Here some of the healthcare IT solutions offered by Prohealthware that streamlines patient care and enhances healthcare performance.

Master Patient Index (MPI): The Master Patient Index (MPI) is an Electronic Medical Record system. This traditional paper model used to store patient medical information. It is always a challenge to identify patient records because of multiple healthcare information systems in hospitals that can lead to duplication of patient records which in turn can increase cost. Prohealthware MPI system and EMPI solution helps you to reduce these risks by using matching algorithms using cross reference patient identifiers. It is a database that maintains a unique index for every patient registered at a health care organization. MPI is an integration solution which creates unified views of data. MPI is not only is easier to identify and merge but also provides great accuracy, confidence and management in information exchange. Apart from that, it supports HL7 Messages and Quick Match Capability.

EMR Systems: EMR stands for Electronic Medical Records (EMR) system lie at the center of any computerized health information system that allows healthcare providers to save time and money, enabling them to better care for their patients. It provides full range of Electronic Medical Record IT solutions for the physician practices. Prohealthware provides a reliable EMR solution with easy-to-use and powerful features, which results in incredible return on investment. EMR system helps physicians to manage their patient’s full information like, clinical experience, including office visits, appointment scheduling, referrals and labs efficiently and cost-effectively. With a suite of easy-to-use yet powerful feature, helps to achieve incredible return on investment through Electronic Medical Record software. Prohealthware offers only HIPAA compliant Electronic Medical Record Software solutions developed by Health level 7 certified developers.

Data Warehousing Solutions: To beat the competition, data warehousing can be your company’s best strategy which transforms your business data into business intelligence. To do so, we need to build a data warehouse having complete, consistent and accurate information. A data warehouse is a collection of resources that can be accessed to retrieve information of a healthcare organizations electronically stored data designed to facilitate reporting and analysis. Prohealthware has the experience in taking large databases and reshaping them to improve efficiency. Data Warehousing Solution generates more useful result that leads to high quality business decisions and reduced cost.

Prohealthware is exclusively focused on integration solutions for healthcare IT solutions/products that enable us to provide Best-in-Class, innovative end-to-end solutions to our clients. ProHealthware has expertise in providing healthcare interface & integration services which will improve clinical & financial outcomes.

Before knowing about its treatment, let us know a bit about asthma and allergy. Asthma is a disease that affects the breathing passage and makes it highly sensitive to certain triggers or substances. Allergy is caused when your body behaves in a peculiar manner to harmless substance. Allergy can cause various sudden reactions like sneezing or itching.

Asthma and nasal allergies have a close relation. Those who suffer from asthma are susceptible to pollen grains and dust particles. When the antibodies in our blood are exposed to allergic substances, the body behaves differently towards these substances. These reactions can be somewhat like asthma symptoms and so allergy and asthma are closely related.

The worst part about asthma is that if you are a victim of this disease then you have to carry your inhaler wherever you go. If one is affected by asthma and allergy as well, then he or she should take care about every small thing. As soon as you realize that, you are suffering from asthma symptoms because of allergy, you should inform your doctor.

If you too are, an asthma patient and are also suffering from various allergies, then here are some treatments for asthma and allergy.

Certain asthma symptoms can be suppressed if you treat your allergy. Find the cause of your allergy and stay away from it or tell your doctor to treat that allergy.
You also have certain medicines that treat asthma and allergy together. Corticosteroids are sprayed into the nose to reduce inflation caused by hay fever. You even get it in the form of creams, which can be applied, to the area of inflation to avoid it.
Montelukast is another pill, which can treat the symptoms that are caused by allergy as well asthma.
Another one is Leukotriene Modifier, which helps the immune system to overcome the allergic symptom.
You will even find certain medications that treat one condition over another like Antihistamines. It is commonly used to treat hay fever, but it is not advisable for treating asthma.
Bronchodilator inhalers are another medication, which work for asthma but not for hay fever. They open up the inhalation passage so that you can breathe easily.
You even get medicines that deal with asthma and allergy differently. The only worse thing in this type of treatment is that you have to swallow a dozen pills before sleeping. However, this continues only until you completely recover from both of them.

Therefore, in this way you can treat both asthma and allergy. If you need more information about your health than feel free to check out Online Medical Help for more Health Information.

