Archive for the ‘Behavioral Health’ Category

Healthcare Business Week in Review: End-of-Life Care, Hospital Costs, New Medicare Plan

May 14th, 2013 by Cheryl Miller


However difficult, end-of-life care issues need to become an integral part of the public health agenda, according to a new article from the American Journal of Public Health by two Johns Hopkins Bloomberg School of Public Health faculty, and advance directives are a critical part of this agenda.

Despite being free, legally binding and readily available, however, too few Americans have completed an advance directive. They need to become routine parts of the conversation between doctors, nurses, and other key health providers and their patients, and viewed as another aspect of preventive care, the authors note.

End-of-life care consumes an estimated 30 percent of Medicare expenditures, and the impact on Medicaid and commercial insurance costs is substantial as well. Increasing the rate of completion of advance directives could conceivably lower these expenses and would do so by respecting patients’ values and wishes.

Want to know what your hospital bill is really charging you for? CMS has now launched a new Web site with detailed information on the charges for services that may be provided during the 100 most common Medicare inpatient stays. The data shows significant variations across the country and within communities in what hospitals charge for these services, CMS officials warn. Even within the same geographic area, hospital charges for similar services can vary significantly. The Web site is part of a new three-part program from the agency to give healthcare consumers more price transparency.

Today's Medicare patients are sicker and have more chronic illnesses, and are driving up the costs of emergency department (ED) care, according to a new report by the American Hospital Association (AHA).

Between 2006 and 2010, the severity of illness of beneficiaries receiving services in the ED increased, as did the rate of use, driving up the intensity of ED care and resources. The report outlines a number of factors that are contributing to this trend, and are detailed in our story.

A proposed Medicare plan that combines hospital, physician, and prescription drug coverage with private supplemental coverage into one health plan could produce savings of $180 billion over a decade and improve care for beneficiaries, according to a new study by researchers at The Johns Hopkins Bloomberg School of Public Health and The Commonwealth Fund.

Under the proposed plan, called "Medicare Essential," Medicare beneficiaries could save a total of $63 billion between 2014 and 2023, with total premium and out-of-pocket costs for beneficiaries estimated to be 17 percent to 40 percent lower than current costs.

According to the article, Medicare Essential would create financial incentives for beneficiaries to select high-quality, cost-effective healthcare services — also known as value-based benefit design. Beneficiaries would be encouraged to choose a primary care physician and providers who meet standards of high value. Beneficiaries selecting such providers would pay lower deductibles and co-pays.

Achieving real cost containment or quality improvement is difficult unless patients and consumers become more active, informed and engaged. How to achieve this? Tailoring your approach towards your low-activation patients and understanding their needs is one way to monitor and create better patient engagement, explains Dr. Judith Hibbard, the professor of health policy at the University of Oregon and the developer of PAM, the Patient Activation Measure.

And lastly, don’t forget to take our latest e-survey, Healthcare Case Management 2013. Care coordination by healthcare case managers is helping to drive clinical and financial outcomes in population health management and bolster emerging models of care such as the patient-centered medical home and the accountable care organization. Share your organization's case management strategies by May 17 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

Risk Assessment, Case Management Help to Improve Dual Eligibles’ Health

April 30th, 2013 by Jessica Fornarotto

"When you look at some of the characteristics of the dual eligibles, in the under 65 population, 66 percent have only a chronic condition and have no functional impairments. But as you move up to the older ages, there’s fewer frailty and a bit more of the chronic conditions," according to Dr. Timothy Schwab, chief medical officer of SCAN Health Plan. SCAN has a strategic approach to serving the dual eligible market, and Dr. Schwab recently discussed how they get this population to complete health assessments as well as the role of case managers in deciding who needs nursing home services. He also discusses how case managers work with the most extreme health condition cases.

Question: SCAN-risk stratifies individuals to determine those at highest risk, using HRAs, claims data and other assessment tools. How does SCAN encourage or incent completion of HRAs and other assessments in what can sometimes be a transient or hard-to-reach population?

Response: Getting completion of the HRA instrument is a challenge in any population, but more so in a very diverse population like the dually eligible. We initially mail our HRA to all new members. Then we follow up with reminder postcards. If we still don’t receive a response, we have a shortened risk assessment form that we ask them to complete through telephonic interactive voice response (IVR). Even with that, we still probably have a 30 percent failure rate to get the HRA done in a timely fashion.

We try to supplement that with information from our physicians. On the first visit to the physician, we can gather information and ultimately supplement it with our claims data on both the medical side and importantly the pharmacy side. We get a lot of valuable information, which makes up for people who don’t complete the HRA.

