The need to control healthcare expenditure (per capita Medicare expenditure at $8973) is no longer in doubt. With over 36% of the $599 Billion Medicare spend on inpatient care, almost 19% on post acute care and over 13% on outpatient services healthcare is looking to new business architectures to contain costs as well as maintain quality. Accountable Care Organizations (ACO’s) is one such business model structured from a fee for service to a pay for performance model.
The aim of an ACO is to reduce healthcare costs, improve quality as well enhance patient experience. ACO’s are legal entities that organize around the concept of a patient centered medical home with primary care physicians forming the core who become the focal point for engaging with the patients to participate in driving superior outcomes. The ACO’s enroll healthcare participants in the care continuum who collaborate together in concert to meet the goals of the ACO. These participants would include specialists, extended care providers (skilled nursing, hospice, extended care), physicians, nurse, dieticians and social workers. Primary Care Physicians can participate in only one ACO; the others may participate in more than one ACO.
ACOs may be fully integrated or they may draw members from outside the organization into the legal structure through agreements to complete all needed participants in the care continuum.
ACO’s have shown benefits. Cigna has done a study showing significant savings in Accountable Care Organizations. Michigan’s Value Partnership Program or Blue Shield Blue Cross MA and others have shown promising savings.
Can this shared savings be increased using collaboration, video and Telehealth technologies? There are indicators that it can:
VA has shown a 19% reduction in hospitalization through its Telehealth program
Geisinger Health Plan has shown a 44% reduction in readmissions with Telehealth
Over 75% of Asthma admissions could have been avoided by using Telehealth
The payout to an ACO is calculated as:
Payout to ACO= (Cost Saving) x (Shared Saving %) x (Quality Performance)
An ACO is a business architecture where caregivers need to collaborate in the delivery of care, very closely, across the care continuum. The Primary Care physician needs to remain engaged with the patient as the patient transitions through different touch-points in the care continuum. Patients remain engaged and vested in their own well-being. The physicians will practice at the top of their license leaving certain functions to appropriately trained nursing.
Healthcare IT will play a major role; one of the requirements is for at least 50% of the primary care physicians to be meaningful use users. ACOs also have to demonstrate evidence-based practice. The ACO eco system should collaborate around an EMR that could be delivered on the cloud as a service to the ecosystem.
The ACO needs to identify at-risk patients and maintain close contact. Case Managers or care coordinators will leverage technology to keep the high touch with at risk patients.
Patients also need to have access to their trending health records as well as receive focused education
An ACO can increase its cost savings through immersive video and collaborations:
Care transitions managed through proactive video collaboration between caregivers help in reducing medical errors and re-admissions
With immersive video based collaboration where the specialists and the primary care physician examine a patient at the same time using multi-point Telehealth saves costs. Such interactions also allow the primary care physician to make more informed decisions over a period of time. ACOs can see huge savings through this provider partnership.
Care coordinators can maintain a video based touch with outpatients and direct nursing visits where needed or bring in physicians or specialists into a video consult with the patient avoiding unnecessary visits to an ER
Telehealth can provide specialist access to patients in skilled or extended care facilities cutting down avoidable ER visits
Telehealth solutions that create physician groups can allow the right care provider, based on specialty or language, to provide care where needed
Technology can be leveraged to manage chronic conditions. “No show patients” is a huge drain in the operational waste in healthcare systems. Whether delivering virtual care in mental health situations, or examining patients who have difficulty traveling to clinics, video consults for movement disorder, neurologic or cardiac patients post operative consults – Telehealth can bring down healthcare costs.
Telehealth can allow specialists to avoid travel to remote clinic. The time saved provides efficiencies whereas the additional patients that a specialist can examine in the time saved provides transformational benefits
Structured collaborative education using technologies such as Webex can be more effective than a written brochure
Video, collaboration and Telehealth can also help in increasing the quality performance measures for ACOs:
The ability of a patient using immersive video and collaboration to stay in touch through care coordinators with physicians, specialists, nurses or social workers enhances the patient caregiver experience.
To succeed ACOs have to create appropriate team plays. Collaboration allows ACOs to dynamically build appropriate care teams to manage patients in different care settings. This helps in driving care coordination and patient safety metrics
Appropriate technologies as well as high touch virtual collaboration through immersive video can help with at-risk patients in any care setting. Structured education and trending personal health records drives adherence, compliance and better outcomes.
All that is good but is there an ROI for collaborative solution video and Telehealth? Yes, our ROI models have shown that such solutions can increase shared savings as well as improve the quality metrics.
