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What Does Patient-Centered Radiology Look Like? Several U.S. Health Systems Are Leading the Way

January 5, 2017
by Heather Landi
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The Advisory Board Company's Miriam Sznycer-Taub outlines how imaging can play into a health system’s broader population health initiative
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In the ongoing transition from fee-for-service to value-based care delivery and payment models, there is an imperative to focus more on the patient, and that holds true for radiology as well.

According to Miriam Sznycer-Taub, a consultant with The Advisory Board Company (Washington, D.C.) who works in the firm’s imaging performance partnership, while the healthcare environment is evolving its focus from volume to cost and outcomes, many imaging leaders continue to have an unchanged perspective and remain focused on efficiency and growth. “We’ve been doing research about imaging leaders as it relates to measuring quality and our results indicated that imaging leaders largely are tracking turnaround time and volumes,” Sznycer-Taub says. “Those metrics are fine for a fee-for-service environment, but we need to think about how the world is changing and change our perspective along with it.”

Sznycer-Taub shared The Advisory Board’s imaging research during a webinar in December with a focus on how health systems can transition radiology services to a more patient-centered model of care. The webinar was sponsored by The Advisory Board and Ambra Health, an imaging technology company.

“Radiology needs to prove its value as an essential component of comprehensive patient care, as refocusing care delivery on the patient can both improve patient outcomes and financial margins,” she said.

Imaging can play into a health system’s broader population health initiative, she noted.  “If you think about the role imaging plays in the care pathway, patients face a lot of roadblocks on the path to care that may prevent them from following through with imaging referral and downstream care. And that means they are not receiving the care that they need and that can cost health systems money down the line.”


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She continued, “Imaging has a unique role to play here. Imaging can play a critical role in patient outcomes, not just diagnostic information, but being sure we’re transitioning to the next step in the care pathway. And, imaging can really be thought of a stepping stone before the actual care pathway. We need to think of imaging as the true entry into the health care system for patients and think about it in that lens that imaging plays this role in patient outcomes as we’re moving from disease-based care to patient-centered care.”

Some healthcare organizations are leveraging imaging technology to improve the patient experience. During the webinar, several healthcare organizations were highlighted:

  • At St. Luke’s University Health Network, a seven-hospital network serving parts of New Jersey and Pennsylvania, imaging leaders have transitioned away from using imaging CDs/DVDs, which often took at least an hour to burn, and implemented a technology platform that uploads imaging and sends patients a secure link to download the imaging themselves with upload times taking less than three minutes.
  • The Houston-based Memorial Hermann Health System, a 13-hospital system, has implemented a cloud-based imaging platform and now has 100 external sending sites connected to its main campus through gateways for receiving trauma and general referrals from external PACS systems in real-time.

Many health systems are taking innovative steps to transition their radiology departments to be more patient-centered. Drilling down on the initiatives, Sznycer-Taub outlined three imperatives that health systems should focus on to achieve patient-centered radiology—patient education, results delivery and patient handoff.

As studies show that patient education improves adherence to care, radiology departments should implement pre-appointment calls to educate and engage patients by assuring patients about the privacy and safety of the procedure and providing information about the procedure and sharing information about the training and background of patients’ assigned technologists, she said.

At Houston Methodist Willowbrook Hospital, a 250-bed hospital in Houston, radiology department staff are trained to call patients before appointments and use careful scripting to ensure patient comprehension of exams and proper preparation. The implementation of the calls significantly increased patient satisfactions and decreased prep time during appointments, she said.

At Cone Health, a six-hospital health system in Greensboro, North Carolina, technologists are held accountable for patient engagement and are required to explain the exam to patients, answer any outstanding questions and, before the scan begins, technologists must document that patient education was completed in the radiology information system.

The second imperative, according to Sznycer-Taub, is to tailor results delivery and keep patients activated beyond the scan. While there are three options for results delivery—the radiology department, the referring physicians and via a patient portal—research has shown that there is a strong patient preference for radiologist delivery of the imaging exam results, she said. A study published in the Journal of the American College of Radiology found that 99 percent of patients agree that radiologist delivery was beneficial and 90 percent said the option for radiologist delivery would make them more likely to return.

