Wednesday, December 30, 2015

There is Nothing Permanent Except Change: Reflections on the Fall Managed Care Forum

Guest Blog from TCS Healthcare Technologies
Tuesday, December 22, 2015

Deborah Keller, RN, BSN
Director of Client Services
TCS Healthcare Technologies

According to the Greek philosopher Heraclitus, “There is nothing permanent except change.” And the managed care industry is no exception to this truism. With a goal of understanding the changes in our industry, four members of the TCS team attended the Fall Managed Care Forum in Las Vegas, presented by the National Association of Managed Care Physicians (NAMCP), the American Association of Integrated Healthcare Delivery Systems (AAIHDS) and the American Association of Managed Care Nurses (AAMCN). Like everyone in the industry, we understand the hot topic in the health industry right now is change and we wanted to participate in the conversation.

Although change is inevitable, it does not come easily and it does not happen quickly. Beginning with the opening presentation by Felizitaz Devine about change management, to the keynote address by Jacques Sokolov, MD, The Future of Healthcare, we all find ourselves on this journey to making sense of the changes to healthcare delivery and management.  What we found was validation from a variety presenters and conversations that some key focus areas are paramount to successfully navigating the changes.  As Sokolov mentioned in his keynote, “We are in a challenging, yet interesting, time for the healthcare industry.”


Woven throughout the presentations was the need for data to support decision making at the clinical program and individual patient level.  Metrics to demonstrate compliance, satisfaction ratings, treatment efficacy, and population assessment are just some of many examples of the increasing need and usage of data.

Many of the details on the use of data to provide support validated the updates and improvements we have made to the ACUITY products. Our clients report great success in using the ACUITY platform to collect, analyze and report the data required to support their Care and Population Health Management programs.  Our Client Services team works with new clients to implement the platform including data integrations, access to critical data for the end user, automated and workflow supported data capture and finally the reporting required to support their business, regulatory and accreditation needs.

Provider Involvement and Engagement

The presentation, Tandigm Health:  Disruptive Innovation in Philadelphia, by Anthony Colletta, MD, MBA, focused on the importance of the Primary Care Provider (PCP) in managing cost and improving patient outcomes.  At the core of the quality based program approach is assuring that providers are given the information and tools that they need to manage the patients for whom they are responsible.   Providing ongoing metrics related to their practice is also key to make ongoing quality improvements to patient management processes and data collection.

New Technological Innovations

The convergence of medicine and technology continues to progress at a pace that some find dizzying while others find palatial, depending on where one sits in the chain of technology innovation and adoption.  What is clear is that there are limitless ways technology could be used to support patient health.  Dr. Thomas Morrow’s presentation, How Avatars Will Be Used in Changing Behavior, was a provocative look into the future.  In thinking of how just the presence of something as simple as a smart phone has changed behaviors already, it is natural to expect this same effect when the device is applied to the self-management of a disease.  Dr. Morrow discussed why people fail to take good care of themselves, why current approaches to address the issue aren’t working, and how a virtual health assistant (VHA) can be a solution.

While change is indeed the hot topic in managed care, some things haven’t changed.   One of these being the need to provide disease specific patient education.  Dr. Charles Vega reminded us of this in his presentation, Providing Optimal Treatment & Management Strategies for Asthma Control.  A key point was that patients need education on things as simple as how to use their inhaler properly as a high percentage of patients are currently using them incorrectly.

Final Thoughts

While we are a newer vendor to this conference, TCS is excited join the Fall Managed Care Forum conversation.  As we look to the New Year and reflect on 2015, it is safe to say that we are embracing change and look forward to what it will mean for the future of managed care and how we can continue to update the ACUITY platform to support these initiatives.


Friday, December 4, 2015

Holiday Package Special

Give a gift that lasts the whole year.

Give yourself or a colleague the gift of one year of membership with the 
American Association of Managed Care Nurses.

This special offer includes a FREE lapel pin, a printed copy of the
 Journal of Managed Care Medicine, and a welcome packet.
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Use the value code
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If you would like to send this package as a gift, just type the recipients name, email and address in the comment box on the application. 
*This offer expires on 12/31/15.


Friday, November 20, 2015

Physicians navigate challenging environment as focus on value drives change

Guest blog by Michelle La Vone, / 16 November, 2015 As hundreds of healthcare professionals took their seats for the the 2015 NAMCP Managed Care Forum in Las Vegas, the opener ended his introduction with a sentiment that elicited subtle nods: “We are in a challenging, yet interesting, time for the healthcare industry.”

Providers across the spectrum are seeing rising costs and demand for accountability paired with an increasingly difficult patient population, which wants care when it wants it, in the shortest amount of time, for the fewest dollars.

The goal of the transition from fee-for-service to value-based care is to lower costs and improve patient health while also ensuring a provider’s bottom line remains sustainable in the long-term. But how is this best executed?

