Archive for the ‘Behavioral Health’ Category

14 Protocols to Enhance Healthcare Home Visits

January 20th, 2015 by Cheryl Miller

Use of telemonitoring equipment, electronic medical records (EMRs), a staff dedicated to monitoring home visits and engaged caregivers are just some of the protocols used to enhance home visits, according to 155 respondents to the Healthcare Intelligence Network’s most recent industry survey on home visits.

Following are 10 more protocols used to improve the home visit process:

  • Inclusion of home visiting physician in hospital rounds; and the collaboration of home visit physician with primary care physician (PCP) and complex case managers.
  • Using our medication management machines with skilled nursing follow-up to increase medication compliance.
  • Proactive phone calls to determine if a patient's condition is worsening and in need of home visits.
  • Daily workflow management algorithms with prioritization and mobile access to electronic case management records.
  • Using teach-back to assure comprehension.
  • Easy to use/wear multimodal, advanced diagnostics telemonitoring allowing patients total mobility and continuous real-time monitoring.
  • Medication reconciliation is crucial in eliminating confusion for the patient, and our electronic medical record (EMR) accurately reflects what the patient is taking, including over-the-counter (OTC) and supplements.
  • Hospital coach gathers information and prepares the patient for discharge, coordinates with home visit staff, home visit team (coach and mobile physician) and completes home visit.
  • Portable EMR to document and review medical information on the spot.
  • EHR-generated lists, community-based team, community Web-based tracking tool, telehome monitoring devices, preferred provider network with skilled nursing facility/long-term acute care (SNF/LTAC), home health and infusion therapy.

Source: 2013 Healthcare Benchmarks: Home Visits

http://hin.3dcartstores.com/2013-Healthcare-Benchmarks-Home-Visits_p_4713.html

2013 Healthcare Benchmarks: Home Visits examines the latest trends in home visits for medical purposes, from the populations visited to top health tasks performed in the home to results and ROI from home interventions.

The Year in Healthcare Intelligence: Reimbursement, Value-Based Results Resonate with Readers

December 29th, 2014 by Patricia Donovan

Newswise, fee-for-value healthcare initiatives eclipsed fee-for-service models.

When survival of healthcare providers hinges on payment for services rendered, it's not surprising our 2014 readers closely tracked news of emerging payment models and results from patient-centered, quality-based initiatives.

Here is a retrospective of stories that dominated our readers' news feeds over the last 12 months:

  • We reported on results from many accountable care organizations (ACO) over the last year, but few generated interest like the Anthem Blue Cross-Healthcare Partners accountable care collaboration that saved more than $4 million. The program succeeded by sharpening its focus to those with two or more chronic diseases—the population that research shows can most effectively be helped by coordinated care, officials state. A dedicated staff of care managers and care coordinators identify hospitalized ACO patients, coordinate transitions of care, and ensure patient care and healthcare resources are accessible.

  • Heads also turned when the Centers for Medicare and Medicaid Services (CMS) proposed updated penalties and incentives for its Medicare Shared Savings Program (MSSP), an accountable care initiative for Medicare beneficiaries. The proposed rules are designed to strengthen MSSP by placing greater emphasis on primary care services and promoting transitions to performance-based risk arrangements. CMS is also suggesting a third ACO model," track 3," which integrates some elements from the Pioneer ACO model.

  • The patient-centered medical home (PCMH) model, a stepping stone to an ACO, garnered its share of readership, especially when the National Committee for Quality Assurance (NCQA) added five measures to its medical home criteria, the gold standard for patient-centered measurement.

    In its third iteration of PCMH standards since 2008, the NCQA added behavioral health integration and care management for high-need populations, among other new criteria.

  • The patient-centered model suffered a setback, however, when one of the first, largest, and longest-running multipayor trials of PCMHs in the United States was associated with limited improvements in quality and was not associated with reductions in use of hospital, emergency department (ED), or ambulatory care services or total costs of care over three years. Research by Rand Corporation and colleagues centered on patient-centered activities in the Southeastern Pennsylvania Chronic Care Initiative.

