While shared savings could be several years in the future for fledgling accountable care organizations, there are shortcuts for physician practices in ACOs to generate population health revenue immediately, explains Tim Gronniger, senior vice p

Healthcare Trends in 2018: Synergies from the Non-Traditional CVS Health-Aetna Merger

Dec 13th, 2017 5m 25s

As 2017 draws to a close, the recent CVS Health-Aetna merger continues to dominate the healthcare conversation. David Buchanan, president, Buchanan Strategies, weighed in on the non-traditional partnership during Trends Shaping the Healthcare I

7 Benefits of Leveraging a Patient Portal to Promote Population Health

Dec 6th, 2017 3m 48s

As patients of Lehigh Valley Health Network (LVHN) began to utilize the features of its newly minted portal, LVHN and its physician providers soon recognized the added benefits of this interactive tool. In this HealthSounds episode, LVHN’s Lind

Focus Group Findings Shape Bronx Community Health Improvement Action Plan

Nov 28th, 2017 4m 59s

How do you engage community residents in their health when many are distrustful of and feel disrespected by the healthcare system? Encourage them to both direct and participate in the initiative, advises Charmaine Ruddock, project director of B

Motivational Interviewing Respectfully Dispels Social Determinant of Health Barriers

Sep 21st, 2017 3m 59s

How can care teams encourage patients to open up about sensitive social determinant of health (SDOH) factors? By employing motivational interviewing to establish a respectful partnership, advises Cindy Buckels, TAV Health director of population

PinnacleHealth' Patient Engagement Coach for Clinicians: Supportive Peer at Provider’s Elbow

Aug 25th, 2017 3m 49s

How receptive are clinicians to being coached in patient engagement techniques? At PinnacleHealth, provider reaction to rollout of patient engagement coaching has followed a standard bell curve, notes Kathryn Shradley, PinnacleHealth’s director

Integrated Case Management: The Surprise Question That Can Improve Timeliness of Hospice Referrals

Aug 21st, 2017 3m 6s

For patients with cancer, palliative care should begin at diagnosis to help them shoulder the disease’s emotional, physical and financial burdens, explains Laura Ostrowsky, director of case management at Memorial Sloan Kettering Cancer Center (

4 Foundational Behaviors Forge Framework for UnityPoint Health Patient Experience Improvement Plan

Aug 1st, 2017 3m 56s

In this podcast, Paige Moore, director of patient experience at UnityPoint Health, describes the rationale and rollout for the four behaviors, which are based on patient and visitor feedback and comments.

Social Determinants of Health: Adapting Screenings for Different Populations

Jul 6th, 2017 3m 17s

In this podcast, Dr. Amanda Parsons, MBA, vice president of community and population health at Montefiore Health System, explains the various screening approaches taken by the physicians, and how that multi-site strategy figures into the health

Michigan SNF Collaborative Sets Competition Aside to Improve Quality and Readmission Rates

May 16th, 2017 4m 15s

In this podcast, Susan Craft of the Henry Ford Health System (HFHS), one of four collaborative founders, outlines a few SNF participation and reporting mandates that run the gamut from meeting attendance to LACE readmission risk scores.

The Science Behind Care Transition Management: More Than Case Managers and Discharge Calls

Mar 30th, 2017 2m 34s

Among the myths surrounding care transitions management is the belief the intervention can be effectively executed pre-discharge or by phone only, explains Jennifer Drago, executive vice president of population health for Sun Health. In this au

CMS' Physician QRUR Tables Highlight High-Value Referral Patterns for Medicare Population

Jan 31st, 2017 3m 7s

Among other data, detail tables in a physician practice’s Quality Use and Resource Reports (QRURs) pinpoint specialist referral networks for Medicare beneficiaries, explains William Holding, consultant, PDA, Inc., which can help physician pract

Beyond Housing, Chronic Care Plus Connects Medically Vulnerable Homeless to Social Services

Dec 20th, 2016 4m 14s

Working to bridge the gap between hospital discharge and permanent supportive housing for homeless patients, the California-based Chronic Care Plus program found that 40 percent of client needs are related to social determinants, explains Paul