There are two groups that usually don’t complete it. The first is the group in long term institutions, like nursing homes. There's a low response rate there. We also have a lower response rate in populations with mild dementia who are living on their own. But we also have a fairly low response rate from very healthy individuals. It’s important to recognize in the dual population that there are a group of duals that are relatively healthy. The only reason they’re a dual is because of financial conditions qualifying them for that. They could be out and about and just not concerned about completing the HRA.

We do not currently provide incentives for the general population to complete the HRA. We have tried some minor incentives with subsets of the population; for example, years ago with our diabetic population we offered a small gift of a foot care program if they completed a mini risk assessment. But in general, we haven’t found it effective.

Question: What percentage of your dual eligibles require disability support and what particular challenges would a case manager working with this subset of beneficiaries encounter?

Response: For our over 65 dual population, about 40 percent are what we classify as nursing facility level of care, or individuals who live in the community but have deficiencies in usually three or more activities of daily living (ADLs). They are frequently getting services for some of those deficiencies and are at high risk of ending up in a nursing home for long-term care, unless interventions are placed.

Of that 40 percent, probably about half are getting some sort of home-based services that are non-Medicare covered; things like personal care, homemaking, bathing assistance, and transportation assistance. For our case managers to make these assessments, do the in-home visits, and develop a care plan, we focus on hiring social workers, geriatric social workers and geriatric nurse practitioners. We spend a lot of time training them, both in how to identify the needs in the home, and how to identify the needs when talking with the caregiver, who is frequently an important part of this conversation.

We also offer on the job training for working with the rest of the team when they present these cases at our team meetings and the interdisciplinary care team meetings.

Question: How can care managers work with the most extreme cases that have multiple physical health and behavioral health, chronic and acute conditions?

Response: Those are the tough ones to work with. The first step is to find the right care manager for that individual. For example, if the primary issue is behavioral health, choose a care manager that excels in behavioral healthcare. That care manager then works with others to resolve the other issues. These people will require more time. You may also need to engage the help of the personal care workers or those in the home, so that they become both the physician and the care manager’s eyes and ears there. Teach them ways to pick up very subtle changes or differences in that person so that you can quickly provide new interventions if the person starts to show signs of deterioration. It’s a classic example of ‘one size doesn’t fit all;’ if your model says we will contact an individual monthly, some may need weekly and some may need daily contact. You may need to figure out ways to get that contact in an easy, efficient way for that individual.

TTYL Craving: Texting Helps Smokers Kick Butts, Healthcare Costs

April 25th, 2013 by Cheryl Miller


Remember the Marlboro Man, who filled black and white TV screens and magazine pages back in the day, always holding a cigarette in his calloused hands?

Initially designed to counter public opinion that filtered cigarettes were for women, he appeared to be the quintessential macho man, unafraid of anything, whether it was errant horses, lawless poachers, or even the front lines of war.

Not surprisingly, the Malboro Man got a makeover of sorts over the years; revealing that he was afraid of something, and that something was chemotherapy. It was one of California’s arsenal of ads they’ve been pummeling the public with for the last few decades. And they're working; in a recent news story published here, the University of California SF reported that the state’s tobacco reform campaign, while costing California $2.4 billion since 1998, reduced healthcare costs by $134 billion, and reduced the sales of cigarette packs by 6.8 billion, amounting to a loss of $28.5 billion in sales to cigarette companies.

Well, a new ad might appear on the sun-drenched horizon soon, featuring the older, wiser Marlboro Man holding a smart phone instead of a lasso, and reading one of many specially timed texts to help him quit smoking.

Agile Health recently announced Kick Buts 2.0, a major upgrade to their Kick Buts high touch, low cost smoking cessation program. Kick Buts delivers personalized text messages to smokers who need advice, support and encouragement as they try to quit smoking. It sends messages at scheduled intervals over a six-month period to help them develop the knowledge, motivation and behavioral skills necessary to drive sustained behavior change.

It also responds immediately to key words from participants requesting help to overcome cravings, slip-ups or relapse. So, someone can text “Craving” and they will receive a pep talk on how to ride the craving out.

It seems like a perfect way to hook the smokers who are already hooked on their smart phones — in particular, kids who've found their way to a cigarette despite the worldwide glut of anti-smoking campaigns. According to our recent survey on mHealth, smart phone apps are the most widely used technology tool today, with text messaging coming in a close second.

