IN THIS ISSUE
Value-driven vs. Volume-driven in Occupational Medicine (OM)
Each quarter, Flash editors work with our in-house experts and trusted industry affiliates to share some thoughts on the current buzz in Employee Health, Occupational Medicine, and Urgent Care.
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Value-driven business model. Who’s ready?
This quarter we got feedback on the current transition from volume- driven to value-driven care from two Occupational Medicine (OM) industry experts who also happen to sit on Net Health’s Agility Advisory Board.
Dr. Michael Gallagher, MD, and Donna Lee Gardner, RN, BSN, MBA, bring their years of experience to a discussion on the current state of OM practice, from both an operations and physician practice perspective.
Read our experts' bios »
Donna Lee Gardner, RN, BSN, MBA, is a senior principal with Ryan Associates and avid supporter of the National Association of Occupational Health Professionals, (NAOHP). Donna Lee has developed productivity indicators for occupational health and rehabilitation programs to enhance staffing and provide quality monitors for staff productivity. Ms. Gardner focuses on operational, financial, customer service and quality assurance standards, and has reviewed approximately 10,000 patient charts and identified millions of dollars left on the table while monitoring documentation and coding processes. She is a noted public speaker and author including program operation manuals and benchmarking materials.
Dr. Mike Gallagher, MD, is board certified in Clinical Informatics and Occupational and Environmental Medicine, and has been an informaticist for over 20 years, 15 of those in healthcare. His first roles were in industry, where he specialized in efficiency and business process engineering for operations and finance. As a medical informaticist at UCSF, Harvard, and LifeMasters he focused on chronic disease management, data governance, quality measures, and the revenue cycle. He has served as the medical director for 8 Urgent Care and Occupational Medicine clinics in California, and was the CMIO and service line manager for UC Berkeley Health Center. He is a diplomate in the American College of Occupational and Environmental Medicine where he is a member of the medical informatics, corporate medicine, and health & productivity working groups.
Gone are the days when occupational medicine programs focused only on treating workers’ on-the-job injuries and providing employment-related testing. With the interest in wellness and consumer participation in healthcare decision-making, OM practices are faced with employer demands for more health promotion services and access to information about healthcare cost and quality outcomes. Employers are also expanding benefits to address the health and wellness needs of workers’ families. As a result, there is greater interest than ever in both employee/patient and employer access to information.
Check out the interview here and see our experts’ answers.
Q: We hear a lot these days about healthcare moving from a volume-driven to a value-driven enterprise. How will that impact the practice of Occupational Medicine?
A: We need to redefine our practice to meet the needs of employers as our clients and contribute NEW services to meet their needs...(read more) »
Donna Lee Gardner
In my opinion, we need to redefine our practice to meet the needs of employers as our clients and contribute NEW services to meet their needs. In the past we were aware of the need to decrease workers’ compensation insurance premiums, decrease lost work days, and help employers maintain an accident free environment. Today, in addition to serving those needs, we have become the gateway to the employer’s employee population health promotion efforts, identifying the needs of the employee population and maintaining their health in a cost effective manner.
Dr. Mike Gallagher
Occupational Medicine in many ways already exemplifies a value-driven health delivery model. Historically, there have been components of Wellness, Patient Centered Medical Home (PCMH), Episodes of Care and Value Based Purchasing (VBP) central to the services employers expect from occupational medicine practices. Updating the narrative to immediate care and concierge on-site care within the traditional OM practice is the latest challenge. Workers’ compensation injury care typically falls under risk management, and healthcare benefits fall under talent management. Combining all of these services and becoming part of the national move toward clinical integration is daunting. Communicating that vision is even more so, but finding the right set of tools to get involved in the clinically integrated industry is the future.
Q: You both mention a need to expand Occupational Medicine practice beyond workers’ compensation claims and traditional employment activities to addressing health maintenance needs of employees. How do you see that happening?
