Archive for March, 2012

Focus on Progress Engages Behavioral Health Clients Telephonically

March 10th, 2012 by Patricia Donovan

Emphasizing that the call is to monitor how well the individual is doing is one way telephonic case managers can engage behavioral health clients in the process, says Jay Hale, director of quality improvement and clinical operations for Carolina Behavioral Health Alliance (CBHA). CBHA uses telephonic case management to impact a wide geographical area from a central location.

Hale shared this strategy and other aspects of CBHA’s telephonic case management program during a March 7 webinar on Telephonic Case Management: Protocols for Behavioral Healthcare Patients.

The use of computer-based surveys by CBHA telephonic case managers has dramatically reduced paperwork, allowing the case managers to make the most of the typical 20-minute phone interaction with a client. The surveys were developed in-house and target vulnerable individuals in three distinct populations — adults with mental illness, adults in substance abuse recovery and children or adolescents with mental illness.

Rating scales in the surveys use words, not numbers, explains Hale, a tactic he says works better over the phone. For example, when asked to rate the presence of symptoms, clients must choose from None, Mild, Moderate or Severe, rather than assigning a numeric rating.

Case managers follow the scripts while engaging patients telephonically, clicking through responses on the screen.

But even with the help of standardized scripts, case managers must employ a conversational style, Hale adds. And it’s not necessarily the length of the phone call, but the frequency of calls, that cements the relationship with the client, as well as the ability of the telephonic case managers to stay on task.

“We’re not here to counsel, but to problem-solve, case-manage, find resources and support the client’s relationship with provider,” says Hale.

CBHA utilizes one case manager for every 40,000 health plan members, and estimates that one of six eligible members engages with a case manager (i.e. completes a survey). CBHA case managers must interact with all three populations, but often admit to relating best to a single group, like adolescents or individuals in recovery from substance abuse.

Although unable to directly tie results to its telephonic case management program, CBHA has seen improvement in 7-day and 30-day follow-up after inpatient stays.

Telephonic case management is crucial at discharge; outreach can include calls to the client, hospital and provider to ensure follow-up appointments are kept.

Listen to an interview with Jay Hale.

Appropriate ER Use May Be Only a Phone Call Away

March 8th, 2012 by Patricia Donovan

Want to reduce avoidable emergency room visits? Pick up the phone, say respondents to our latest Reducing Avoidable ER Visits e-survey — either to respond to callers to your health advice line or to contact patients following an ER visit or hospital stay.

Healthcare organizations who responded to the September 2011 survey report that nurses and doctors are staffing telephonic health advice lines in greater frequency to assess patients before they come to the ER unnecessarily and to educate them about appropriate venues of care. Consider these 2011 survey data:

  • 41 percent of respondents offer nurse-only health advice lines;
  • The use of nurse-only advice lines has jumped 11 percent from 2010 to 2011;
  • 8 percent of respondents offer nurse-physician health advice lines;
  • For 12 percent of respondents, physicians are called in to triage high-acuity calls;
  • Almost 39 percent take time during calls to nurse-only health lines to promote proxy and alternative health services such as an urgent care center, an opportunity second only to contacting patients within 48 hours of the emergency room visit.

The 134 respondents included hospitals, health plans, physicians and other healthcare organizations. A detailed analysis of the 2011 survey provides critical benchmarks that show how the industry is working to reduce avoidable hospital emergency department visits, including data on program components, challenges and benefits and ROI.

Patricia Curtis, RN, BSN, MBA, is director of operations for clinical care services for Optima Health, whose nurse advice line has evolved from a call center supporting a staff model HMO to a critical tool for improving the efficiency of healthcare use. Nurses on the phone work from clinical protocols developed in-house and reviewed by Optima’s physicians.

“We have nurses completing all the assessments. They may or may not ask all of these questions, but [the protocol] gives them a good guide and types of questions they should be asking — for example, things they should be looking for in the triage,” Ms. Curtis explains. “Based on responses to those questions, the [electronic] protocols will lead the nurse to decide what level of care the person needs.

“[Patients] can call any time day or night to ask questions, and there’s always a nurse here to answer those questions,” she continues. All protocols are reviewed at least annually and are available to physicians should they want to see them.

Optima Health was not a survey respondent, but Curtis presented an overview of its nurse advice line during a recent Healthcare Intelligence Network webinar, Maximizing the Nurse Advice Line To Ensure Appropriate Healthcare Utilization.

