Quiz 2 Flashcards
Patient-Centered Medical Home (PCMH)
Emphasis on the central role of primary care and care coordination, with the vision that every person should have the opportunity to easily access high-quality primary care in a place that is familiar and knowledgeable about their health care needs and choices.
Accountable Care Organization (ACO)
Emphasis on the urgent need to think beyond patients to populations, providing vision for increased accountability for performance and spending across the health care system.
Shared Savings Program
Rewarding providers by paying them a bonus that is explicitly connected to the amount by which they reduce the total cost of care compared to expected levels.
-Born of the Affordable Care Act
Capitation (Global Payment)
The provider is responsible for the costs of all care that a patient receives.
-The risk is on the provider.
Episode-of-Care Payment
Providers are paid a single payment for all services associated with a hospitalization or other episode of acute care.
National Committee for Quality Assurance (NCQA)
The U.S.’s largest credentialing organization.
-Offer PCMH designation to providers who achieve goals related to accessible, coordinated, and patient-centered care.
Pioneer ACO program
- Designed to show how particular ACO payment arrangements can best improve care and generate savings for Medicare
- Evaluate various risk-sharing agreements.
Medicare Shared Savings Program (MSSP)
Program designed to facilitate coordination and cooperation among providers to improve quality of care for Medicare fee-for-service (FFS) beneficiaries and reduce costs.
-Key component of Medicare delivery system reform initiative brought about by Affordable Care Act.
ACO Challenges
- Working across organizational boundaries.
- Building requisite data sharing networks
- Patient engagement in the care process
ACO Core Processes: Stratification
The ability to identify a patient or cohort at risk for a negative health event or preventable health care utilization.
1) Identify risk
2) Alert appropriate stakeholders
3) Timely intervention in the care process
ACO Core Processes: Care Management
Patient-centered management and coordination of care events/activities in multiple care settings by one or more providers.
-Aimed to help the most complex patients within a system.
ACO Core Processes: Managing Contracts and Financial Performance
- Estimating reimbursement and associated payment distributions.
- Carrying out predictive modeling for reimbursement contracts.
- Measuring performance against contracts and predicting profitability.
- Integrating with other key processes to share information.
ACO Core Processes: Measuring, Predicting, and Improving Performance
- Ramifications for failure; Reward for improvements
- Providers must forecast which patients are likely to become high-risk to begin earlier intervention.
- Retrospective monitoring: finding out what didn’t happen and why.
ACO Core Processes: Preparation and Automation
Transition to value-based payment models is dependent on providers adopting IT solutions for automation and supporting core processes.
Health IT Capabilities: Data
- Focus on information that powers clinical decision making
- Creating a holistic view of patients within a healthcare network:
1) Master Patient Indices
2) Record Locator Service
Health IT Capabilities: Revenue Cycle Systems
Must complement routine activities such as: patient registration, appointment scheduling, and patient billing administration.
Health IT Capabilities: Care Management Systems
Enable proactive surveillance, automation, coordination, and facilitation of services for different sub-populations.
-Automation allows care managers to handle 2x-3x more patients than possible with manual management.
Health IT Capabilities: Rules and Workflow Engines
Monitor process performance and alerts staff to missed steps, sequence issues, and delays.
-Workflow engines specialize in executing a business process.
Health IT Capabilities: Data Warehouse, Analytics, and Business Intelligence
Predictive analytics tools can help caregivers identify patients who are likely to present in the ER or be readmitted so they can tailor interventions and avoid penalties for excessive re-admissions.
Analytics
Facilitate proactive management of key performance metrics
Enterprise Data Warehouse
Fuels a wide range of analytic needs and provides intelligence to enable continual care process improvement initiatives.
Health IT Capabilities: Health Information Exchange (HIE)
Enables providers to obtain composite clinical picture of the patient regardless of where the patient is seen.
Health IT Capabilities: Registries and Scorecards
Enable providers to identify, scores, and predict risks of individuals or populations to allow targeted intervention implementations.
-Serves as “central database” of PHM
Predictive Analytics
Predicting likelihoods, based on historical data, as to outcomes in given situations.
-Uses statistical modeling, decision analysis, and machine learning techniques to create probabilities of scenarios.
HIE: Directed Exchange
Ability to send and receive secure information electronically between care providers to support care efforts.
HIE: Query-Based Exchange
Ability for providers to find and/or request information on a patient from other providers.
-Often used for unplanned care.
HIE: Consumer-Mediated Exchange
Ability for patients to aggregate and control the use of their health information among providers.
Health IT Capabilities: Longitudinal Record
Presents a complete picture of a patient’s health history
Health IT Capabilities: Care Plan
Provides a consolidated, normalized view of indicators to be monitored, events due to happen, and actions to be taken.