A: The occupational medicine program of today requires the management team to redefine the program’s mission and identify product lines and services that are in keeping with that mission...(read more) »
Donna Lee Gardner
Today, we are challenged to help employers maintain the health of their employees and THEIR FAMIILIES and to decrease all INSURANCE premiums. The occupational medicine program of today requires the management team to redefine the program’s mission and identify product lines and services that are in keeping with that mission. A successful OM program has both preventive and treatment components with product lines that meet the needs of the market.
Dr. Mike Gallagher
It’s happening already. Integrated health care has become a catchphrase in the industry. In 2008 the Institute for Healthcare Improvement, (IHI), defined the Triple Aim, which has been simplified by many to include cost, quality and experience of care, to describe an approach to health system performance. This heralded the beginning of the modern phase of the 360° longitudinal view of wellness. The American Recovery and Reinvestment Act, (ARRA), later in 2009, in response to financial crisis, and the associated Healthcare and Information Technology for Economic and Clinical Health Act, (HITECH), provisions for the meaningful use, (MU), of technology to ensure improvements in quality has ushered in the current world of health and wellness apps, and the further integration of wearable tech and patient health record, (PHR) linked smart devices.
Q: What can Occupational Medicine clinics do right now to add value?
A: Simplicity is the key. Occupational Medicine providers have been practicing many aspects of integrated medicine for years. We practice evidence-based medicine to ensure that...(read more) »
Donna Lee Gardner
With Mission and Services defined at the clinic level, as we make the move away from volume-driven practice we need to be able to define the value we bring to our clients through clinical and operational outcomes. The development of standards is the foundation for excellent outcomes. Clinic management must direct the staff to follow program and service standards for their patients. The monitoring of adherence to standards will demonstrate clinical outcomes in compliance with the American College of Occupational and Environmental Physicians (ACOEM) guidelines and the program Standards of Care. Additionally, management must assure that the staff provides operational and customer service levels that meet each client’s expectations of outstanding customer service. Our goals now are not solely based on financial outcomes as, today, without patient and client satisfaction, we may find insurance providers reducing or declining reimbursement for our services.
The development of standards and the subsequent outcomes that will demonstrate the value we provide to our customers are administrative challenges. Accepted categories for Occupational Medicine standards are:
- Operational standards
- Staffing standards
- Financial standards
- Treatment/clinical standards
- Customer service standards
- Sales and marketing standards
Each of the product lines where service is provided should include a process for monitoring the above standards or outcome categories. Once established, a successful program can provide both internal and external clients with a report card addressing each product line and the outcomes achieved by those product line standards and services. Programs can then demonstrate the value they provide to their clients and the communities served, transitioning successfully to a value-driven care model.
Dr. Mike Gallagher
Simplicity is the key. Occupational Medicine providers have been practicing many aspects of integrated medicine for years. We practice evidence-based medicine to ensure that conservative treatment is applied appropriately according to the ACOEM guidelines, or the Work Loss Data Institute’s Official Disability Guidelines (ODG) or other evidence based guidelines based on efficacy of treatment forms. We submit correct claims, comply with Value Based Payment (VBP), usually in providing preventive services like surveillance and routine exams, share information electronically and coordinate closely with all stakeholders similar to the requirements for PCMH.
Q: What do you see for the future of Occupational Medicine practices?