The second annual survey also found that phone calls out to patients — particularly those recently discharged from the ER or hospital — are making a difference. Key is making these calls within two days of discharge — to confirm that the patient has made a follow-up appointment, that he or she has seen the primary care provider and that there are no questions regarding the care plan provided at discharge.

And finally, more than two-thirds of respondents notify primary care providers when their patients visit the ER, part of an overall trend of engaging physicians in efforts to promote appropriate ER use. (A quarter of respondents say this is the most significant challenge of reducing avoidable ED utilization.)

Physicians successful in these efforts should be rewarded with incentives, said 80 percent of survey respondents, although one respondent feared that if incentives were offered, “providers may keep patients out of the ER even when to admit them would be medically prudent.”

Conversely, two-thirds of survey respondents did not want to see hospitals suffer financial penalties for avoidable visits to their emergency rooms.

Meet Health Coach Lorie Gardner: Health Coaches Key to Patient-Centered Care and Preventive Medicine

March 7th, 2012 by Cheryl Miller

This month’s inside look at a health coach, the choices she made on the road to success, and the challenges ahead.

Excerpted from the March 2012 Health Coach Huddle.

Lorie Gardner, RN, BSN, CEO/Founder HealthLink Advocates, Inc.

HIN: What was your first job out of college and how did you get into health coaching?

Lorie Gardner: My first job out of college was at NYU Medical Center in Manhattan in 1978. It was an incredible acute care, inner city setting where I learned a tremendous amount in a very short time. During my experience there I realized very quickly that there was more to health and healing than “conventional” medicine. I witnessed at that time the power and strength of the mind in the healing success of patients, and that was the beginning of my interest in health coaching.

Have you received any health coaching certifications? If so, please list these certifications.

I recently completed the 14-week Wellness Inventory certification program.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road?

After staying home to raise my family, I was offered a consultant job as a clinical study manager at a large orthopaedic company managing clinical studies. I had experience in this field prior to staying home to raise my children. As I continued my work at this company it became clear that I needed to be working more directly with people and assisting them with their healthcare. I did not feel my gifts and talents were being fully used in that company and felt a calling back to the nursing field in some capacity.

In brief, describe your organization.

After a year-long credentialing course by Healthcare Liaison, I started my business as a healthcare advocate in March of 2010. My firm, HealthLink Advocates, Inc. is dedicated to achieving quality healthcare for clients through care coordination, education and research and health coaching. We recently affiliated with FEMTIQUE Associates Inc., a non-profit 501(c) (3) organization that provides professional health coaching to women and their families.

What are two or three important concepts or rules that you follow in health coaching?

    Providing my clients with a safe space to optimize coaching and communication.
    Ensuring that my clients know that the coaching relationship is a partnership to provide facilitation of their direction and motivation.
    To be an excellent listener and ask masterful questions that facilitate increased awareness in my clients.

What is the single-most successful thing that your company is doing now?

Providing information to the community that the services of a health/wellness coach and a healthcare advocate are available for those that choose to optimize their healthcare and wellness.

Do you see a trend or path that you have to lock onto for 2012?

The new healthcare reform is clearly directed towards both patient-centered care and preventive medicine. I believe that healthcare advocates and health coaching will be a key component in achieving these goals for patients as well as the healthcare system.

What is the most satisfying thing about being a health coach?

Clearly, for me, the most satisfying aspect of health coaching is the sense of accomplishment when a client experiences a renewed sense of well being and excitement for life. In addition, to know that I was able to facilitate a client’s awareness to make a sustainable lifestyle change is extraordinary.

Where did you grow up?

Huntington, N.Y.

What college did you attend? Is there a moment from that time that stands out?

I attended Niagara University in Niagara Falls, N.Y. The moment I started my clinical experience in the hospital I knew I was in the right profession, a profession that I had chosen when I was 5 years old.

Are you married? Do you have children?

I am married 26 years and have 3 children, ages 25, 20 and 15 years.

What is your favorite hobby and how did it develop in your life?

My favorite hobbies are reading, exercising and gardening. I have always been active and involved with sports. My love of reading was enhanced after taking philosophy courses in college. I was intrigued with philosophy and metaphysics.

Is there a book you recently read or movie you saw that you would recommend?

I loved the new movie Iron Lady with Meryl Streep about Margaret Thatcher’s life. Her courage and commitment to service and her country were remarkable. I love Wayne Dyer’s books, especially Inspiration, Your Ultimate Calling, and Change Your Thoughts, Change Your Life.