She noted that there are drawbacks and challenges with radiologist-led results delivery, such as higher costs, potential liability and more time required by radiologists. Additionally, referring physicians often want to retain full ownership of patient care and radiologists often have no prior relationship with patients.

Sznycer-Taub also said research shows that offering patient portals that include delivery of imaging-related content can provide more rapid delivery of exam results to patients. Health systems can build in a time delay on portal access in order to enable referring physicians to connect with patients first and can provide a brief explanation of the results in lay language in the radiology report.

“These approaches are not mutually exclusive and the radiologist, referring physician and the patient portal can play complementary roles,” she said. “Whether results are delivered by the referrer, a radiologist and/or a patient portal, institutions should consider the needs and wishes of all stakeholders involved.”

The third imperative is to ensure a successful patient handoff. Research indicates that 15 percent of electronic exam notifications are not ready by the referring physicians, Sznycer-Taub said, and she recommends radiology departments develop ways to confirm that referring physicians have received the results to be a safety net that helps to bridge the referrer-patient gap. “To be integrated into patient-centered care, imaging needs to close the loop as patients move to the next step of the process,” she said.

At the La Crosse, Wis.-based Gundersen Health System, which operates three hospitals, imaging leaders have implemented an incidental findings tracking initiative to ensure patient follow-up. As part of this initiative, the radiology department activated a query box in voice recognition software so radiologists can indicate the need for follow-up care on the report. Staff members run weekly reports, compile cases that need follow-up and send messages via Epic to referring physicians to confirm the report has been received. In that message, referring physicians are requested to indicate a follow-up plan and the radiology department documents the response to maintain a record of physician communication.

Additionally, if the referrer doesn’t respond after two weeks, the case passes is passed to a quality assurance radiologist to contact the referrer, and, as a last step, the QA radiologist alerts the department chairmen.

Additionally, at Gundersen, the radiology department matches emergency department patients who do not have a referring physician with internal medicine residents for follow-up care.

“There’s this gap between radiology and the referrer and someone needs to bridge the gap and radiology is best positioned to fill that void,” she said.

Essentially, Sznycer-Taub contends that imaging programs should take responsibility for follow-up care by confirming that referrers have acted upon radiology results. “In this way, radiology confirms that its product has been utilized as intended and adds value as a patient care coordinator,” she said.


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NCQA Moves Into the Population Health Sphere With Two New Programs

December 10, 2018
by Mark Hagland, Editor-in-Chief
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The NCQA announced on Monday that it was expanding its reach to encompass the measurement of population health management programs

The NCQA (National Committee for Quality Assurance), the Washington, D.C.-based not-for-profit organization best known for its managed health plan quality measurement work, announced on Dec. 10 that it was expanding its reach to encompass the population health movement, through two new programs. In a press release released on Monday afternoon, the NCQA announced that, “As part of its mission to improve the quality of health care, the National Committee for Quality Assurance (NCQA) is launching two new programs. Population Health Program Accreditation assesses how an organization applies population health concepts to programs for a defined population. Population Health Management Prevalidation reviews health IT solutions to determine their ability to support population health management functions.”

“The Population Health Management Programs suite moves us into greater alignment with the focus on person-centered population health management,” said Margaret E. O’Kane, NCQA’s president, in a statement in the press release. “Not only does it add value to existing quality improvement efforts, it also demonstrates an organization’s highest level of commitment to improving the quality of care that meets people’s needs.”

As the press release noted, “The Population Health Program Accreditation standards provide a framework for organizations to align with evidence-based care, become more efficient and better at managing complex needs. This helps keep individuals healthier by controlling risks and preventing unnecessary costs. The program evaluates organizations in: data integration; population assessment; population segmentation; targeted interventions; practitioner support; measurement and quality improvement.”

Further, the press release notes that organizations that apply for accreditation can “improve person-centered care… improve operational efficiency… support contracting needs… [and] provide added value.”

