OIG Series Strategy 7: Utilizing Technology to Share Patient Information

Today, we conclude our series on the study conducted by the Office of Inspector General: “ACOs’ Strategies for Transitioning to Value-Based Care: Lessons From the Medicare Shared Savings Program.” Each installment covered a different strategy that twenty high-performing Accountable Care Organizations (ACOs) implemented to achieve ongoing success. To bring things to a close, we are discussing how the use of technology to share patient information leads to enhanced communication, cooperation, and savings.   Access to shared clinical and financial claims data provides a baseline to measure and predict a patient’s quality, cost, and utilization outcomes. Knowing where a patient stands in terms of …

Diabetes Awareness Month

November is Diabetes Awareness Month. I had the pleasure of hosting Lightbeam’s Clinical Transformation Advisor, Jessica Scruton, on an episode of the Population Health Podcast discussing this chronic condition. Her experience as a nurse and witnessing diabetes mismanagement stirs a desire to educate patients on essential health topics whenever she can. Be sure to listen to the episode to hear more tips and firsthand experiences from Jessica on diabetes management. Types of Diabetes There are four different types of diabetes: type 1 (or juvenile diabetes), type 2 (or adult onset diabetes), gestational diabetes, and prediabetes. Each is slightly different, but …

OIG Series Strategy 6: Addressing Behavioral Health Needs and Social Determinants of Health

Value-based healthcare organizations are not afraid to create new approaches to care delivery if it means patients have better access and avoid emergencies. Often, behavioral health issues and social determinants of health (SDoH) are to blame for adverse, yet avoidable outcomes. The sixth Office of Inspector General (OIG) study strategy for the twenty high-performing Accountable Care Organizations (ACOs) is confronting the behavioral needs and social determinants that prevent patients from receiving timely, appropriate treatment. The surveyed ACOs achieved positive outcomes by recognizing and addressing both of these challenges, and all ACOs can benefit from similar actions.  The Acting Inspector General of the …

AI, and Then What?

The last time we discussed artificial intelligence (AI) and machine learning, we covered the basics of what they are, what they are not, and how useful they are when applied to the healthcare industry. Today we are discussing the human side of AI’s capabilities; how the insights gathered from these analytics allow care plans and patient interventions to take shape for physician and care team action. AI and machine learning allow healthcare providers to better tailor care and maximize the impact of their in-person visits with patients. These focused interventions give providers the ability to continuously survey data and generate insights that can be crafted into care pathways, empowering care managers and helping them understand an intervention’s success.   The Importance of Machine Learning  AI and machine …

OIG Series Strategy 5: Coordinating Skilled Nursing and Home Healthcare

The innovation of receiving care in the home allows otherwise unable patients to receive the medical help they need. In the recent Office of Inspector General (OIG) study, the fifth strategy that twenty high-performing Accountable Care Organizations (ACOs) utilized is working closely with skilled nursing facilities (SNFs) and home health agencies (HHAs). Their practices not only amounted to outstanding clinical and financial results, but also raised the quality of care in SNFs and HHAs with simple organizational practices and thoughtful oversight. The Challenges of SNFs and HHAs Joanne M. Chiedi, the Acting Inspector General of the Department of Health and Human …

Integrating Breast Cancer Detection with Value-Based Care: An Interview with Lightbeam’s Jessica Scruton

Breast Cancer Awareness Month is well underway, and today we are discussing the integration of preventative measures with value-based care strategies to proactively treat patients and maintain cost-conscious practices. Our in-house Clinical Transformation Advisor, Jessica Scruton, BSN, RN, CCM, took the time to discuss both of these topics in honor of this initiative. Jessica has been in the healthcare space for over 20 years, and before joining Lightbeam, she served as a Senior Director of Clinical Advisory at her previous healthcare company. During her time as a nurse, she served in the intensive care unit (ICU), where she realized she …

OIG Series Strategy 4: Managing Hospitalizations

We are continuing our review of the Office of Inspector General’s (OIG) study on the seven strategies that twenty high-performing Accountable Care Organizations (ACOs) use to generate impactful results.  Today we are discussing strategy four: managing hospitalizations. The largest portion of fee-for-service Medicare spending is hospitalizations, and proper health maintenance can lead to timely preventative treatment to reduce admissions before they occur and help prevent readmissions later. In this post, we will cover the challenges that the surveyed ACOs face, and the fundamental steps they take to improve their numbers.   Engaging Hospitals  Joanne M. Chiedi, the Acting Inspector General of the Department …

Part 2 of Our Breakdown of the CMS Primary Cares Initiatives: Direct Contracting

The Centers for Medicare & Medicaid Services (CMS) Primary Cares Initiative announced in April 2019 was two-part. We have already covered the Primary Care First (PCF) payment model options; now, we are moving into another group of value-based models that organizations can choose from called Direct Contracting (DC). These voluntary payment structures allow providers to take on risk while operating under value-based care principles to cut costs and increase the quality of care. Plus, Direct Contracting offers enhanced flexibility for providers to help their patients beyond their immediate medical needs. Direct Contracting Objectives As Primary Care First’s foundation was the …

OIG Series Strategy 3: Managing Beneficiaries with Costly or Complex Care Needs

As a former bedside ICU nurse, I have seen numerous patients reach a breaking point in their condition management. Whether their worsening was related to overlooked social determinants of health (SDoH) or the neglect of their treatment, I am a witness to the impact of proper care coordination when it comes to managing high-risk beneficiaries. Careful coordination not only affects patient quality outcomes, but also results in tremendous reductions in spending from a value-based care perspective. Today, we are continuing our analysis of the Office of Inspector General (OIG) report about twenty high-performing Accountable Care Organizations (ACOs) who earned well-deserved recognition for …

Part 1 of Our Breakdown of the CMS Primary Cares Initiatives: Primary Care First

Announced in April of 2019, the Centers for Medicare & Medicaid Services (CMS) revealed two new paths of payment options for primary care and other providers pursuing risk-based agreements: Primary Care First (PCF) and Direct Contracting (DC). As with any new CMS guideline, there is much to unpack. This week, we are discussing Primary Care First and the options primary care providers (PCPs) have based on their patients. Primary Care First “Primary Care First reflects a regionally-based, multi-payer approach to care delivery and payment. Primary Care First fosters practitioner independence by increasing flexibility for primary care, providing participating practitioners with …