This is in part because it is considered a complete protein. It contains all essential amino acids our bodies need including lysine. Quinoa actually has plenty of this vital amino acid. Amino acids are needed by your body to create proteins that are then used in repairing and building muscle fibers. In our current diet, we get most of our protein from animal products. Only a handful of grains and other plant based foods contain all the different types of protein blocks we need. It is one of the reasons Quinoa is called the mother of all grains and is classified as a superfood.

Quinoa is also good for you because it is full of fiber and low in sodium and cholesterol. It also contains plenty of Iron, Magnesium, Phosperous, Manganese, Thiamin, Riboflavin, Folate, Vitamin B6, Vitamin E and Niacine. All those nutrients make it a very healthy whole grain choice that also happens to be low-calorie. It comes to no-one’s surprise that it is now classified as a super food.

With all that fiber and protein, it is a great food to include when you are trying to lose some weight since both of those nutrients help keep you full longer. Try having it instead of high-carb foods like pasta and white rice. Not only is it healthier, it also won’t affect your blood sugar levels as much which helps keep down cravings later.

Not only is quinoa a very versatlie grain – you can make breads, puddings, and pilaf like side dishes out of it or just serve it like a breakfast porridge – it is also gluten free, making it a great choice for anyone suffering from celiac disease. It’s also delicious on salads and gives a plain old plate of lettuce and vegetables some extra texture and flavor.

Still not convinced this is worth a try? Let’s see what you can expect to gain from it. In other words, what types of health benefits can you expect from this superfood? It can improve your heart health and is a great source of antioxidants which may prevent cancer. It also contains quite a bit of lignans which help protect your heart. To top it all off, it’s a whole grain which is the type of food we could all use more of in our diets. No wonder it is considered so food for you.

Skipping meals is a common phenomenon among corporate executives, and most of them find healthy eating quite boring- if not out of choice, but by compulsion. Moreover, they also tend to rely more on junk and fried foods for their daily nutritional requirement, which are all the more harmful.

But this kind of unhealthy eating habits begin to show their results within a short span of time. They start gaining weight fast with addition of fats in all the wrong places, and develop blood cholesterol related problems at an early age. This also happens because, the corporate executives, over the time, become more sedentary, but their eating habits remain the same. To undo all these effects one just needs to do two simple things – follow a disciplined eating regimen, and do workout on a regular basis.

- Here are few important yet not-so-complicated healthy nutrition tips for corporate executives:

- Never skip meals. When you do so, your body does not get the requisite nutrients and fails to generate calories that is required to keep you fit and fine. In a while your basic metabolic rate decreases, and you start to feel fatigued.

- Take small meals at regular intervals to keep your energy level high.

- Have a blast at the breakfast table. Do keep it king size, and include more of whole fruits, milk products, seeds and lentils, egg whites, and fiber-rich breads and cereals.

- Restrict the amount of tea/coffee that you consume in your office in a whole day. However, herbal tea or ginger tea works great for stress management.

- Avoid caffeine and excess intake of sugar (in the form of canned beverages), as these cause irritability, lack of concentration, depression, emotional instability etc, thus adversely affecting your overall productivity.

- Junks are a strict no no for corporate executives. Fix a day in a week, say Friday, to feast on some delicious pizzas and burgers, and for rest of the week, practice restraint.

- Keep a packet of multi-grain biscuits, oatmeal cookies, or roasted peanuts or walnuts in office to munch on, whenever you feel hungry.

Follow these simple nutrition tips and you will see the difference in you soon.

A Chocolate Free Diet:

Pugs just like any other dog should never have chocolate. Aside from making a dog uncomfortable, chocolate is actually toxic to them. This is just not because of a concern for health problems due to gaining weight or from consuming too much sugar. Consuming chocolate can lead to major problems and cause your pet to die. Chocolate may taste like a piece of heaven to us, but to a dog it is poisonous. You need to keep chocolate away from your dog at all costs. Some people believe it is okay to give them a little bit, but it is never okay.

Food and Chemical Allergies:

Food and chemical allergies are sometimes not specific allergies. They may happen over a period of time due to certain foods or chemicals in the environment. These allergies are much harder to pinpoint because they may develop an allergic response that can mimic almost anything. The main concern is taking care of your Pug, and of course to check with your veterinarian if any problems result. If your dog tends to get sick after visiting certain places or eating certain things, you should pay attention to see if you can narrow down the cause and get your dog back to optimum health again.

