Archive for the ‘Behavioral Health’ Category

Chronic Care Plus for the Chronically Homeless: ‘Recuperative Care on Steroids’

September 28th, 2017 by Patricia Donovan

Chronic Care Plus is designed for ‘Joe,’ a prototypical vulnerable client and frequent hospital user who for some reason has not connected to either his community or healthcare system.

Illumination Foundation’s joint venture pilot, which began as an ER diversion project, now offers community-based stabilization following a hospital stay for medically vulnerable chronically homeless patients. Here, Illumination Foundation CEO Paul Leon describes the origins of Chronic Care Plus (CCP), which has been associated with a $7 million annual medical cost avoidance at all hospitals visited by the 38 CCP clients.

Back in 2008 when we first started, we began to realize that housing was healthcare. With many of the patients we were seeing, although we experienced great success, we ended up discharging them many times back into a shelter or into an assisted living or sober living situation. And although these options were better than being in the hospital or being discharged to the street, we knew we could improve on this.

So, in 2013, we implemented the Chronic Care Plus (CCP) program. Basically, CCP was recuperative care on steroids. It was recuperative care with more tightly wrapped social services and a longer length of stay. At that time, we began a pilot program in conjunction with UniHealth and St. Joseph’s Hospital in which we took the 28 most frequent users and kept them in housing for two years. We also brought these individuals through recuperative care, and wrapped them tightly with social services.

These efforts would eventually lead us to create our ‘Street2Home’ program, which we’re working on now. It implements more bridge housing and permanent supportive housing that is supplied not only by us but by collaboratives in the community. We are able to link to these collaboratives to take our individual, our ‘Joe,’ from a street to eventual permanent housing.

Source: Homelessness and Healthcare: Creating a Safety Net for Super Utilizers with Medical Bridge Housing

home visits

Homelessness and Healthcare: Creating a Safety Net for Super Utilizers with Medical Bridge Housing spotlights a California partnership that provides medical ‘bridge’ housing to homeless patients following hospitalization. This recuperative care initiative reduced avoidable hospital readmissions and ER visits and significantly lowered costs for the collaborating organizations.

SDOH Video: Tackling the Social, Economic and Environmental Factors That Shape Health

September 7th, 2017 by Patricia Donovan

Initiatives such as CMS’ Accountable Health Communities Model and other population health platforms encourage healthcare organizations to tackle the broad range of social, economic and environmental factors known as social determinants of health (SDOH) that shape an individual’s health.

This video from the Healthcare Intelligence Network highlights how healthcare organizations address SDOH factors, based on benchmarks from HIN’s 2017 Social Determinants of Health Survey.

 

 

Source: 2017 Healthcare Benchmarks: Social Determinants of Health

SDOH benchmarks

2017 Healthcare Benchmarks: Social Determinants of Health documents the efforts of more than 140 healthcare organizations to assess social, economic and environmental factors in patients and to begin to redesign care management to account for these factors. These metrics are compiled from responses to the February 2017 Social Determinants of Health survey by the Healthcare Intelligence Network.

Infographic: Opioid Overdose Characteristics in Medicaid Members

August 28th, 2017 by Melanie Matthews

Medicaid members are prescribed opioids twice as often as other patients—and are six times more likely to overdose, according to a new infographic by Conduent.

Conduent examined drug use patterns, care coordination issues (number of prescribing physicians seen and pharmacies used), substance abuse history and pain-related diagnoses.

The infographic summarizes the results by highlighting factors that both increase prescription opioid overdose risks and can define management strategies.

Behavioral Health Patient Engagement: Using Motivational Interviewing Techniques and Strategies To Improve OutcomesAs the critical role of an engaged, activated healthcare consumer becomes more apparent in a value-based healthcare system, healthcare organizations are focusing on patient engagement and activation programs.

In a recent industry survey on trends in patient engagement, healthcare organizations reported that behavioral health conditions presented a particular challenge to patient engagement initiatives. However, there is robust evidence that motivational interviewing is a powerful approach for treating substance abuse, anxiety and depression.