However, the health of the ROI will depend on a sound network architecture and the investment in appropriate Video and Telehealth solutions:
The Telehealth solution should be scalable. Statistically 20% of the patients are responsible for 80% of the costs. Even with the smallest ACO with 5000 patients that translates to at least 1000 patients that need closer care. Even if 20% of these are at-risk that translates to over 200 patients that need a high touch video collaboration. This besides the Telehealth network across the care continuum of the ACO eco-system.
The Telehealth solution should accommodate and adapt to a variety of tethered and untethered end points as well as bandwidths
The Telehealth solution should be resilient and stay alive in the case of server failure
The Telehealth/Video and Collaboration solution should be built on a medical grade network infrastructure with a solid foundational architecture
The Telehealth solution should be simpler than a telephone to use. Single click collaboration will widen adoption
Primary care physicians and specialist need to collaborate on patients. The Telehealth solution should allow physicians, specialists and radiologists seamless collaboration with medical images without having to exit out of the collaboration session
The Telehealth solution should have the ability to push or pull data to/from EMR’s
ACOs are team plays so the Telehealth solution should allow the primary care physician and a team of specialists or care givers to examine a patient at the same time with vitals being shared to providers that need to see or listen to the telemetry. A variety of telemetry devices will allow different specialist to take advantage of the solution and provide cost saving virtual care
The Telehealth solution should allow grouping of specialists from different systems by specialty, care team or language. The system should abstract all complexities of contact center, collaboration technology, presence, firewall traversal and build these virtual groups as if they existed in one physical organization
Physicians are not always available, the solution should indicate presence status of the care givers so that the available care provider can be brought into a consult when needed
Finally an ACO creates a virtual organization and the Telehealth solution should integrate into the business and IT architecture of the ACO
An ACO is a collaborative organization. Healthcare services will be delivered over the network. The business architecture will implement on the IT and Network architecture; it is important to ensure that the network architecture foundation is strong and secure.
There will be big ACO successes and some not so big. Factors that will drive success are:
Healthcare ICT and careful architecture considerations
Immersive and pervasive collaboration and team play
An ACO creates a new way to deliver care. Process will be key to ensure operational efficiencies. Mapping out the care process across the continuum for each condition, cardiac bypass or diabetes or any other condition, then creating a checklist and ensuring adherence and compliance with the process across the care continuum will help in predictable outcomes. A team of process designers to design these processes and then measure them through appropriate metrics will allow optimizing and realizing desired outcomes as well as shared savings. Success will depend on vision, strategy and execution.
It’s a great time to be at Cisco. Earlier this week, Susie Wee, chief technology and experience officer (CTEO) for the Collaboration Technology Group, unveiled the “collaboration geeks”: the engineers, researchers and designers behind the technology, to a handful of press and analysts. We were excited (and a bit nervous!) to share how Cisco is approaching user experience (UE) and design. These changes aren’t just happening from the product side, but are also evolving our internal thinking about being more user-centric across the organization.
Have you ever heard of a CTEO? Probably not, because it is a new role that we created to address the importance of coupling user experience and technology. As CTEO, Susie is responsible for driving innovation and experience design in Cisco’s collaboration products and software services. The first step involved in making a cultural change is how we approach product design. But what does this mean for her team? Below is a short excerpt from our User Experience Day event.
At Cisco, we’re dedicated to changing the way we work, live, play and learn. We’re always looking to break down barriers among staff; one example is how we’re approaching user experience design. Our team is looking into principles, guidelines, and archetypes that represent an organizational-wide approach to user experience design. The design team really lays the foundation for growing the influence and scope of all the UE specialists into strategic conversations where user experience can impact what we design and how we design. We coined the term “XQ” as the eXperience Quotient of the organization. XQ is a tool and metric that we developed to measure our customer’s experience with our products and our user experience-centric development process.
Another example is how our engineers are thinking about their products from the user perspective and pulling in the user experience designers and my team (user experience researchers) as well. To showcase this at the event, engineers brought in a number of XQ demos to show this thinking firsthand: Read More »
Gartner recently released their 2012 Magic Quadrant for Corporate Telephony, and I am incredibly pleased to share that Cisco was placed in the leader’s quadrant. These results come just after Cisco was recognized as a leader in Gartner’s 2012 Magic Quadrant for Unified Communications. We believe that, together, these reports signal the momentum that Cisco is experiencing as a leader in Collaboration.
And yes, the momentum has been strong! This past April, Cisco achieved a new milestone by shipping more than 50 million IP phones. We’ve also gained significant traction with Cisco Jabber, which enables instant messaging, conferencing, voice and telepresence video on multiple devices, increasing 55% in license volume year over year.
