AIMHI Intelligence

Memphis Program Reduces Emergency Room Trips

Within 10 minutes of receiving a 911 call that a 61-year-old man had passed out, a paramedic and a doctor pulled up outside J.K. Lewis Senior Center in a red SUV. The health care duo checked the patient’s heart rate, blood pressure and temperature. Last year, the man would have […]

Only 3% of emergency room visits may truly be avoidable, study suggests

Though many emergency rooms are overcrowded and some patients may not have urgent needs, just a fraction of visits are truly “avoidable,” according to a new study. Researchers examined data from the National Hospital Ambulatory Medical Care Survey from 2005 to 2011 that included more than 115,000 records representing 424 […]

4 strategies to reduce ER overcrowding

Overcrowded emergency rooms are common in hospitals across the country. But several key strategies unite the facilities that are most effectively tackling this problem, according to a new study. Researchers stratified hospitals into three groups based on data from the Centers for Medicare & Medicaid Services: highest-performing, high-performing and low-performing, […]

Dying At Home In An Opioid Crisis: Hospices Grapple With Stolen Meds

Nothing seemed to help the patient — and hospice staff didn’t know why. They sent home more painkillers for weeks. But the elderly woman, who had severe dementia and incurable breast cancer, kept calling out in pain. The answer came when the woman’s daughter, who was taking care of her […]

Health care is moving at the speed of light, and for many health system CEOs that requires a need for agility to tackle what’s now and what’s next. Deloitte recently surveyed 20 CEOs from large health systems across the country to uncover what’s top of mind and how they are moving forward in an uncertain – and sometimes challenging – market. While none of the key themes emerging from our interviews around funding, value-based care, talent, and technology have really changed since we last spoke with health system CEOs in 2015, the urgency certainly has. Instead of talking about their 10-year plans like they did two years ago, these CEOs are now concerned with what’s happening now, and what might happen with Medicaid tomorrow. Many top concerns are compounded by uncertainty around the new administration, Congress, and the future direction of federal health care policy. Top concerns among health system CEOs include: • Preparing for potentially changing Medicaid reimbursement models and other policy issues • Implementing population health and value-based care • Maintaining or improving margins • Recruiting and retaining top talent, including health care leaders • Keeping up with evolving technology and cybersecurity risks • Adapting to changing consumer demands and expectations I’m not surprised health system CEOs are concerned about policy and federal funding. The debate around health care reform has dominated the news cycle since January. However, despite the uncertain outcome and impact of Congress’s health care reform efforts, there are, what I call, “no regrets” pursuits that health systems and hospitals can consider. These include: • Integrating business vertically • Triaging patients to direct them to the appropriate level of care • Reducing cost and inefficiencies across the system Vertical integration As we know, health care is changing. For years, there has been little incentive for hospitals to direct patients to – or coordinate with – step-down or other less expensive settings of care. But now that is changing. Government payment models such as those promoted through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), along with commercial value-based reimbursement agreements, are helping push many hospitals to reconsider their relationships with other health care stakeholders. Depending on a hospital’s patient population, it might make sense to vertically integrate with other health care partners. This could include payers, post-acute care facilities, and physician practices. If revenues aren’t going to increase, hospitals and health systems may need to think about new revenue streams. An integrated care delivery system can help coordinate care across the continuum and track patients more efficiently. Triaging patients Another strategy health system leaders could consider would be to implement stronger triaging systems that help direct patients to the most appropriate care setting. If a hospital or health system is vertically integrated, and owns or partners with urgent care clinics and/or physician practices, it can refer patients to those settings rather than providing care in the emergency department (ED), which can cost thousands of dollars per hour to operate. If an increasing number of uninsured patients come to the ED – and hospitals anticipate more uncompensated care – there is likely a financial incentive to actively direct some of these patients to a lower-cost and/or more appropriate care settings. Reducing inefficiencies Though many health systems have looked for efficiencies around the margins of providing care, they now likely need to find greater clinical efficiency. They might need to rethink how care is delivered and at what cost. Generally, reimbursement is not increasing in the government or commercial sectors. As many hospitals continue to take on more risk, it will likely be important to deliver care as efficiently and effectively as possible. Though many health system CEOs have found new revenue streams through the acquisition of physician practices and other hospitals, they might not yet understand how to operate as a system. Hospitals within a health system sometimes continue to operate independently of one another rather than tapping into their synergies. Though the health care debate is ongoing, and the future of the Medicaid program is unclear, there are strategies that health system CEOs can pursue today. Regardless of what happens with Medicaid, government and commercial payers are likely not interested in paying hospitals more than they already do. Looking for ways to vertically integrate, triage patients, and reduce inefficiencies can help prepare hospitals for a value-based reimbursement system. Health system CEOs should consider how to deliver care to patients in the most cost-effective way possible. The organization leaders that figure this out first will be the ones shaping the future of health care, and those health system CEOs will sleep much more soundly.

Health care is moving at the speed of light, and for many health system CEOs that requires a need for agility to tackle what’s now and what’s next. Deloitte recently surveyed 20 CEOs from large health systems across the country to uncover what’s top of mind and how they are […]

These ‘community paramedics’ offer help before 911 is dialed

For those known as the “familiar faces” most likely to dial 911, this island city across the bay from San Francisco is trying a new approach – getting in touch with them before they call. “It changes the role we’ve traditionally had with folks,” said Patrick Corder, part of the […]

Scam Caller Claims Loved One Is Hurt in Crash, Then Demands Money

In an elaborate scheme for scammers to get cash, some people are being led to believe their loved ones are in danger. Maria Mejia said she was working at a North Texas hospital when her phone began ringing repeatedly one afternoon. When she answered, the person on the other end […]

How paramedics helped BlueCross BlueShield of New Mexico reduce ER usage, readmissions

From what BlueCross BlueShield of New Mexico has found, establishing a partnership with community paramedics is not only good medicine, it’s good for business.   The insurer’s Community Paramedicine program, which started out as a pilot project in the fall of 2015, is targeted at Medicaid members who have either been identified as […]

Blue Cross NC taps CMS’ chief medical officer Conway as new president

Dr. Patrick Conway, the CMS’ chief medical officer, is headed to work for Blue Cross and Blue Shield of North Carolina as its president and CEO, starting Oct. 1. The insurer’s current president and CEO Brad Wilson, who is retiring, will remain in his role “for an appropriate period to […]