Allergy Season:

Just like human beings, Pugs can also suffer from seasonal allergies. Having allergies is no fun for humans or dogs so it is a good idea to take care of any symptoms as quickly as possible so your dog can be comfortable. Otherwise your Pug may suffer from itchiness as well as a plethora of other symptoms. The best way to handle allergies is to get a veterinarian/dermatologist who can take a look at the symptoms and formulate a treatment plan. This may include taking antihistamines, using special shampoos or even taking steroidal medications. The point is to get the symptoms under control so you can both get back to enjoying life again.

Allergies can pose a big problem with Pugs if for no other reason than they cannot always be identified quickly. Allergies include chocolate, allergies to something they ingest and whatever they might come into contact with during the course of the day and regular seasonal allergies as well. Being vigilant and taking care of these allergies requires stopping them as quickly as possible and might even save your dogs life. A trip to the vet may seem expensive, but could very well be worth the money if it ends up saving your dogs life. Some breeds require more health care than others and the Pug just happens to be one of those breeds.

In school
On a field trip
At home with a caregiver
At a sports practice or an event that you cannot attend
Sleep over at a friend’s house

It’s important to keep your child’s school, caregivers coaches and teachers up to date on your child’s allergies. This is why it’s vital to keep your child’s health information handy and up to date, especially when they will be staying with a babysitter, daycare, or at school. It is always a good idea to allow your child’s caregiver’s to view your children’s health information that should be known in the case that your child suffers an allergy attack. In many cases, this health information has saved thousands of lives of children who have severe allergies and allergic reactions to certain foods and products.

Three questions:

Do you provide your entire child’s allergy information with their school and caregivers?
If you do, do you provide them with a severe allergy letter?
Does your child’s school or caregiver know the reactions of your child’s allergies?

One of the safest ways to make sure your child’s school and caregivers know there allergies and reactions is to use Vital Locket.  Vital locket is a fantastic device that allows you to store all of your child’s medical information in one secure location. This information can include blood type, medications, allergic reactions, and doctor contact information. You are then able to view and print your child’s allergies at any time via a secure Internet connection. Because all of the medical information will be in one place, it makes it extremely easy for you to pull this information up for your babysitter or caregiver.

Your Vital Locket profile puts you at ease by keeping all your family’s information at your fingertips, readily available anytime you may need it.

This has been a major factor necessitating healthcare reform, along with increasing healthcare costs and health premium rates, as well as the high number of the uninsured (about 47 million or approximately 16% of the total population).

President Obama signed the health reform into law in March 2010 to improve the quality and efficiency of healthcare, address the inefficiencies of the existing healthcare structure, and to decrease the number of uninsured people in the U.S. The health reform bill outlines several provisions such as universal health coverage, cost containment, increase in insurance market competition, excise tax on medical device manufacturers, and lower drug costs for Medicaid and Medicare. The health reform provisions thus directly impact the U.S. healthcare industry and its stakeholders.

The report forecasts and analyzes the future impact of the health reforms on the U.S. healthcare industry. This covers direct as well as indirect impacts of the provisions on pharmaceutical, medical devices, and health insurance industries. Indirect impact refers to provisions that do not specifically apply to these industries. Each section offers a strategic analysis of the impact of Obama’s health reforms on the U.S. healthcare structure.

What makes our reports unique?

* We provide the longest market segmentation chain in this industry- not many reports provide market breakdown upto level 5.

* We provide 10% customization. Normally it is seen that clients do not find specific market intelligence that they are looking for. Our customization will ensure that you necessarily get the market intelligence you are looking for and we get a loyal customer.

* We conduct detailed market positioning, product positioning and competitive positioning. Entry strategies, gaps and opportunities are identified for all the stakeholders.

* Comprehensive market analysis for the following sectors:

Pharmaceuticals, Medical Devices, Biotechnology, Semiconductor and Electronics, Energy and Power Supplies, Food and Beverages, Chemicals, Advanced Materials, Industrial Automation, and Telecom and IT. We also analyze retailers and super-retailers, technology providers, and research and development (R&D) companies.

Key questions answered

* What is the structure of U.S. healthcare system and what are the pitfalls within the current system?

* What are the major provisions of the U.S. Healthcare reform?

* How would the provisions of healthcare reforms affect U.S. healthcare industry in near future?

* What will be the drivers and restraints for different stakeholders of the U.S. healthcare industry in the near future?

* What can be the possible business implications for the U.S healthcare industry and its stakeholders such as Pharmaceuticals, Medical device manufacturers and health insurance industry?

* What will be the impact of Healthcare reforms on the U.S. economy?

