A Guide to Care Management: Five Competencies Every Health System Must Have

The goal and responsibility of every healthcare organization and provider using a care management approach is to deliver the right care at the right time to the right patients. This standard of care management can only be achieved if five competencies are in place:

  • Data Integration
  • Patient Stratification and Intake
  • Care Coordination
  • Patient Engagement
  • Performance Measurement
This guide to care management reviews each competency and shows how to put it all together into an effective program that gets results for organizations and patients alike.

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Leading Wisely: Better Executive Decision Support

The next step in the evolution of executive decision support is here—introducing Leading Wisely. With real-time alerts and customizable reports, healthcare leaders now have access to the actionable insights and meaningful information they need to make strategic decisions. Unlike traditional dashboards or static reports, Leading Wisely helps executives avoid being blindsided, giving them complete control over their data.

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Healthcare Dashboards vs. Scorecards: Use Both to Improve Outcomes

Healthcare IT leaders tend to debate over which tool is best for measuring and sustaining outcomes improvement goals: healthcare dashboards or scorecards. But using both tools is the most effective approach. “Scoreboards” take advantage of the high-level, strategic capacity of scorecards and the real-time, operational functionality of dashboards. But using both effectively requires a thorough understanding of the who, what, when, and how of each tool.

  • Who: Scorecards are for leaders; dashboards are for the frontline.
  • What: Scorecards are strategic; dashboards are operational.
  • When: Scorecards are daily, weekly, or monthly reports; dashboards are real-time or near real-time.
  • How: Scorecards enforce accountability and provide actionable data; dashboards provide drill-down capability and inform root cause.
Despite the different but equally important aspects of each tool, they best support outcomes improvement when used together.

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Outcomes Improvement Governance: A Handbook for Success and Achieving More with Less

For healthcare organizations looking to achieve outcomes improvement goals, effective governance is the most essential must-have. This leadership culture ensures success by enabling health systems to invest in outcomes improvement and allocate resources appropriately toward these goals. This executive report is an outcomes improvement governance handbook centered on four guiding principles (and associated helpful steps) health systems can follow to achieve effective governance and start achieving more with less:

  1. Stakeholder engagement
  2. Shared understanding
  3. Alignment
  4. Focus
With these four principles, organizations can build a foundation of engagement and focus around the work, where they maximize strengths, and discover and address weaknesses. They establish an improvement methodology, define their goals, and sustain and standardize improvement work.

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In Pursuit of the Patient Stratification Gold Standard: Getting There with Healthcare Analytics

Even the healthiest among us would benefit from some level of care management, but resources are limited and patients must be stratified to facilitate prioritized enrollment into care management programs. Therefore, health systems need to identify not only high-cost, high-risk, and rising-risk patients, but also patients who are truly impactable. This article explains how systems can use healthcare analytics, at varying levels of maturity, to improve patient stratification and, ultimately, achieve the gold standard:

  • Level 1 (where to start): use healthcare analytics to identify high-cost, high-risk patients in a population.
  • Level 2: use healthcare analytics to identify patients with rising-risk profiles.
  • Level 3 (highest level of maturity): use healthcare analytics to identify patients who are truly impactable (the patient stratification gold standard).
Analytics is key to achieving the patient stratification gold standard, but should enhance (not replace) clinical judgement. Stratification lists need to go through workflows in which clinicians remove patients that aren’t appropriate for enrollment.

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The Best Care Management Teams Empower Patients like Abdel

What do the best care management teams in the industry have in common? They engage and empower their patients to play a leadership role in their healthcare. After all, patients without the skills to manage their care incur costs up to 21 percent higher than engaged patients. Engaging and empowering patients as the most important members of the care management team makes sense on many fronts—as health systems assume more responsibility and financial risks for patients’ outcomes and costs, there will certainly be more interest in expanding the role of patients in their care. This blog explains why engaging patients like 68-year-old Abdel not only instills a gratifying sense of empowerment, but also improves outcomes and controls costs—the many benefits of an effective care management team.

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Preparing for Changes to Medicare Reimbursement—The Latest CMS Proposed Measures

Health systems that aren’t prepared for changes to Medicare reimbursement under a value-based system risk quality penalties and reduced reimbursement. They can protect themselves by following the Centers for Medicare and Medicaid Service’s (CMS) annual Measures Under Consideration List—and not waiting till it’s too late to address gaps in their system. The measures accepted from the list of proposals will help determine the areas of care delivery that Medicare will hold organizations accountable for. It’s never too early for health systems to prepare. CMS selects measures that are already nationally recognized as priority areas for improvement, giving organizations proactive direction in their improvement strategy.

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How Care Management Done Right Improves Patient Satisfaction and ROI

A comprehensive care management program organizes many moving parts into an efficient workflow and brings order to the complex, often messy, world of healthcare. Care coordination harmonizes the workflow of clinicians, patients, family, social workers, and therapists, to name a few. It facilitates medication reconciliation, care compliance, appointment scheduling, and communication with patients, as well as engagement between patients and the care team. Care coordination concentrates on the highest-utilization, highest-cost patients to produce better clinical, operational, and financial outcomes, the bottom line goals for healthcare systems involved in population health and value-based care. This article details the benefits of, and barriers to, care management and coordination, their role in population health, and the technology that’s helping to automate this area of healthcare.

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The Healthcare Outcomes Improvement Engine: The Best Way to Ensure Sustainable, Scalable Change

How do healthcare organizations create a systemwide focus on outcomes improvement? They build a healthcare outcomes improvement engine—a mechanism designed to drive successful and sustainable change. Creating this outcomes improvement engine requires four critical components:

  1. Engaging executives around outcomes improvement.
  2. Prioritizing opportunities most likely to succeed.
  3. Adequately staffing initiatives.
  4. Communicating success early and often.
Once up and running, multidisciplinary engagement and standardized improvement processes fuel the outcomes improvement engine in its mission to produce sustainable, scalable improvement.

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Is Value-Based Healthcare Here to Stay? Looking for Answers in New Policies

Healthcare leaders are eager for a modicum of clarity when it comes to the industry’s shift to value-based healthcare given the uncertainties of Congress and the new Administration. Fortunately, an analysis of three key pieces of information tells us value-based healthcare is likely here to stay:

  1. The 21st Century Cures Act (Cures).
  2. The Executive Order on reducing the “burden” of the Affordable Care Act (ACA).
  3. Tom Price’s comments at his confirmation hearings.
It is a relatively safe bet that value-based healthcare delivery and payment programs will continue to be supported by federal law and regulation for several reasons:
  • Bipartisan support: The success of Cures indicates that bipartisan cooperation will continue on key healthcare issues.
  • Market-based innovation: The emerging evidence is that Congress and the Administration will support innovation in payment and delivery models.
  • Support for Existing ACA Innovation programs: Although highly uncertain, there are some indications that not all of the ACA will be scrapped.

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How to Use Text Analytics in Healthcare to Improve Outcomes—Why You Need More than NLP

Given the fact that up to 80 percent of clinical data is stored in unstructured text, healthcare organizations need to harness the power of text analytics. But, surprisingly, less than five percent of health systems use it due to resource limitations and the complexity of text analytics. But given the industry’s necessity to use text analytics to create precise patient registries, enhance their understanding of high-risk patient populations, and improve outcomes, this executive report explains why systems must start using it—and explains how to get started. Health systems can start using text analytics to improve outcomes by focusing on four key components:

  1. Optimize text search (display, medical terminologies, and context).
  2. Enhance context and extract values with an NLP pipeline.
  3. Always validate the algorithm.
  4. Focus on interoperability and integration using a Late-Binding approach.
This broad approach with position health systems for clinical and financial success.

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Why Patient-Reported Outcomes Are the Future of Healthcare—and the Key to Ruth’s Independence

Patient-reported outcomes (PROs), defined as “any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else,” are the future of healthcare. In addition to helping people like 80-year-old-Ruth continue to live interpedently, PROs—interchangeable with the term patient-generated health data (PGHD)—have several benefits:

  1. Effectively supplement existing clinical data, filling in gaps in information and providing a more comprehensive picture of ongoing patient health.
  2. Provide important information about how patients are doing between medical visits.
  3. Gather information on an ongoing basis—rather than just one point in time—and provide information relevant to preventive and chronic care management.
The new technologies that enable PROs and PGHD (e.g., sensors that detect whether Ruth takes food out of her refrigerator on a regular basis), generate important data outside of patients’ traditional care environments, sharing it with care teams to expand the depth, breadth, and continuity of information available to improve healthcare and outcomes.

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Introducing Health Catalyst MACRA Measures & Insights—Addresses Top Physician Concern: Capturing Compliance Measures

A recent Health Catalyst®/Peer60 survey revealed that compiling quality metrics is the top concern for physicians—a regulatory burden expected to worsen in 2017 as physicians struggle to report quality metrics for the Medicare Access & CHIP Reauthorization Act (MACRA)—the federal law that changes the way Medicare pays doctors. MACRA Measures & Insights™—Health Catalyst’s new MACRA solution—does so much more than alleviate this reporting burden:

  • Helps health systems track and monitor all MACRA measures across multiple departments.
  • Helps systems maximize Medicare reimbursement and monitor performance against measures year over year.
  • Enables healthcare organizations to tactically and strategically identify the optimal measures to include within multi-year, value-based care contracts with commercial payers.
Powered by the Health Catalyst Analytics Platform™, which can integrate virtually all of the granular data in a healthcare system, including claims and other external data, MACRA Measures & Insights gives health systems deep insight into performance measures at the degree of detail required for measurement and performance improvement.

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Are Health Systems Ready for MACRA? Survey Reveals the Number One MACRA Concern and Varying Degrees of Readiness

The Medicare Access and Chip Reauthorization Act (MACRA) replaces a number of value-based reimbursement programs and will use 2017 as its first reporting year. But, despite being right around the corner, a survey of healthcare professionals around the country reveals only one-third are ready. But while only 35 percent of respondents have a strategy and believe they’re prepared for MACRA, most will participate in the new program. A majority of surveyed hospitals believe MACRA will benefit their physicians (or that they’ll at least break even). MACRA is new, complicated, and rife with uncertainties given the new administration. According to the survey, the top concern for health systems is compiling MACRA quality measures. But despite the industry’s slow movement towards MACRA, the bottom line is that it’s right around the corner, so hospitals must start preparing for MACRA today.

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Health Catalyst® Introduces catalyst.ai™: Machine Learning in Healthcare Is Now for Everyone

Despite its prevalence in many other industries (and its use by most Americans every single day), machine learning in healthcare is far behind. But not for long, because Health Catalyst® is bringing this life-saving technology to healthcare with catalyst.ai™—a new machine learning technology initiative that helps healthcare organizations of any size use predictive analytics to transform healthcare. The clinical, operational, and financial opportunities catalyst.ai gives health systems are limitless:

  • Prevent hospital acquired infections.
  • Predict chronic disease.
  • Reduce readmissions
  • Reduce hospital Length-of-Stay.
  • Predict propensity-to-pay.
  • Predict no-shows.
Catalyst.ai™ (machine learning models built into every Health Catalyst application) together with healthcare.ai™ (a collaborative, open source repository of standardized machine learning methodologies and production-quality code that makes it easy to deploy machine learning in any environment), represents a new era of powerful predictive analytics that will not only improve outcomes, but also save lives.

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Against the Odds: How this Small Community Hospital Used Six Strategies to Succeed in Value-Based Care

The constant thread weaving through every healthcare organizational strategy should be adherence to the Triple Aim. But with uncertainty generated by the changes at the federal level, healthcare organizations may be tempted to put their value-based care plans on hold. This article explains why that’s not necessary and lists six strategies for thriving under a fee-for-value model: 1.) Use Leadership and Team Structure to Support Improvement 2.) Drive Down Costs 3.) Reduce Unnecessary Waste 4.) Encourage the Learning Organization 5.) Prioritize Patient Education 6.) Track Data and Outcomes This blog cites one small medical center with odds stacked against it, and how it is managing to not only weather the changes, but also distinguish itself by staying true to the values of the Triple Aim.

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The 3 Must-Have Qualities of a Care Management System

Care management systems are defined in many ways, but the only effective system comprises three qualities:

1) It’s comprehensive and includes a suite of tools to address all five core competencies of care management. 2) It’s inclusive of all EMRs and other data sources to enable thorough communication and analysis. 3) It’s analytics-driven design facilitates clinical decision making and workflow.

Ultimately, an effective system improves outcomes and becomes an indispensable tool for managing population health. This article describes what drives successful care management, and reveals a suite of applications that aid care team members and patients through advanced algorithms and embedded analytics. Learn how technology is helping to develop appropriate interventions and improve clinical and financial outcomes.

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Reducing Unwanted Variation in Healthcare Clears the Way for Outcomes Improvement

According to statistician W. Edwards Deming, “Uncontrolled variation is the enemy of quality.” The statement is particularly true of outcomes improvement in healthcare, where variation threatens quality across processes and outcomes. To improve outcomes, health systems must recognize where and how inconsistency impacts their outcomes and reduce unwanted variation. There are three key steps to reducing unwanted variation:

  1. Remove obstacles to success on a communitywide level.
  2. Maintain open lines of communication and share lessons learned.
  3. Decrease the magnitude of variation.

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Why Clinicians Are the Missing Link in Healthcare Quality Improvement and Three Principles to Solve the Problem

When it comes to successful quality improvement (QI) in healthcare, clinicians tend to be the missing link. Fortunately, the disconnect between QI initiatives and the day-to-day work of clinicians can be explained and resolved if health systems adopt and embrace three clinician-focused principles:

  • Principle #1: QI starts at the front line (initiatives should be identified and driven by clinicians).
  • Principle #2: QI makes it easy for clinicians to do the right thing (removes barriers to good work rather than increasing the amount of work clinicians do).
  • Principle #3: QI empowers clinicians to adapt care (even if it’s not QI protocol).
Although some clinicians are enthusiastic advocates of their systems’ QI efforts, most are suspicious because they’re frequently cut out of the decision-making process or forced to ignore their best clinical judgement. Health systems that work to close the gap between leaders and clinicians by embracing these three principles will add the missing link—clinicians—back into successful healthcare QI.

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Three Essential Systems for Effective Population Health Management

An effective population health management program must include three systems: Healthcare Analytics, Best Practice, and Adoption. Organizations with only one or two of these systems often display symptoms of weak and ineffective capability for population health management.  But when you have a analytics foundation based upon a data warehouse, combined with evidence-based practices contained in a best practice system, and the ability to deploy and implement systematic changes to healthcare processes, health systems are truly prepared to manage population of patients.

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How Care Management Improves Performance for Clinicians, Compliance with MACRA, and Outcomes for Patients Like Olivia

As the link between performance and reimbursement in healthcare continues to grow, effective care management is key. And two critical components of effective care management are analytical tools and a multidisciplinary approach:

  • Analytical tools help clinicians stratify patients by risk and need and make it easier to collaborate and coordinate care for patients (and monitor their progress over time).
  • A multidisciplinary approach broadens the support patients receive, engages both patients and their families in their care, and improves medication adherence (between 40 and 75 percent of older people do not take their medications at the right time or in the right amount).
Care management programs do more than make patients healthier and make it easier for clinicians to coordinate care for their patients—they also improve performance and compliance with MACRA: a quality payment model that requires physicians to focus on optimizing care of their chronic disease patients across the continuum in the inpatient and outpatient environment.

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Hospital Readmissions Reduction Program: Keys to Success

Avoidable readmissions are a major financial major problem for the healthcare industry, especially for government payers. To tackle this problem, CMS launched the Hospital Readmissions Reduction Program (HRRP). While some hospitals may be able to absorb the financial penalties under HRRP, they still need to track increasingly complex reporting metrics. Most tracking solutions are inadequate for today’s complicated reporting needs. A healthcare enterprise data warehouse and analytics applications, however, are designed to solve the numerous reporting burdens. When used together, they also deliver a robust solution that enables hospitals to track and drive real cost and quality improvement initiatives, all without the need for users to be technical experts.

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Three Must-Haves for Generating Innovation in Healthcare IT

What most often restricts IT innovation at a healthcare organization? It's not limitations of the tools for innovation (the data infrastructure) or the workforce, but the organizational culture of the health system. A culture that's too focused on past failed initiatives and their consequences won't identify opportunities that lead to new ideas. They likely have the right parts for a great idea, but aren't enabling those parts for innovation. Organizations can build and environment that fosters innovation in healthcare IT by operating with three principles:

  1. Give teams the freedom to fail.
  2. Remember the adjacent possible.
  3. Leverage organizational networks.

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Governance in Healthcare: Leadership for Successful Improvement

Successful outcomes improvement in healthcare requires strong leadership to make decisions, allocate resources, and prioritize initiatives. For improvement to succeed and endure, health systems can’t leave any part of leadership to chance. Instead, effective governance requires thoughtful, deliberate development. Otherwise, improvement initiatives stall or fail to launch, as stakeholders debate goals and strategies. To succeed, governance structure must be solid enough to withstand any challenges to improvement initiatives—from resource constraints to skeptics. Effective governance in healthcare operates with four guiding principles:

  1. Engage the right stakeholders.
  2. Establish a shared understanding of objectives.
  3. Align incentives and rules of engagement.
  4. Practice disciplined prioritization.

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Data for Improving Healthcare vs. Data for Exasperating Healthcare Workers

For better or worse, hospitals are obligated to collect and report data for regulatory purposes. Or they feel compelled to meet some reputational metric. The problem is, an inordinate amount of time can be spent on what is considered data for accountability or punishment, when the real focus should be on data for learning and improvement. When time, effort, and resources are dedicated to the latter, it leads to real outcomes improvement. Deming has three views of focusing on a process and this article applies them to healthcare:

  1. Sub-optimization, over-emphasizing a single part at the expense of the whole.
  2. Extreme over-emphasis, also called gaming the system.
  3. The right amount of focus, the only path to improvement.
With data for learning as the primary goal, improving clinical, operational, and financial processes becomes an internal strategy that lifts the entire healthcare system.

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