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POSTED February 8, 2018

How to Make BPCI-A Work For You

BPCI Advanced is coming fast.

Given the success of many organizations in BPCI 1.0, surgeons and hospitals are eager to capitalize on the financial perks of quarterbacking the entire episode of care.

The basic idea of BPCI-A -- included as an Advanced Alternative Payment Model (AAPM) under MACRA -- is similar to BPCI 1.0 -- i.e. incentivize providers to reduce unnecessary variation across the holistic episode of care.

From our work with leading centers across the country, three themes have emerged as mission-critical to drive bundled payment success:

  • Optimize patients
  • Standardize and manage post-op care
  • Continuously monitor outcomes

Optimize Patients

In the new bundle model- retrospective reconciliation will play a large roll in what your organization can get back from CMS. While we don't yet know specifics of this biannual calculation, we do know that quality performance can alter your reconciliation amount by up to 10%. So focusing on improving this metric is key, as it can have significant impact on your CMS reimbursement.

Patient optimization is a critical part of cost & quality improvement. There are a wide-range of validated risk assessment tools and research on the hard stops for surgery (e.g. A1C levels, BMI, smoking, etc.). It’s imperative that all physicians buy into and leverage these tools to ensure the right patients are being operated on. For patients who are not optimized, there must be resources to support them in the changes that can be made to get them to be a safe and successful surgical candidate.

Standardize and manage post-op care

For joint replacement, the variation in cost occurs after discharge (30-50% of total episode cost is post-acute). The hospital stay is micromanaged, but when patients return home, Care Teams lose complete control of the outcomes. Patients are on their own, and without ongoing education, communication or monitoring, problems arise.

Historically, Care Teams relied on traditional post-acute services (e.g. SNF, Home Health, Outpatient PT) to manage their patients’ recovery, but these services are costly and cannot be sustained. Many top centers have begun to digitize recovery with tele-rehab and remote navigation, proven to enable control for a lower cost, and this trend will only continue to grow.

Continuously Monitor Outcomes

You can’t improve what you can’t measure. In order to build a culture of ongoing improvement, you must track outcomes (e.g. PROs, patient satisfaction, etc.), episode costs and complications in as close to real-time as possible. Teams must have analytic capabilities to understand unnecessary physician and facility variation. Evidence will not only expose current opportunities, but can point to and validate future solutions.

The only way to achieve this efficiently is to increase connectivity with the patient, so data can be collected wherever they go. Implementing real-time monitoring that consistently engages patients is the best way to capture valuable data that can guide system-wide decision-making.

Even the most efficient providers are committing to care redesign in the face of BPCI-A. They will need to overhaul their service lines quickly and thoughtfully, in order to get the most bang for the healthcare buck with this new model. It’s time to embrace the change.

Applications are due March 12th. For information on how to apply, click here


POSTED January 17, 2018

Creating a Valuable Patient-Provider Relationship

Ange Delgado leads the product team at Force

Implementing value-based care means improving or maintaining quality while reducing costs and variation. Given that many unnecessary costs occur when the patient is in the hospital, (and that shorter hospital stays decrease risk of infection) reducing length of stay is a priority. However, the less time patients spend in the hospital and around the care team, the more important it becomes to extend patient - provider communication outside the hospital.

The transfer of information from provider to patient is a critical element of successful care. Traditionally, that transfer occurs through in-person visits, hours of phone calls, and a paper packet of information that gets sent home with the patient. Providers remain a key source of patient instruction and direction, but intermittent phone calls and few in person office visits are not sufficient across an episode of care.

Many organizations are looking to technology to help them keep in touch with patients outside the hospital. The obvious solution is to use messaging tools to bridge the gap between patient and provider. While this is a good first step, simply opening up more access to 1:1 conversation might actually add work for providers rather than decrease it.

Building a messenger alone doesn’t replace the large educational paper packet that patients are sent home with and told to read. And it doesn’t help provider have better context for patients’ questions. Tech platforms have a unique ability to effectively answer questions before they need to be asked. Here are some important features for scaling communication:

Asynchronous messaging and telecommunication

Telehealth has been a buzzword for strategies in implementing value based care. While real-time video visits give providers a great sense of a patient’s progress, they are criticized for not actually saving providers much time. A solution to that problem is asynchronous video. Patients can send video updates demonstrating wound healing, range of motion, gait -- all without the need for the patient and provider to be sitting down at their computers at the same time. With asynchronous video, providers can review videos on their own time.