ACOs and clinically integrated networks are key, the speakers agreed, but so is not jumping the gun. Organizations need to think about operations first, said Lillian Lee-Chun, a manager at ECG Management Consultants. They need to research and understand their local market dynamics, technological platforms, and opportunities for reimbursement. Reducing utilization of high-cost services through disease management, nurse navigators, preventive wellness, and other strategies could eventually hit a group’s bottom line, said Chun, so providers should plan appropriately to seek fair and valuable reimbursements.

To see successful models, one could look at Banner Health in Arizona, Memorial Hermann in Texas, or Care4Texans, also in Texas. Banner Health bills itself as a clinically integrated organization (CIO) co-owned and co-governed with two physician groups: Banner Medical Group and Arizona Integrated Physicians. It has a statewide presence, which Jacque Sokolov, M.D., chairman and CEO of SSB Solutions, thinks is invaluable. “A total state presence gives you state employees and a whole lot of markets,” he said.

Memorial Hermann also considers itself a CIO, and a large part of its success comes from its broad reach. It has more than 200 locations in a 60 by 60 mile primary service area in Houston and has been taking advantage of synergies in retail health and satellite emergency departments. Sokolov believes health systems need alternative delivery sites like these to ensure patient reach without breaking the bank.

A driving factor of success for the Care4Texans (C4T) is its physician-led approach, something that did not initially come easy. Brett Esrock, CEO of Providence Health Network who sits on the Board of Directors for C4T, said getting physicians to be main drivers in the C4T strategy elicited eye rolls.

“Essentially we had to develop a vision for the organization instead of just guiding principles. There were more eye rolls than you could shake a stick at. We distributed vomit bags for people who really didn’t want to participate.”

Eventually, physicians saw that C4T could contribute to real cost-savings, and they established their vision. Today, more than 300 physicians are part of C4T.

Overall, speakers seemed to agree on one thing: Adaptation to new modes of care, whether it be telemedicine, partnerships with retail clinics, or clinically integrated networks, will soon be imperative to staying financially successful and socially relevant. Keeping an open mind and being willing to change is what will differentiate the best from the average. Evolution of healthcare is here, and unavoidable.

View DRG blog.

Tuesday, November 17, 2015

Fall Managed Care Forum 2015 in Las Vegas

 Keynote Sessions/Business Track

As Director of Member Services for AAMCN, it was wonderful to meet our members and get the chance to talk face to face at our biannual Fall conference. It is an important part of the association growth for me to be able to hear comments and opinions on how we are currently serving our nurses and to also get ideas for innovation. When I hear how much our members enjoy the services that we have to offer and that our conferences provide the education they were looking for along with captivating and interesting subject matter, it really makes my job fulfilling.

Health Management Track

Breaking the conference down into 3 concurrent tracks really provided an opportunity to be able to attend the sessions that you wanted to. The Business Track, Health Management Track, and Oncology Track all presented at the same time, which allowed you to switch tracks and always have a choice of 3 different speakers and subjects.

Oncology Track
The receptions held gave everyone a perfect chance to mingle and meet new people. On Wednesday evening, the nurses attended their own reception while the Medical Directors Meet and Greet occurred next door. This gave each specialty a focused time for networking. The following night, a general reception was held for every guest to attend.
Chihuly Glass Sculpture in the Bellagio Lobby
The award for the Managed Care Nurse Leader of the Year was given to Stefany Almaden for her great example of leadership qualities, mentoring achievements, and contributions to managed care.
 Stefany Almaden, MCNLOY Award Winner
The three nurses who took their Certified Managed Care Nurse (CMCN) exam at the conference Wednesday morning all passed and received their certificates. Congratulations to Janice Perry, Lorie Hoekstra, and Joan Patrick-Morris!
                   Janice Perry, RN, CMCN                                     Lorie Hoekstra, RN, CMCN

Innovation awards are given to 3 companies or organizations that improve quality and reduce costs using innovative methods.The AAMCN Innovation award focuses on managed care nursing and was awarded to Priority Health's Coordinating the Coordinators.  

Jacquelyn Smith, AAMCN President (left) and Mary Cooley with Priority Health (right).

The NAMCP Innovation award focuses on managed care and was awarded to NorthStar Alliance Anesthesia for its Enhanced Recovery Program. Unfortunately they couldn't be there to accept the award. And lastly, the AAIHDS Innovation Award was given to Ochsner Health System’s Center for Innovation for the Ochsner Hypertension Digital Medicine Program.

Jonathan Wilt with Oschner Health System (left) and Doug Chaet, co-founder of AAIHDS (right).
The exhibit hall was thoroughly decked out with fancy booth lighting and eye-catching graphics. And who doesn't love the opportunity for free nic-nacs? In the process, you could learn about new products and methods. There really were some interesting inventions for treatment that I never would have learned about outside of the conference.