Behavioral Health Patient Engagement: Using Motivational Interviewing Techniques and Strategies To Improve Outcomes, a 45-minute webinar now available for replay, Mia Croyle with the University of Wisconsin School of Medicine and Public Health shares key learnings from patient engagement initiatives targeted at patients with behavioral health conditions.

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5 Practitioner Tactics for Tackling the Opioid Epidemic

August 15th, 2017 by Susan Butterworth, PhD, and Amanda Sharp, MPH, Q-Consult LLC
opioids

There is promising evidence that motivational interviewing can successfully reduce both the use of non-medical opioid use and overdose risk behaviors for prescription opioids.

Despite evidence and guidelines to the contrary, including significant risk of addiction, there remains a widespread belief among many clinicians and patients alike that opioid medication is a viable and effective first option for multiple chronic pain conditions. Practitioners feel pressure to provide opioids upon patient request, yet many have neither the resources nor the skill set to manage the physiological and psychological complications that can arise when treating a patient with opioids long-term.

As one qualitative study found, it can be awkward at best, and confrontational at worst, when refusing a patient’s request for opioids. Thus, clinicians are faced with the challenging balancing act of providing pain relief for their patients while simultaneously managing the potential for addiction and misuse – with most clinicians ill-equipped for the herculean task.

“Not providing the [opioid] prescription is very hard. It takes time to do the research on the patient. Confronting the patient with a problem is emotionally draining. Doing it 5-10 times in one shift is not only a reality, it is downright crippling. It sucks out [sic] last bit of energy out of your soul. Rather than confronting patients and arguing, it’s far easier to write a prescription for narcotics and move on to the next patient. This is the mindset of thousands of physicians.”
Anonymous Physician, April 25, 2013

Along with knowledge about alternative treatments, a valuable skill set for clinicians in this situation is an effective communication approach to address the possible scenarios that emerge:

  • Engaging patients in discussions about the risks of opioids;
  • Validating the frustration of chronic pain;
  • Evoking commitment to try alternative modalities;
  • Eliciting honesty about unhealthy/drug-seeking behaviors; and

Sharing concerns and resources for opioid addiction.

Motivational Interviewing (MI) is an evidence-based communication approach that has been adapted for the brief healthcare setting to address many lifestyle management issues, including chronic pain. There is one promising clinical trial that used a single MI session in an emergency department to successfully reduce both the use of non-medical opioid use and overdose risk behaviors for prescription opioids as compared to a control group. Even beginning proficiency in MI equips practitioners with the confidence and skills needed to engage patients in conversations that generally lead to outcomes of being able to maintain rapport and successfully incorporate best practice guidelines for chronic pain treatment.

Consider the following two scenarios:

Scenario 1: Your patient has recently hurt their back and has requested strong pain medication.

Scenario 2: You suspect your patient may have an addiction to opioids.

In both cases, a practitioner, competent in the MI approach, would be able to use the following strategies to successfully navigate these challenging waters. These principles and strategies are based on Miller and Rollnick’s description of MI practice.

Engage and Partner

Taking a minute or two to build rapport with the patient may be counter-intuitive to a busy clinician. However, consider the time that is spent in unproductive arguments and power struggles. Research has shown that taking a more patient-centered approach is more time-efficient in the long run. Although the clinician is an expert in clinical aspects, the patient is the expert of their life, and the only one with the ability to commit to the suggested treatment plan. By stepping out of the authoritarian role, ideally, the clinician can partner with the patient in a collaborative way to problem-solve together. When a person helps to identify the best treatment course for themselves, they feel more ownership and are more committed; thus, are more likely to follow through.

Express Empathy

A core component of engaging is being able to express empathy, or the ability to convey accurate understanding through the eyes of the patient. This takes compassion, effort, genuine interest, and reflective listening. The clinician does not need to become a counselor to provide a meaningful statement that lets the patient know that the practitioner “gets it”. When the patient feels understood and accepted, they are more receptive to the clinician’s advice and guidance.

