Reducing Avoidable Medicaid ER Visits With a Community Partnership Approach

Anxiety caused by the wait for a non-urgent appointment or lack of awareness that they are assigned a primary care physician are just two barriers to appropriate ER utilization by a diverse Medicaid population, explains Laura Linebach, director of quality improvement at L.A. Care Health Plan. As part of a health plan-hospital collaboration with a goal of reducing non-acute ER use by children ages 1 to 19, L.A. Care Health Plan has launched a Nurse Advice Line and developed a range of materials to educate parents about appropriate use of the ER. Ms. Linebach describes these tools as well as a metric in L.A. Care Health Plan’s pay for performance program that measures group providers’ appropriate resource use.

Laura Linebach presented during Reducing Avoidable Medicaid ER Visits With a Community Partnership Approach, a 45-minute webinar on May 9, 2012, during which she will share the inside details on how the health plan worked with the hospital to target avoidable ER use and results from the initiative.

Length: 5:51 minutes

Geisinger Reduces All-Cause 30-Day Readmission Rates Through Remote Monitoring Program

Geisinger Health Plan reduced the relative risk of all-cause 30-day readmissions by 44 percent compared to a matched control group using an interactive voice response (IVR) system developed by AMC Health. The IVR system targeted patients who were at high risk for readmissions following a hospital discharge. Care managers identified those complex patients that were at high risk for post-discharge complications that could lead to a readmission, explained Dr. Maria Lopes, chief medical officer at AMC Health.

The IVR system makes one call per week for four weeks, using branching logic to identify issues with medication adherence, PCP follow-up, and complications, as well as a risk and falls assessment. The program is integrated into the care management workflow to make this impact, she added.

Length: 11:07 minutes

Recruiting, Training and Case Load Management Strategies for Embedded Case Managers

When looking for new hires for its embedded case management program, Bon Secours Health System looks for critical thinking skills and previous roles that are transferable, such as work with chronic disease patients, explains Irene Zolotorofe, administrative director of clinical operations at Bon Secours. Zolotorofe also describes the importance of matching personalities when placing a case manager in a physician practice, how to build a trusting relationship between an embedded case manager and the physician and Bon Secour’s embedded case manager training process.

Irene Zolotorofe presented during Recruiting, Training and Case Load Management Strategies for Embedded Case Managers, a 45-minute webinar on May 3, 2012, sharing the process that Bon Secours has established for recruiting, selecting and placing an embedded case manager in their practices, along with details on case load management, tools used by case managers, benchmarks for measuring effectiveness and much more.

Length: 6:27 minutes

Second Annual Benchmarks in Reducing Avoidable ER Use: Pain Management Driving ‘Ultra Utilizers’

The use of nurse-only health advice lines to reduce avoidable ER visits is up 10 percent over 2010 levels, according to HIN’s second annual survey on reducing avoidable emergency room use. In this podcast, Melanie Matthews shares key metrics from the 2011 survey, including program availability, health advice line use, new benchmarks on contributions from health coaches and health educators in this area and the biggest barrier to program launch.

Also, Dr. Mina Chang describes the methodology behind Ohio Medicaid’s interventions to encourage appropriate ED utilization by this population.

Need more information on this topic? Download an executive summary of the survey results.

Length: 3:00 minutes