Monthly Archives: November 2016

DPRP And Diabetes Care Management

The United States has been seeing a significant increase in the rate of newly diagnosed diabetes over the past decade. Diabetes will change the total lifestyle of a person. Once you get it, you have to bear with it throughout your lifetime. Diabetes ranks seventh in the list of the world’s most killing diseases. Though it is quite well-known most of the Americans are still not fully aware of the consequences of diabetes.

More than 29 million Americans are currently surviving with diabetes and three fourth of American adults are having prediabetes. Prediabetes is a health condition that has the high risk of developing type 2 diabetes, which without immediate attention and health counseling may lead to heart attack and strokes.

American Diabetes Association has estimated that every year over $322 billion is spent to treat diabetes and prediabetes. Every year more people get added to diabetes population list yet the good news is that type 2 diabetes is completely preventable. Prevention can be made by engaging prediabetes patients with a good medical care plan, creating awareness and education, and by involving each of them in their own care.

DPRP and Diabetes Disease Management

The peril of diabetes has a huge impact and it is right to say prevention of diabetes needs more attention than ever before. So the Centers for Disease Control and Prevention (CDC) established the CDC Diabetes Prevention Recognition Program (DPRP) as part of the National Diabetes Prevention Program(DPP). The center is pioneered to spread awareness about diabetes, and to find people with prediabetes condition to involve them in a lifestyle intervention program concerning to reduce the risk of getting type 2 diabetes.

To make this program a success it requires active participants. However, if people are less interested it is difficult to accomplish. DPRP will recognize organizations who can provide lifestyle intervention to prediabetes people. Also, these organizations have to report to CDC every year. The key reasons for organizations adopting Diabetes Disease Management Program in practices are to better clinical outcomes, reducing medical costs and utilization, and improving patient satisfaction.

Educating patients using evidence-based practice guidelines, and providing assistance to prevent complications will substantially reduce the utilization cost. This program also encourages people’s participation in self-management. Self-care is much needed because no two diabetic people can follow the same medication process. Each individual patient has to be treated one other way.

Why diabetic patient needs more care?

A study states that half of type 2 affected diabetes individuals are above 60 years of age with the highest ratio found in above 80 years age group, and this number is expected to multiple doubles within few years. This aged population requires good caretakers (like practitioner nurses or care coordinators).

Diabetic patients need daily monitoring, frequent changes in diet plan and care plan, periodic blood glucose test, proper maintenance of reports and all these tasks require quite a lot of human efforts. A good Care Management Tool will ease the process only when health providers choose the best one from the market.

Simple solution for better heal

With technology in hand, providers can bring miracles in patient’s life. Alerts, notification, e-consult, tracking, feedback and lot more features are readily available as a simple integrated solution. The Providers just have to pick up one right suitable management software to make use of it.

Wouldn’t it be useful if a software intimates a physician if there is any change in the patient’s blood glucose level, allows the physician to immediately reach to that patient to identify the reason for rising in glucose level, create and push the care plan to respective care coordinators and make changes in diet plan? It not only improves immediate care but also reduces costs, patient wait time, and more importantly it helps to avoid emergency room visits.

Our HealthViewX DPRP Solution is one such simple software designed to bring a better change in patient health and to ease the work of health professionals.

Why Are Medical Referrals So Important?

It’s a usual day, several in-patients are under your care, many scheduled patients are already seated in the waiting area and the ambulance has brought in an emergency case. On top of this, a pile of paperwork promises to cut your lunchtime in half. In between, scheduled patients come in and some of them need to be referred out. While Patient referrals can be time-consuming and tedious, they are an imperative process in healthcare operations.

Theoretically, the referral process is simple – if the initial diagnosis concludes that the patient needs special care or medical guidance then the patient’s primary provider will suggest providers or schedule an appointment with a specialist. The patient fulfills their end of the bargain by going to the specialist and getting treated.

In practice, the provider may only suggest a specialist because they know them and checking for availability and getting an appointment with the specialist is easier said than done. Even if this criteria is met, the patient may end up going to another specialist, or not get treated at all. 

There is more at stake here than just a few missed appointments. Statistics show that the number of medical referrals are on the rise in the US and with referrals gaining importance, is it critical for both the patients and the practice. Following are a few reasons why referrals are important:

Care Outcome: In an industry under transformation from fee-based to performance-based, the medical outcome and patient experience will continue to become more important, a trend most visible in an Accountable Care Organizations (ACOs) setup. ACOs are responsible for the health of the population they serve and shares the cost of care with Medicare. If the cost of care exceeds the preset limit and/or the quality is not up to the standard then it could affect ACO reimbursement. Most of the time the referring provider does not know about the cost of the specialist or the quality of care.

Revenue Management: Referring a patient could be a risky gamble from a revenue management perspective. It is often observed that the only revenue inflow from a referral is for the specialist. Once a primary provider refers a patient out of his practice to a specialist, the patient is out of the provider’s control. The patient may further be referred to another specialist or even to a rival hospital system. Even if the provider has sent the patients to the right specialist, the patients have been going to another specialist unbeknownst to the provider. Ultimately, the provider’s practice is losing future revenue without even knowing.