Share Concerns while Supporting Autonomy

In MI, the clinician is not simply following the patient but is a full partner. After establishing rapport and trust, it is not amiss to share any concerns that the provider has, if patient autonomy is concretely verbalized. The patient can always go to another doctor to get what they want; by acknowledging that it is the patient’s choice to pursue what they feel is best for them, the patient relaxes. This allows the clinician to share their concern in a way that does not elicit defensiveness.

Manage Expectations

It is important to manage the expectations of the patient. By clearly and transparently stating up front what the clinician feels is best practice and ethically viable, the patient is not disappointed later. Openly share that alternative treatment options may not address the pain as completely as opioids might initially, or, in the case of addiction, that there may be withdrawal symptoms when discontinuing the medication. Honesty preserves trust and conveys the clinician’s desire to support the patient as fully as possible, while still maintaining his integrity of practice.

Provide Decision Support with Menu of Options

Now the patient is ready for a menu of options with the pros and cons succinctly laid out. These include therapies such as non-opioid meds, stretching, and alternative treatments. Some of these options may be those that the clinician is not prepared to provide; e.g., if the patient is still favoring the option of more opioids. The clinician has been transparent about which options he feels are best and is willing to provide; however, the patient is in the driver’s seat to choose the best treatment course for himself. In most cases, the clinician can positively influence the patient’s decision. If not, the discussion remains professional, rapport is not lost, and the patient will feel comfortable returning to this provider. This keeps the door open to further dialogue about the situation.

There are many resources available for those who are interested in getting trained in MI, and the approach can be used for any lifestyle management or treatment adherent situation. However, a fair warning that MI is a complex skill set and cannot be learned in a one-and-done workshop. Just like learning to speak a foreign language or play a musical instrument, it takes practice and feedback from an expert over time to develop a meaningful proficiency. As many clinicians can attest though, this is one hard-earned competency that is more than worth it — for the practitioner, the patient and society!

Susan Butterworth, PhD

Amanda Sharp, MPH

About the Authors: Susan Butterworth, PhD, is principal and Amanda Sharp, MPH is program manager for Q-Consult LLC. Both are both members of the Motivational Interviewing Network of Trainers. Please visit Q-Consult, LLC their blog and find out more about patient-centered initiatives that increase patient engagement and improve clinical outcomes.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

2017 ACO Snapshot: As Adoption Swells, Social Determinants of Health High on Accountable Care Agenda

June 29th, 2017 by Patricia Donovan

Nearly two-thirds of 2017 ACO Survey respondents attribute a reduction in hospital readmissions to accountable care activity.

Healthcare organizations may have been wary back in 2011, when the Department of Health and Human Services (HHS) first introduced the accountable care organization (ACO) model. The HHS viewed the ACO framework as a tool to contain skyrocketing healthcare costs.

Fast-forward six years, and most resistance to ACOs appears to have dissipated. According to 2017 ACO metrics from the Healthcare Intelligence Network (HIN), ACO adoption more than doubled from 2013 to 2017, with the number of healthcare organizations participating in ACOs rising from 34 to 71 percent.

During that same period, the percentage of ACOs using shared savings models to reimburse its providers increased from 22 to 33 percent, HIN’s fourth comprehensive ACO snapshot found.

And in the spirit of delivering patient-centered, value-based care, ACOs have embraced a whole-person approach. In new ACO benchmarks identified this year, 37 percent of ACOs assess members for social determinants of health (SDOH). In support of that trend, the 2017 survey also found that one-third of responding ACOs include behavioral health providers.

Since that first accountable care foray by HHS, the number of ACO models has proliferated. The May 2017 HIN survey found that, of current ACO initiatives, the Medicare Shared Savings Program (MSSP) from the Centers for Medicare and Medicaid Services (CMS) remains the front runner, with MSSP participation hovering near the same 66 percent level attained in HIN’s 2013 ACO snapshot.

Looking ahead to ACO models launching in 2018, 24 percent of respondents will embrace the Medicare ACO Track 1+ Model, a payment design that incorporates more limited downside risk.