"These days I prescribe a lot more apps than medications," says Dr. Eric Topol, who was profiled on Rock Center with Brian Williams recently, and is author of The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. He points to the smartphone as a leading breakout tool, with the eventual ability to detect cancer cells circulating in the blood or warn patients of an imminent heart attack or monitor glucose levels through a sensor implanted in the body which, when activated, sends a signal to the patient's smart phone.

"A ninety-year-old can leave the hospital and be monitored remotely like he's still in the ER," says Dr. Topol, and it is this kind of remote technology that could save the healthcare industry millions in prescription drugs and unnecessary tests.

Healthcare Week in Review: Hospital Trends, Suggestions for Reducing Readmissions

April 22nd, 2013 by Cheryl Miller

Physicians have them; so do nurses, and even teachers. So why not case managers?

Aides, or extenders, could be one of several new key trends for case managers, says case manager Teri Treiger. Because they are often faced with large amounts of administrative work in addition to clinical assignments, aides can help take care of details and allow case managers to be much more efficient.

Efficiency and collaboration could help the widespread number of preventable hospital readmissions among Medicare beneficiaries, according to researchers at Penn State, the Weill Cornell Medical College and the University of Pennsylvania. But it will take time, more time than many healthcare professionals originally anticipated, time that is costing the nation nearly $18 billion annually, because of the lack of collaborative relationships among providers in different care settings, researchers say.

A majority of hospitals are in agreement that ACOs are key to remaining competitive. According to a new study from L.E.K. Consulting, over 80 percent of surveyed hospitals are making future plans to join or are already participating in an ACO.

Hospital executives also intend to invest significantly on information technology (IT) and facilities over the next five years in order to stay ahead, researchers found. Hospitals are investing in mechanisms that will help them improve quality metrics and outcomes and gain a competitive advantage in the marketplace, researchers note. Researchers also found that there will be major changes in purchasing dynamics, as we detail in our story here.

Nearly half of adult residents living in the metropolitan Texas area are uninsured, making it the highest area of uninsured adults in the metro United States for the second year in a row, according to the Gallup-Healthways Well-Being Index.

This is nearly three times the national average of 16.9 percent; a percentage which has remained the same since 2011, but jumped by two percent in 2008. Metropolitan areas in Vermont, Massachusetts and New Hampshire had the lowest uninsured rates. Geographically, these rates haven’t changed; and demographically, one group in particular, Hispanics, remains uninsured.

Researchers expect these figures to change, however, as healthcare reforms take effect.

And lastly, young adults under 26 insured on their parents' health insurance plans due to federal mandate are more likely to be treated for depression, substance abuse and pregnancy, according to new research from the nonpartisan Employee Benefit Research Institute (EBRI). This report is the first to identify the major treatments the coverage is used for, researchers note.

Guest Post: 3 Ways to Reduce Prescription Drug Abuse

April 17th, 2013 by Joe Baxter

prescription drug abuse

Drug manufacturers should educate providers on proper use of pain relievers.

Prescription drug abuse is the nation’s fastest-growing drug problem, according to the Office of National Drug Control Policy (ONDCP). There are many explanations, but most noticeably is the problem of overprescribing by physicians. The ONDCP has established a prescription drug abuse prevention plan that includes stopping 'pill mills' and taking action against physicians who over-prescribe.

The problem is not always neglectful physicians, but rather, uninformed ones. According to the ONDCP’s strategic plan to reduce abuse, most physicians receive little training on proper prescribing methods and recognizing substance abuse in their patients. A survey in 2000 found that only 56 percent of national medical residency programs required between 3-12 hours of substance use disorder training. A study done in 2008 showed improvement nationally but the efforts were not applied equally across the board.

There is indeed a discrepancy among practitioners and proper prescribing practices. To fix this issue, the ONDCP plans to work alongside Congress to implement the following:

  • Require authorized prescribers requesting DEA registration to have training on responsible prescribing practices and abuse/dependence recognition prior to registration.
  • Require drug manufacturers to create educational material to train providers on proper use of pain relievers.
  • Encourage medical and healthcare boards to require education on proper prescription practices in medical, nursing, pharmacy and dental programs. They also want to outreach to student groups to distribute educational materials.

Unfortunately, there are those practitioners who abuse their power and prescribe opioids for non-medical purposes. Because these physicians, who are illegitimately prescribing, are functioning under a medical umbrella, they rarely get caught.