To Refer Or Not To Refer: A patient is referred to a specialist when a provider determines a reason for specialist care or the complexity of the patient’s condition is beyond the range of the primary provider. While issuing referrals appears straightforward, the parameters that would necessitate the initiation of referrals are vague at best. Wrong decisions on referral can cause serious problems for the provider.

How big a problem? Consequences range from unwanted costs to legal action. Wrong referral leads to uncalled expense, if the primary provider refers to a specialist whose capabilities cannot fulfil the patients requirements. The patient’s conditions could worsen because of the primary provider’s delay in facilitating the needed treatment, and the patient in question can file a legal case against the provider.

Our healthcare system relies heavily on referrals. For quite some time the healthcare sector favored specialty over primary physicians (evident in the disproportion of primary providers we have) but evidence now compels us to look at the care delivery pyramid and amend necessary changes for better care delivery and efficiency.

The importance of referral is that it is not just the next step in care delivery, but for patients who may need desperate treatment, an efficient referral could lead them on the path to recovery.

Create and Manage your Medical Referral Network Better!

Referral Management Solution helps providers to send patient referrals and to keep track of them. The purpose of the solution is to achieve a better outcome by improving communication and coordination between healthcare providers and patients.
Electronic Referrals or e-Referral enables endless patient information sharing throughout the care continuum in a secured way without violating HIPAA complaint. It also makes hospital referral process simple, manageable and reviewable at any given point.

Referral software integrates with EMR and will soon eliminate paperwork and documentation. A study suggests that paperless referrals have increased the follow-up rates up to 30-40%.
The Healthcare process workflow is considered to be one of the most challenging environments with regards to the complexity and security involved, Referral Solution helps to extemporize the hospital’s process flow and enables quick referrals.

The followings are the features of Referral Solution:

1. Better Access

The focus of Referral software is to improve the doctor-patient communication to provide better care and to improve health outcome. Physicians can send seamless referrals within or outside the network and the patients can communicate to their specialist anytime. This endless access helps patients to engage better in self-care.

2. Manage Referrals

Referral Solution helps to send right information to the right person at the right time. It also helps the provider to manage the workflow of information back and forth. PCP who usually initiates the referral can view the referral history and can track and drill down to check the status in detail for any number of referrals initiated from their facility.

3. E-Consultation

E-consultation reduces unnecessary face-to-face hospital visits. The well -designed Referral Solution makes it easy for patients and caregivers to exchange messages and medical diagnostic attachments like X-rays, screening images, and clinical notes with the specialists. A specialist or PCP can instantly get connected to their patient for e-consultation either via texts, calls, or video calls.

4. Reminders and Alerts Notification

Both physicians and patients get reminders about their upcoming scheduled meetings. The solution will allow you to manage all these alerts. Automated alerts are also sent to keep physicians informed if they miss any alerts or in case of emergency.

5. Schedule Appointments

The physician can quickly fix appointments with their patients if they are under risk conditions. Scheduled appointments can be managed online through portals in case if they want to postpone or cancel the meeting after seeing improvements in patient’s health condition.

6. Post Feedback and Loop Closure

Feedback along with all treatment details will be sent back to the referred PCP from the specialist for EMR update. Once the patient record is updated PCP will close the referral loop.
Some hospitals find reducing referral leakage and readmissions after implementing Referral Management Solution at their practice.

7. Referral Leakage

Medical records are highly confidential and it requires a safe and secure transfer. Also, the probability of leakage of data is high when PCP is looking at multiple cases on a given day.

In order to avoid leakage, providers need to update the physician’s directory list frequently.
This problem can be solved by encrypting the file with a password. People who have credentials are the only ones who will be able to access, view and share the patient record.

HealthViewX Referral Management Solution helps to send referrals secure and seamlessly, provide quick access to patient data, send notifications and alerts, and share information throughout to ensure closure of referral loop.

DPRP – An Initiative To Control Diabetes

It is estimated that more than twenty-nine million of the population in the United States are affected by diabetes and it is listed as the seventh leading death causing disease.

Diabetes Mellitus is a high blood glucose level that results in either because of inadequate insulin secretion or body cells that do not respond to insulin. This disease without treatment will damage many body parts leading to complications such as strokes, heart disease, and kidney failure.

Prediabetes is a stage before diabetes. An elevated blood sugar level but below the threshold of diabetes condition is a symptom of prediabetes and it is becoming more common in America. One out of every three Americans have prediabetes and many of them are not aware of it. Prediabetes can gradually develop to Type 2 diabetes.

The other condition called Type 1 diabetes, where the human body does not secrete insulin. This type is referred to as insulin-dependent diabetes, juvenile diabetes, or early-onset diabetes. Type 1 is not common as Type 2 diabetes. On average 5% of diabetes patients belongs to Type 1.

