Value-Based Care: 3 Ways to Better Engage Behavioral Health Patients after Treatment

The need to finance the diagnosis and treatment of behavioral health problems in primary care settings was acknowledged by medical surveys from over 20 years ago. But until recently, there were no financial incentives for integrated behavioral healthcare services. Thankfully that’s all set to change.

There is a significant movement towards integration as more healthcare providers are acknowledging the need to address the impact of behavioral health on chronic diseases such as diabetes and cardiovascular disease, but the actual catalyst here is the value-based directives to provide better-quality and cost-efficient care. There is also reimbursement starting for monitoring and following patients that should also improve outcomes, and get healthcare proactively focused on patients post-treatment.

About Substance Abuse

An estimated 25 million Americans are directly affected by substance abuse. If you take into consideration those who are indirectly affected by the same – such as the families of abusers or the people injured/killed by intoxicated drivers, an additional 40 million people can be factored into the equation.

Substance abuse victim

Substance abuse exacts a heavy financial toll on not just the individual, but also the community and the economy – resulting from the reduced productivity, health care costs, accidents, property damage and so on. Though over 10 million adults are afflicted by the progressive disease of alcoholism, an additional 12.5 million Americans are estimated to be addicted to drugs such as barbiturates, opiates, sedatives, psycho-stimulants and so on.

Prescription drug abuse is quite common, but how do you know if you are having a substance abuse problem? Does having a drink a day count as alcohol abuse? How do you know where that fine line is? If you are worried whether you or your loved one is addicted, look out for the following warning signs:

  • Is the substance being used on a regular basis? This may be on a daily basis, weekends or in binges.
  • Feelings of guilt regarding substance use.
  • Failed attempts to stop using the substance.
  • Feelings of anger or defensiveness when someone comments about the substance use
  • Withdrawal symptoms such as trembling, sweating, hallucinations and high blood pressure.

The Link Between Substance Abuse And Behavioral Health

When a person is diagnosed to have both substance abuse and mental health problems such as depression, or anxiety, it is called a dual diagnosis. Known as co-occurring disorders, having such additional mental health issues make it harder to overcome the substance abuse problems.

Overhead shot of hard drugs and alcohol on wooden table.


As per a report from the Journal of the American Medical Association,

  • 37% of alcohol abusers and 53% of drug abusers also have at least one serious mental illness.
  • Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs.
  • The National Alliance on Mental Illness revealed that 10.2 million American adults suffer from co-occurring mental health and addiction disorders.

Though a specific cause for substance abuse cannot be established, a combination of hereditary, environmental and social factors can be held to blame.

Substance Abuse And Behavioral Health Treatments

Treating behavioral health issues often include lifestyle changes and medication while overcoming substance abuse may require a variety of therapies which are all geared towards abstinence. Substance abuse treatments mostly involve detoxification, managing of withdrawal symptoms and behavioral therapy. Counseling that involves group and individual guidance, as well as peer support, is equally important for both cases.

Effective treatment of co-occurring disorders requires an integrated approach. The substance abuse problem and the mental disorder have to addressed and treated together. Patient care continuum is an important factor here. Irrespective of which issue occurred first, long-term recovery from both involves simultaneous treatments by the same team of treatment care providers. The continuum of patient care ensures the delivery of healthcare over a longer period of time. This creates a support system for the patients and encourages them to abstain from substance abuse.

To enhance the chances of successful recovery in the outpatient setting and to reduce readmission, behavioral health services should implement the following value-based care models:


Behavioral healthcare providers should partner directly with the patient and his care team to plan and execute patient-centered recovery initiatives. Such a team effort that engages the patient helps establish essential outpatient services, enhances discharge planning, and routine outpatient follow-ups. Diversity People Exercise Class Relax Concept

Psychotherapy is another treatment that helps patients understand their own behavior as well as motivations. This approach also aids in developing self-esteem and coping with stress. Telehealth software is handy for quick health consultations or medical support, so behavioral healthcare services should implement this system wherever possible and ensure it is affordable to the overall community.



If you are a healthcare provider, it is not enough to just have an Electronic Health Record (EHR) system. For better documentation and analytics, the EHR should be updated or augmented with a patient management and engagement solution to support documentation of community care coordination, follow-up appointments and transmission of discharge records.

EHR is also a useful tool for goal setting meetings with the patient and their families. An enhanced EHR system with a patient management/engagement solution can help you monitor and evaluate the process of care as well as the outcome measures.


Social determinants of health play a vital role in understanding the causes of substance abuse in specific communities. Understanding the cause helps to deal with it and neutralize threats that cause recovering addicts to revert to the drug/alcohol abuse.

A peer support specialist can foster a trusting relationship with the patient and act as his advocate. A person diagnosed with a mental health diagnosis, but has been in recovery for at least a year can get a peer support specialist certification. Such individuals participate-in or run recovery groups.

An effective patient management tool that allows messaging, virtual check-ins, and can be as mobile as the patient can make an impact on this relationship and trust-building interactions.

They are better equipped to motivate patients to participate in care planning and encourage outpatient follow-ups to maintain recovery. They also lend their support during a crisis, as needed. Self-help groups like Alcoholics Anonymous have been found to be extremely effective in establishing a support network.




How Health Care Professionals Can Sleep Better Despite Shift Work

Shift work is common in the health care professions, but that doesn’t make it healthy. Working nights or rotating shifts is associated with increased risk of type 2 diabetes, cardiovascular disease, and possibly even cancer. While the reasons aren’t fully understood, researchers believe it’s a lack of sleep that’s behind this heightened disease risk.


