Humana Remote Monitoring Pilots Engage Member’s Circle of Care

Humana’s remote monitoring pilots go beyond traditional targets of heart failure, diabetes and COPD to observe functionally challenged members, explains Gail Miller. This novel approach uses a Personal Emergency Response System (PERS) with a built-in accelerometer to monitor members challenged by activities of daily living (ADL), says the VP of telephonic clinical operations in Humana’s care management organization, Humana Cares/SeniorBridge. Another pilot, a collaboration with HealthSense, places sensors around the member’s home to study algorithms of normal movement so Humana can detect changes and intervene before a member’s crisis.

All Humana remote monitoring pilots engage the circle of care surrounding the member — be it home health, a family member, or a spouse.

Gail Miller shared more details of Humana’s telephonic care management and how remote monitoring pilots will enhance care coordination during a March 19, 2014 webinar, Integrating Mobile Health Remote Patient Monitoring with Telephonic Care Management for Improved Care Coordination Results, a 45-minute program sponsored by The Healthcare Intelligence Network.

Length: 4:26 minutes

Medicare Pioneer ACO Year One: Lessons from a Top-Performer

Lauded for its care coordination service, Monarch had to overcome a few challenges when retrofitting the Naylor Transition of Care (TOC) model for the ACO — among them insufficient patient access, patient skepticism and resource limitations. By focusing on readmissions reductions and four disease management conditions — ESRD, COPD, CHF and diabetes — and creating a care coordination team that included the newly created care navigator, case managers, and pharmacist, the organization has improved patient compliance, reduced negative drug interactions and hospital days and improved patients access to community services.

During Medicare Pioneer ACO Year One: Lessons from a Top-Performer, a September 18th webinar at 1:30 pm Eastern, Colin LeClair, executive director of ACO for Monarch HealthCare, shared first year lessons from its Medicare Pioneer ACO experience, how it evolved in year two and the impact on its organization’s participation in other accountable care organizations.

Length: 14:03 minutes

Motivational Interviewing by Ochsner Health Coaches Drives Results in 4 Key Areas

When health coaches employ motivational interviewing during patient encounters, expect upticks in medication adherence, weight loss, HbA1c levels and overall engagement, notes Alicia Vail, RN health coach for Ochsner Health System. Ochsner’s eight health coaches focus on patients with diabetes, hypertension and obesity who have come to their attention by way of physician referrals, health screenings and pre-chart reviews.

In this podcast, Ms. Vail describes how Ochsner Health System incorporates health coaches in its clinic structure and describes the benefits that result from the coaching intervention.

Alicia Vail and Bill Appelgate, executive director of the Iowa Chronic Care Consortium, shared how an evidence-based health coaching focus drives returns in a value-based payment delivery system during a June 19, 2013 webinar, Health Coaching’s Value in Accountable Care and Medical Homes.

Length: 3:59 minutes

Healthcare Performance Benchmarks: Diabetes Management

The use of a disease-specific approach to improve health outcomes and self-management for patients with diabetes is utilized by 77 percent of organizations, according to HIN’s 2011 survey on diabetes management programs. In this podcast, Melanie Matthews shares key metrics from the survey, including the role of the case manager, the use of incentives, the staff member responsible for diabetes management and the greatest challenge associated with the control of diabetes.

Also, Kathy Brieger, Hudson River HealthCare chief operating officer, describes HRHC’s four-pronged approach to weight management for the 3,400 adult patients it serves.

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

Length: 3:02 minutes

Diabetes Management in the Medical Home: A Diabetes Collaborative Takes Team-Based Approach

Hudson River HealthCare (HRHC) takes a team approach to disease management in the 3,400 adult patients with diabetes it serves, explains Kathy Brieger, RD, CDE, HRHC’s chief operations officer. Ms. Brieger describes the multiple levels of care available to patients served by the HRHC Diabetes Collaborative, a four-point strategy for weight management that targets the most challenging aspect of managing diabetes, and HRHC’s upcoming trial of telepsychiatry at selected FQHCs.

Ms. Brieger presented during Diabetes Management in the Medical Home, a 45-minute webinar on January 26, 2012, providing the inside details on HRHC’s diabetes management program and the program’s impact on its diabetic patients. Brieger shared how to: identify and assess patients for diabetes management, including an analysis of literacy and learning and social barriers that could impact outcomes for complex patients; train staff and report quality data to drive further performance improvement; and much more.

Length: 4:58 minutes

Tackling Healthcare Fragmentation with Innovative Health Management Solutions

Through the implementation of innovative health management programs, we can improve the performance of our healthcare system, says Steve Wigginton, president of Health Integrated, a leading health management solutions company. This podcast discusses how Health plans that make investments in wellness, chronic condition management and technology can enjoy a healthy return on investment with improved health outcomes for their members. To download a case study of one health plan’s successful use of health management solutions that improved outcomes and reduced costs, and for more information on Health Integrated, please visit: or call 800-323-0286.

Length: 11:27 minutes

Closing Gaps in Care for Chronic Conditions

The fragmentation in the U.S. healthcare system for the care of chronic conditions, like diabetes, asthma, heart disease, and depression, causes the health of individuals with these chronic conditions to deteriorate while driving up expenses in emergency room visits and inpatient stays, says Steve Wigginton, president of Health Integrated, a health management solutions company. In this podcast, Wigginton describes how by closing gaps in care, addressing the interplay between medical and psychosocial health and providing day-to-day support for these patients, organizations can avoid costly emergency room visits and inpatient stays.

Length: 5:58 minutes

New Approach to Chronic Pain: Focus on Patient, Not Condition

Too often, pain management tends to focus on the conditions rather than the people experiencing the pain, says Dr. Agostino Villani, internationally recognized expert on chronic pain, CEO of Triad Healthcare, Inc., and author of Pain Is Not A Disease. According to Dr. Villani, this way of thinking depersonalizes the experience of pain and treats it as a disease instead of the complex, personal event that it really is.

In Part 1 of this interview with Dr. Villani, he discusses his new book as well as pain management programs, pain level reduction strategies and side effects of pain medications. In Part 2, Dr. Villani discusses the importance of the physician-patient relationship, measuring the outcomes of pain management and med school curricula surrounding the topic of pain management.

Length: Part 1: 14:04 minutes

Length: Part 2: 13:49 minutes