Powerful Research and analysis

The analysts working with MarketsandMarkets come from renowned publishers and market research firms, globally, adding their expertise and domain understanding. We get the facts from over 22,000 news and information sources, a huge database of key industry participants and draw on our relationships with more than 900 market research companies across the world. We, at MarketsandMarkets, are inspired to help our clients grow by providing qualitative business insights with our huge market intelligence repository.

Table of contents

1 Introduction

1.1 Key Take-Aways

1.2 Report description

1.3 Stakeholders

1.4 Research Methodology

2 u.s. healthcare industry Overview

2.1 Overview of HealthCare System in U.S.

2.2 Healthcare reforms in the U.S.

2.2.1 Agenda of Obama’s healthCAre reforms

2.2.2 challenges for Obama’s healthCAre reforms

2.2.3 Impact of Obama’s healthCare reforms on the healthcare industry

2.2.3.1 Impact on Health Insurance Industry

2.2.3.2 Impact of on Pharmaceutical and Medical Devices Industries

2.2.3.3 Empowerment of Healthcare consumers and its impact on U.S. economy

3 U.S. Healthcare system

3.1 Healthcare structure in the U.S.

3.1.1 Reimbursement and financing

3.1.1.1 Public health insurance

3.1.1.1.1 Medicare

3.1.1.1.2 Medicaid

3.1.1.1.3 Other public systems

3.1.1.2 Private health insurance

3.1.1.2.1 Employer-sponsored insurance

3.1.1.2.2 Private non-group insurance (individual market)

3.1.1.2.3 Private group insurance (cooperative)

3.1.2 Regulatory environment

3.1.2.1 Healthcare laws

3.1.2.2 Regulating bodies

3.1.2.2.1 The Center for Devices and Radiological Health (CDRH)

3.1.2.2.2 U.S. Food and Drug Administration (FDA)

3.2 Healthcare Expenditure

3.2.1 Total Healthcare expenditure

3.2.2 Per capita healthcare expenditure

3.2.3 Healthcare budget and health reforms

3.2.4 Obama’s Stimulus Package for healthcare sector

3.3 Need for  healthCARE reforms

3.3.1 Rising Healthcare Costs

3.3.2 Unaffordable health insurance

3.3.3 Uneven health coverage

3.3.4 Lack of quality healthcare

4 Obama’s HealthCare Reforms

4.1 Obama’s proposed strategies for healthcare reforms

4.1.1 increasing affordability and accessibility of healthcare

4.1.2 improving public health

4.1.3 lower healthcare costs

4.1.4 improving quality of healthcare

4.2 Obama’s initiatives in healthcare

4.2.1 Obama’s healthCare reformS

4.2.1.1 Patient Protection and Affordable Care Act, 2009

4.2.1.2 Health Care and Education Reconciliation Act 2010

4.2.1.3 Healthcare Reforms – Implementation Timeline

4.2.2 Other health initiatives

4.2.2.1 Children’s Health Insurance Program Reauthorization Act, 2009 (CHIPRA)

4.2.2.2 American Recovery and Reinvestment Act, 2009

5 Impact of Obama’s health reform provisions on the U.S. healthcare industry

5.1 impact on Medical devices industry

5.1.1 Excise Tax

5.1.2 IncreaseD fda COMPLIANCE

5.1.3 Increased transparency through CER and ban on sunshine provision

5.1.4 INDIRECT IMPACTS

5.1.5 business implications for medical device manufacturers

5.2 impact on Pharmaceutical industry

5.2.1 excise tax: a potential negative impact

5.2.2 lOWER DRUG PRICES THROUGH MEDICARE AND MEDICAID

5.2.3 Rebates for new formulations of branded drugs

5.2.4 Increase inspection and compliance costs

5.2.5 12-year exclusivity for biologics and New regulatory pathway for biosimilars