  • There was good news on the medical home front, however: A study published in September, 2014 attributed reductions in emergency room visits, principally by patients with chronic illness, to the PCMH approach. Research by Independence Blue Cross (Independence) and CTI Clinical Trial and Consulting Services (CTI), and published by Health Services Research, found that transitions to a medical home were associated with a 5 to 8 percent reduction in ED utilization. This finding is specific to patients with chronic illness(es) having one or more ED visits in any given year. These reductions were most evident among patients with diabetes.

  • Readers also paid attention when Geisinger Health System, an early adoptor of care coordination for chronic illness, announced that its all-or-none or “bundled” approach to primary care for patients with diabetes produced better health outcomes, and the benefits happened quickly for the more than 4,000 patients in the study. The system-wide approach was not easy, warned Geisinger: the model requires constant evaluation, and must be scalable across a variety of practice settings.

  • Also raising the bar for physician practices was Highmark, which shared six requirements for the "best practices" element of its successful pay-for-performance initiative. Physician practices can earn additional rewards for completion of an office-based best practice project, essentially a small pilot, that involves measurement and reporting.

  • On the flip side, reporting of some questionable hospital pricing strategies rated some page views as well. Data released early in 2014 by National Nurses United (NNU) and the Institute for Health and Socio-Economic Policy (IHSP) found that some U.S. hospitals charge more than 10 times their cost, or nearly $1200 for every $100 of their total costs. Public oversight or regulation seems to help constrain excessive pricing, researchers found; Maryland, probably the most regulated state in the United States, has the lowest average charges of all the states among its 10 most expensive hospitals.

  • Cost savings aside, readers seemed especially attuned to new approaches or technologies designed to streamline healthcare delivery and enhance the patient experience, such as an uptick in remote monitoring.

    One hundred percent of respondents to the Telehealth in 2013 Survey by the Healthcare Intelligence Network monitor weight and vital signs, up from a respective 79 and 77 percent in 2010. The health conditions monitored remotely remain the same from 2010, the top three being heart failure, COPD and diabetes.

  • And finally, as all eyes focus on care management interventions that span the healthcare continuum, many readers responded to a story on a CMS pilot that would give hospice patients more options in the type of care they wish to receive at the end of life. Under the Medicare Care Choices Model, individuals who meet Medicare hospice eligibility requirements could receive palliative care services from certain hospice providers while concurrently receiving services provided by their curative care providers.

Were these stories on your news radar in 2014? Stay up-to-date in 2015 with the latest healthcare news, trends and benchmarks with a free subscription to the Healthcare Business Weekly Update.

Multi-Specialty Telehealth Collaborative Offers One-Stop Healthcare for Underserved, Remote Patients

October 24th, 2014 by Cheryl Miller

It’s all about the patient.

That’s what prompted Blue Shield of California and Adventist Health, both not-for-profit organizations, to collaborate on a telehealth program that could afford quality care to all Californians, when and where they need it, says Lisa Williams, senior director of strategic integration and execution, healthcare quality and affordability, Blue Shield of California, during Creating a Virtual Multi-Specialty Physician Network: A Payor-Provider Telehealth Collaborative, an October 15th webinar, now available for replay.

The presentation also featured Robert Marchuk, vice president of ancillary services at Adventist Health, and Christine Martin, director of operations, Adventist Health; all three shared the inside details on the collaboration and the shared mission and values that has led to the program's success.

Located in largely rural markets, access to specialists is especially critical for the program’s success, Ms. Williams says. The nine-site program, which launched in March, includes 11 specialties, ranging from cardiology to dermatology to orthopedics and rheumatology, which account for the majority of volume in pre-op and post-op care. Specialists are all board-certified and credentialed. The program will expand to an additional 16 sites by the end of this year, with plans to add telepsychiatry, she says.