A: As we move forward, we can expect that our treatments and medical information will continue to be important to share through HIE technology, Continuity of Care Documents, (CCDs), etc. Our treatments impact primary and specialty care through...(read more) »
Donna Lee Gardner
Looking forward, the Occupational Medicine program best prepared for the future will have done a thorough review of its mission and scope of services to assure that all employer client needs are accounted for. A successful occupational medicine program has both preventive and treatment components with product lines that meet the needs of the market that can include:
- Injury Management – which includes services for the prevention of work-related injuries and the treatment and follow-up of injured workers
- Health Management – for the provision of health exams (e.g., post-offer physicals) and services and assistance with legal and regulatory compliance
- Rehabilitation – including functional screening, treatment and educational programs for employees
- Substance Abuse Testing – for the screening of employee candidates, post injury testing, Department of Transportation testing, random employee testing, ‘for cause’ testing, and breath alcohol testing as well as special requested testing by employers with contracts with laboratories for saliva and hair testing
- Episodic Care Services – contracted by employers as a non-insurance product for the provision of care for non-work related injuries and illnesses for the employees and in some cases their family members and significant others in the employee household
- Preventive Services – such as work site health screening and educational programs to enhance the health and wellness of employees
- Medical Loss Management – targeting the management of any non-work-related illnesses or injuries that employees may have, as well as special contracting for FMLA oversight
- Employer On-Site Health Clinics – providing specific contracted services from OSHA screening to a full service occupational medicine clinic
- Employee Assistance Programs – to provide the employer’s workforce with access to professionals who can assist in the development of coping skills to handle crises in daily living, from substance abuse to depression
- Family Care – primarily to provide the population health needs of the employees’ families and their significant others
- Safety management services – directed by the boarded occupational medicine physician who provides the employer with guidance and knowledge of the workplace environment and regulatory compliance issues for a safe and hazard free work environment for all employees
Dr. Mike Gallagher
In the Occupational Medicine world we turned to electronic technologies long before HITECH and MU made it practically mandatory. That electronic world of surveillance data for tracking and prevention of gaps-in-care, and the requirements of maintaining data for reporting to state and claims administrators has allowed our practices to generate reports and analytics that would leave the primary care world envious. We can track length of injury duration, the total cost of medical treatment, impact on activities of daily life using absence and work accommodations, and engagement (while direct patient engagement usually relies on surveys) through direct feedback from our contracted employer customers and their representatives.
As we move forward, we can expect that our treatments and medical information will continue to be important to share through HIE technology, Continuity of Care Documents, (CCDs), etc. Our treatments impact primary and specialty care through medications like MAOi’s for chronic pain or NSAIDS in the renal impaired, and our surveillance chest x-rays and injury related CTs which contribute to total radiation should be considered alongside all other sources. The in-depth understanding we have of ADLs and IADLs is a benefit to primary care, as well as the stakeholders who are responsible for the cost of care, the employer, many of whom provide health coverage and wellness programs. In my opinion, we need to redefine our practice to meet the needs of employers as our clients.
Agility continues to support the efforts of our Providers and clinics to demonstrate value for services rendered.
Current features include:
- Clinical decision support tools, including a link to MD Guidelines, facilitating documentation of evidence-based practice
- Clinical Practice Guidelines alerts per user role to ensure evidence-based medicine is reinforced at the time of service, facilitating and supporting quality patient care
- Ability to track Provider progress toward quality initiatives associated with 9 Clinical Quality Measures (CQMs), selected for their applicability to commonly seen conditions in OM and UC
Forthcoming enhancements include:
- An enhanced Patient/Employee Portal, will combine 2 existing portals to facilitate a better user experience to make it easier to participate in one’s own health care. The enhancements will also make it easier to comply with employer regulations. The portal will include highly requested functionality, such as:
- The ability to add a new allergy and
- 2-way conversation(s) via the Inbox
Given Meaningful Use dependencies in the Patient/Employee Portal, it will become available upon successful review by Drummond, an authorized testing authority, to ensure functionality complies with current 2014 edition Meaningful Use requirements.
- PQRS reporting via the Net Health Specialty Care Registry, allowing Providers to seamlessly report their data to CMS. Additionally, this connection will facilitate the ability for each Provider to track their progress toward each of 9 CMS quality initiatives.
For more information on all the latest Agility features please contact Agility Client Services at email@example.com.
Training and information about Agility features, as well as educational information about new release content, can always be found online at Net Health University.
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