The proliferation of over-prescribing has also led to illegal pill mills. These are doctors, clinics and/or pharmacies that are prescribing powerful prescription drugs for non-medical purposes. The ONDCP will try to eliminate these pill mills in hopes that prescription drug abuse will decrease.

Retired from the field of medical research, Joe Baxter is now a freelance writer specializing in medical journals. Apart from writing, he spends the rest of his free time traveling abroad and working in his wood shop.

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.

Infographic: The Numbers Behind the Autism “Tsunami”

April 15th, 2013 by Melanie Matthews

About 1 in 50 children in the United States now have autism, making it the country’s fastest-growing serious developmental disability, according to a new Centers for Disease Control study from March 2013.

While health insurance coverage for autism varies by state, treatment costs for families and society at large is expensive.
A new infographic details the cost implications and an overview of state health insurance coverage for autism.

The Numbers Behind the Autism Tsunami

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You may also be interested in this related resource: Managing Behavioral Healthcare, 3rd Edition.

Telephonic Case Management: Call Frequency Secures Relationship with Vulnerable Populations

April 10th, 2013 by Patricia Donovan
telephonic case management

Call frequency is a key factor of telephonic case management.

Determining the frequency of case management calls is a key parameter of interacting with populations telephonically, advises Jay Hale, LPC, CEAP, director of quality improvement and clinical operations at Carolina Behavioral Health Alliance (CBHA).

We follow all of these members for one year because we are looking at helping people manage and maintain changes in their life over all four seasons. In addition to progression of the disease, lack of treatment adherence has also become a factor. There are social triggers in people’s lives that make a difference in whether or not they maintain their recovery, wellness and well-being. We want to support people through the holidays, major traumatic events, anniversaries of major traumatic events and other parts of their lives that may be significant for them.

With telephonic case management, it is important to call often up front to start and maintain a relationship. It is not so much the amount of time spent on the call, as the frequency of calls that helps secure the relationship with members. We want to talk to individuals frequently and spread it out over time by increasing the length of time between calls.

We want to get the relationship started, maintain the relationship and then pull back as the individuals begin to work on their own and become more successful in their own wellness/recovery program from mental illness or from an addictive disease.

Our ratio protocol was very aggressive and optimistic. We originally had weekly calls up front for the first month, spreading out to biweekly calls and monthly calls, and bimonthly calls as it went on throughout the year. That was a very aggressive idea. The reality was that much of our population is a working population because we have all self-insured or privately insured members. Therefore, they have a difficult time maintaining that kind of protocol. We backed off that a little bit, and we went to biweekly phone calls up front. Then we spread that out over time to monthly calls and then bimonthly calls as people begin to improve.

Listen to an audio interview with Jay Hale.

Q&A: Embedded Workplaces, Home Visits Emerging Trends for Case Managers

March 28th, 2013 by Cheryl Miller

As the healthcare industry continues to evolve in the wake of ACA reforms, case managers are taking on more standardized collaborative approaches to care coordination and its changing delivery systems.

Prior to her presentation during a February webinar on The Role of Case Managers in Emerging Care Delivery Models, we talked with Teresa Treiger, RN-BC, MA, CHCQM-CM/TOC, CCM, president, Ascent Care Management, about emerging trends in case management, including embedding case managers at large employer work sites, and the proliferation of home visits.

HIN: What advice do you have for case managers going into embedded workplaces and what are some of the obstacles those already embedded have encountered?

(Teresa Treiger): One of the most important things to keep in mind is that you’re walking into someone else’s territory, where dynamics and relationships are already established. There’s a trust amongst the staff that’s already there.

As a case manager, you need to survey the landscape to figure out how people relate to each other, and then just use good business etiquette, for lack of a better way of expressing it. It doesn’t mean that you change your case management process. Absolutely not. We know case management. But how we relate to the people around us is probably the number one thing.

You will be faced with a situation, without a doubt, that has challenged other people. It could be a difficult patient or a patient that’s labeled as being difficult. And that is where you are going to prove your worth, by leveraging the skills that you have to find out what really is the issue or issues going on, and finding ways of addressing them. You might not be able to solve all of them. But you can address them in a professional way, helping that individual to resolve something, to get a service they haven’t been able to, maybe obtain some equipment or get a community resource hooked up with them. That’s when you start to develop your own currency of trust with the people that you work with, and that's what’s going to get you firmly ensconced as a part of the team.

HIN: Will we see more case managers called upon to do home based care?