This 2017 accountable care snapshot, which reflects feedback from 104 hospitals, health systems, payors, physician practices and others, also captured the following trends:

  • More than half—57 percent—participate in the Medicare Chronic Care Management program;
  • Cost and provider reimbursement are the top ACO challenges for 18 percent of 2017 respondents;
  • Clinical outcomes are the most telling measure of ACO success, say 83 percent of responding ACOs;
  • Twenty-nine percent of respondents not currently administering an ACO expect to launch an accountable care organization in the coming year;
  • 75 percent expect CMS to try and proactively assign Medicare beneficiaries to physician ACO panels to boost patient and provider participation.

Download HIN’s latest white paper, “Accountable Care Organizations in 2017: ACO Adoption Doubles in 4 Years As Shared Savings Gain Favor,” for a summary of May 2017 feedback from 104 hospitals and health systems, multi-specialty physician practices, health plans, and others on ACO activity.

Infographic: Medicaid’s Role in Behavioral Healthcare

May 19th, 2017 by Melanie Matthews

Medicaid restructuring as proposed in the American Health Care Act could limit states’ ability to care for people with behavioral health conditions, according to a new infographic by the Kaiser Family Foundation.

The infographic details how Medicaid currently enables people with behavioral health needs to access care and how reduced federal spending could limit behavioral health coverage and services.

Behavioral Health Patient Engagement: Using Motivational Interviewing Techniques and Strategies To Improve OutcomesAs the critical role of an engaged, activated healthcare consumer becomes more apparent in a value-based healthcare system, healthcare organizations are focusing on patient engagement and activation programs.

In a recent industry survey on trends in patient engagement, healthcare organizations reported that behavioral health conditions presented a particular challenge to patient engagement initiatives. However, there is robust evidence that motivational interviewing is a powerful approach for treating substance abuse, anxiety and depression.

Behavioral Health Patient Engagement: Using Motivational Interviewing Techniques and Strategies To Improve Outcomes, a 45-minute webinar now available for replay, Mia Croyle with the University of Wisconsin School of Medicine and Public Health shares key learnings from patient engagement initiatives targeted at patients with behavioral health conditions.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

In Care Coordination of Medically Vulnerable Homeless Patients, Housing is a Form of Healthcare

January 17th, 2017 by Patricia Donovan

Chronic Care Plus recuperative care reduced ER visits by homeless patients by 84 percent, and avoided nearly $3 million in medical costs.

Most patients discharged from the hospital ultimately return to a secure home environment. Not so for homeless or unstably housed patients; disconnected from healthcare and their community, their lack of stable housing compounds their medical difficulties following a hospital stay.

Enter Chronic Care Plus (CCP), a safety net recuperative care program in California whose mission is to bridge this gap between hospital discharge and permanent supportive housing for homeless patients, or “Joes,” as Illumination Foundation Founder and CEO Paul Leon characterized his client profile during a recent presentation.

“I’m sure you can identify the ‘Joes’ in your neighborhood,” Leon told participants during Intensive Care Coordination for Healthcare Super Utilizers: Community Collaborations Stabilize Medically Vulnerable Homeless Patients, a December 2016 webinar now available for replay. “They’ve come into the ER but are never quite connected with either a federally qualified health clinic (FQHC), your own hospital clinic or any available resources in your community.”

The CCP program not only provides housing for recently discharged homeless or unstably housed individuals in model or dormitory-like settings but also reconnects them to the healthcare continuum. The program then wraps clients in a plethora of services, including housing placement, financial literacy, job placement, transportation and behavioral health support.

Back in 2008, Leon’s organization was one of only about seven in the nation to provide recuperative care (also known as medical respite care). Recuperative care is care to homeless persons recovering from an acute illness or injury, no longer in need of acute care but unable to sustain recovery if living on the street or other unsuitable place, Leon explained. Today there are about 80 such programs in the United States.