5.2.6 coverage of clinical trial costs

5.2.7 business implications for pharma/ biotech industry

5.3 impact on Insurance industry

5.3.1 Medical Loss Ratio (MLR)

5.3.2 mANDATORY COVERAGE PROVISIONS

5.3.2.1 Guaranteed eligibility

5.3.2.2 Ban on annual and lifetime limits

5.3.2.3 Mandatory preventive care and immunizations without cost sharing

5.3.3 Annual fees and tax implications

5.3.4 Health insurance exchange

5.3.5 Improvement in Child coverage

5.3.6 Cost Containment Provisions

5.3.7 Employer Play-or-Pay policy

5.3.8 business implications for insurance industry

5.4 Impact on other stakeholders (beneficiaries and hospitals)

5.4.1 Impact of healthcare reforms on beneficiaries

5.4.2 IMPACT OF HEALTHCARE REFORMs ON HOSPITALS

6 Economic Impact of Obama’s healthcare reforms

6.1 Economic Impact

This paper will serve as an update to Wyatt Matas & Associates’ “The Delineation of Healthcare: The Natural Evolution of a Healthy Industry” (“Delineation”). In it we will describe the dramatic shift of industry dynamics occurring as a result of the sweeping overhaul of healthcare signed into law on March 23, 2010 by President Obama. As a result of this legislation, a new Medicare reimbursement penalty for hospitals with high avoidable readmission rates and economic incentives created by the Independence at Home Act (IAH) will force the home care sector to add greater value to the larger healthcare industry in order to thrive. This new legislative framework positions home care to be the solution to the problems plaguing the entire healthcare system. Home care agencies will now have a unique opportunity to provide real value to the health care system while earning significant financial gains.

These changes will benefit all home care stakeholders, including patients, providers and payers. This new framework represents the beginning of a period of sustained opportunity, innovation and industry prominence for those home care organizations that are able to take advantage of this structural industry shift.  Those who can adapt to these inevitable environmental changes and emerge as industry leaders will have a substantial and defendable competitive advantage in the future of US healthcare.  However, home care agencies wishing to take advantage of these opportunities will need to move away from general, episodic care toward sustained, coordinated care of all patient needs by becoming coordinated care management companies.

Avoidable Hospital Readmissions

In an effort to control the increasing rates of avoidable readmissions, a new Medicare regulation will go into effect October 1, 2012.(1) This new regulation will penalize hospitals with avoidable readmissions higher than the national average by cutting 1% of their gross Medicare reimbursement.  If a hospital is not able to improve its rates of readmission, the penalty will escalate. As hospitals nation-wide strive to reduce their avoidable readmission rates, the national average rate will in turn be lowered, forcing hospitals to continually improve.

Avoidable readmissions use limited, expensive hospital resources

One out of five Medicare hospital discharges results in an avoidable readmission.(2) Of these readmissions, patients with chronic condition co-morbidity experience the highest rates of avoidable readmissions.(3) Most of these patients returning to the hospital as avoidable readmissions are already unprofitable even before the imposition of the coming reimbursement penalty.(4) These patients also have high average lengths of stay, crowding out capacity for more profitable, surgical patients. Therefore hospitals not only experience real-time loss of cash flow but also the opportunity cost of not devoting resources to higher margin business, such as joint replacements. With many hospitals already over burdened, this expensive trend cannot continue.

Home care agencies tend to shift costs to hospitals

Home care agencies have traditionally been the low-cost care providers for patients transitioning home after hospital discharge.  However, while on a per diem basis home care is the lowest-cost option, much of the actual costs of caring for a post-facility discharge patient are shifted to hospitals and other facility-based providers through avoidable readmissions. Some agencies have hospital readmission rates within 30 days of discharge as high as 30%. Because of this the home care sector has experienced significant reimbursement cuts and criticism. In fact, CMS recently announced its recommendation to cut home care’s reimbursement rate by 4.75% starting January 1, 2011.(5)

Home care has opportunity to grow but must meet healthcare needs

All indications make clear that when it comes to evaluating the results of health care providers only one measure of cost and quality will ultimately matter – the percentage of avoidable readmissions.  Factors such as federal and state budget cuts, an aging baby boomer generation consuming increasing levels of healthcare services, and a shortage of nurses and other healthcare professionals will add to the stress for payer sources to find ways to cut costs and lower avoidable readmissions.  Home care is positioned better than any other healthcare sector to play a significant role as a solution to this enormous challenge. However, if homecare does not step forward as a leader to solve or at least manage these challenges, another sector will. Homecare’s ability to adequately address and provide solutions to the avoidable readmission problem is what will prevent the industry from becoming marginalized and have the opportunity to thrive.

Independence at Home Act (IAH)

Currently, 25% of Medicare beneficiaries account for 85% of the cost of Medicare spending, while 50% only account for 4% of total cost (See Figure 1.)(6) The most costly of these beneficiaries all have one or more chronic diseases.  IAH (H.R. 2560, S. 1131) became law on March 23rd, 2010, as a component of the Patient Protection and Affordable Care Act (PPACA), in order to control increasing Medicare expenditures and at the same time provide effective and efficient care for these high-risk patients. (7)

Figure 1.