Health IT Capabilities: Patient Engagement Tools
- Portals to securely communicate with providers, pay bills, review test results, fill prescriptions, etc.
- Social Media to communicate with patient populations and guide discussions.
- Automated messaging to notify patients of vital care information, such as appointments and RX refill.
Health IT Capabilities: Pros of Telemedicine/Telehealth
- Increased access for disabled patients
- Convenient patient interactions
- Expand geographic horizons to locations lacking in medical coverage.
- Track at-home progress
Health IT Capabilities: Cons of Telemedicine/Telehealth
- Lack of provider acceptance.
- Interstate licensing issues
- Issues of confidentiality and liability
- Data standards.
- Lack of universal reimbursement.
Patient Portal Adoption Tips (KLAS)
- Patient education
- Educate staff as if they are patients.
- Give patients a reason to use the portal.
- Talk to your vendor and physicians.
- Hold your vendor accountable.
Use of Social Media
- Create a sense of community
- Share clinical research insights
- Raise awareness of cause-related issues or personal health crises.
- Provide assistance with physician, treatment, or care facility selection.
- Complements traditional patient satisfaction measures.
Care Plan Attributes
1) Foundational Plan
2) Medical Care Strategies and Care Maintenance
3) Transient Plan
4) Common plan (applied to a shared population)
5) Risk: Chance of failure to adhere to care plan
6) Not all care is amenable to a predefined plan.
7) Plans based on evidence of best care and health practices
Plan-Centric EHR
- A library of plans covering a wide variety of situations.
- Algorithms to determine a patient’s Master Plan
- Team-based to include the patient and all providers involved in the plan
Business Model Shift
A change from applications focused on the patient’s record to applications on the patient’s focused plan of health.
System Acquisition
The process that occurs from the decision is made to select a new system (or replace an existing one) until the time a contract has been negotiated and signed.
System Development Life Cycle (SDLC)
The process an organization goes through in planning, selecting, implementing, and evaluating a health care information system.
System Acquisition Process: Planning and Analysis
Focused on the business problem, or the organization’s strategy, independent of any technology that can or will be used.
- Examination of issues with current system to identify opportunities for improvement.
- Assess the feasibility of a new system
- Asses the needs of the system’s users.
- Define the functional requirements.
System Acquisition Process: Design Phase
The evaluation of alternative solutions to address the business problem.
- Review available systems on the market.
- Meeting with vendors to explore solutions
Cost-Benefit Analysis
Is the solution worth the investment?
System Implementation Process: Implementation
The significant allocation of resources in completing tasks, such as:
- Conducting work-flow and process analyses
- Installation of the system
- Testing the system
- Training staff
- Converting data
- Preparing the organization for a go-live of the new system.
System Implementation Process: Support and Evaluation
- Maintenance of the system
- Fixing bugs, glitches
- Providing updates
- Justifying system success via meaningful results for executive organization members.
Project Steering Committee
Team assembled to plan, organize, coordinate, and manage all aspects of the acquisition process.
Request For Proposal (RFP)
- Committee creates a detailed list of their organization’s system requirement features and functions.
- Vendors reply to this proposal with a detailed outline of how their product can meet the needs of the organization.
Request for Information (RFI)
Committee requests basic information from vendors. such as: vendor’s background, product descriptions, and service capabilities.
A shorter, less formal version of the RFP.
Project repository
Serves as a record of the project steering committee’s progress and activities.
Includes: Meeting minutes, vendor correspondence, RFP or RFI, evaluation forms, and summary reports.
IT Architecture: Architecture
The core technologies and software, integrated together by IT staff and vendors, to create the organization’s system.
IT Architecture: Platform
The specific vendors and technologies chosen for an organization’s information system.
IT Architecture: Infrastructure
The organization’s base IT technology, such as networks, servers, and workstations.
Application Integration: Best of Breed
Each department picks the best application it can find and then attempts to integrate the applications by means of an interface engine that manages the transfer of data within the system.
Application Integration: Monolithic
The architecture of a set of applications that all come from one vendor, sharing a common database management system and common interface for all users.
Application Integration: Visual Integration
Wraps a common browser user interface around a set of diverse applications.
Population Health Management
The proactive application of strategies and interventions to defined groups in order to improve the health of people within the group at lower cost.
- Include high and low risk patients.
- Across the entire continuum of care
Fee-For-Service
The provision of payment by individual hospitals rather than care coordinated across numerous providers.
- Providers rewarded for volume.
- Focus on complex solutions that cost more.
Value-based Care
Focus on cost-efficient care that is provided only as necessary.
-Providers rewarded for quality of care.