Irregular work schedules disrupt the body’s circadian rhythm, which is the internal clock that tells your body when it’s time to feel awake or tired. The result is difficulty falling and staying asleep, poor quality sleep during the night, and fatigue and impaired concentration during the day. This is known as shift work sleep disorder (SWSD), and if left unresolved, it can contribute to more serious health problems from depression to heart disease.

Improve the Sleep Environment

Between sunlight, outside noise, and interruptions, a peaceful sleep environment is harder to achieve during daylight hours. Medical workers can shut out distractions and create a bedroom environment that mimics night by following these tips.

●    Hang blackout curtains or blinds to exclude outside light.

sleep better concept

●    Wear earplugs and run a white noise machine to minimize distracting sounds.

●    Program the thermostat to between 60 and 67 degrees during sleep hours.

●    Invest in a better mattress, especially if back pain is an issue while sleeping or at work.  A good mattress relieves pressure points and aligns the spine to minimize discomfort. For example, memory foam is a popular choice for back pain, which 80 percent of Americans will experience at some point in their lives.


Trick the Brain

The body’s circadian clock is timed to natural light cycles. By changing how they receive natural light, medical professionals can better adapt to shift work. People who start their day when it’s dark should use a light box upon waking to mimic natural sunlight. This tricks the body into believing it’s daytime. At the end of a shift, Cigna recommends workers mimic evening hours by wearing dark sunglasses while driving home. Some people also benefit from taking melatonin supplements, as shift work can disrupt the body’s natural production of melatonin.

How CMS plays a role in the future of Remote Monitoring

At long last, the biggest payer in the U.S, the Centers for Medicare and Medicaid Services (CMS), has recognized that remote patient observing (RPM) assumes a noteworthy part later on of medicinal services conveyance. Fortunately, CMS is boosting the utilization of remote patient checking innovation for gathering and dissecting quietly created wellbeing information.

Since the start of 2018, human services suppliers have possessed the capacity to charge for the time they spend recording the You've got serious problem...patient information exchanged by remote patient monitoring software. They could use the recently unbundled repayment code CPT 99091 for this very reason. This move by the CMS has quickened the selection of remote checking devices into clinical practices.


The 2 Final QPP Rules from CMS

In spite of the fact that the proceeding with movements of CMS strategies can be somewhat confounding, each new measure speaks to CMS’s push to help social insurance suppliers in giving the most ideal care by empowering advancement and rivalry inside the American human services framework. These standards offer doctors the chance to exploit the most recent repayment conspires as CMS shifts towards a more esteem based care that offers elective care techniques to its members. CMS chairman, Seema Verma uncovered that these principles help reinforce the patient-provider communication and enable patients to comprehend the estimation of care as opposed to the volume of tests.

CMC had discharged two new guidelines for medicinal services suppliers influenced by MACRA, in November 2017, of which the ‘2018 Quality Payment Program (QPP) Final Rule’ came in to impact on first January 2018. This governs influences members in QPP as it rolled out imperative improvements to the repayment for remote care. The second manage, specifically ‘the 2018 Physician Fee Schedule Final Rule’ centers around the installment models for Medicare. Another framework for execution information accommodation for the QPP was propelled on January second, 2018, which permits to essentially streamline the procedures for partaking doctors.

QPP Rule No: 1 – Upgradation of PGHD to Higher Ratings

The Quality Payment Program was at first made as a piece of the MACRA in 2015 with the expectation of helping the progress of social insurance suppliers from pay per benefit over to a more esteem based care.

An eminent change in the 2018 QPP Final Rule was the upgradation of Patient-Generated Health Data (PGHD) to a higher rating which permitted the human services suppliers to improve score in the CPIA classification for to connecting with patients by utilizing remote patient observing programming. CMS had perceived the clinical estimatio

n of ‘Quiet Generated Health Data’ and they have suggested that doctors offer advanced administrations that enhance tolerant commitment and give persistent help to patients wherever they are, outside the doctor’s facility or the specialist’s office.

Doctors do need to observe that the utilization of aloof gadgets for recording understanding wellbeing information isn’t repaid by the CMS as these gadgets can’t transmit PGHD continuously. Along these lines, so as to be repaid, the care suppliers must utilize dynamic gadgets that transmit and get PGHD and clinical criticism to the specialist or patient progressively.

QPP Rule No: 2 – Unbundling of the CPT Code 99091

As per the 2018 PFS Final Rule, the CMS ‘packaged’ CPT code 99091 moved toward becoming ‘unbundled’, with impact from January 1, 2018. This CPT code was labeled by CMS for the ‘investigation of clinical information put away in a PC’.

Packaging implied that the code must be utilized as a part of simultaneousness with a standard assessment and administration benefit code. Be that as it may, this implied the patient was required to make an in-person visit to his doctor/other social insurance suppliers.

Remote medicine concept.

The unbundling of the CPT code 99091 is awesome news for all worried as this implies the suppliers can be repaid independently for the time, (30 mins at any given moment) they spend on gathering and breaking down any remote Patient-Generated Health Data. The best part about the unbundling of this code is that doctors are not subject to face to face understanding visits for getting repayments for the time they spend on remote care. This is a help for both the patient who does not need to make the expensive outing and in addition for the treating doctor who won’t need to stress over his repayments.