IAH allows for physicians and other licensed, independent practitioners (LIPs), such as nurse practitioners, and physician assistants, to serve as primary care providers (PCPs) for high-risk patients with one or more chronic diseases. Most importantly these healthcare professionals will coordinate care with other providers such as home care, hospice and specialty pharmacy (e.g. infusion therapy).  This high level of coordination will produce substantial net savings to the healthcare system at the same time a higher quality of care than is currently being delivered.

IAH will lower costs and incentivize savings

Unlike the current business models that are designed entirely around reimbursement, the IAH program will be funded primarily from the cost savings it achieves. For care providers who are able to achieve a 5% annual savings of forecasted costs for an individual patient’s care, the savings will split such that 80% goes to the provider and 20% goes to CMS. Given the annual costs associated with caring for high-risk patients, those providers who achieve the outlined objectives stand to reap substantial financial benefits.

Figure 2 (page 4) illustrates the savings of four institutions that developed physician and nurse practitioner lead home visit programs.  The middle column shows that expenditures for visits in the home increased as part of the program. However, overall costs associated with caring for this patient population decreased dramatically.

Figure 2.

Figure 3 shows the Veterans Administration’s most recently published data for its Home-Based Primary Care program.(8) Although costs associated with home care and outpatient services increased, there was significant savings in the more costly hospital and nursing home settings because chronic disease patients were more effectively able to manage their health at home.

Figure 3.

Initially, IAH will be a three-year demonstration, including only 50 providers and serving 10,000 patients. However, given the Congressional Budget Office’s projection that IAH will be budget neutral with likely savings and the expected positive response from patients and their caregivers, its implementation is likely to accelerate.

New Opportunities for Home Care

Given the new avoidable readmission penalties and the introduction of IAH’s economic incentives, home care is positioned better than any other healthcare sector to adapt and meet the demands of the changing healthcare industry. Through low-cost, patient-centered care, home care will be able to attract a much greater percentage of healthcare dollars.

Hospitals will refer to companies with lowest readmission rates

Neither home care nor hospitals can continue operating home healthcare the way they have been given the new penalties.Currently, the best performing U.S. hospitals produce 1- 3% net operating margins, while 20% of all U.S. hospitals have negative operating margins.(9) With narrow to negative margins, a 1% Medicare reimbursement penalty could prove catastrophic for any hospital that is not able to rein in its avoidable readmission rate.

However, this reimbursement change will prove to be an opportunity for independent home care agencies, in particular, because hospitals have a greater incentive to refer their patients to the most efficient agencies that are least likely to readmit the hospital’s patients. Hospital-owned agencies may no longer receive preferential referrals. Independent agencies that are able to demonstrate low avoidable readmission rates will have a competitive advantage in receiving referrals from hospitals that are particularly concerned with their readmission rates. Some hospitals may even have to consider closing or spinning off their agencies to be certain they can shop for the best possible provider. Even the largest hospital-owned home care agencies’ profits would have a difficult time off setting a 1% or greater reduction in Medicare reimbursement.

Home care becoming primary care source will bring more money to sector

Medicare will not be the only payer wanting to pursue cost savings programs similar to IAH. Given the substantial budget deficits faced across the country, state Medicaid programs will be looking to develop similar programs to enroll individuals with multiple chronic diseases. Commercial insurers will also be highly motivated to enact similar programs to effectively care for the previously 40 million uninsured they are required to extend coverage to as part of the PPACA. Since proactive monitoring and care is the only means by which to minimize often unnecessary hospitalizations and other healthcare costs, all payer sources will be looking to these types of providers to manage patients with costly chronic diseases.

IAH model will attract new, talented physicians to primary care

Although the primary care physician shortage is often cited as a significant obstacle to the success of IAH, we believe it will actually attract new, young talent to the field. The IAH model of care will allow physicians and other LIPs to serve patients in need of care at the same time they are earning a substantial living. Economic incentives from payers will also allow them to earn more money based on their outcomes. As IAH-type care becomes standard it will attract younger physicians who might otherwise go into an office-based practice as well as attract those currently practicing as hospitalists. Additionally, more medical students will choose internal medicine rather than becoming specialists as the pay off becomes greater.

The Value Progression

While a new and tremendous opportunity exists for the home care sector, agencies still face significant challenges to maximize the value they add to the healthcare industry. One view is that the home care sector will create and preserve value along a Value Progression (see Figure 4).  To maximize value, agencies will have to advance along the Value Progression from providing basic home healthcare to more comprehensive, coordinated chronic care management.  This section of the paper will outline the specific health care delivery and expertise levels that agencies will need to achieve in order to thrive.

Figure 4.

Basic Home Care

Home care, at its most basic level, is episodic such that a hospital or other provider will refer a patient to an agency because of a specific event or episode for a specified amount of time. As Wyatt Matas & Associates discussed in the “Delineation” white paper, in the mid-2000′s the US experienced a proliferation of home care agencies, all boasting the highest quality of care, taking all insurances, accepting weekend referrals, etc. However, in general, it very difficult for referral sources to differentiate one agency’s services from another’s.

While some home care agencies offering this basic type of care may maintain profitable margins right now, they will not be able to sustain growth or profitability into the future. Basic Home care providers will experience real losses given the changes in avoidable readmissions penalties and the new economic incentives in IAH. Moving along the Value Progression will not just be a way for companies to gain a competitive advantage, it will be necessary for agencies’ survival.

Specialty Programs

In an effort to differentiate its services and provide patients with more effective care, Gentiva Health Services began to offer specialty programs designed for specific conditions in the mid-2000s. These programs offered referral sources identifiable products that they could recommend to their patients, thereby distinguishing Gentiva’s services from other agencies’.  However, the rest of the home health sector quickly jumped on the trend and now most specialty programs tend to be points of parity rather than sources of competitive advantage.

Furthermore, with lawmakers and other entities looking to reduce healthcare expenditures wherever possible, specialty programs that focus on high levels of therapy utilization, such as joint replacement and fall prevention, will face the greatest challenges in the near future. Firstly, these programs are perceived as addressing or managing “expensive” chronic diseases like diabetes and heart failure.  Secondly, although they can save the system significant sums in avoided trips to the ER and hospitalizations, not to mention the improved quality of life for patients served, the lack of variability in the physical therapy visit frequency for these programs brings them into question.

Coordinated Chronic Care Management

Coordinated chronic care management companies look beyond episodic, event-based care and consider the entire process of a chronic disease.  They serve as health educators, care coordinators as well as care providers for their patients. We maintain our position we set forth in “Delineation” that those companies that effectively become coordinated chronic care management companies will have a clear competitive advantage over providers that do not.

IAH will, in effect, serve as a subset of coordinated chronic care management. To provide effective care and benefit from the economic incentives, IAH practices will seek to partner with home care agencies that demonstrate high-level coordination. While the details of the contract have not yet been disclosed, we believe Amedisys’ recent partnership with Humana is an early example of this.

Figure 5 (page illustrates a dramatic example of the profound impact an effective coordinated chronic care management initiative.  Home Healthcare Partners of Dallas, Texas has successfully implemented tele-health and other active patient monitoring and intervention techniques to lower its avoidable readmissions.

Figure 5.

Considerations for Home Care Agencies

While the future profitability of home care is far from certain, the rapid and significant change within the industry is undeniable.  Organizations of all sizes and ownership structures must determine if and how they will adapt to the changing landscape. Home care organizations will to evaluate their options and what financial, clinical and operational resources will be required to move along the Value Progression.

Those organizations choosing to advance towards coordinated chronic care management will need to have a clear strategic plan and talented staff able to execute it.  Some companies will choose to acquire the talent to make by acquiring an organization that already possesses the requisite expertise. Other companies will enter into joint ventures or other formal partnerships to gain access to the skills they lack.

Organizations that choose to remain focused on specialty programs will have to critically examine their competitive landscape and indentify the skills and resources they need to differentiate themselves. Maximizing efficiency to maintain margins and cash flow will also be essential as reimbursements continue to be cut.  It is clear that agencies will no longer be able to be all things to all referral sources and must select a specialty program in which they can truly excel.

Regardless of the organization’s choice to differentiate its specialty programs or move towards coordinated chronic care management, this is an exceptional time to create value and position the company for continued growth and profitability into the future. Failure to act however will result in real and significant economic losses and for the company. The only option to thrive in this new healthcare environment is to advance.

About Wyatt Matas & Associates

Wyatt Matas & Associates is an investment banking firm that specializes in advising healthcare service providers on strategic and financial matters. We aim to provide thought leadership regarding opportunities and challenges facing the rapidly evolving healthcare services industry.  Our focus in this process is establishing enduring relationships based on performance, trust and integrity.

We provide buy and sell-side mergers and acquisition, equity and debt capital sourcing, restructuring and strategic advisory services. Unlike larger and less specialized investment banks, Wyatt Matas & Associates is not owned by a larger financial institution. This allows us the time to focus on custom solutions to ensure our clients’ success. Also, unlike other investment banks, in certain circumstances we deploy our own capital and expertise in joint ventures and direct investment in client companies.  We only pursue these opportunities that can benefit from our unique experience, relationships and skill-sets.

Given the unique nature of the healthcare sectors Wyatt Matas & Associates has developed a healthcare management consulting group. WMA Strategic Healthcare Advisors develops strategies and tactics for growth oriented healthcare service clients. Our primary objective is to capitalize on our team’s deep industry experience combined with our extensive network of operators, financiers, consultants and other expert professionals to help our clients achieve their goals. The Strategic Advisors unit delivers customized, practical and actionable solutions to provide its clients with a clear understanding of the steps required to create significant value. If needed, our team will step in on an interim management basis or find the appropriate professional to help take a company to the next level.

1 Jencks, S.F., M.V. Williams, and E.A. Coleman. “Rehospitalizations among Patients in the Medicare Fee-for-Service Program.” New England Journal of Medicine 360.14 (2009).

2 Jencks.

3 Chronic Conditions: Making the Case for Ongoing Care. Partnership for Solutions. Johns Hopkins University, 2004. Web. .

4 Jencks.

5 Jencks.

6 Congressional Budget Office, Based on Data from Centers for Medicare and Medicaid Services.

7 Chronic Conditions

8 Home Healthcare Partners, LLC

9 “Should Chronically Ill Patients Be Treated in the Hospital Setting?” Healthcare Economist, 18 Mar. 2010. .

On the average, a person could experience several allergic reactions to one or more things. This happens when we breathe in something that is usually harmless and our immune system (the body’s barrier against viruses and bacteria) classifies it as harmful and attacks. These are the allergens that we need to avoid exposure to. The hard part is, it is difficult to avoid allergens if we don’t know specifically what we are allergic to. Much harder still, allergens are everywhere. They can be in the form of plant pollens from trees, grasses, and weeds, dust mites, animal dander, cockroaches, mold, chemicals, and so forth. It makes it thrice as hard to avoid because pollen and mold may become airborne and can travel easily for miles.

Those affected with allergic rhinitis, also called nasal allergy, pollinosis, or hay fever is commonly caused by plant pollens. Some weeds depend on the wind for cross-pollination than insects to produce seasonal allergies. This makes allergies hard to avoid. Allergies symptoms are a result of the release of histamine, a very important protein in the body which mediates inflammation and is involved in many reactions. Here are the common symptoms that you may experience: itchy, puffy, and watery eyes, stuffy nose, sneezing, coughing, decreased sense of smell, headache, and wheezing. This makes it very bothersome as aside from these, one can experience shortness of breath because the airways become constricted as the body’s response to the allergens. Should the immune system over activate and not be treated, it may result to complications and life-threatening situations. Relief of symptoms is a must!

Allergies treatment is a big factor to those who have allergies. For one, it would be less bothersome for them if they have relief from their symptoms. Having itchy eyes and a runny nose is not exactly a recipe for a happy day. Having it for three consecutive days is already a burden, what more if it extends to more than that? The symptoms also get worse during different seasons. It is important to know what to do and prevent it from occurring before the season changes.

To be diagnosed accurately, check with your physician and let him help you determine which particles you are allergic to. For all the over-the-counter-medications, which includes the anti-histamine medications, that is available in the market to provide symptomatic relief, still the best way to treat the allergic rhinitis is to avoid exposure to allergens. It is also the most cost-effective way in managing allergies. It is best to remove pets from the house to avoid animal dander, staying indoors when there are high pollen counts, control dust mites by using plastic-lined covers for mattress and pillows, and remove any that could absorb minute particles of dust such as stuff toys, carpets and drapes. Allergies treatment may include over-the-counter medications for symptomatic relief and shot for uncontrollable symptoms or unavoidable allergens (or those present all throughout the year).

Do not be afraid to have your allergies checked. You have nothing to lose but a lot to gain. It is important that you know what you are allergic to so you could have better prevention. Enjoy life without the burden of allergies symptoms!