(Teresa Treiger): I think so, for a couple of different reasons. There are already community-based companies that do home care. And (case managers) may be part of or leading the team of lay care workers for these companies, (acting as) main points of contact to their individuals, at least when the client, or a family member has the resources to engage a company like this. These are often for-profit companies that will step in and provide a network of community-based individuals who come in and help for those who don't qualify for other services.

There’s also the Visiting Nurse Associations (VNAs.) I’m not entirely sure what they’re going to be doing with case managers, but there is definitely an opportunity for them.

Accountable care organizations (ACOs) will also be using case managers that are assigned into a practice, or a group. It doesn’t matter where the patients of that group are, in the hospital, in the skilled nurse facility, at home. That case manager is part of that individual’s team. If the individual is at home, and hopefully most of them will be, they’re going to be helped there. It's very resource intensive, because not only is the case manager not in the office, where other people may need him or her, there’s travel time, and the issues that go with that. And so while it sounds like a really great plan, the reality is there’s a cost involved, of both money and human resource.

The bottom line is that the Affordable Care Act (ACA) already highlighted community-based care. So the opportunities will be and continue to be out there for case managers to be more involved with their communities at a community level.

Infographic: Smoking Statistics for U.S. Adults with Mental Illness

March 8th, 2013 by Patricia Donovan

People with mental illness smoke at much higher rates than the U.S. population as a whole, but are as interested in quitting as other smokers and can quit successfully with more intensive smoking cessation treatment.

Those are the conclusions of a recent report released by the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA), which found that adults who suffer from mental illness are 70 percent more likely to be cigarette smokers. About 36 percent of adults with mental illness smoke, compared to 21 percent of adults with no mental illness.

Smoking Statistics for US Adults with Mental Illness

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You may also be interested in this related resource: 2011 Benchmarks in Tobacco Cessation and Prevention.

New LinkedIn Forum, CaseTalk, for Healthcare’s Case Managers

February 22nd, 2013 by Cheryl Miller

We are happy to announce the recent launch of CaseTalk...a Forum for Care Coordinators, a new online interactive resource for case managers and other healthcare professionals on LinkedIn, where members can weigh in on best practices, news analysis, and network with others.

We've assembled a panel of prominent case management professionals to oversee the forum, who will consistently advise on current issues and advances in case management, and discuss the needs of patients and professionals. They are:

Stacey Hodgman, MS, RN-BC, CCDS, CPUM, senior director of care management at Kindred Healthcare, has been an RN for over 20 years with 16 years of case management expertise and experience working for managed care organizations, short and long term acute hospitals and work site wellness programs. She has worked for Kindred Healthcare since 2007 in care management leadership roles. Stacey is ANCC Board certified in case management, a certified case manager administrator (CMAC) and has served two terms as an elected member of the executive board of directors for the Case Management Society of New England (CMSNE.) She received her nursing and undergraduate degrees from Rivier College and her Masters degree from George Washington University. Stacey volunteers for the Massachusetts Registered Nurses Association (MARN) as a career guide/counselor for new nursing graduates. She has authored articles in professional journals including Professional Case Management, the official journal of the Case Management Society of New England. Stacey is committed and passionate to patient advocacy and improving transitions of care as patients move throughout the healthcare continuum.

Teresa “Teri” M. Treiger, RN-BC, MA, CHCQM-TOC/CM, CCM, principal at Ascent Care Management, LLC, has over 30 years of healthcare industry and 20 years of care management experience. Following years of bedside nursing, Teri worked in managed care, acute hospital, rehabilitation and long term care settings eventually focusing in program design and implementation. Teri has published on case management topics such as patient-centered medical home, advancing technology use, and future trends in care management. She was primary investigator in the 2010 Health Information Technology Survey and participant in the 2012 Survey Update. Teri co-authored chapters on interdisciplinary care transition teams for the American Gerontological Society and business considerations legal nurse consultants for the American Association of Legal Nurse Consultants. She serves on the Editorial Board of Hospitalist Program Management, Lippincott’s Professional Case Management, Case Management Monitor, and CMSA Today.


Ms. Jan Van der Mei, RN, MS, ACM, Sutter Health Sacramento Sierra’s regional director for care management programs supports four hospitals with 800+ average daily census, two medical groups and one multi-specialty IPA. As the care management director, she is responsible for planning and operations for disease management including heart failure, asthma, diabetes, heart health and care coordination/medical office case management for patients with chronic illness, as well as anti-coagulation management. Ms. Van der Mei speaks to national audiences on case management and disease and population management issues and also serves as a Sutter Health internal consultant for system improvements in case management models.

We welcome all healthcare case managers and other healthcare professionals to join our discussions, here.