The Code Guidelines for Reimbursement of Remote Care

According to the new CMS QPP last principles, the CPT code 99091 can’t be utilized more than once in a 30-day time frame for a particular patient. The repayment will incorporate

  • Time spent on getting to, assessing and examining PGHD information
  • Time went through on correspondence with the patient
  • Time spent on documentation because of the investigation

To charge for the administration, the doctor needs to get the recipient assent for the administration ahead of time and this must be reported in the patient’s therapeutic record. The doctor likewise needs to spend at least 30 minutes for each month checking on and breaking down the information for the given patient. The time taken to roll out improvements to the current care design because of inspecting the patient information can likewise be incorporated into the repayment charges. This is likewise comprehensive of the time spent on related documentation and to impart the progressions to the patient and additionally their parental figure, assuming any.

Fortunately, CMS does not confine the repayment with more organized telehealth or in-person rules for the mind. This gives some space to adaptability in the remote patient checking programming or innovation utilized and also the manner by which the innovation is utilized for creating and transmitting the Patient-Generated Health Data. This adaptability inside the rules mull over the multitudinous applications and gadgets accessible in the present markets for delivering and transferring wellbeing information hence empowering patients to pick their favored stages for transmitting information to their doctors.

This move from CMS gives numerous impetuses to doctors to invest their energy gathering and translating understanding information and to give better care in light of this information. They will set aside their valuable time to investigate understanding records as they are currently more guaranteed of being repaid for this action. This looks encouraging as medicinal services are moving from exorbitant and difficult in-person visits to more complete and long-haul remote care programs that fittingly acclimatize PGHD to upgrade tolerant outcomes.


CMS is by all accounts unquestionably grasping telemedicine and remote social insurance with all these new approach refreshes. They are mulling over different social determinants of health, particularly the ones that make it troublesome for patients to visit the doctors by and by. These may differ from the absence of information about therapeutic arrangements to monetary issues or the inaccessibility of transport in a specific area. The unbundling of the CPT code 99091 makes in-patients visits pointless,

Doctors video conference

which is generally a costly weight for both the doctor and in addition the patient.

The redesign of PGHD use to a “high” evaluating enables doctors to show signs of improvement scores for connecting with patients by utilizing innovation, in the Clinical Practice Improvement Activity (CPIA) class. The reason for the CPIA class is to urge the doctors to be more associated with ventures that prompt upgrades in persistent commitment, client administration et cetera, which thusly guarantees more esteem based care.

For an effective changeover to esteem based care from the customary pay per benefit framework, it is vital that social insurance suppliers are compensated for actualizing new projects like telemedicine and remote medicinal services programming, which thusly help to streamline the care homes by diminishing expenses and enhancing quiet results. The ongoing changes made in the QPP codes makes it apparent that CMS recognizes the estimation of such acknowledgment and is to be sure assuming a noteworthy part in advancing remote checking. Presently it’s up to the doctors to exploit these strategy changes to refresh their medicinal services innovation to benefit from programs that offer better proficiency, investment funds and in addition persistent results.

Parents of baby treated for a nap and a bottle of formula billed $18000

It’s true that patients are at the focal point in the healthcare sector with patient engagement solutions and patient care software. But, we often see patients bearing the brunt of highly unreasonable treatment costs.
Jang Yeo Im was on a vacation in 2016 to San Francisco. Her 8 years old son, Park Jeon Whan fell off the bed in the hotel room and hit his head. So, Jang and her husband called 911 and the child was taken to Zuckerberg San Francisco General Hospital. The doctors said the child was fine. There was minor bruising on his nose and forehead. Whan took a nap and drank infant formula. He was discharged after a few hours. But, the bill amounted to $18,836 for a visit of just 3 hours and 22 minutes. A mysterious fee of $15,666 was charged as “trauma activation” or “trauma response fee”.
Many fees that American hospitals charge don’t exist in other countries. But, the highest is “trauma fee” amounting to more than $10,000 and it is applied arbitrarily. Trauma fee is charged by the trauma center when it activates and assembles a team of medical professionals that can meet a patient with serious injuries in the ER.

The 3 Keys That Ensure Success of Physician Groups in Bundled Payment Programs

Bundled installments are turned out to be very compelling in Medicare’s endeavor to move from conventional expense for-administration to esteem based installment models. BPCI packaged installments have been seen to spare cash while improving patient care. The recently disclosed BPCI Advanced program will start in October and it plans to expand on the accomplishment of the current BP


CI activity. While there might be the individuals who dissent, associations that have possessed the capacity to adequately actualize packaged installments programs have discovered that such value based care has made significant changes in the way human services is composed.

The cost-adequacy of the program and the care esteem it gives relies upon what number of doctors will alter the way they hone. One of the significant costs that can be kept away from is the broad and frequently unnecessary expanded hospitalization remain amid a scene of care. A ‘scene’ of care is the time of an intense sickness or a surgery and the accompanying recuperation time frame. On the off chance that patients can be guided by their doctors to invest more energy recouping at home, and be remotely observed to ensure they are on track for recuperation, this can radically diminish the costs engaged with their medicinal services.


Male medicine doctor holding in hands bunch of hundred dollars

Under the current BPCI program which closes on September 30, 2018, numerous doctor bunches have wound up to be very effective in their undertakings. Their experience offers significant bits of knowledge for different doctors to upgrade their care homes. There are sure vital components that are the keys to guarantee doctor bunches prevail in packaged installment programs.


1. Doctor Engagement:

Making prominent upgrades in the medicinal services frameworks with activities like the BPCI packaged installment can’t be accomplished without appropriate doctor commitment.