Central to the program is its care coordination center, a full-service, virtual, multi-specialty physician practice with robust patient and provider supporting services, says Mr. Marchuk. Similarly to a one-stop shopping site, when patients enter a site, clinicians make one phone call regarding that patient to the center, which coordinates all aspects of that patient’s care, from scheduling an appointment with the provider and the clinic itself, ensuring all patient records are available and uploaded to their electronic medical record (EMR), to scheduling follow-up ancillary services and physician appointments and billing. “It’s been very successful,” says Mr. Marchuk, “and really sets us apart from other programs.”

Identifying gaps in their markets, and then finding the right specialty and specialist for that market are big parts of the process, Mr. Marchuk continues. "There are physicians out there that can be wonderful on a face-to-face visit and very, very good clinically, but don't necessarily lend themselves well to a video interaction, so we screen very carefully."

Clinician engagement, extensive training, and communication at all points of contact are also important, says Ms. Martin. “You can never over-communicate,” she says. Patients, staff, local providers and specialty providers all need to know what’s going on, so the experience can be as seamless as possible.

Reimbursement for telehealth is still on the negotiation table, Mr. Marchuk adds. But ultimately, it pays to invest in the technology now for the future.

“It’s one of the fastest growing growing fields. It’s affordable, accessible, and cost-effective. Telehealth really can enhance the physician and patient relationship.”

Listen to interviews with Robert Marchuk and Lisa Williams.

Adventist Population Health Management Incentives Engage Employees, Curb Costs

October 16th, 2014 by Cheryl Miller

If employees are healthier, they're more effective, engaged in their work, and more present, says Elizabeth Miller, vice president of care management at White Memorial Medical Center (part of Adventist Health). Presenteeism is part of the company's "Engaged Health Plan," a patient engagement strategy that is targeted to save as much as $49 million overall.

To engage patients, you can offer incentives. For example, at Adventist Health we outreach to our entire organization, our own employees, and we are on track to save millions of dollars with that. We call it ‘The Engaged Health Plan’ and it’s a reduced monthly cost on their health insurance. It is a bi-weekly reduction of $50, which is significant. They’re saving $100 a month. We engaged by taking their blood pressure, their weight and their blood glucose. We created an exercise plan for them with their consent, talked to them about their physical conditioning and what they wanted to see in their physical. We also talked about the ideal health population, and how we consider a healthy employee a more effective employee.

It’s costing our organization money to put this on; even though it’s our own health plan, it does cost. Why did Adventist Health go in this direction? You can see with the cost and the savings that it will save us $49 million. It is a mission. We are a faith-based organization, but it is a mission of ours to improve the health status. And it is also going to improve us financially. If our employees are healthier, they’re more effective, more engaged in their work, more present. You’ve heard of presenteeism. These are things that we’ve looked at.

dual eligibles care
Elizabeth Miller, RN, MSN, is the vice president of care management, diabetes program at White Memorial Medical Center, Adventist Health. Ms. Miller is accountable for the daily operations of the care management team, nurse care managers, social workers and the diabetes program, ensuring optimal patient flow through the healthcare continuum of care.

Source: Population Health Framework: 27 Strategies to Drive Engagement, Access & Risk Stratification

Community Linkages Support HCSC’s Holistic Approach to Duals

September 25th, 2014 by Cheryl Miller

Meeting the holistic needs of the individual, and not treating them as a diagnosis has been key to Health Care Services Corporation's (HCSC) work with dual eligibles. Here, Julie Faulhaber, HCSC’s vice president of enterprise Medicaid, describes the organization's innovative use of community care connections to engage the unique challenges of this largely older adult and disabled population in population health management.

Question: What are some examples of HCSC community connections and how do these linkages benefit Medicare-Medicaid beneficiaries?

Julie Faulhaber: Our community connections are really critical to the success of our program. We work with a number of different community agencies in our state: the community mental health centers, the public health agency, and also with those types of agencies that deliver long term care services or have worked with those with mental health concerns.

