Caring for High-Need, High-Cost Patients — An Urgent Priority

http://www.nejm.org/doi/full/10.1056/NEJMp1608511?utm_source=TrendMD&utm_medium=cpc&utm_campaign=NEJM_TrendMD

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Improving the performance of America’s health system will require improving care for the patients who use it most: people with multiple chronic conditions that are often complicated by patients’ limited ability to care for themselves independently and by their complex social needs. Focusing on this population makes sense for humanitarian, demographic, and financial reasons.

From a humanitarian standpoint, high-need, high-cost (HNHC) patients deserve heightened attention both because they have major health care problems and because they are more likely than other patients to be affected by preventable health care quality and safety problems, given their frequent contact with the system. Demographically, the aging of our population ensures that HNHC patients, many of whom are older adults, will account for an increasing proportion of users of our health care system. And financially, the care of HNHC patients is costly. One frequently cited statistic is that they compose the 5% of our population that accounts for 50% of the country’s annual health care spending.

At least three steps are essential to meeting the needs of these patients: developing a deep understanding of this diverse population; identifying evidence-based programs that offer them higher-quality, integrated care at lower cost; and accelerating the adoption of these programs on a national level. Although we are making progress in each of these areas, much work remains.

 

Four ways demand for healthcare data will grow in 2017

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/four-ways-demand-healthcare-data-will-grow-2017

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The New Year presents challenges on many fronts, including questions surrounding how President-elect Donald Trump will change healthcare policy. Yet, “repeal and replace” or “replace and improve” activities on The Hill, though not “business as usual,” won’t necessarily slow down data-driven focus areas in healthcare that will continue in 2017.

Here are four key ways demand for data will grow in the year ahead:

1. Increased demand for insight into discharge gaps, risks and exposures.

As delivery and payment models continue placing risk within the care setting, increased insight into the member’s (the patient’s) likelihood of adherence or compliance is critical in evaluating expected outcomes and coordination of care post-discharge. Socioeconomic data surrounding the patient and their caregiver can complete the picture of their expected behavior.

2. Maximizing identity management capabilities.

Identity insight and management solutions will be critical to ensure the right approach for the right member but, more importantly, to securely house and validate identity data. While a national patient identifier may become closer to reality at some point, for now, identity management techniques can be critical to ensuring all operational processes and players within the care payment and delivery setting can link the right information for each individual.

3. Integration of health-tracking wearables into care analytics.

The market for wearable fitness and health devices has grown exponentially. Integration of health tracking wearables into the care analytic systems creates opportunities for using wearable metrics as a basis for member rewards but also in risk scoring for compliance augmentation for new targets, for member engagement, and for prediction of medical complications or improvement.

4. Evaluation of provider performance.

While the release of MACRA benchmarks has gotten considerable attention the past month, it is really only a beginning. Commercial plans have attempted various P4P approaches over the years with one missing ingredient, now shared with MACRA: Insight into patient profiles and behaviors and their influence and impact on ultimate outcomes. Socioeconomic data augmenting existing measurement sources can serve a critical role in tiering performance measures with patient make-up to arrive at a more mutually accepted performance structure.

Healthcare organizations and payers should reach out to new data sources, augment their thinking with them, and redefine how their day is focused on insights into their most valuable player: the customer, the member and the patient.

Top 2017 challenges healthcare executives face

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/top-2017-challenges-healthcare-executives-face?cfcache=true&ampGUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=15022017

Working as a managed care executive in today’s healthcare environment is a demanding role. According to Managed Healthcare Executive’s 2016 State of the Industry Survey, challenges abound. Government requirements and mandates, such as implementing value-based reimbursement, are difficult to meet. Meanwhile, employing new technologies, such as electronic health records and data analytics, is no easy task. Pharmaceutical costs continue to rise dramatically, burdening the entire system.

The survey findings, based on 160 responses, show the biggest challenges that executives at health systems, health plans, pharmacy benefit organizations, and more anticipate next year. Here’s a closer look at the survey results, and what industry experts say organizations can do to overcome them.

Bankrupt North Philadelphia Health System to sell shuttered hospital

http://www.beckershospitalreview.com/hospital-transactions-and-valuation/bankrupt-north-philadelphia-health-system-to-sell-shuttered-hospital.html

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North Philadelphia Health System, which filed for Chapter 11 bankruptcy Dec. 30, has inked a deal to sell St. Joseph’s Hospital in Philadelphia, which closed in March 2016, according to a motion filed in bankruptcy court Monday.

According to the sales contract attached to the motion, NPHS has agreed to sell the hospital to MMP Hospital Partners in Philadelphia for $8.12 million. NPHS filed the motion Monday to sell the hospital free and clear of liens.

The closing of the sale is conditioned on NPHS receiving approval from the bankruptcy court, and the system said the sale is slated to take place within two weeks of the entry of a court order approving the motion. A hearing on the motion is scheduled for March 22 at 11:00 a.m.

NPHS currently operates two facilities in Philadelphia: Girard Medical Center, a 168-bed psychiatric hospital, and Goldman Clinic, a substance abuse treatment center.

Lawyer sentenced to prison for stealing $1.2M in patient payments from St. Luke’s

http://www.beckershospitalreview.com/legal-regulatory-issues/lawyer-sentenced-to-prison-for-stealing-1-2m-in-patient-payments-from-st-luke-s.html

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Alan B. Gallas, 65, was sentenced Friday to one year and one day in federal prison for stealing more than $1.2 million from Kansas City, Mo.-based St. Luke’s Health System between 2009 and July 2015, according to the Department of Justice.

