Star Quality ratings program --- metrics CMS weights most heavily in its assignment of stars --- can typically be traced to poor provider and member engagement, notes Joseph Johnson, vice president of L.E.K. Consulting. Johnson suggests ways to enlist support from these two stakeholder groups, and describes how MA plans should prepare for the possible display in 2014 of CAHPS care coordination ratings along with with its star scores...

Duration: 00:07:57


Moving Forward with Payment Bundling

3/12/2013
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Since the idea of payment bundling was first introduced 10 years ago, justification for the episode-based reimbursement model has shifted from quality and innovation gains to its proven ability to reduce the total cost of healthcare, notes Jay Sultan, associate vice president and chief product portfolio architect for Trizetto. Healthcare entities testing bundled payments should keep two key factors in mind when trying to engage physicians in the model, Sultan adds, describing the type of...

Duration: 00:14:25


Integrated Health Coaching: The Next Generation in Health Behavior Change M

9/18/2012
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Integrated health coaching's person-centric approach to health behaviors across the entire health risk continuum aligns with many of the key principles of post-ACA care delivery models like the patient-centered medical home and the accountable care organization (ACO), explains Dr. Dennis Richling, HealthFitness chief medical and wellness officer. Dr. Richling and HealthFitness Vice President of Service Delivery Kelly Merriman describe the population presenting the greatest opportunities for...

Duration: 00:08:36


Population Health Management: Achieving Results in a Value-Based Healthcare

9/14/2012
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Before shifting from a disease-focused to population health management (PHM) approach, healthcare organizations need to do their homework, advises Patricia Curran, principal in Buck Consultants' National Clinical Practice --- from researching the population's culture to examining its patterns of healthcare usage and cost trends. In this interview, Ms. Curran describes the four key research areas, as well as some of the barriers encountered along the road to population health management. She...

Duration: 00:05:20


The Patient-Centered Medical Home: Lessons from a Statewide Rollout

7/11/2012
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Nurse educators provide essential support to physician practices in Florida Blue's rollout of a statewide patient-centered medical home, explains Barbara Haasis, RN, CCRN, senior clinical lead for Florida Blue's quality reward and recognition programs. They help practices meet key disease metrics within Florida Blue's performance scorecards, and can direct providers to both internal and external resources to help them resolve patient issues. Ms. Hassis also explains why providing after-hours...

Duration: 00:05:11


Recruiting, Training and Case Load Management Strategies for Embedded Case

4/12/2012
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When looking for new hires for its embedded case management program, Bon Secours Health System looks for critical thinking skills and previous roles that are transferable, such as work with chronic disease patients, explains Irene Zolotorofe, administrative director of clinical operations at Bon Secours. Zolotorofe also describes the importance of matching personalities when placing a case manager in a physician practice, how to build a trusting relationship between an embedded case manager...

Duration: 00:06:27

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