Since then, his foundation created standards and best practices, and in 2013 launched CCP—”recuperative care on steroids, with tightly wrapped social services and a longer length of stay,” Leon explained.

Originating as an ED diversion pilot aimed at 20 of the highest users of a local hospital ER, CCP has transformed discharge planning for the homeless and has served more than 2,500 patients since its inception.

During the presentation, Leon shared a host of program analytics, including recuperative care criteria client demographics and CCP statistics on medical, behavioral health, housing and other services provided. He also shared CCP’s future plans, and some of the program’s barriers and challenges, including medical management education and closing gaps in social services.

In terms of program outcomes, CCP has amassed significant savings as it closes gaps in care and reduces healthcare utilization, including 322 fewer ER visits by this population (a 84.3 percent decrease) and $2.8 million in medical cost avoidance at three participating hospitals.

“For Orange County hospitals as a total, we estimate that there was $5.2 million of savings,” added John Kim, grants director of the Illumination Foundation. “If we compare the year prior on an annualized cost basis, that comes to over $7 million of savings to Orange County hospitals.”

Click here for an interview with Paul Leon on Chronic Care Plus’s challenges and lessons learned as it connects its medically vulnerable homeless to social services.

Infographic: The Opioid Burden on Hospitals

January 6th, 2017 by Melanie Matthews

The nation’s opioid epidemic resulted in a 64 percent increase in opioid-related hospital stays between 2005 and 2014. However, hospital rates varied widely by state, according to a new infographic by the Agency for Healthcare Research & Quality.

The infographic shows the states with the highest and lowest rates in 2014.

Infographic: The Opioid Burden on Hospitals

Behavioral Health Patient Engagement: Using Motivational Interviewing Techniques and Strategies To Improve OutcomesAs the critical role of an engaged, activated healthcare consumer becomes more apparent in a value-based healthcare system, healthcare organizations are focusing on patient engagement and activation programs.

In a recent industry survey on trends in patient engagement, healthcare organizations reported that behavioral health conditions presented a particular challenge to patient engagement initiatives. However, there is robust evidence that motivational interviewing is a powerful approach for treating substance abuse, anxiety and depression.

Behavioral Health Patient Engagement: Using Motivational Interviewing Techniques and Strategies To Improve Outcomes, a 45-minute webinar now available for replay, Mia Croyle with the University of Wisconsin School of Medicine and Public Health shares key learnings from patient engagement initiatives targeted at patients with behavioral health conditions.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today. Have an infographic you’d like featured on our site? Click here for submission guidelines.

Use Annual Wellness Visit to Screen for Social Determinants of Health in High-Risk Medicare Population

December 13th, 2016 by Patricia Donovan

The social determinant of social isolation carries the same health risk as smoking, and double that of obesity.

With about a third of health outcomes determined by human behavior choices, according to a Robert Wood Johnson Foundation study, improving population health should be as straightforward as fostering healthy behaviors in patients and health plan members.

But what’s unstated in that data point is that the remaining 70 percent of health outcomes are determined by social determinants of health—areas that involve an individual’s social and environmental condition as well as experiences that directly impact health and health status.

By addressing social determinants, healthcare organizations can dramatically impact patient outcomes as well as their own financial success under value-based care, advised Dr. Randall Williams, chief executive officer, Pharos Innovations, during Social Determinants and Population Health: Moving Beyond Clinical Data in a Value-Based Healthcare System, a December 2016 webinar now available for replay.

“The challenge is that few healthcare systems are currently equipped to identify individuals within their populations who have social determinant challenges,” said Dr. Williams, “And few are still are structured to coordinate both medical and nonmedical support needs.”

The Medicare annual wellness visit is an ideal opportunity to screen beneficiaries for social determinants—particularly rising and high-risk patients, who frequently face a higher percentage of social determinant challenges.

Primary social determinants include the individual’s access to healthcare, their socio- and economic conditions, and factors related to their living environment such as air or water quality, availability of food, and transportation.

