PROFESSIONAL PATIENT ADVOCATE

Advocating helps today Teaching self-advocacy helps

for a lifetime

The shifting paradigm No longer a physician controlled

relationship Patients expected to comply or they will

receive less attention Changes in reimbursement to reflect FFS,

and changes in therapeutic outcome and process

Risk adjustment for payment strategies Penalties for non-participating physicians

FROM CONFUSION TO FUSION

Jeffrey HarrisUntangled Healthcare

Untangled HealthcareAssisting communities to monitor and improve healthcarewww.untangledhealthcare.comwww.untangled health.com All presentations on Slide shareJeffharris@untangled healthcare.com

"Go to the people, live with them, learn from them....Start with what they know, build with what they have...."Lao Tzu

The new payment model Process and Outcome Measures Fee for Service Improvement from Baseline Accountable Care Organizations Carrot

and Stick

28% of 500 persons with no previous healthcare visit in prior year to death

We can’t boil the ocean but we can teach people their right to access

The Patient Advocate ProcessTransition Management

Monitor

Discover

Bio-Psycho-Social HistoryGoals, Wants, Needs

ActivateInsurance ExchangePrimary Care Medical Home Patient Contract

Evaluate

Patient ComplianceDisease Self MasteryLearning Barriers Assist

Identify and link community resources:Transportation, Meals on Wheels, Patient Peers

EducatePrimary and Secondary PreventionSelf MonitoringResource UtilizationUrgent Care GuidelinesCommunication Skills

Functional StatusPhysicalSocialCognitiveComplianceComorbidity

Assist with reporting outcomes to PCP

ALPHABET SOUPNHIN (National Health Information Network)The components of HIT: NHIN, e-HR, e-Rx, e-labs, Secure messaging, online appoints, Patient right to electronic file within 24 hours (not e-fax) Computerized order entryTimeline-2010-2017

Health Information ExchangesState Level

Com

mun

ityHI

E

Business Domain HIE

Provider Groups

Health Plans

The Patient’s Universe and Patients Rights to Share

Prescription and

Diagnostic Testing

Standards

Personal Health

Records

Hospital Systems and Ambulatory Centers and PracticesElectronic Medical Record

Old TechnologyElectronic Health Record

New Technology

HITECH Act Enforcement Final RuleThe Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009,

was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology. 

THE TOOLS YOU USE WILL BE DEPENDENT ON THE STAGES OF DEVELOPMENT IN YOUR

LOCAL ENVIRONMENTManual transcription errors of critical information used to influence critical

treatment decisions continues to be the largest source of “therapeutic

misadventure”

Office of National Coordinator For HIT

Data Set Considerations Addressed by standard

Identity Verification

• Provider Info, e-HR info, PHR Info, Demographics

• Involves requirement to produce audit similar to credit report, who, what, when, where

Access Restriction and Management By Data Class

• HIV/SIDS, Mental Health, Substance abuse, Sickle Cell, Genetic Information, STD, Developmental Diabetes

• The ability to control who can see, edit, save: Includes time limitations, embargoed records

Content Preferences

• Service reminders, Labs, Advanced Directives, Living Will, DNR, Healthcare Proxy, Lab and test results, Language needs, Clergy Preference

Components of Access Management

• Level or Status (Opt In, Opt Out)

• Involves requirement to produce audit similar to credit report, who, what, when, where

Consent Information

• Requester type and location, purpose and use, sensitive flags such as Labs, Meds, Diagnosis, Notes

• The ability to control who can see, edit, save: Includes time limitations, embargoed records

Content Preferences

• Service reminders, Labs, Advanced Directives, Living Will, DNR, Healthcare Proxy, Lab and test results, Language needs, Clergy Preference

Local hospital affiliate

Local Pharmacy

Single Practice EMR Silo

Non Integrated System

Graphic Representation of National InitiativeData Exchange Illustrated

Integrated System with e-HR

Health Info Exchange

EHR

Specialist EHR

PCMH

SureScript

s

PharmacyCom

mun

icatio

n Ba

rrier

PHR

Hospital System

EHR

Various Labs

LIMS

fImaging

PACS

Resources

Resources

Selecting providers

Payment ResourcesDon’t forget PAP Programs

Activating Patients

My PHR

How I connected my system

Located physician with knowledge of health data interchange and motivation to heal

Located surgeons who would treat me as equal

Located tools online that worked and were interoperable

Created my own accounts {HealthVault, Connected to

Connected to CVS, SPINN secure Communication and LabCorp

Decision Support

Details of record source

Who ordered drug

Med

icat

ion

Reco

ncili

atio

n

Where did record come from

Is this patient staying with medical home or Dr. Shopping

Family History

Mon

itor

ing

My Droid Diabetes Meal and Insulin Managers

Choosing a hospital

If patients are readmitted is that the hospital issue or does it say something

about the supporting community?

In conclusion, patients hospitalized with CHF have a high risk for readmission after discharge. Patients with a history of hospitalization as a result of CHF, longer hospital stay, and a history of hypertension are at increased risk for readmission, and our data suggest that socioeconomic factors, including poor follow-up visits, poor professional support, and no occupation, are also potentially important predictors. Therefore a systematic CHF patient management system that coordinates care in the hospital, outpatient, and home settings is clearly needed to reduce the morbidity and mortality of patients with CHF and thus lower the over-all costs for the treatment of these patients.

What we have known for 20 years but just now have the incentives aligned

What Scenarios are Patient Advocates Likely to FaceApparently

Healthy

• Educate on reform• Educate on Medical Home

Episodic Care

• Participate in care coordination• Educate on provider selection and best

practices

Chronic Care

• Participate in interdisciplinary coordination

• Monitor patient for self mastery

Meaningful Use Time Line

2010-2011Attestation to

implement

2012-2013Proof of

adoption and population

management

2014-2020Submission to

ACOs, penalties for not

complying

HITECH Act Bush administration effort to create a standardized electronic health record

Physician Protection and Patient Safety Act: Charles Randle

Accordable Care Act Present Administrate ion Effort to alter reimbursement for first contact, comprehensive and continuous care (Primary Care Medical Home and Insurance Reform

What has changed in last decade

DIABETIC GANGRENE PRIOR TO AMPUTATION

DIABETIC WITH HEALTHY FEETGOOD SELF MANAGEMENT My feet forever

please

What is the difference between an engaged patient and one without influence to engage