Our history of success has been validated many times before, not only by sales growth and market share gains, but also acknowledged by technology analysts as an industry leading vendor in this space for more than ten years. Most of you have followed this validation and we believe this year’s Magic Quadrant is just another example.
At Cisco, we understand that our customers don’t make decisions on data, voice or video alone. Instead, they are looking for integrated solutions that deliver the rich media capabilities their users demand, and at the same time, provide the agility, resiliency and high quality experiences the business demands.
According to Gartner analysts Jay Lassman, Geoff Johnson, and Steve Blood in their Corporate Telephony report, “We evaluated vendors for their understanding of how customer needs are changing (both for users and the IT group responsible for managing telephony). It was especially important to see how vendors proposed to complement, or compete with, UC collaboration solutions.” Read More »
I was lucky enough to meet GE CEO Jeff Immelt at a Cisco event some years ago and interview him on the topic of leadership. My biggest takeaway from listening to him: leadership is about how you “show up.” In other words, it’s how we act and behave in everyday situations that define our leadership persona. I’m pretty sure he meant it literally, as in how we “show up” in the physical world.
But how do we “show up” as leaders in a world where work is increasingly done on a mobile phone or tablet, or using a video chat, web conference or Telepresence? This is one of the great leadership challenges of this hyper-connected world: as a leader you will need to know what I like to call your “Collaboration Persona” – that way in which your leadership style shows up when you’re not in the physical world.
How should you approach building your Collaboration Persona? Here are three steps:
1) Know yourself: Whether it is in the physical world or virtual, how we show up should authentically represent who we are. Click here to take a quick online assessment to discover your authentic communication style (Click on the green “Take Survey” button). This confidential assessment is a bit like the Myers-Briggs test and provides you with a customized profile of your unique communication style; it reveals how you naturally process information, and how you prefer to deliver that information to others. Most importantly, the assessment provides a simple vocabulary to communicate your style to others. Are you conceptual or analytical? An introvert or an extrovert?
2) Know where you excel as a “Virtual Star”: Just as you play to your strengths in the real world, play to your strengths in the virtual world. Here are some examples:
If you are a conceptual thinker, you will excel when the team needs someone to explain the aspirations of a decision, such as a vision. These thinkers will be good on video presentations during virtual meetings. It’s not that conceptual people aren’t good in online discussion forums where the medium calls for more precise language; it’s more about playing to the strength of conceptual thinkers – they love talking about ideas and tapping into that passion on video is a great way to play to one’s strengths.
If you are an analytical thinker, you will excel at “making it real” when communicating a decision to your team. These thinkers are outstanding in virtual mediums where precision communicates best – such as online question and answer sessions and discussion forums. Again, it’s not that analytical thinkers aren’t outstanding on video, where the communication is sometimes more free-flow; it’s that online Q&A and discussions forums play to the strong logical nature of analytical thinkers – they love communicating the steps taken, the process used, and the supporting facts of a decision.
3) Get out there and practice on your medium: When you align your communication style to these new forms of communication, you’ll find it easy to participate in the increasingly virtual, mobile, social and visual work environment that your teams leverage to get better, more productive results every day. You can’t underestimate how your team will appreciate your unique efforts at participation in the world they live in.
At last week’s iHT2 Health Summit at the New York Academy of Medicine, I had the pleasure of introducing Dr. Ben Kanter, chief medical information officer at Palomar Health, California’s largest health district. During his presentation, Dr. Kanter discussed the new $1B, 11-story Palomar Health Medical Center in western Escondido which opened for patient care on August 19, 2012. Called the “Hospital of the Future” by healthcare pundits, the new Palomar facility integrates key technologies, such as EMR, video and collaboration solutions, into an environment that uses nature, light, and outdoor space which work together to promote healing.
During the design phase, Palomar’s leadership team, including Dr. Kanter, worked closely with Cisco on the goal of creating a higher level of mobility and collaboration among clinicians, patients and their families. Cisco technologies currently in use include unified communications (video, WebEx, Wireless IP Phones) along with Unified Computing System, all tied together via a wired and wireless Cisco medical-grade network.
Dr. Ben Kanter, chief medical information officer at Palomar Health:
“The ability Cisco provides to tie everyone in the hospital together – patients, nurses, pharmacists, physicians, infection control, administrative teams -- through a security optimized, mobile and video-enabled environment, will have significant, positive impact across the healthcare continuum. Now patients have greater freedoms within the hospital, without compromising their health, as they are observed both inside and outside of hospital walls. And the ability for our doctors to review patient information from a mobile device, and conference in a nurse and a specialist at the same time to discuss the case, will completely change patient care.”
We invite you to learn more about Palomar Health and to watch a four-minute highlights video about the new medical center.