iLoveBenefits: Industry News Blog

They may be ‘satisfied’ but are they getting the value they need?

Most Health-Insured Adults are Satisfied With Their Primary Care Physician

Salesforce recently released its 2016 Connected Patient Report on adults who have health insurance and a primary care physician. Here are some key findings from the report:

  • 91% of patients are satisfied with their primary care physician.
  • 3 in 4 patients (76%) use phones to communicate with their doctors and set appointments.
  • 62% of patients rely on their doctors to manage their data, while 29% keep their records at home.
  • Half of health-insured patients (48%) report having the same doctor for the past 10 years.
  • 1 in 3 patients feel their doctors would not recognize them walking down the street.
  • 62% of patients would be open to virtual care treatments as an alternative to in-office doctor visits.

Source: Salesforce, June 27, 2016

Hospital at Home model gains steam

Hospital at Home model gains steam as Mt. Sinai program cuts costs, readmissions

Monday, June 6, 2016 | By Zack Budryk

Cutting readmissions and reducing medical errors, the nation’s third-leading cause of death, are among the healthcare industry’s top priorities, and the secret to solving both may be stepping up home care, according to Oregon Public Broadcasting.

Nearly two years ago, New York’s Mt. Sinai Hospital premiered the Mobile Acute Care Team (MACT) program. This pilot program aims to deliver hospital-quality home care for patients who are at high risk for readmission. So far, the ongoing pilot has cut costs by nearly 20 percent, according to the article, while also reducing an unspecified percentage of readmissions and delivering high patient satisfaction.

Under the program, Mt. Sinai partners with community institutions such as Visiting Nurse Service of New York to provide home treatment for such conditions as chronic obstructive pulmonary disease (COPD), congestive heart failure, diabetes and urinary tract infections, according to a blog post from the hospital. “This is a real paradigm shift in medicine,” Mt. Sinai’s Linda DeCherrie, M.D., told OPB.  People will often say on first glance, ‘That sounds so great that we should definitely do that,’ but when you really get into it, it’s a totally different way of providing care.”

Medicare’s refusal to cover hospital-at-home services has kept many such programs from getting off the ground, but the Center for Medicaid & Medicaid Services’ Innovation Center awarded the MACT project $9.6 million in 2014 as part of its second round of Health Care Innovation Awards.

Nor is the MACT program the only example of such a program working; an internal analysis of the Humana At Home care management service found it cut hospitalizations among participants 45 percent while boosting survival rates, according toOpen Minds. Those Hospital at Home programs that have demonstrated consistent success have been connected to primary- and palliative care programs as well as disease-management programsFierceHealthcare previously reported.

To learn more: – read the OPB article – here’s the Mt. Sinai blog post – read the CMS announcement – check out the Open Minds post

Related Articles: How to make Hospital at Home programs work How transitional care cuts readmission risk First Medicare-approved transitional care center opens for business Readmission reduction solution: House calls How hospital-community partnerships can boost population health ER overcrowding solution: Community paramedicine

IOM: Improving Diagnosis in Health Care

The 2015 report Improving Diagnosis in Health Care says that patients and their loved ones should be central members of the diagnostic team; they provide vital input that informs diagnosis and decisions about the path of care. Yet for a variety of reasons, patients may not be effectively engaged in the diagnostic process.Visit this page with resources to facilitate communication between patients and clinicians.

7 Things to Know about 2014 Pioneer ACO Performance


  1. During 2014, Pioneer ACOs generated total savings of $120 million, an increase of 24% from 2013 ($96 million),and 2012 ($88 million).
  2. Of 15 Pioneer ACOs who generated savings, 11 qualified for shared savings payments of $82 million
  3. Of 5 Pioneer ACOs who generated losses, three owed shared losses, paying CMS $9 million
  4. Average Pioneer savings per ACO increased from $2.7 million per ACO in 2012 to $4.2 million per ACO in 2013 to $6.0 million per ACO in 2014
  5. The mean quality score among Pioneer ACOs increased to 87.2 percent in 2014 from 85.2 percent in 2013, and 71.8 percent in 2013
  6. Pioneer AOCs showed improvements in 28 of 33 quality measures and experienced average improvements of 3.6% across all quality measures compared to 2013
  7. Pioneer ACOs improved the average performance score for patient and caregiver experience in 5 out of 7 measures compared to 2013

Source: CMS Fact Sheet, Medicare ACOs Provide Improved Care While Slowing Cost Growth in 2014

HMO Redux ? Have we learned our lessons?