As the US medicinal services industry rethinks itself wit


h BPCI Medicare projects to enhance results of not only one patient, but rather that of the whole populace, this recharging expects doctors to advance, assume responsibility and lead the rest. From conveying the cutting edge care to telling authority positions, doctors have a huge part to play. Since they drive an essential 75 – 85% of all quality and cost choices, doctor withdrawal can convert into noteworthy money related misfortunes. Since a doctor ‘s preparing and viewpoint is not the same as that of the healing center chiefs, challenges are higher with regards to organizing their reactions to the quickly changing commercial center and directions.

The American Hospital Association characterizes doctor commitment as: “Articulated eagerness portrayed by having a place, pride and dependability which encourage a commonly dedicated connection amongst doctors and associations bringing about the persisting quest for hierarchical objectives and vocation enhancement.”

Health Care Concept. Doctor holding a stethoscope and medicare word on gray background.


The absence of doctor commitment can in the long run prompt burnout or the specialists leaving their occupations. Negligence suit is regularly an aftereffect of patient disappointment emerging from understanding supplier correspondence issues. Connected with doctors are generally ready to discuss better with patients. They can inspire the patient as well as the whole care group to facilitate over the scene and adequately execute the value-based care design.

Following a careful release, drew in specialists will probably compose post-intense care when they are engaged with a 90-day time frame mind design. This noteworthily affects the patient’s use of such administrations and can decidedly affect patient care continuum.


2. Care Coordination Among Providers

An esteem based medicinal services framework has an exceptionally complex system that includes patients, healing facilities, doctors, drug stores, post-intense care et cetera.

In such a divided human services framework, mind coordination among its different players is one of the major keys to making a successful packaged installment program. Doctor commitment relies upon how much specialists feel focused on the doctor’s facility’s main goal and qualities. Post-intense care suppliers must will to take after the doctor’s care designs and result in objectives.

Caseworkers must facilitate the care of post-intense care suppliers and specialists to streamline the care conventions. It is most vital for all required to keep the lines of correspondence open. Preparing programs that attention on enhancing persistent supplier relational abilities can prompt noteworthy advance inpatient treatment adherence and additionally quiet fulfillment.

Care Coordination is extremely troublesome as there are numerous moving parts for suppliers inside and outside the system, different suppliers along the patient’s recuperation way, and a massive measure of detail to oversee – and a significant part of the coordination is presently performed – the way it was done in the good ‘old days – post-its and telephone calls (or no coordination by any stretch of the imagination).

Medical exam



3. Information Analytics

Another key component of effective packaged installment programs is Data investigation. The principles and controls encompassing packaged installment activities like the BPCI Advanced can leave generally befuddled. Numerous care suppliers decline to get required as they don’t generally comprehend the complexities or they may feel the dangers are too high.

The most ideal approach to address this obstruction is the power utilization of information investigation. Examination of the information on singular doctor execution can energize sound rivalry among doctors which will, in the end, prompt better value-based care and treatment results.

Information investigation help pinpoint varieties in mind designs and also the conventions that should be refreshed. Such investigation can enable associations to overhaul their procedures to tailor special and point by point mind designs that are more viable in offering some incentive-based care at brought down expenses.

The Lifecycle Health cloud stage connects with and screens patients and in addition their hover of parental figures to gather and break down information. With its best in class Telehealth programming, Lifecycle Health gives continuous permeability into the care quality, quiet fulfillment and expenses crosswise over suppliers to guarantee your association’s accomplishment in packaged installment programs.

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3 Reasons Why Social Determinants of Health Is The Future of Value-Based Care

The conditions in which individuals are conceived, develop, live, work and age are known as their social determinants of health. These conditions of their lives are influenced by the division of cash, and different assets at the worldwide, national and nearby levels. Social determinants are basically in charge of wellbeing imbalances. It is the thing that makes the uncalled for and unnecessary contrasts in wellbeing status inside and between nations.

A symbol of health and the globe .

More investigations are presently being directed to truly contemplate the effect of social determinants of health (SDOH or SDH) as dealing with these is pivotal for enhanced medicinal services results, for example, better general health shut care holes and lower costs. Reena Pande, MD, the main therapeutic officer at AbleTo says, “In the event that you don’t address the social strength of patients, you can’t address the rest.”

The 5 Major Social Determinants of Health

Despite the fact that there are numerous social determinants of health, they can be assembled into five primary classifications:

Social Determinants of Health

1. Monetary Instability: Poverty, joblessness, sustenance frailty, lodging insecurity and so forth can without much of a stretch leave a man monetarily temperamental. Such a man winds up having various wellbeing related issues.

2. Instructive concerns: High school graduation, Enrollment in advanced education, Language and proficiency, Early youth training and improvement and so forth can’t be kept away from while considering the physical and mental prosperity of a person.

3. Social and Community Background: Social attachment, Civic non – investment, Discrimination, and so forth can influence a man’s wellbeing physically and rationally.

4. Wellbeing and Healthcare: Accessibility to social insurance, Accessibility to essential care and Health proficiency among people is likewise a representing factor.

5. The living region and Environment around: Availability of sound nourishments, Quality of lodging, Crime and brutality around, ecological conditions

Summing up, the social determinants of health have a critical part in a person’s human services as it relies on the accessibility and openness of medicinal services. Care groups likewise can’t reject the enthusiastic blockers, for example, social, push, dejection, deprivation, and providing care challenges the patients might confront.

A definitive achievement of an esteem construct medicinal services framework depends with respect to calculating in the social determinants into the human services condition. Michael Millenson, leader of Health Quality Advisors says, “You can’t get where you need to abandon patients running there with you”. Fuse of social well-being into standard human services is a promising patient intercession, all things considered conduct issues are a noteworthy determinant of medicinal services costs. So treating individuals comprehensively is the thing that picking up force.