Dr. Williams presented several patient scenarios illustrating key social determinants, including social isolation, in which individuals, particularly the elderly, are lonely, lack companionship and frequently suffer from depression. “Social isolation carries the same health risk as smoking and double that of obesity,” he said.

While technology is useful in reducing social isolation, studies by the Pew Research Center determined that segments of the population with the highest percentage of chronic illness tend to be least connected to the Internet or even to mobile technologies.

“Accountable care organizations (ACOs) and other organizations managing populations must continue to push technology-enhanced care models,” said Dr. Williams, “But they also have to understand and assess technology barriers and inequalities in their populations, especially among those with chronic conditions.”

In another patient scenario, loss of transportation severely hampered an eighty-year-old woman’s ability to complete physical rehabilitation following a knee replacement.

Dr. Williams then described multiple approaches for healthcare organizations to begin to address social determinants in population health, including patients’ cultural biases, which may make them more or less open to specific care options. This fundamental care redesign should include an environmental assessment to catalog available social and community resources, he said, providing several examples.

“This is not the kind of information you’re going to find in a traditional electronic health record or even care management platforms,” he concluded.

2017 Healthcare Success Formula: Care Management Sophistication and ‘Patient Stickiness’

November 29th, 2016 by Patricia Donovan

HIN’s 13th annual planning session provided a roadmap to key healthcare issues, challenges and opportunities in 2017.

Whether concerned with healthcare delivery or reimbursement for services rendered, providers and payors alike will need to be nimble in the coming year to survive and thrive in a sharply shifting, value-based marketplace, advises Steven Valentine, vice president, Advisory Consulting Services, Premier Inc.

“Be aware: the competitors you’ve had in the past are changing, and you’re seeing more competition with various Internet providers, CVS, Apple, Watson. It’s all going to change,” said Valentine during Trends Shaping the Healthcare Industry in 2017: A Strategic Planning Session, a November 2016 webinar now available for replay.

But what healthcare shouldn’t panic about, at least for the immediate future, is the demise of the Affordable Care Act (ACA).

“[The ACA] is not going to be canceled any time soon,” Valentine emphasized during the thirteenth annual planning session sponsored by the Healthcare Intelligence Network. “We would expect it would take two years, at least, to begin to put in some kind of a replacement program.”

Assuring participants that within all this industry flux are opportunities, Valentine suggested they follow the lead of retail pharmacy CVS. “CVS envisions itself as a full service healthcare organization with a goal of ‘patient stickiness.’ In other words, CVS is saying, ‘I need patients to rely on me as their source of getting started for healthcare.'”

Later in the program, he offered participants a four-point plan for improving patient stickiness.

As for care management sophistication, Valentine pointed to the pairing of hospitals with a case manager, with incentives for care managers and hospitalists to manage down length of stay, or manage resource consumption.

“We’re probably gravitating more toward care management models that are outside the four walls of the hospitals…which will give us better economies, better outcomes, people more specialized in the areas they’re in that could really help provide better quality at a lower cost.”

And while the healthcare thought leader believes Medicare will remain essentially untouched by the incoming presidential administration, he did identify nearly a dozen areas where President-Elect Donald Trump’s ‘Better Way’ might eventually make its mark on healthcare, including more price transparency and the sale of insurance across state lines.

Moving on to sector-specific forecasts, Valentine outlined four expectations for health plans, including a push for more access points like telehealth and urgent care centers and added pressure to reduce chronic care costs.

Healthcare providers should focus on population health and immerse themselves in data analytics to better prepare for MACRA and the narrow, quality-based provider networks that will result.

Both sectors should expect more consumer demand for accountability, Valentine said, since patients and health plan members are fed up with rising costs and armed with more transparency information and health awareness.

Valentine concluded his presentation with eight guiding principles for 2017 success, including collaboration between health plans and physicians.

And in the Q&A that followed, Valentine offered guidance on a number of issues, including how providers can grow their population bases; identifying and addressing social health determinants; succeeding in value-based healthcare, and offering efficient, integrated behavioral healthcare services.

Click here to listen to advice from Steven Valentine on employing technology for patient engagement.