Welcome to Intelligent Healthcare Insights

Treo Solutions’ Intelligent Healthcare Insights Blog provides the latest information on healthcare policy, administration, analytics and research to provide you with insight and information on the changes, challenges and opportunities presented by healthcare transformation.

Our authors provide perspective for providers, payers, intermediaries and patients on topics that include Total cost of care, population health management, meaningful use, predictive modeling, accountable care, ACOs and Medicaid and Medicare.

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September 3, 2014

What Can Go Wrong with PCP Attribution and How It Can Be Prevented

A collaborative effort to improve PCP attribution can impact population health efforts

Attributing a person to a primary care physician (PCP) is an essential feature of population health management because it enables an accurate and fair assessment of the quality of care a provider delivers. Attribution is based on the concept that a PCP is responsible to a person across time and the entire continuum of care. It establishes this responsibility, creating a relationship between a person and his or her PCP.
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August 22, 2014
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August 13, 2014

The Greatest Opportunity for Value Happens When Incentives Align with Cost and Quality

Data from early-adopter ACOs proves that incentive alignment is key to achieving high-value health care

We have been working with clients engaged in accountable care initiatives for several years now. As the early adopters are becoming seasoned veterans, we are able to derive lessons learned from those initial experiences. One lesson is clear: provider incentives must align with both cost and value.

Four Things Providers Need Before They Can Embrace Value-Based Payment

Success with value-based payment models means preparing providers for the transition

The concept that payment for health care should be based on quality and clinically meaningful outcomes is not new; but the current breadth, variety and rapid adoption of value-based models is unprecedented. Value-based payment models now include accountable care organizations (ACOs), patient-centered medical homes (PCMHs), bundled and episode-based payments, and pay for performance structures.

The Untapped Savings Opportunity for ACOs: Engage Specialists in Your Total Cost of Care Program

To sustain success, ACOs should incorporate episodes to measure specialist value

A recent article in Health Affairs discussed how early Medicare ACOs have largely ignored the role that surgeons and other specialists contribute to the total cost of care (TCC) for their patients. The results of the survey are not surprising. We see ACOs across our client base focusing on the same low-hanging opportunities to create savings: improving care coordination in an effort to reduce preventable initial admissions, readmissions and ER visits. The good news is that this approach works, at least in the beginning.
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July 25, 2014

Will the “Quantified Self” Change Health Care?

Yes. To achieve real success in population health we need health care consumers to actively engage in the behaviors necessary to secure their health. “Patient” engagement is the holy grail of health care. However, despite decades of research into health behavior and ways to change it, we don’t seem to be any closer. I think that is about to change. 

July 17, 2014

A 30th Birthday Party for the DRGs

Celebrating the methodology that forever changed hospital inpatient financing

On June 12, Xerox Corporation and 3M Health Information Systems sponsored a full-day symposium to honor the 30th anniversary of the implementation of diagnosis related groups (DRGs) titled “DRGs at Age 30: Looking Back, Looking Forward.” In today’s America, it’s hard to imagine a government healthcare initiative that is supported by both Republicans and Democrats, saves billions of dollars, improves health care, and is adopted by payers throughout the country -- and then around the world.

Medical Homes: It's Not “Do They Work?” But “How Do They Work?”

Finding what works for improving the medical home model

Earlier this year, the Journal of the American Medical Association (JAMA) published a widely publicized but limited article on medical homes in Pennsylvania that found little improvements in quality and no improvements in costs or utilization associated with medical homes. The authors concluded medical homes may generally “need further refinement” -- a phrase that was taken by many in the press to mean that medical homes “don’t work.”

July 1, 2014

The Iowa Health and Wellness Plan Uses a Health Risk Assessment to Uncover Why Patients Don’t Get the Outcomes They Want

Iowa relies on Treo’s AssessMyHealth.com tool to gain insight into social determinants of health and patient-reported information

When a person fails to follow recommended treatment plans we might label them ‘”non-compliant” because we lack insight into the multiple other issues that get between people and the outcomes they want.  Some of these issues include a lack of adequate finances, difficulty accessing care in a timely manner, not understanding instructions, and lacking confidence in the ability to self-manage.

If health care providers have a reliable way to unmask these issues it gives them powerful insight into opportunities to improve outcomes, for example:

June 25, 2014

APR-DRGs’ Aftermath in New York: Changing the Payment Dynamic

New York’s payment system is based on a newer, more granular methodology resulting in big changes for payers and providers

The New York State (NYS) Medicaid program transitioned to a risk-adjusted inpatient payment system at the end of 2009, using All Patient Refined Diagnosis Related Groups (APR-DRGs). Treo Solutions supported the NYS Department of Health’s inpatient transformation and calculated the payment system metrics, including relative weights.