Despite the fact that physical afflictions keep assuming a noteworthy part in a man’s life, considering and managing the patient’s mental hindrances will do ponders for their mending. This way to deal with general social insurance has enduring effects. Despite the fact that a lot of research is being led on this point, it’s not as basic as it sounds and can’t be accomplished medium-term. Seeing more about social determinants will prepare for better patient engagement, as parental figures get a clearer ability to know east from west and sight on where to go and how to go about it.

3 Reasons why Social Determinants of Health is the Future of Value-based Care

Social determinants of health administer the fate of the value based care since they guarantee:


The absence of information, and additionally the entrance to fundamental assets can influence the general strength of a populace unfavorably. A patient with budgetary battles will think that its hard to pay for the required therapeutic counsels and in addition the meds. Somebody who can’t get to dependable transportation for follow-up physical checkups winds up missing it. A patient who oversees independent from anyone else with no in-home help additionally may endure a mishap if there is nobody to check that he/she is eating adequately and having the endorsed drugs legitimately. In all these the cases, there is the higher danger of readmission and the standard medicinal services designs fall flat. At the point when there is enhanced patient provider communication, at that point, the care supplier can show signs of improvement handle of such impediments.

Health visitor and a senior man with tablet during home visit.

In an esteem based medicinal services framework, the suppliers can distinguish these kinds of in danger patients. At that point, they can mediate in the circumstances at the ideal time to give arrangements that fulfill not just the person’s particular needs. This likewise improves the probability of a more positive result. Clearly, it is the worry about the effect of social determinants of health that has yielded the enhanced general wellbeing status in such cases.

2. Lessened CARE GAPS

A care director to just survey the patient’s release outline and current medicinal records to effortlessly get a thought of his wellbeing status. Yet, to precisely evaluate a person’s 30-day readmission chance – or the danger of an unfavorable occasion – suppliers need to think past this rundown of the patient’s medicinal medications. Examining the patient-particular social determinants of health information is the key here in light of the fact that it can foresee the impactability of the care administrations. The utilization of examination clubbed with the information of social determinants help the care suppliers to discover that a costly home visit can be supplanted by a more affordable auspicious follow-up require a patient who is living alone.

Preventive care is likewise a vital piece of social insurance. An esteem centered association in Minnesota enlisted its patients in a ‘Social Determinants’ program with a point was to build preventive care and decrease preventable healing facility confirmations for powerless patients. Different care coordination models were utilized to address a patient’s’ physical, conduct, social and monetary needs. ED visits were diminished by 9.1% and outpatient visits expanded by 3.3% inside a time of actualizing the program. Obviously that tending to and treating just the maladies without considering its underlying driver won’t yield the coveted wellbeing comes about.


The achievement of any model relies upon its cost-viability or the income it produces. The lead is material to esteem based care models too. The care suppliers ought to have an understanding into the general prosperity and the well-being status of the patient populace they have embraced. The care suppliers can be punished something else. For instance, they are in danger if a patient is readmitted to the doctor’s facility inside 30 long stretches of release. This will influence the general expenses contrarily. For esteem based care to have a genuine effect, the care suppliers must take remedial and prudent steps to manage the social determinants of health.


Fusing the social determinants of health into the human services structure can use the entire picture to a substantially larger amount. Making sense of the real causes behind a populace’s disease can prompt more successful arrangements in reestablishing their wellbeing. Social determinants make it less demanding to perceive the estimation of financial conditions and expresses that they are basic in remaining solid.

The mechanical ability has helped considerably to manage the expanding populace and to discover inventive arrangements that convey better clinical outcomes. Human services area is changing quickly and future-availability is what will make the required effect and energy. Understanding and defeat social determinants of well-being make the establishment of preventive care. So concentrating on it implies a major win for everybody engaged with the human services industry.

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The BPCI Advanced: The Next Generation of Bundled Payments from CMS

Funny piggybank standing on clipboard with document

The United States Centers for Medicare & Medicaid Services (CMS) has introduced a new voluntary bundled payment model initiative known as the Bundled Payments for Care Improvement Advanced (BPCI Advanced).

Announced at the beginning of 2018, the BPCI Advanced has come in within just months after several mandatory bundled payment programs were canceled. During their initial phases, bundled payment initiatives had exhibited great promise. But later on, many challenges, ranging from identifying patients, understanding provider claim inputs and defining effective strategies, cropped up. The design of the new BPCI program has renewed the interest in episodic cost management as it counteracts the risks and complex implications connected to the former Medicare program MACRA.

Understanding Bundled Payments

Building up a high quality, but affordable and accessible healthcare system that puts patients first, is the foremost goal at CMS. Previously, Medicare used to make separate payments to healthcare providers such as hospitals, post-acute care providers, physicians, etc. for each and every service performed for their patients irrespective of whether it was a single and short illness or a prolonged course of treatment. But they discovered that this payment model resulted in fragmented care, a lack of patient engagement and coordination between providers and healthcare settings. Care providers were being rewarded for the quantity of services offered rather than the quality of their care.

Bundled payments for care improvement which align incentives for providers were more effective and efficient as it encourages them to work closely together across all settings and specialties. All the payments of multiple services that beneficiaries receive during an episode of care are linked together. Healthcare providers involved in this payment arrangement are held accountable both performance-wise and financially for episodes of care. This leads to better patient engagement, coordination and more value-based care at a lower cost to Medicare. Those receiving the bundled payments may either end up with gains or losses depending on how successfully they handled their resources and costs during each episode of care.