“As the role of primary care expands in the evolving healthcare landscape, there has been increasing discussion about expanding the team, and re-tasking members of those teams to allow everyone to “practice up to their licence.” This is a major part of the patient-centered medical home, and integral to making any such transformation successful.”

Then there is this…

“The patient needs to call and reach my office. A telephone encounter is created in the EHR. Now I have to stop what I’m doing, and “create” a referral to the dermatologist, as if this was some sort of magical, healing, useful thing. More often than not we need to select some benign (or made up) diagnosis (“dermatitis” or “nevus, non-neoplastic”) that will allow the patient to be seen, since we most likely do not know why they are there, and allow the dermatologist to be reimbursed by the insurance company.

It’s not just that I don’t want to do this work, it’s not just that it’s tedious work, but it’s work that no one should have to do. A ridiculous administrative burden has been created that prevents every one of us, no matter the level of our licensure, from being able to do the jobs in healthcare that we are desperately trying to do, and that we desperately want to do.”

So are ACO and patient-centered care just recreating the very reasons that HMOs failed? Of course there are all of the improvements and tools that are now being applied, that didn’t exist in the 1990’s HMO era. But from a public relations perspective, have we learned the lessons of the past on the parts of the physician, the physician’s office and the patient?

Emailing with your Doctor

Most adults want doctors who offer e-mail communicationA survey by Catalyst Healthcare Research found 93% of responding people said they would choose a physician who offers e-mail communication. Researchers also found one-quarter of those people would select the practice even if they were charged $25 per episode. (5/13)

What is an ACO? Only partially kidding.

Are all ACOs alike. Somehow, I rather doubt it.

According to a recent report:

  • The total number of Medicare ACOs (Accountable Care Organizations) is now 368, up from 259 a year ago
  • The total number of ACOs is 522, up from 320 a year ago
  • About 10% of all Medicare beneficiaries will now receive their healthcare from ACOs
  • Medicare ACOs currently serve 33 million non-Medicare patients, up from 25 million in July 2013
  • The total number of patients in organizations with ACO arrangements with at least one payer—both Medicare and non-Medicare—is now roughly 15 to 18% of the population.

Source: “Accountable Care Organizations Now Serve Up To 17% Of Americans,” Oliver Wyman Press Release, April 23, 2014,–of-americans.html

Study Examines Effectiveness of Automated Approaches for Receiving Patient Feedback

A new study supported by the Agency for Healthcare Research and Quality (AHRQ) suggests that many patients who do not improve as expected after a medical appointment don’t take further action to address unresolved problems. The study found that systematic follow-up, including a live follow-up call and those made by an interactive voice response system, can potentially identify and connect patients to needed care. “Exploration of an automated approach for receiving patient feedback after outpatient acute care visits” appeared online March 8 in the Journal of General Internal Medicine.


Researchers evaluated patients seen in outpatient settings for evaluation and treatment of a new health problem. The patients received a live follow-up call one week after their visit and via an interactive voice response system (IVRS) three weeks after their visit to determine their satisfaction with the diagnosis and treatment(s) provided. The study showed that automated telephone feedback systems can feasibly be used to follow-up on patient outcomes in outpatient settings. Further research on the effectiveness of this technology is needed to determine the role of automated telephone feedback systems in ambulatory care settings.


Select to access the abstract:

ACO and Patient Patterns

It is early and this data is even earlier. Initial indications of patient patient patterns as we enter the world of Medicare ACOs.

  • 80.4% of Medicare beneficiaries who were assigned to an Accountable Care Organization (ACO) in 2010, were assigned to the same ACO in 2011, and 19.6% were not
  • Among ACO-assigned beneficiaries, 8.7% of office visits with primary care physicians were provided outside of the assigned ACO
  • Among ACO-assigned beneficiaries, 66.7% of office visits with specialists were provided outside of the assigned ACO
  • 37.9% of Medicare spending on outpatient care billed by ACO physicians was devoted to ACO-assigned beneficiaries, and 62.1% was not

Source: “Outpatient Care Patterns and Organizational Accountability in Medicare,” JAMA Internal Medicine, abstract only, April 21, 2014,

Three quarters of elderly patients prefer coordinated care, but most don’t get it

Most older patients prefer coordinated care but few receive it, survey finds
A survey by the John A. Hartford Foundation revealed 73% of elderly patients said they would prefer coordinated care from a team of medical professionals, but only 27% reported receiving such care. Researchers also found that 48% of older patients said they would consider switching primary care doctors if coordinated team care is available elsewhere. (4/3)

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