Let's also take a minute to appreciate the conference location. The Bellagio itself is a beautiful hotel with views that dazzle at night with the dancing fountains, the lighted Eiffel tower and strip just across the street. On my first morning, I was blown away by the majestic mountains just outside the city. If gambling isn't your thing, there's still so much to do and see. I'm looking forward to next year's Fall Forum and I hope you are too!



Friday, October 30, 2015

Creepy Ghost Stories from Nurses on Duty

Below is a compilation of the creepiest supernatural encounters of nurses gathered and submitted through

“I’m Okay”

“I was working in the ward on a night duty for quite some time. One night, I had to write down each patient’s name, when I spotted a patient that I had not seen for a couple of weeks. I felt weird when I was about to think that he had been transferred to our surgical hospital. He looked at me in the eyes and smiled as I gave him a gesture as if everything is fine. It was a relief seeing him in his best look than what I remember. However, when putting in my notes I could not find his name on the patient census. I looked him up by name and was amazed to see that it said he had died two days earlier. It was like he came back to say he was fine.”

The Supervisor

Image: Cul-de-sac Shack
“In the district hospital I previously worked at, it has been very usual for us staff nurses to see a lady in white walking down the hallway in the early hours of the morning-patients would see her too. We lost one of our nursing supervisors a couple of years ago, she died unexpectedly. Our med room call light frequently goes off when absolutely no one is in there or has been near the room. We all believe it’s Sup Dolor checking in.”


“Doing my rounds as a new RN in a unit, I saw an old lady dressed in hospital’s gown. Thinking that the patient was lost or couldn’t sleep, I signaled her from afar (we’re at the opposite ends of the hallway) to ask what’s wrong. Grabbing her attention, she turned her face to me, smiled and passed through a wall into a patient’s room! I froze from what I saw. I found out later that the woman had died three days earlier from a car accident, and ‘watching over’ her husband who was hospitalized in the room she entered.”



Out of the Window

“I was working on a night shift when a call light goes off for room 130. For all I know, this room has no one in it, so I canceled the light from the desk but it wouldn’t cancel. I walked down to the room just to check. Upon entering the room, I heard a budging sound on the window, like something or someone is trying to get out. Knowing what might be happening, I took up all the courage I could and took a deep breath, opened the lights, and walked to the window and opened it. I felt weird because a soft breeze went by and flew by me and then out of the window. I later found out that a patient had died during the morning and apparently, the nurses before my shift didn’t open the window. Weird as it may sound, but when someone passes, let them go and open the room’s windows!”

“Bless You”

“I worked the night shift alone at one of the oldest nursing home while in college. I’ve got a lot of stories to tell but this one really changed my spunky attitude. I was about to get extra linen in a room and I sneezed, and from behind me -clear as day- I heard “Bless you.”
The feeling of it was as if I was about to start a prayer and to my surprise… a voice whispered near my ear “Our Father in heaven..”
From then on, I used to stop myself from sneezing and didn’t recite The Lord’s Prayer for quite some time.”

The Intruder

“I worked as a registry nurse Noc shift and it was a very quiet and peaceful at 3am while doing simple floor rounds I felt something behind me, turned around and saw a shadowy girly figure wearing a hospital gown run into a residents room. I wasn’t terrified at all despite knowing the story I was thinking intruder. So I immediately entered the room and the resident in the room was up (an Alzheimer’s patient) and she said “Did you see that?” I was like “What” and the resident said “She went in there (pointing to the closed bathroom). I waited a bit and called for help to insure it wasn’t an intruder and the unit was clear. To this day I can’t explain it, but know what I saw and oddly enough what my patient saw despite her mental status. Weird, but it’s my job–nursing.”

Playful Balloons

“It was my second year working in the institution as an RN, I worked night shift on a pediatric unit. Our patients were often preschool and school-age children. We had a patient who would always want her visitors to bring balloons whenever they come to visit her. She died earlier after her long stay in the hospital. Days passed, one of my co-workers celebrated her birthday to which we had several balloons in the station. We noticed two balloons floated slowly bobbing–up and down. Now this would not have bothered me BUT those balloons then stopped by the girl’s previous room just right in front of the door and slowly went BACK INTO THE NURSES’ STATION!!! This cannot be explained by air currents!!”


“I just thought of my own experience when I used to work in a hospital in Japan. I was working on an overnight shift. The main nurses’ office is locked and only RN, LPN, and administration have keys. The nurses’ station (where I was) was just next to the office and it was exactly 3am when I heard a loud crash coming from the office. The next day I found out that a filing cabinet had fallen over and papers were all over the floor. Windows were closed, door was locked, air condition was unplugged. I was like, “Did someone just try to pass by me last night??!”

The Visit

“I used to work in a nursing home as an aid and thought of my co-worker who had a strange experience. One night, she was trying to check on a patient who is a Nun. According to her, a group of nuns came in the room but never bothered to talk to her except for one whom she had an eye contact. However, no one else on the floor had seen the nuns come or go. Rumor has it the hospital was built exactly where an old convent building was based before being ravaged by fire in the late 1800’s.”