CMS Announcements on BPCI Advanced

Economic Diagnosis Concept - Dollars, Calculator, Stethoscope

The BPCI Advanced is classified as an Advanced Alternative Payment Model (APM) under the Quality Payment Program. The first group of participants are set to be active from October 1, 2018, and the model period performance will be for three months, till December 31, 2023.

All applications were processed via the BPCI Advanced Application Portal. Applications submitted outside of the Application Portal were not be accepted. Incomplete applications were also rejected. As per the plan, Target Prices are to be calculated and distributed to the applicants before the first performance period of each year. The target prices for this year are expected to be distributed in May 2018 and the applicants have time up to August 2018 to sign their participation agreements.

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Clinical Episodes in BPCI Advanced Model

Doctor talking with patient in doctors office

CMS has announced that the Bundled Payments for Care Improvement Advanced model will test a new iteration of bundled payments for 32 Clinical Episode which includes 29 inpatient Clinical Episodes and 3 outpatient Clinical Episodes. Participants of the BPCI Advanced will be held accountable for one or more Clinical Episodes from the launch of the program in October 2018 and are not allowed to add or drop such Clinical Episodes until January 1, 2020.

Inpatient Clinical Episodes

  1. Disorders of the liver excluding malignancy, cirrhosis, alcoholic hepatitis
  2. Acute myocardial infarction
  3. Back & neck except spinal fusion
  4. Cardiac arrhythmia
  5. Cardiac defibrillator
  6. Cardiac valve
  7. Cellulitis
  8. Cervical spinal fusion
  9. COPD, bronchitis, asthma
  10. Combined anterior posterior spinal fusion

Outpatient Clinical Episodes

  1. Percutaneous Coronary Intervention (PCI)
  2. Cardiac Defibrillator
  3. Back & Neck except Spinal Fusion

The Conveners for BPCI Advanced program

From hospitals and physicians to post-acute providers, multiple independent parties are engaged in delivering patient care across an episode. An organization that brings together these various care-providing parties is called a convener. The convener distributes the above mentioned bonus or pays the penalty incurred with higher than benchmark FFS costs. The BPCI Advanced program applications were due on March 12. Starting on Oct. 1, 2018, the participants are subject to immediate downside risk.

Any organisation can play the role of convener, but they must have adequate administrative capacity, the financial capacity to take on the risks and the ability to gain the trust of the various bundle participants. Hospitals, large physician groups, third-party consultancies, or specialty associations like the Academy of Academic Medical Colleges can serve conveners who rally local providers into agreements.

Lifecycle Health’s has designed a healthcare care coordination software platform where all individuals involved in patient’s episode of care, including the patient and all the care providers, are able to coordinate and collaborate throughout the treatment episode. Though it may seem like greek to most, our team of experts at Lifecycle Health understand what CMS is looking for. The Lifecycle Health cloud platform organizes and links the key metrics from given Medicare claims data and makes informed suggestions that saves providers time and costs. From quality of care to costs and patient satisfaction, the Lifecycle Health platform allows its members to get real-time visibility into a patient’s episode across the various providers involved. Allow us to guide your organization to efficiently master the all new bundled payment program, the BPCI Advanced.


All you need to know about the updated C Difficile Infection Clinical Guidance from IDSA-SHEA

Recently, an updated clinical practice guideline for ‘Clostridium difficile infections’ (CDI) was published in an online journal called Clinical Infectious Diseases. Doing so, the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) shared updated guidelines for diagnosing and treating Clostridium difficile infections.

The wide-ranging clinical practice guideline talking about the epidemiology, diagnosis, treatment, and prevention of CDI was written by a multinational expert panel, which included physicians and was validated by the IDSA and SHEA.

The guideline, which is an update from the earlier 2010 IDSA/SHEA CDI recommendation, will serve as a very important resource to the medical, infection prevention, and public health communities. It also presents several unresolved aspects of CDI diagnosis, treatment, and prevention that highlight important potential research opportunities for the academic community.

Worldwide, CDI remains an urgent public health problem.  In the United States alone, CDI is the most common healthcare-associated pathogen, with around half a million cases and more than 29,000 deaths attributable to C difficile each year.

The latest update by SHEA and IDSA has incorporated recommendations for children (this is after following the adult endorsements for epidemiology, diagnosis, and treatment), includes substantial changes in the supervision of this infection and reflects the evolving controversy over best methods for diagnosis. As physicians and healthcare unit staff you must be aware of the fact that, Clostridium difficile remains the most important cause of healthcare-associated diarrhea and has become the most commonly identified cause of healthcare-associated infection in adults in the United States.  Additionally, C. difficile has recognized itself as an important community pathogen.

Although the occurrence of the epidemic and virulent ribotype 027 strain has declined noticeably along with overall CDI rates in parts of Europe, but it still remains one of the most commonly identified strains in the United States – where it is causing a sizable minority of CDIs, especially healthcare-associated CDIs.

In simple terms, the updated guidelines, eventually recommend epidemiology, diagnosis, treatment, infection prevention, and environmental management.

  1. Clifford McDonald, MD, co-chair of the guidelines panel and associate director for science in the Division of Healthcare Quality Promotion for the Centers for Disease Control and Prevention (CDC) opined that “We can better control this epidemic by learning how to use new treatments and diagnostics. The role of the infectious disease specialist is critical, not only in providing expert diagnosis and treatment of C. diff. infections, but also in helping set institutional policies that will lead to their prevention – including reducing the inappropriate use of antibiotics through good stewardship.”