Social Determinants of Health: Scenarios to Encourage the Sharing of Sensitive Information

Dec 16th, 2016 3m 16s

Identifying social determinants of health (SDH) requires providers to probe beyond the scope of clinical data. But how can health teams ensure that patients and health plan members provide valid data during SDH assessments? In this audio interv

Trends Shaping Healthcare in 2017: Employ Technology for Patient Engagement

Nov 21st, 2016 2m 52s

The engagement of patients, particularly those with multiple chronic conditions, continues to challenge healthcare providers. However, as Steven Valentine, vice president of advisory consulting services for Premier Inc., explains in this podcas

MACRA Prerequisite: Procure QRUR Performance Data to Maximize MIPS Success

Oct 31st, 2016 3m 12s

Prior to enrollment in MACRA’s Merit-Based Incentive Payment System (MIPS), physician practices should request their confidential Quality Use and Resource Report (QRUR) from the Centers for Medicare and Medicaid Services (CMS) for crucial perfo

UT Southwestern ACO Home Health Narrow Network Reinforces Providers’ Home Care Accountability

Oct 4th, 2016 3m 21s

After UT Southwestern Accountable Care Network (UTSACN) discovered its home health spend was more than twice the national average, it applied data analytics to create a preferred home health network of 20 agencies (down from 1,200) that has sav

UPMC RAVEN ECCPs ‘Driving Force’ in Reducing Long-Term Care Hospitalizations

Aug 17th, 2016 3m 56s

Under its partnership with CMS to improve quality of care in long-term care (LTC) facilities by reducing avoidable hospitalizations, the University of Pittsburgh Medical Center RAVEN project embeds clinical staff within eighteen nursing facilit

Connected Care Management: Do Mathematical Risk Predictors Trump Provider Intuition?

Aug 11th, 2016 3m 4s

Even when employing sophisticated predictive analytics to zero in on population health risk, healthcare organizations shouldn’t discount providers’ intuition, advises Luke Hansen, MD, vice president and chief medical officer, population health

Population Health Management: Don’t Ignore Natural Inertia Driving Low-Risk Populations

Aug 10th, 2016 4m 8s

By focusing chiefly on moving high-risk patients down to the low-risk band, population health management programs are in danger of missing the “natural inertia” driving low-risk patients right back into that high-risk stratum, cautions Dr. Adri

MACRA for Small Physician Practices: Don’t Let the Technology Intimidate You

Jul 21st, 2016 4m

Rather than threatening to drop Medicare volumes or open a concierge practice, small and solo physician practices daunted by MACRA technology requirements should sit tight and avail themselves of current and promised education and training from

Behavioral Health Patient Engagement: Change Talk Highly Predictive of Behavior Change

Jul 14th, 2016 3m 40s

Increasingly in motivational interviewing (MI) research, change talk—anything a patient or client says that counts as an argument for change—is a reliable sign they’re ready to make a change, notes Mia Croyle with the University of Wisconsin Sc

For Success in Accountable Care Models, Educate Providers on the Ground

Apr 14th, 2016 3m 26s

Whether an ACO is assessing readiness for CMS’s Next Generation ACO model or is already a Medicare Shared Savings Program (MSSP) participant, face-to-face education of non-executive providers living the day-to-day ACO reality is critical to tha

Horizon BCBSNJ Episodes of Care: No-Risk Retrospective Model Paves Way for Value-Based Migration

Apr 13th, 2016 4m 12s

While it does not immediately eliminate fee for service, a retrospective upside-only payment model is helping to transform the spirit of the payor-provider relationship, notes Lili Brillstein, director of the Horizon Blue Cross Blue Shield of N

Hearst Health Prize Winner CCNC: Care Transition Management Not ‘One-Size-Fits-All’

Apr 11th, 2016 3m 23s

Community Care of North Carolina’s Transitional Care program was awarded the Hearst Health Prize this month not only for demonstrating how effective transitional care is for its 1.5 million Medicaid beneficiaries, but also for continually evalu