Real time data collection

Responding to patient concerns and questions about their progress can be difficult and inefficient without insight into their progress. Collecting and displaying data points including step count and pain level helps care team members understand the context for their patients concerns. This reduces the need for follow up questions and allows for swift, thorough responses.

Phased, digestible education

While it’s important to manage patient expectations and explain the care plan well ahead of the surgery, attempting to understand every detail at once can be overwhelming. Paper packets can be long and confusing, and long conversations during in-office visits can vary and be forgotten. Standardizing and delivering the details at the right time, and in the right medium, makes a big difference.

If the goal is truly to scale the most important and underutilized member of the Care Team -- the patient -- then care delivery itself has to change. Innovating around the way clinical information is shared is part of that shift. As care continues to move online, there is opportunity to create a new transparency and connectivity within the patient-provider relationship. Providers who adopt the right technology, can offer unprecedented levels of clarity to patients and Care Teams.


POSTED January 4, 2018

Power User Spotlight: Katie at Muve Health

Here at Force we are lucky to work with some pretty incredible healthcare professionals. This spotlight series serves to celebrate some of the fantastic users of the Force platform. It's a chance to learn from Force pros about favorite features, tips and tricks and learn more about them in the process.

Katie is a navigator at Muve Health. With over 10 years of orthopaedic nursing experience, Katie is no stranger to the changing tides of healthcare and rolling with the punches to ensure the best outcomes for her patients.

Compared to your prior nursing experience, how has now using Force changed your day to day?

I’ve had the fortunate opportunity to practice in a similar role that I’m doing now in the past with trying to manage patients preoperatively and postoperatively. Being able to communicate with all of my patients via 1 seamless platform has made my life so much easier as well as having the opportunity to ensure that patients are being compliant with what has been prescribed for them.

What features do you find most useful?

Having a view of who is all caught up on their forms has been super useful. It gives me a quick glance of who I need to follow up with. I also really enjoy being able to receive pictures through the messaging system. This allows the patients and me to have a safe environment to check on them.

Do you find that Force makes you more efficient? If so, what do you do with the added time?

It absolutely makes me more efficient!! I am now able to spend time talking with the patients about their emotional needs for the procedure they are about to have and create a deeper connection with them. This in turn I have found, creates a bigger accountability to complete their surveys/forms. It’s a win/win for everyone!

How do you think about technology’s role on a care team now and in the future?

I don’t know what I would do without technology being a part of my care for a patient. It’s how we all communicate these days and allows us to track outcomes and most importantly reach patients that may not have easy access to healthcare with the exercises. I’m sure it will only increasingly become part of the way healthcare is delivered in the future.

What other challenges are you facing that technology could address?

I think we still have a lot of opportunity in the way we integrate with other health care services. There seems to be a gap in what happens at the doctor's office, hospital, therapy services and whatever else the patient may utilize to have a successful surgical outcome.

What's a fun fact about you?

I have participated in 7 Spartan Races!!


POSTED December 13, 2017

Charlie Martin and the New Business Mindset

In a recent episode of A Healthy Dose podcast, interviewee Charlie Martin shared his thoughts on the future of healthcare. The founder of the Vanguard Health Systems, who entered the industry quite literally from the ground up with his work in construction, is now planning on tearing it down. In his own bio, he presents himself as a man on a new mission. “As a former hospital operator, Charlie Martin is well aware that he was part of the problem with healthcare and healthcare delivery. Now, he wants to be part of the solution.”

While some of his thoughts on the issue were a bit radical -- his ideal scenario involves cutting in-hospital care in half, and doing “the half that’s left...for half the price.” -- his line of thinking speaks to the coming trends and changes.

The issue is, the entire healthcare system costs too much, and changes must be made to maximize efficiency. The question then becomes, what are the leaders doing now to position themselves in a way that prepares them for this future ultimately leading them to greater success than those that don't?

Adopt a Commercial Business Plan and Mindest:

Going digital to go global

Uber is a leading taxi service without owning cars, AirBnB is a major hotel competitor without owning buildings. Software and digital platforms are gaining serious traction in every other industry, and it will in healthcare too.

Physical hospitals are massive cost drivers, so moving recovery into the home, which has positive impacts on outcomes anyway, will keep costs down. Many health systems are already doing this, but without fully rectifying the miscommunication that comes with distance. Technology can help bridge that gap with communication and education while preventing unnecessary post-acute costs.

Right now, physicians have to increase their patient volumes astronomically to maintain a profit. But, in current systems, more patients means harder to manage. Going digital expands reach to any patient no matter how far, while physicians better manage the high volumes of care.