Dr. McDonald further elaborates that, not everyone diagnosed with C. diff. requires treatment, “We often find people get better on their own if they stop taking the offending antibiotic.”

The new guidelines put forth by the SHEA and IDSA are:

  • Fidaxomicin or Vancomycin – Antibiotics vancomycin or fidaxomicin should be used for initial treatment of even mild C. diff., rather than metronidazole. In the previous guidelines this was recommended as first-line therapy. Study shows the cure rates are higher for vancomycin and fidaxomicin than for metronidazole.
  • Fecal Microbiota Transplantation (FMT) – The guidelines recommend FMT for treatment of people with two or more recurrences of C. diff. and for whom traditional antibiotic treatment has not worked.

FMT is a first-hand treatment since the last guidelines were published; however it is not approved by the Food and Drug Administration (FDA). Nevertheless, FDA has issued Guidance for Industry regarding the use of FMT to treat C. diff. infection not responsive to standard therapies

FMT involves transferring fecal bacteria from a healthy person’s stool to the gut of a person with recurrent C. diff., to replenish the good bacteria and control the disease-causing bacteria.

  • Further the updated guidelines include the same suggestions for preventing the spread of C. diff. as the 2010 guidelines. This includes isolating infected patients and ensuring healthcare workers and visitors use gloves and gowns. Additionally, it also calls for increased attention to antibiotic stewardship to reduce the unwarranted use of the drugs.
  • While nearly all antibiotics predispose people to C. diff., some are of particular concern, including the fluoroquinolones, cephalosporins and clindamycin.
  • The guidelines make no recommendation for the use of probiotics.
  • “We tell patients that for the most part they won’t hurt, but at this point we can’t make a recommendation for which ones to use and specifically how to use them,” concluded Dr. McDonald.

The new recommendations also include guidelines for epidemiologic surveillance, diagnosis, and treatment of C. diff. in children, which the 2010 guidelines did not address.


Top 2 Reasons Why Value-Based Care Options of Patient Engagement Improve Treatment Quality for Patients

When it comes to value-based care options, experiments are still ongoing with better and highly-evolved choices expected to come to the forefront in the days to come.  However, it does not in indicate that the present options in any way lack the treatment quality for patients.

Rather there has been a massive rise in the number of people looking for the flexible and economical ways of treatment that a value-based healthcare system offers — and the demand has multiplied in all the three domains of healthcare including physical, mental and social. Value-based healthcare concept seems to be highly effective and in line with the real objective of health care: increasing value. The health outcomes measure value which certainly matters to the patients who analyze it relative to the cost of achieving these outcomes.

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In order to ensure that value-based healthcare is implemented to the fullest and all the domains of health are included in the care-cycle, the transformation must be introduced from both the healthcare providers as well as the patients. The emphasis should be to establish true health outcomes, implementing appropriate health payment schemes, and strengthen primary care to build integrated health systems that reduce moral hazards but aggressively promote value to ensure a health policy as well as health information technology that fits well the community is created.

Understanding The Genesis Of Value-Based Care

A value-based care is a type of reimbursement that decides the payments for care delivery based on the quality of care provided by the care provider. It rewards providers for both effective patient engagement, care effectiveness, and efficiency. In the past few years, this type of reimbursement has evolved as one of the most efficient alternatives and potential replacement for the regular fee-for-service type of reimbursements in which the patients/payer pay the provider retrospectively for the services they deliver on annual fee schedules or bill charges.

The traditional fee-for-service reimbursement model promotes quantity of services. However, lately, the federal medical programs have developed multiple reimbursement programs rewarding healthcare providers for the quality of care they provide to the patients. The primary aim of such value-based care programs is to fulfill three objectives:

  • To provide better care to individual patients
  • Improving the strategies for population health management
  • Reducing the overall healthcare costs

Putting The Patients First With BPCI Advanced

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And this is exactly what the Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) are planning to do by announcing a completely novel voluntary episode payment model – Bundled Payments for Care Improvement Advanced (PBCI Advanced). With this model, the centers aim to test a new iteration of bundled payments for 32 Clinical Episodes with the aim to align incentives among participating health care providers to reduce expenditures and improve quality of care for Medicare beneficiaries.

This model will be run under the Quality Payment Program as an Advanced Alternative Payment Model (APM) which is exactly what patients can expect with a value-based care. Most important goals of this model are to provide an affordable, accessible healthcare system that puts the patients first. And it can be easily achieved with the help of latest provider engagement software.

2 Reasons How Value-Based Care Can Improve Treatment Quality Of Patients


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With the cost pressures in the healthcare sector increasing steadily, established remuneration models related to healthcare services are now undergoing transition around the world. Now fees for performance and value-based systems are most eagerly preferred over the increased fees for service. Even the major players in the medical fraternity including Medicare and Medicaid in the United States, the National Healthcare Institute in the Netherlands, the National Health Service in the UK and many other leading university hospitals in Europe have taken a step in this direction.

Correct and timely diagnosis is the path to a successful and positive patient outcome. When a patient visits a doctor for the first time, the initial few minutes are dedicated to determining the subsequent steps that directly influence the cost and of course the treatment. The diagnosis itself being a complex challenge it has a high potential for human error as well as errors that arise from the whole system itself.