Meanwhile, “Population Health Management Prevalidation evaluates health IT systems and identifies functionality that supports or meets NCQA standards for population health management. Prevalidation increases a program’s value to NCQA-Accredited organizations and assures current and potential customers that health IT solutions support their goals. The program evaluates solutions on up to four areas: data integration; population assessment; segmentation; case management systems.”



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At the D.C. Department of Health Care Finance, Digging into Data Issues to Collaborate Across Healthcare

November 22, 2018
by Mark Hagland, Editor-in-Chief
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The D.C. Department of Health Care of Finance’s Kerda DeHaan shares her perspectives on data management for healthcare collaboration

Collaboration is taking place more and more across different types of healthcare entities these days—not only between hospitals and health insurers, for example, but also very much between local government entities on the one hand, and both providers (hospitals and physicians) and managed Medicaid plans, as well.

Among those government agencies moving forward to engage more fully with providers and provider organizations is the District of Columbia Department of Health Care Finance (DHCF), which is working across numerous lines in order to improve both the care management and cost profiles of care delivery for Medicaid recipients in Washington, D.C.

The work that Kerda DeHaan, a management analyst with the D.C. Department of Health Care, is helping to lead with colleagues in her area is ongoing, and involves multiple elements, including data management, project management, and health information exchange. DeHaan spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland regarding this ongoing work. Below are excerpts from that interview.

You’re involved in a number of data management-related types of work right now, correct?

Yes. Among other things, we’re in the midst of building our Medicaid data warehouse; we’ve been going through the independent validation and verification (IVV) process with CMS [the federal Centers for Medicare and Medicaid Services]. We’ve been working with HealthEC, incorporating all of our Medicaid claims data into their platform. So we are creating endless reports.


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Kerda DeHaan

We track utilization, cost, we track on the managed health plan side the capitation payments we pay them versus MLR [medical loss ratio data]; our fraud and abuse team has been making great use of it. They’ve identified $8 million in costs from beneficiaries no longer in the District of Columbia, but who’ve remained on our rolls. And for the reconciliation of our payments, we can use the data warehouse for our payments. Previously, we’d have to get a report from the MMIS [Medicaid management information system] vendor, in order to [match and verify data]. With HealthEC, we’ve got a 3D analytics platform that we’re using, and we’ve saved money in identifying the beneficiaries who should not be on the rolls, and improved the time it takes for us to process payments, and we can now more closely track MCO [managed care organization] payments—the capitation payments.

That involves a very high volume of healthcare payments, correct?

Yes. For every beneficiary, we pay the managed care organizations a certain amount of money every month to handle the care for that beneficiary. We’ve got 190,000 people covered. And the MCOs report to us what the provider payments were, on a monthly basis. Now we can track better what the MCOs are spending to pay the providers. The dashboard makes it much easier to track those payments. It’s improved our overall functioning.

We have over 250,000 between managed care and FFS. Managed care 190,000, FFS, around 60,000. We also manage the Alliance population—that’s another program that the district has for individuals who are legal non-citizen residents.

What are the underlying functional challenges in this area of data management?

Before we’d implemented the data warehouse, we had to rely on our data analysis and research division to run all the reports for us. We’d have to put in a data request and hope for results within a week. This allows anyone in the agency to run their own reports and get access to data. And they’re really backed up: they do both internal and external data reports. And so you could be waiting for a while, especially during the time of the year when we have budget questions; and anything the director might want would be their top priority.

So now, the concern is, having everyone understand what they’re seeing, and looking at the data in the same way, and standardizing what they’re meaning; before, we couldn’t even get access.

Has budget been an issue?

So far, budget has not been an issue; I know the warehouse cost more than originally anticipated; but we haven’t had any constraints so far.

What are the lessons learned so far in going through a process like this?

One big lesson was that, in the beginning, we didn’t really understand the scope of what really needed to happen. So it was underfunded initially just because there wasn’t a clear understanding of how to accomplish this project. So the first lesson would be, to do more analysis upfront, to really understand the requirements. But in a lot of cases, we feel the pressure to move ahead.