Create an Experience

In a commercialized market, inundated with choice, healthcare systems will need to find new ways to captivate the “consumer patient” by meeting them where they are -- they way every other business does. Offering a stellar product isn’t enough anymore. You have to frame your product to fit into a holistic experience.

The first step is to understand that your entire episode of care is the “product”. Each step in the care process must then be treated as equal parts of the whole, from the moment surgery is scheduled, through recovery. How patients experience that product is clinical, administrative, and emotional. Health systems are becoming responsible for all of it.

Transparency with Cost and Effectiveness of the Product

As it stands, patients are only presented the final cost of a given procedure after the fact, when the explanation of benefits comes in the mail. That’s like picking out a pair of socks at the store, only to find out after the credit card swipe that they cost $100, and there's no return policy. But in a consumer-centered market, that may not always be the case.

Heightened healthcare competition requires key differentiators, on which patients can base their consumer decisions. As patients increasingly become major players in the payor game, they will actively seek out the best bang for their buck. This shift will put pressure on systems to prove excellence in both quality and price.

To do this, you have to collect valuable data and use it. By implementing actionable metrics you can gain insight into how to make your already great product even better in the eyes of the consumer. Then, when you’ve created an episode of care with evidence of quality, you can market the product effectively. Consumer-patients do their research, they want proof they are making the best purchase.

Health organizations that capitalize this business-mindset strategy will earn their spot as a Center of Excellence thus earning the high volumes that equate to profit. The leaders in this new market of healthcare will see astronomic payoffs when the transition is all said and done.


POSTED December 8, 2017

Commercialization of Healthcare: Impacts and Future Trends

The days of neighborhood doctors you stick with for a lifetime are declining. We are entering an era of pick-and-choose physicians where the customers can analyze their available options and weigh differences to make a decision. Are their outcomes good? Have previous patients been satisfied with the level of care? Is the price right?

Advances in medicine have allowed us to tackle diseases and increase life expectancies enormously. But just as Dr. Arthur Barkley found back in 1988, “although the collective health of the nation has improved dramatically... surveys reveal declining satisfaction with personal health.” And similar trends exist today, 30 years later. This is more relevant to Healthcare now than ever before as uninvolved patients shift to active consumers.

The gap between healthcare and retail markets grows ever smaller. Dr. Barkley suggested, even in the late 80s, that it is the commercialization of healthcare that is leading this shift and causing a “climate of apprehension, insecurity and alarm about disease.” As patients increasingly play a consumer role in healthcare, it becomes increasingly important that physician leaders apply traditional business insights to their patient relationships. Emotive branding, targeted marketing and strategic communication will need to be used to gain the attention and trust of the consumer patient.

Clearly this idea isn't new, and has been a long time coming. But it is now progressing to a point that can no longer be ignored. We are reaching a breaking point. With cost of care on the rise, patients are now players in the medical financial game and, with new metric-driven technology, can actively seek out the best bang for their buck.

With the Center for Medicare & Medicaid Service (CMS) pushing for an increase in data collection as part of their Meaningful Use program, we will begin to see more transparency into outcomes and provider effectiveness. Patients, now inundated with choice, can and will use this information to make decisions about which centers of care or providers best fit with their needs.

This need for lower prices has driven the rise of alternate payment models, pushing care and recovery to the home, and the need for patient engagement. Healthcare organizations must adapt and restructure to fit this new medical landscape in a way that will benefit both patient and provider.

Capitalism has been at work within the healthcare system but has really only lead to inflated costs. Health care is expensive. Employers can’t afford it anymore, and neither can patients. Instead we must put a commercialized system to work in a way that will benefit the consumer patient. The time for reducing costs must be now.


POSTED November 28, 2017

Same Day Discharge Total Joint Arthroplasty on the Rise

Total Joint Arthroplasty (TJA) is one of the most reliable and in-demand orthopaedic procedures with over 1 million cases performed annually in the United States alone. By 2030, this number is expected to reach 2-4 million. This sharp upward trend is primarily driven by an aging of the population with longer life expectancies.

Sg2 Analysis TJA Projections

Luckily, clinical advancements are keeping up with the demand. Since its introduction in the 1960’s, TJA has become safer, more efficient, and more cost effective. In particular, minimally invasive and anterior approaches have shown to minimize postoperative pain and help patients recover faster.

With the development of new surgical techniques and rapid recovery protocols as well as the CMS’s proposal to provide coverage for TJA in outpatient settings, there has been an increasing trend towards same-day discharge TJA. According to the Ambulatory Surgery Center Association, more than 200 ambulatory surgical centers (ASC) across the US perform outpatient TJAs. Hospitals are also shifting toward outpatient TJA in order to compete with the growing number of ASCs.