Misdiagnosis is a serious issue that can lead to unnecessary treatment of non-existing conditions or improper treatment or even proper yet delayed treatment. All these issues not only impact the patient but also the provider. More often, the diagnostic errors are caused as a result of staff shortages, temporary overwork or even time pressure. The occurrence of diagnostic errors can be restricted with the help of a modern software-based workforce management system that contributes to optimizing the organization of in-house resources.

When robust hospital information systems and innovative user-friendly diagnostic tools are used it cuts down errors leading to faster and accurate diagnosis.


It is an established fact that quality of diagnosis, treatment decisions based on this diagnosis and the monitoring of the treatment can have a significant impact on the patient outcomes. However, it is very much important that the results are transparent if improved outcomes are expected. According to economist Michel Porter, the providers do not have an option but to improve value if they want to survive the challenges of lower payment rates and potential loss of market share.

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Although the hospital managers are well aware of this situation, they are not aware of the suitable measurement methods. With the patient engagement software, a healthcare provider is solely dedicated to one patient and all his attention is focused on the patient. The discussion is more on a one-to-one basis with the patient entirely depending on the provider for his suggestions. The credibility of the healthcare provider is at stake and he is certainly handling more responsibility of taking care of the patient across the care continuum while serving a hospital environment and after the patient starts their recovery outside the hospital stay.

The approach is more practical and effective as no payment adjustments are expected. The transparency in communication ensures that patient is well aware of the condition and is prepared to face the health challenges, and is more accountable for their own responsibilities for a good recovery. This ultimately leads to a positive outcome for the healthcare providers as well as the patient is well aware of their recovery needs and responsibilities.


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Telehealth and patient monitoring software is the right answer that fulfills all the expectations of the patients and the care-providers who not only are seeking technically accurate statistics and transparency but are expecting to cut down on expenses as well as time spent in transition after the initial clinic visit or hospital stay. Remote monitoring and video visits for patients with complicated health conditions are now fast becoming largely popular as it lowers costs and promotes simplicity, patient visibility, transparency and operational efficiency.

With the leverage Lifecycle Health technology platform and patient navigation services, you can easily transform a healthcare provider’s operations and patient care services into a streamlined, affordable, and effective patient experience. For more info, visit


Patient care tracking solutions – How important are they?

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Managing a healthcare facility with utmost precision is not an easy task. As a physician and business owner of a facility, you are aware that when resources are limited and the in-house staff is getting smaller and smaller, having patient tracking software and tools to maximize efficiency while providing an excellent patient engagement is the need of the hour.

Having technological solutions to track patient care can aid in every step, right from checking in new patients to managing their care with the correct treatments and medication. Streamlining your operations, with the help of patient care software result in better care for your patient’s.

A patient’s time of stay depends on effective patient tracking solutions and the arrangement of their healthcare plan. The length of stay has a direct impact on capacity management and further on costs and revenue. A robust patient tracking solution and administration empowers patients to flow at their best possible rate with respect to service times, quality, safety and resource consumption. Enhance your everyday tasks and patient care with technology that works for you.

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What are the Key Benefits of a Patient Tracking system?

  • Improved Patient Care – Manage procedures more effectively to lessen patient waiting times.
  • Resource Management – Gain critical information into patient status to allocate resources productively.
  • Productivity – Spend less time on administrative assignment and more on understanding patient care.
  • Feedback – The patient tracking solutions help physicians to make the correct choices with real-time information.

What is Patient Tracking system and how does it help?

Medicinal or Healthcare facility is one of the vital elements where tracking and managing patient data is critical. Guaranteeing that patients are constantly coordinated with the right medical history, medications and doctor’s guidelines is basic to giving them the correct care. The healthcare industry is quickly embracing the patient engagement tools such as the tracking system to have the capacity to precisely and quickly ensure they have the correct data. Keep in mind that precise information that is easily available ensures a seamless patient-provider engagement while maximizing your facilities bottom line.

Complete and accurate information likewise also leads to precise medical billing at registration, as all the products and services have been noted down by the software when they were treated. It’s a known secret that every medical organization needs to be profitable. With an efficient patient tracking solution, facilities can reduce operational and overhead costs, while providing value based care. Empowering your staff with the correct technological tools enables them to accomplish more with less.

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Staff deficiencies and working in double shifts is a common thing in a healthcare facility, where specialists and overburdened attendants must keep on providing responsive care to patients. Through patient monitoring solutions, healthcare providers can handle multiple duties without getting bogged down in a solitary location. Staff can remotely program patient procedures and can also be alerted to changes in the physical condition of a patient. By using Wi-Fi empowered cell phones particularly intended for healthcare services, such as telehealth solutions can enhance the speed and nature of restorative treatment, even when there is a shortage of in-house staff.

An appropriately coordinated patient tracking system offers fast, exact and secure information gathering to healthcare providers so they know the status of patient’s health all the time. A full-fledged patient engagement solution should incorporate the following points:

  • Services recording
  • Asset usage and allocation
  • Patient check-in and identification
  • Care and medication administration
  • Accessing patient history
  • Vitals tracking

Having the right devices, from wristband printers to portable PCs, for your staff is fundamental for a profitable patient tracking solution. We can help ensure you and your facility has everything that is required by your specific application needs and software.

At Lifecycle Health, we are the experts in healthcare domain that fulfills your business needs. Our platform allows healthcare networks, physician practices, and downstream providers to distantly monitor, engage, and collaborate with patient care in order to save time, enhance reimbursements and have satisfied patient engagement.

As patient care evolves to become more of a value-care or fixed-cost driven business, the efficiencies involved make the difference in giving fantastic care and enhancing the financial flow. Come, connect with us feel the difference of seamless healthcare management tools.