Mr. Gallas’ firm, Gallas & Schultz, collected past-due payments from patients for the hospital network. Money collected by the firm on behalf of St. Luke’s was supposed to go into a trust account. However, Mr. Gallas admitted in April that he had employees put holds on more than $1.2 million in St. Luke’s collections and then transfer the funds to the law firm’s operating account.

Mr. Gallas’ law partner Mark J. Schultz, 57, pleaded guilty Friday to participating in the fraud conspiracy. He admitted to transferring funds from the trust account to the law firm’s operating account. The total amount of funds diverted by Mr. Schultz will be determined by the court at his sentencing hearing, according to the DOJ. He faces up to five years in federal prison for his role in the scheme.

In addition to his prison term, Mr. Gallas was ordered to pay more than $1.2 million in restitution.

21 recent hospital transactions and partnerships

http://www.beckershospitalreview.com/hospital-transactions-and-valuation/21-recent-hospital-transactions-and-partnerships-21317.html

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The following healthcare mergers, acquisitions and general partnerships took place or were announced in the past week.

A state-by-state breakdown of hospital adjusted expenses per inpatient day

http://www.beckershospitalreview.com/finance/a-state-by-state-breakdown-of-hospital-adjusted-expenses-per-inpatient-day.html

OR Efficiencies

Here are the adjusted expenses per inpatient day in 2015, organized by hospital ownership type, in all 50 states and the District of Columbia, according to the latest statistics from Kaiser State Health Facts.

These figures, which are based on information from the 2015 American Hospital Association Annual Survey, include all operating and nonoperating expenses for registered U.S. community hospitals, defined as public, nonfederal, short-term general and other hospitals. The figures are an estimate of the expenses incurred in a day of inpatient care and have been adjusted higher to reflect an estimate of the volume of outpatient services, according to the Kaiser Family Foundation.

United States

  • State/local government hospitals — $2,013
  • Nonprofit hospitals — $2,413
  • For-profit hospitals — $1,831

Kaiser Permanente operating income grows as membership booms

http://www.beckershospitalreview.com/finance/kaiser-permanente-operating-income-grows-as-membership-booms.html

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Oakland, Calif.-based Kaiser Permanente saw revenue and operating income increase in 2016, according to recently released bondholder documents.

Kaiser said operating revenue for its nonprofit hospital and health plan unit climbed 6.4 percent year over year to $64.6 billion in 2016. After factoring in expenses, Kaiser ended 2016 with operating income of $1.9 billion, up from $1.8 billion in the year prior.

Kaiser reported a strong year in health plan membership growth. The system ended 2016 with 10.7 million members, an increase of 4.2 percent from the year prior. After completing its acquisition of Seattle-based health plan Group Health Cooperative Feb. 1, Kaiser’s health plan membership now tops 11 million.

In 2016, Kaiser’s capital spending increased to $2.8 billion, up slightly from $2.7 billion in 2015. The system opened a new technology campus in Atlanta and 12 new medical offices and two new dental offices last year.

Fueled by strong nonoperating income, Kaiser reported net income of $3.1 billion in 2016, up from $1.8 billion in 2015.

Aetna, UnitedHealth show increasing appetite for value-based care contracts

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Aetna has long held a goal to reach 75 to 80 percent of its medical spend in value-based relationships by 2020.

The biggest health insurers are moving quickly towards to value-based care arrangements, their recent earnings reports show.

While Aetna has long-held a goal to reach 75 to 80 percent of its medical spend in value-based relationships by 2020, Aetna’s medical spend is now 45 percent tied to value, CEO Mark Bertolini said during last week’s fourth quarter earnings call.

“One way we measure our success is by how well we are able to keep our members out of the hospital and in their homes and communities,” Bertolini said. “For example, in 2016, we reduced total acute admissions by approximately 4 percent, and we deployed predictive modeling to target members at the greatest risk of readmission.”

Aetna has achieved a 27 percent reduction in readmission rates using multidisciplinary care teams that engage facilities to develop effective discharge plans, he said.

“Collectively, these clinical programs have driven a best-in-class Stars readmission rate among national competitors,” he said.

Aetna sees more opportunities for reducing utilization over the long-term in readmission rates, and in a reduction in inpatient days. Unit price is still the driver in value-based purchasing, Bertolini said.

“I think value-based contracting is going to continue to be encouraged by even the current administration as a way of getting a handle on healthcare costs,” he said. “We have a healthy pipeline of opportunities. They will not all be joint ventures. I think there are other models emerging.”

UnitedHealthcare is increasingly helping states manage care for their complex, vulnerable and most costly populations, as well as assisting employers with programs to support the needs of retirees and employees with chronic conditions, according to CEO Stephen Hemsley in the insurer’s earnings report.

50 healthcare organizations dubbed best in supply chain by GHX

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Systems recognized for their work in improving operational performance and driving down costs through automation.

Global Healthcare Exchange has announced its annual list of the healthcare provider organizations being recognized as the 2016 GHX “Best 50” Supply Chains in North America.

The supply chains are being recognized for their work in improving operational performance and driving down costs through automation. The recipients will be honored at the 17th annual Healthcare Supply Chain Summit from April 24-26 at the Gaylord National Resort in National Harbor, Maryland.

The list, alphabetically, is as follows: