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You may have noticed that the Centers for Medicare & Medicaid Services has introduced some new accountable care organization models that take into account social health-related needs such as food insecurity or unstable housing, and it wants to see whether addressing these needs can help improve health outcomes and reduce costs. It’s as they say, a good start.
The reason I say it’s a good start is because the CMS model will not pay directly or indirectly for any community services received by patients. Providers must use their award monies to connect people with those offering such community services. So it is really more about awareness and navigation than about providing the services. In some respects, it is another carrot and stick, check-it-off-the-list item. And there have been more and more of these cropping up. Annual wellness visit, end-of-life talk--check and check.
The real consequences happen when a person leaves the physician office or hospital. Unless someone is actually advocating for patients--in some respects holding their hands to make sure they not only connect with but also receive services--health outcomes will not improve. And let’s face it; if your organization does not already know the community services available and have relationships with those organizations, well, you shouldn’t be in business. And if there are service gaps, you should be developing programs to fill those, too. So maybe all CMS is doing is encouraging a little more effort in addressing this in the office or at discharge. Heck, if you’re going to pay us to do it, sure why not?
Ask most healthcare CEOs the utilization rate for the Medicare Annual Wellness Visit (AWV) and they will probably not know it. While it is reimbursable, the cost/benefit ratio favors practices sticking to what makes them money. They need to see the bigger picture.
The AWV reimburses on average $117 per visit, and to capture all of the documentation necessary to financially benefit the practice, it requires approximately 45 minutes. And if you don’t code properly, well, that’s another story.
Most find the AWV time-consuming, tedious and a financial burden.
There is a marketing term called loss leader. It’s the idea that you provide a product or service that is an enticement to help grow the number of customers you have. You may break even or lose money. But that is the cost to introduce new people to you.
For healthcare organizations, the gamble is that once they have experienced the care you offer they will come back and tell others.
There were many presentations at the March conference of the American College of Healthcare Executives regarding population health management. With value-based purchasing heating up, accountable care organizations forming fast, and readmissions a big hot button, it's only natural that keeping people well and out of the hospital would be a part of the conversation.
I am not a clinician, but I know enough to understand that population health management has been focused on the chronic conditions that eat up cost, challenge access and could be controlled--heart disease, diabetes or cancer, for example.
But is dementia, including Alzheimer's, really being addressed in current population health management models? I would contend no.
I have contended that hospitals are going kicking and screaming into value-based purchasing and have surmised that when the Centers for Medicare & Medicaid Services moves, private insurers will follow. That's why I find it utterly fascinating that one of our local health systems is in a heated battle with a large insurer that wants to introduce pay-for-performance into future pricing scenarios. The insurer took out multiple full-page ads in the daily newspaper. It's currently a he-said, she-said debate. Stay tuned.
As we move into bundled-payment scenarios and accountable care organizations (ACOs), I think one of the biggest hurdles we face is changing our mindset. Believe me, most of my clients are still in a fee-for-service mentality, knowing, but not quite acting on, the shift in healthcare. It's a juggling act, and real money is involved. But guess what: It is the inevitable future and all payers will follow.
Superficially, many people look at the intense focus on patient experience as an effort to keep patients satisfied (however that is defined) and worse, making them happy. Happy people do not always make for happy outcomes even if your Hospital Consumer Assessment of Healthcare Providers scores mislead you otherwise.
Patient experience is about four things in this priority order: patient safety, clinical quality, patient satisfaction and value received. Get the first two right and chances are you will achieve the third, while scoring where you want in retrospective data.
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