- The Connected Patient: Using Digital Health in Care Management
- MSSP Rules: Barriers to Using ACOs for Multipayer Contracting
- Federal Court Upholds Virginia's Certificate of Public Need Laws, Fueling Ongoing Antitrust Debate Concerning the Future of State CON Programs
- California Court of Appeal Reminds Medical Groups That Certain Risk-Sharing Arrangements May Require a Knox-Keene License
- Better Late Than Never: CMS Provides Much-Needed Clarity on the 60-Day Overpayment Refund Requirements
Authors: Jill Thorpe, Partner, Healthcare | Kier Wallis, Senior Manager
Editor's note: Medicaid programs are increasingly driving delivery system transformation, changing how providers care for Medicaid populations and how they are paid for their services. Working with their community partners, providers have begun to develop a variety of innovative, person-centered care management models that attempt to better integrate the delivery system with critical social services—and the reinvention of care delivery is just beginning. In a recent webinar, "The Connected Patient: Using Digital Health in Care Management," Manatt Health explored how emerging care management models supported by digital technologies can help improve the health of Medicaid populations and the quality of care they receive, while also reducing costs. Key points are summarized below. To view the program free on demand, click here. To download a free copy of the presentation, click here.
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What Is Connected Health?
Broadly speaking, connected health is a model for healthcare delivery that uses technology to provide healthcare remotely. Connected health aims to maximize healthcare resources and provide increased, flexible opportunities for consumers to engage with clinicians and manage their own care. Connected health can cover a wide variety of areas. For example, it can be a way for life sciences companies to engage with patients, for researchers to collect patient-generated data, or for family and friends to build a support network to promote a patient's health and wellness. For connected health in care management to scale, however, selecting the right digital health tools for a targeted population is essential.
Because possibilities of connected health in care management are vast, this article focuses on the use of connected health for a particular target population: Medicaid patients. Not only are Medicaid patients a large, addressable population with particular needs, we believe connected health in care management for these patients will gain significant traction as a result of Medicaid-led reforms. Before turning to specific connected health solutions for this population, we provide an overview of "megatrends" driving the adoption of connected health solutions generally and an overview of these Medicaid-led reforms.
What Are the Megatrends Driving Connected Health Adoption?
There are five key megatrends driving the adoption of connected health:
1. The shortage of physicians and nurses;
2. The move to value-based care and payment;
3. The ubiquity of consumer devices, making it possible to address disparities in access;
4. Consumer demand for choice, including price and quality transparency, as well as increased convenience and personalization; and
5. The aging population, requiring in-home care.
In addition, there are four key enablers of connected health adoption:
1. The rise of HIPAA-compliant clouds that offer stronger levels of privacy and security;
2. Emerging assessment standards that reduce friction between technology vendors and the covered entities;
3. The rise of electronic medical records (EMRs) and the associated demand for interoperability and real-time data to drive actionable interventions; and
4. The growing venture capital investment, with $8 billion currently invested in health technology companies.
What Are the Medicaid Trends Opening Opportunities for Digital Health?
Since Medicaid's creation in 1965, it has become the nation's main public health insurance program for the low-income population. The passage of the Affordable Care Act (ACA) in 2010 sought to expand Medicaid coverage to millions of previously uninsured adults and streamline enrollment. The ACA also emphasized the need for the Medicaid delivery system to transition to increasingly coordinated and innovative care models with the goal of achieving the "Triple Aim"—improved care for individuals, better population health and reduced costs.
As of February 2016, 30 states and Washington, D.C., have expanded Medicaid, and Medicaid is the single largest source of coverage in the United States. Most states that are expanding Medicaid are doing so through their existing delivery systems. In many states, that means expanding through managed care where states contract with managed care organizations (MCOs) to provide services to the Medicaid population. MCOs accept capitated payments or a set payment amount for the services they provide, encouraging the MCO and its provider network to effectively manage care and reduce unnecessary utilization.
As we think about emerging trends in Medicaid, expansion is certainly at the forefront, but expansion is happening in conjunction with delivery system and payment reform. New York's Delivery System Reform Incentive Payment (DSRIP) Program and Arkansas's multipayer, episode-based bundled payment program are just two examples.
Why Should Technology Be Integrated Into the Care Process?
The dynamic between patients and providers is quickly changing to include technology. Just as people are increasingly comfortable navigating between physical and virtual environments using their smartphones, patients are becoming increasingly comfortable using connected technologies to interact with their healthcare providers.
According to some studies, as many as 20% of patients actually prefer some form of electronic communication—such as video, email or texting—to an in-person office visit. Also, according to survey results released by the Office of the National Coordinator for Health IT (ONC), 81% of people who access their health information online found the information to be useful. ONC also found that people with online access to their electronic health records (EHRs) have a greater desire to do something about their health. Connected health solutions in care management therefore present additional avenues for patients to engage in their health, supported by their health teams.
What do providers think about patients and technology? A recent Accenture report found that providers have a favorable view of patients' technology adoption, reporting that it improved patient engagement, satisfaction and communication.
How Can Connected Health Technologies Be Integrated Into the Care Process?
Integrating connected health technologies into new modes of delivering care is a doubly daunting process and presents its own barrier to adoption. To overcome this barrier, it's worth learning from a real-world example of how it was done. We provide below a case study of how in-home remote monitoring technologies were adopted in a new care management program, and then consider other kinds of connected health technologies that are particularly well-suited to be integrated onto the same care management platform for Medicaid patients.
Case Study 1: Care Management With In-Home Monitoring
In 2012, the Health Resources and Services Administration (HRSA) awarded its first peer-to-peer grant for one federally qualified health center (FQHC) to teach another FQHC how to stand up and provide chronic care management services using in-home remote monitoring technologies. The project offers a model of how a DSRIP-funded project could be established to accomplish the same goals.
The Mentor: Roanoke-Chowan Community Health Center (RCCHC) is an FQHC operating in Eastern North Carolina in one of the poorest congressional districts, with a median income of just $23,500 and 21% of the population uninsured. As one might expect among low-income, poorly educated populations, there is a high incidence of chronic disease, such as cardiovascular disease, diabetes and hypertension. There also are significant barriers to care, including lack of transportation and poor health literacy.
RCCHC adopted in-home remote monitoring technologies—wireless weight scales, blood pressure monitors, glucometers and pulse-oximeters—into its care management program in 2006. Researchers from Wake Forest Medical School validated the positive clinical outcomes of its care management practice and published its findings in peer-reviewed journals. In the intervening years, RCCHC provided care management services to other healthcare providers in North Carolina through North Carolina's Telehealth Provider Network and began to contract with accountable care organizations within the state.
The Mentee: Mosaic Medical Community (Mosaic) is an FQHC in Oregon with 12 locations serving 23,000 patients, most of whom are enrolled in Medicaid. Mosaic did not have any care management workflows and was in the preparation stage of being connected to the Oregon Clinical Health Information Network (OCHIN), the health information exchange and shared electronic medical record for Mosaic and other members of Oregon's Coordinated Care Organization (CCO).
The Project: Under the HRSA grant, RCCHC's team of clinicians and project management consultants provided technical assistance on all phases of implementing a care management program with in-home remote monitoring but did not do so in a vacuum. At the same time, RCCHC worked with Mosaic to plan the transition of its care management program from a paper-based program to an automated workflow integrated with OCHIN. In addition, RCCHC worked with Mosaic to develop a train-the-trainer program, so that Mosaic can...