There are three main drivers contributing to the shift towards the outpatient delivery model:

1) Reduced costs for both patients and providers

Performing TJA in outpatient settings reduces the overall costs by as much as 50%. Richter et al. have shown that outpatient total knee arthroplasty (TKA), on average, led to $20,500 savings per patient. Aynardi et al. reported similar findings in total hip arthroplasty (THA) population.

2) Increased convenience and psychological benefits

According to Dr. Roy Davidovitch, Director of Hip Center at NYU Langone Medical Center, recovering at home not only adds convenience but also brings physical and psychological benefits that can boost patient’s recovery. Dr. William Hozack, Director of Joint Replacement at Thomas Jefferson University Hospital, shares this view in his recent study about in-home recovery, commenting that, “Patients were generally happy and content in the comfort of their own home during recovery.”

3) Lower risk of hospital-acquired infections after surgery.

Outpatient TJA offers reduced risk for hospital-acquired infection, which is one of the top causes of arthroplasty failure and need for revision. Currently, peri-prosthetic joint infection (PJI) rates for TKA and THA are approximately 0.3-0.6% and 1%, respectively. Although it may not seem high, it is still considered one of the most challenging complications following TJA, resulting in a burden on both patients and providers. According to Solarino et al., prevention should be the first and best strategy. Minimizing the duration of hospitalization would significantly reduce the risk of infection and further hospitalization.

While the future of outpatient TJA seems promising, there are still concerns regarding its safety and pain management. One of the biggest criticisms is the possibility of uncommon yet fetal postoperative conditions including deep vein thrombosis (DVT) and pulmonary embolism (PE).

However, these side effects could be avoided if high risk patients are properly identified preoperatively. At NYU Langone, Dr. Davidovitch and his team are using a comprehensive protocol that they developed with the anesthesiology, nursing and physical therapy departments. His team is also using technology to track patient progress and stay connected throughout patient recovery.

This migration will continue. It’s something of a no-brainer, for qualified patients same-day discharge provides quality care at lower costs.

*Projection Graph data from Sg2 Analytics*


POSTED November 17, 2017

Buzzword Breakdown: "Patient Engagement"

The healthcare industry is facing a time of transition. In any industry, shifts in business models, modes of communication and availability of options lead to changes in consumer behavior, and health care is no different. The consumers of healthcare, once compliant patients, are now key players in their choice and plan of care. Enter: Patient Engagement

What does ‘Patient Engagement’ really mean?

Patients spend most of their time outside the hospital, out in the world, living their lives. Their behavior when they’re on their own will determine how healthy they are.

So, in order to successfully keep patients healthy, it’s important to support them in understanding and participating in their care. Patient engagement is about empowering patients to better take care of themselves.

Why do I keep hearing about it?

The shift towards bundled payment and value-based care has led administrators to focus on increasing efficiency (i.e. reduce costs) while maintaining, and hopefully improving, patient outcomes. This evolution has led to a focus on decreasing hospital stays and face-to-face patient appointments. This means that even more of a patient’s recovery is happening at home. While in many ways, this is good for efficiency and patient comfort and safety, clinicians need better ways to stay connected to their patients as they heal outside the hospital. Without patient engagement and support, good surgeries can result in readmission, suboptimal outcomes and low patient satisfaction.

But if we give patients direct communication, education and documentation at their fingertips, we activate the engagement between clinician-patient partnership. This allows both patients and doctors to regain control over health outcomes

By supporting the patient in becoming a lead player in their care, the entire team can become more efficient and cost-effective. And, as research shows, more engaged patients tend to have a greater commitment to care and personal health. They are therefore more likely to engage in preventative or postoperative treatment and healthy behavior, ultimately leading to more successful patient outcomes.

What does “patient engagement” mean for the future?

Okay. So we know that patient engagement is an asset. But how do you do it well? How do you measure it?

First step is to breakdown the broad term “patient engagement” into actionable metrics. Defining and implementing metrics allows providers access the information you’d have in the hospital, or in this case, information necessary to keeping patients from readmittance to the hospital.

Scalable and measurable strategies  for engaging patients include technology. Technology allows for the necessary level of patient mobility and accessibility, while scaling the work of patient navigators. With the right platforms, organizations can determine what metrics define engagement for them and study the impacts of their efforts in order to create best practices.

Patient Engagement technology is the the golden ticket through the new medical frontier. It can bring care to patients fingertips, so that providers can increase efficiency without sacrificing quality.


