Advocating helps today Teaching self-advocacy helps for a lifetime.
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Transcript of Advocating helps today Teaching self-advocacy helps for a lifetime.
The shifting paradigm
No longer a physician controlled relationship
Patients expected to comply or they will receive less attention
Changes in reimbursement to reflect FFS, and changes in therapeutic outcome and process
Risk adjustment for payment strategies Penalties for non-participating physicians
FROM CONFUSION TO FUSION
Jeffrey HarrisUntangled Healthcare
Untangled HealthcareAssisting communities to monitor and improve healthcarewww.untangledhealthcare.comwww.untangled health.com All presentations on Slide shareJeffharris@untangled healthcare.com
"Go to the people, live with them, learn from them....Start with what they know, build with what they have...."Lao Tzu
The new payment model
Process and Outcome Measures Fee for Service Improvement from Baseline Accountable Care Organizations Carrot
and Stick
28% of 500 persons with no previous healthcare visit in prior year to death
We can’t boil the ocean but we can teach people their right to access
The Patient Advocate ProcessTransition Management
Monitor
Discover
Bio-Psycho-Social HistoryGoals, Wants, Needs
ActivateInsurance ExchangePrimary Care Medical Home Patient Contract
Evaluate
Patient ComplianceDisease Self MasteryLearning Barriers
AssistIdentify and link community resources:Transportation, Meals on Wheels, Patient Peers
EducatePrimary and Secondary PreventionSelf MonitoringResource UtilizationUrgent Care GuidelinesCommunication Skills
Functional StatusPhysicalSocialCognitiveComplianceComorbidity
Assist with reporting outcomes to PCP
ALPHABET SOUPNHIN (National Health Information Network)The components of HIT: NHIN, e-HR, e-Rx, e-labs, Secure messaging, online appoints, Patient right to electronic file within 24 hours (not e-fax) Computerized order entryTimeline-2010-2017
Health Information ExchangesState Level
Com
munit
yH
IE
Business Domain HIE
Provider Groups
Health Plans
The Patient’s Universe and Patients Rights to Share
Prescription and Diagnostic
Testing Standards
Personal Health Records
Hospital Systems and Ambulatory Centers and PracticesElectronic Medical Record
Old TechnologyElectronic Health Record
New Technology
HITECH Act Enforcement Final RuleThe Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009,
was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology.
THE TOOLS YOU USE WILL BE DEPENDENT ON THE STAGES OF DEVELOPMENT IN YOUR
LOCAL ENVIRONMENT
Manual transcription errors of critical information used to influence critical
treatment decisions continues to be the largest source of “therapeutic
misadventure”
Data Set Considerations Addressed by standard
Identity Verification
• Provider Info, e-HR info, PHR Info, Demographics
• Involves requirement to produce audit similar to credit report, who, what, when, where
Access Restriction and Management By Data Class
• HIV/SIDS, Mental Health, Substance abuse, Sickle Cell, Genetic Information, STD, Developmental Diabetes
• The ability to control who can see, edit, save: Includes time limitations, embargoed records
Content Preferences
• Service reminders, Labs, Advanced Directives, Living Will, DNR, Healthcare Proxy, Lab and test results, Language needs, Clergy Preference
Components of Access Management
• Level or Status (Opt In, Opt Out)
• Involves requirement to produce audit similar to credit report, who, what, when, where
Consent Information
• Requester type and location, purpose and use, sensitive flags such as Labs, Meds, Diagnosis, Notes
• The ability to control who can see, edit, save: Includes time limitations, embargoed records
Content Preferences
• Service reminders, Labs, Advanced Directives, Living Will, DNR, Healthcare Proxy, Lab and test results, Language needs, Clergy Preference
Local hospital affiliate
Local Pharmacy
Single Practice EMR Silo
Non Integrated System
Graphic Representation of National InitiativeData Exchange Illustrated
Integrated System with e-HR
Health Info Exchange
EHR
Specialist EHR
PCMH
SureScript
s
PharmacyCom
munic
ati
on B
arr
ier
PHR
Hospital System
EHR
Various Labs
LIMS
fImaging
PACS
How I connected my system
Located physician with knowledge of health data interchange and motivation to heal
Located surgeons who would treat me as equal
Located tools online that worked and were interoperable
Created my own accounts {HealthVault, Connected to
Connected to CVS, SPINN secure Communication and LabCorp
Who ordered drug
Med
icati
on
Recon
cilia
tion
Where did record come from
Is this patient staying with medical home or Dr. Shopping
If patients are readmitted is that the hospital issue or does it say something
about the supporting community?
In conclusion, patients hospitalized with CHF have a high risk for readmission after discharge. Patients with a history of hospitalization as a result of CHF, longer hospital stay, and a history of hypertension are at increased risk for readmission, and our data suggest that socioeconomic factors, including poor follow-up visits, poor professional support, and no occupation, are also potentially important predictors. Therefore a systematic CHF patient management system that coordinates care in the hospital, outpatient, and home settings is clearly needed to reduce the morbidity and mortality of patients with CHF and thus lower the over-all costs for the treatment of these patients.
What we have known for 20 years but just now have the incentives aligned
What Scenarios are Patient Advocates Likely to Face
Apparently
Healthy
• Educate on reform• Educate on Medical Home
Episodic Care
• Participate in care coordination• Educate on provider selection and best
practices
Chronic
Care
• Participate in interdisciplinary coordination
• Monitor patient for self mastery
Meaningful Use Time Line
2010-2011Attestation to
implement
2012-2013Proof of
adoption and population
management
2014-2020Submission to
ACOs, penalties for not
complying
HITECH Act Bush administration effort to create a standardized electronic health record
Physician Protection and Patient Safety Act: Charles Randle
Accordable Care Act Present Administrate ion Effort to alter reimbursement for first contact, comprehensive and continuous care (Primary Care Medical Home and Insurance Reform
What has changed in last decade