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.

Posted in:
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.

Posted in:
June 24, 2014

Live from HFMA: Will Data Fix Our Broken Health Care System?

HFMA keynote Atul Gwande promotes data and understanding population health as the solution for a broken health care delivery system

At the 2014 HFMA conference here in Las Vegas, Dr. Atul Gawande delivered the keynote address and outlined four emerging lessons about U.S. health care. They are:

  1. The debate about whether to provide health care coverage to Americans is over.
  2. The delivery system is still broken.
  3. Understanding the sickest is how we fix our health care system.
  4. Success requires making data the most important resource to clinicians and patients for improving care.

So, what does this really mean and what is missing from this picture?

June 12, 2014

Is Socioeconomic Status Another Dimension for Health Risk Adjustment?

A review of the debate over incorporating SES factors into the Medicare Hospital Readmissions Reduction Program

The Medicare Hospital Readmissions Reduction Program (HRRP), established under the Affordable Care Act (ACA), provides a financial incentive to hospitals to lower readmission rates. Beginning October 2012, the HRRP, which applies to all general hospitals paid under the Medicare Inpatient Prospective Payment System (IPPS)1, imposed a financial penalty on hospitals with excess Medicare readmissions. Debate has followed around the appropriateness of adding socioeconomic status (SES) factors to clinical factors in risk-adjusting targeted readmission rates.

June 9, 2014

Health Equity: Data and Analytics Are The Great Equalizer

The same tactics for improved public health can be applied to addressing health care delivery and access

Those in public health believe that everyone is entitled to breathe the same clean air, drink the same safe water, and eat the same uncontaminated food.  Public health protects and promotes health for everyone -- regardless of race, sex, age, socioeconomic status, whether among rural or urban dwellers, whether the employed or unemployed.

Posted in:
May 30, 2014

The Family Physician: What It Is, What It Is Not and Why It Matters for Population Health

A recent effort in redefining the role of the family physician is one path to improved population health outcomes and lower cost trends

Good population health outcomes and cost trends are more likely in settings with a good foundation of primary care (Macinko 2007). So, it makes sense that those developing programs to support healthcare delivery system changes would benefit from a clear description of high-performing primary care. A rigorous definition of the role of family physicians provides clear insight into key program details. 

Posted in:
May 30, 2014

The Power of Multi-Payer Initiatives: Plans Collaborate to Meet Demand for Consumer Price Transparency

The Health Care Cost Institute partners with major health plans to announce transparency tool

The Affordable Care Act is having a clear impact on the transparency movement. With the rise of high-deductible health plans and the exchanges, consumers need access to healthcare cost and quality data now more than ever before. The demand for transparency tools continues to grow.