POSTED November 14, 2017

Research Showing Efficacy of Home Recovery is AAHKS 2017 Poster Winner

Meredith Crizer is a joint Research Fellow at The Rothman Institute.

While a large majority of orthopaedic centers still refer patients for formal supervised PT following total knee arthroplasty, there has been growing interest in effectively providing home-based rehabilitation without the need for professional supervision. This likely reflects uncertainty as to the benefit of utilizing such a costly ancillary service, which accounted for $468 million in Medicare costs following primary TKA in 2009, and patient preference for performing rehabilitation in the comfort and convenience of their own home.

The Research Team at the Rothman Institute completed a prospective randomized control trial which questioned the role of formal physical therapy after a total knee replacement by comparing patients among three different groups. The first completed formal outpatient physiotherapy (OPT) sessions, the second used a web-based physiotherapy (Web PT), Force Therapeutics, to complete an unsupervised home exercise program, and the third group was given paper-based physiotherapy (Paper PT) to complete the same program.

The primary outcome assessed patients passive knee flexion at baseline, 4 weeks, and 6 months postoperatively. Ultimately we found there was no difference between patients going to outpatient PT compared to patients completing exercises programs on their own.

Formal PT sessions have been considered a necessary component of postoperative rehabilitation and care following a total joint replacement. The results of our study disrupt this assumption by finding that unsupervised exercises programs are an effective strategy for restoring patients’ functional outcomes. We were prepared for a big reaction to this study, and were happy to find it was a positive one. I had the opportunity to present the study at the Annual Meeting of the Eastern Orthopaedic Association (EOA) and it was the Primary Knee poster winner at AAHKS. (Meredith was featured in our EOA wrap-up video discussing her experience presenting the study.)

Receiving recognition at AAHKS validates our work. It increases public exposure to this topic, and helps refute current beliefs surrounding formal PT. As this topic continues to garner recognition, skepticism surrounding unsupervised home exercise programs will dissipate.

This is in line with healthcare’s movement towards more cost-efficient care. Formal PT services are expensive for providers and patients alike. For Providers the average cost of traditional formal PT sessions after TKA is roughly $2,500 per case, while the average cost of these home based exercises programs is less than $100 per case. The implementation of home exercise programs would create substantial costs savings within bundle payments. Increased utilization of technology may also improve coordination during the episode of care.

Similar to long hospital stays or bed rest, formal PT has been considered a must thus far. However, the findings of this study in particular has questioned its effectiveness. Research like this study will change the way providers routinely prescribe formal therapy and give patients greater autonomy over their recovery.

**This study is pending publication


POSTED November 9, 2017

AAHKS Wrap Up: The Era of Healthcare Technology Has Arrived

Check out our wrap-up video with Dr. Richard Iorio here

Innovative technology leading the trend towards evidence-based solutions within the value-based landscape was a central topic at AAHKS 2017. Research showing the clinical and financial benefits of digital programs are snowballing, which is increasing and broadening interest.

“I think healthtech dominated the meeting,” said Dr. Richard Iorio, a presenter at the conference. “Many of the pre-meeting symposia were dedicated to health tech applications and several of the papers that were presented were first iterations of health tech applications on clinical care.”

These studies found positive correlations with both patient outcomes and cost efficiencies. A valuable indicator as health systems across the country work to lower cost of care deliver while maintaining outcomes. “This,” according to Dr. Jess Lonner, Principal Investigator of a multi-center, technology-based study, “was clearly an opportunity for us to standardize care in a less expensive way.”

As Dr. Iorio points out, “[Care delivery] is a huge cost item for CMS and for the country. We’re doing 1.2 Million lower extremity total joints a year. We need to deliver that care in a more efficient and cost effective manner, and I think technology is the way to do that.”

Dr. Davidovitch introduced the term “EPRA”, or Electronic Patient Rehabilitation Application while presenting a paper called “Home Health Services are not Required Following Total Hip Arthroplasty.” According to the study summary in the program, the study “comparatively evaluated patients receiving EPRA and EPRA-HHS [home health services] demonstrating that there was no difference in PRO scores. Thus it may be assumed that both methods of postoperative rehabilitation are equivalent in terms of clinical outcomes and that HHS may be a redundant service.” This has huge implications for the future of orthopedic care delivery.

Dr. Iorio expects a wave of health tech adoption. “Now that larger more academic institutions are getting on board, and are then publishing that data giving it veracity and academic gravitas,” he said. “I think it’ll be more widely accepted as something that is not only interesting, but essential to deliver care in an efficient manner.”