Second, you really need strong project management from the outset. There was a time when we didn’t have the appropriate resources applied to this. And, just as when you’re building a house, one thing needs to happen before another, we were trying to do too many things simultaneously at the time.

Ultimately, where is this going for your organization in the next few years?

What we’re hoping is that this would be incorporated into our health information exchange. We have a separate project for that, utilizing the claims data in our warehouse to share it with providers. We’d like to improve on that, so there’s sharing between what’s in the electronic health record, and claims. So there’s an effort to access the EHR [electronic health record] data, especially from the FQHCs [federally qualified health centers] that we work closely with, and expanding out from there. The data warehouse is quite capable of ingesting that information. Some paperwork has to be worked through, to facilitate that. And then, ultimately, helping providers see their own performance. So as we move towards more value-based arrangements—and we already have P4P with some of the MCOs, FQHCs, and nursing homes—they’ll be able to track their own performance, and see what we’re seeing, all in real time. So that’s the long-term goal.

With regard to pulling EHR information from the FQHCs, have there been some process issues involved?

Yes, absolutely. There have been quite a few process issues in general, and sometimes, it comes down to other organizations requiring us to help them procure whatever systems they might need to connect to us, which we’re not against doing, but those things take time. And then there’s the ownership piece: can we trust the data? But for the most part, especially with the FHQCs and some of our sister agencies, we’re getting to the point where everyone sees it as a win-wing, and there’s enough of a consensus in order to move forward.

What might CIOs and CMIOs think about, around all this, especially around the potential for collaboration with government agencies like yours?

Ideally, we’d like for hospitals to partner with us and our managed care organizations in solving some of these issues in healthcare, including the cost of emergency department care, and so on. That would be the biggest thing. Right now, and this is not a secret, a couple of our hospital systems in the District are hoping to hold out for better contracts with our managed care organizations, and 80 percent of our beneficiaries are served by those MCOs. So we’d like to understand that we’re trying to help folks who need care, and not focus so much on the revenues involved. We’re over 96-percent insured now in the District. So there’s probably enough to go around, so we’d love for them to move forward with us collaboratively. And we have to ponder whether we should encourage the development and participation in ACOs, including among our FQHCs. Things have to be seen as helping our beneficiaries.

What does the future of data management for population health and care management, look like to you, in the next several years?

For us in the District, the future is going to be not only a robust warehouse that includes claims information, vital records information, and EHR data, but also, more connectivity with our community partners, and forming more of a robust referral network, so that if one agency sees someone who has a problem, say, with housing, they can immediately send the referral, seamlessly through the system, to get care. We’re looking at it as very inter-connected. You can develop a pretty good snapshot, based on a variety of sources.

The social determinants of health are clearly a big element in all this; and you’re already focused on those, obviously.

Yes, we are very focused on those; we’re just very limited in terms of our access to that data. We’re working with our human services and public health agencies, to improve access. And I should mention a big initiative within the Department of Health Care Finance: we have two health home programs, one for people with serious mental illness issues, the other with chronic conditions. The Department of Behavioral Health manages the first, and the Department of Health Care Finance, my agency, DC Medicaid, manages the second. You have to have three or more chronic conditions in order to qualify.

We have partnerships with 12 providers, in those, mostly FQHCs, a few community providers, and a couple of hospital systems. We’ve been using another module from HealthEC for those programs. We need to get permission to have external users to come in; but at that point, they’d be able to capture a lot of the social determinants as well. We feel we’re a bit closer to the providers, in that sense, since they work closely with the beneficiaries. And we’ve got a technical assistance grant to help them understand how to incorporate this kind of care management into their practice, to move into a value-based planning mode. That’s a big effort. We’re just now developing our performance measures on that, to see how we’ve been doing. It’s been live for about a year. It’s called MyHealth GPS, Guiding Patients to Services. And we’re using the HealthEC Care Manager Module, which we call the Care Coordination Navigation Program; it’s a case management system. Also, we do plan to expand that to incorporate medication therapy management. We have a pharmacist on board who will be using part of that care management module to manage his side of things.



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