In an effort to prevent this, the Centers for Disease Control and Prevention (CDC) established a program called Diabetes Prevention and Recognition Program (DPRP).

Diabetes Prevention and Recognition Program (DPRP)

Diabetes Prevention and Recognition Program (DPRP) is a program facilitated by CDC. It provides information about Type 2 diabetes to people who are at risk, providers and also to the health insurers. The motive of this initiative is to recognize and give quality assurance measures for organizations to effectively deliver the Lifestyle Change Programs.

DPRP program is initiated based on many studies, and it is a part of a successful program called Diabetes Prevention Program (DPP).

The focus of DPRP is to provide assistance to people who are expected to be affected by Type 2 diabetes and to educate them about diabetes prevention measures.

CDC gives a detailed description of DPRP standards for Type 2 diabetes prevention lifestyle intervention program and it explains how to apply, earn and maintain recognition.

Organizations which have the knowledge and skilled staff for lifestyle coaching can apply for recognition. After getting approval from CDC the organization should implement the lifestyle program, regularly monitor the program, provide guidance to coaches and ensure the program achieves the desired results.

Like any other program, DPRP also ensures quality reporting, recognized organizations are expected to submit data every 12 months to CDC. Organizations who fail to submit the evaluation data will lose their recognition and need to re-apply for it.

The organization will enroll the participants if they are

1. A minimum of 18 years old with BMI of ≥24 kg/m2 or ≥22 kg/m2, if Asian.

2. A minimum of 50% participants must have self-blood test report or any claim code that indicates they have prediabetes within the past year (maybe self-reported)
a. Fasting glucose of 100 to 125 mg/dl
b. Plasma glucose measured 2 hours after a 75 gm glucose load of 140 to 199 mg/dl
c. A1c of 5.7 to 6.4
d. Clinically diagnosed GDM during a previous pregnancy (maybe self-reported)

3. A maximum of 50% eligible participants is from CDC Prediabetes Screening Test of the American Diabetes Association Type 2 Diabetes Risk Test or on a claims-based risk assessment.

Diabetes is a preventable disease. The fluctuation in blood sugar level can be controlled so people can live a normal life. But when it is not controlled the condition gets worse sometimes even causes death.

The importance of DPRP program is to postpone diabetes and its terrible side effects. The main reason for this increase in diabetes population is primarily due to lack of awareness. DPRP is employed to create awareness in order to control the disease.

Redesigning the Healthcare Delivery Model To Suit The Future

The WHO predicts that in the decades to come to the population of people above 65 will surpass that of children under 5 years of age. Analyzing the current trends, it can be concluded that many of these senior citizens are prone to have one or more chronic conditions.

Chronic conditions could mean more expenses for the payers and more pressure to the system. This is a volatile situation, where the social and demographic changes resulting will have a negative impact on efficiency and per capita cost factor.

To cope with this rise in senior population with chronic conditions, healthcare systems will have to manage the following:

1. Adding human resources:
Perhaps the most obvious but the most important step to adapt is to invest in human resources. It has been observed that human interactions cannot be substituted, healthcare delivery centers who focus on having optimum qualified resources in their care delivery system have more often proved to deliver the better patient experience.

2. Precision Medicine:
Precision medicine is understanding and acknowledging that different patients react to medication and treatment differently due to genetic disposition. Treatment and medication must be engineered to get the best result as possible.

Connected devices and health monitoring equipment that aids in gathering patient information near to real-time helps best possible health outcomes achievable even in the most complex scenarios.

3. Overcoming impending shortage of healthcare professionals:

The proportion of healthcare providers to that of the population is already less than ideal. This trend is said to continue even as the number and necessity of patients multiply. Healthcare providers must find a way to bridge the gap between demand and supply in healthcare. One way to do it is to create new models of care delivery using technology to stretch help across geographic distances. Telemedicine is a viable option available for healthcare professionals to augment their services in order to do more with less time and resources.

4. Holistic Medicine:

Decades of focus on specialization has made healthcare professionals see a disease or its symptom as an isolated case, and the patients are considered cured by only removing the disease. In practice, a person might be suffering from multiple health issues and a simplified isolated view might do more harm than good to a patient.

5. Leading cause and concentrated efforts

In the coming years and even now, termination of a patient’s life is more likely to occur due to traceable lifestyle choices or practices than from any infection or diseases. For example the relation between obesity and disease has for long been proven beyond any doubt, furthermore, obesity and related illness will increase the cost of treating a patient. Therefore a concentrated effort to reduce obesity can bring about a positive result in reducing the possibility of heart disease and stroke.

Like obesity, scientific observation can identify key causes of a disease and healthcare providers can make a concentrated effort in reducing the causes in a population.

These are the most important steps a healthcare provider will have to consider in improving healthcare outcomes.

The transition to a more technology involved healthcare delivery management can tremendously help providers be agiler and more effective with necessary amendments.
Healthcare strategies must be relooked to have a more holistic & flexible approach not only to accommodate CMS led changes but also to benefit the entire population.