We work across the board. All of these agencies catch our members, and we try to have relationships with them in order to gain access to our members, for example to better understand the types of services and support that our members truly need and where to access them. That’s been a key component of our program. We also look for community health workers who have backgrounds in the cultural needs of our members, which helps to engage them initially and maintain engagement.

HIN: What are the most common behavioral health issues your duals face and how has HCSC addressed these issues?

Julie Faulhaber: Our members have the full range of behavioral health issues that one would expect in a dual eligible population. Of course, the majority of individuals are experiencing depression and those types of concerns are often in conjunction with some physical disability. Referring back to the previous question on community linkages, we develop relationships with community agencies that support people with mental illness.

Other behavioral health concerns include those agencies that help people with recovery from addiction. We also worked with an integrated team in our own model of people with behavioral health backgrounds as well as our traditional physical healthcare model. That integration has been important for us in meeting the holistic needs of the individual and not treating them as a diagnosis.

dual eligibles care
Julie Faulhaber, vice president, enterprise Medicaid for Health Care Service Corporation (HCSC), a $52 billion health insurance company with 13.2 million members operating in five states, is responsible for the leadership and oversight of HCSC’s Enterprise Medicaid Business. This includes expansion of Medicaid programs across HCSC’s Blue Cross Blue Shield plans in Illinois, Montana, New Mexico and Texas.

Source: Dual Eligibles Care and Service Planning: Integrative Approaches for the Medicare-Medicaid Population

Infographic: Behavioral Health Service Utilization Among Foster Children

August 15th, 2014 by Melanie Matthews

Nearly one in three children within the United States' foster system use behavioral health services, representing only three percent of all children in Medicaid, but 15 percent of those using behavioral health services and 29 percent of Medicaid expenditures for children’s behavioral health services.

This infographic from the Center for Health Care Strategies compares behavioral healthcare use and expense for Medicaid-enrolled children in general versus those in foster care.

Behavioral Health Service Utilization Among Foster Children

Implementing Evidence Based Practices in Behavioral HealthIn this innovative and reader-friendly guide, Implementing Evidence Based Practices in Behavioral Health, leading researchers from the Dartmouth Psychiatric Research Center examine the implementation of evidence-based practices in behavioral health and offer practical strategies for bringing these practices into routine clinical settings. They look at implementation as a specific process, a set of activities and responsibilities designed to successfully launch a practice and integrate it into routine care, using strategies carried out across many levels of an organization and at various stages.

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.

Yale Online Forum Helps Teens with Diabetes “Not Look Like a Jerk”

August 14th, 2014 by Cheryl Miller

Being a teenager is hard enough; when it’s complicated by a chronic disease like type 1 diabetes, it’s even harder.

Enter telehealth, in the form of a monitored discussion board for teens with the disease.

Margaret Grey, DrPH, RN, FAAN, Dean and Annie Goodrich Professor at the Yale School of Nursing, has spent the majority of her career helping patients and families manage chronic conditions, and helping kids — teenagers in particular — manage their diabetes through their teen years so they can reduce their risk of long-term complications.

“I’ve been studying these kids for 30 years,” says the pediatric nurse practitioner, who, prior to assuming the deanship in 2005, served as associate dean for scholarly affairs and was the founding director of the school's doctoral program and the NIH-funded Center for Self and Family Management and a related pre- and post-doctoral training program. “Kids have black and white thinking — and have to manage how to 'not look like a jerk' by being given the skills to manage their disease, to think about it in a different way.”

Grey and other researchers conducted several clinical trials: an advanced diabetic education project and a life skills program, which showed that teens with diabetes' overall health and quality of life were better after going through both programs. Results showed that intensive therapy and better metabolic control reduced the incidence and progression of microvascular and neuropathic complications from diabetes from 27 percent to 76 percent.

But how to maintain those results? According to researchers, "Metabolic control tends to deteriorate as a combined result of insulin resistance that accompanies the hormonal changes of adolescence and lower adherence to the treatment regimen often associated with the desire for autonomy.”

“So we took those interventions and developed an online program kids could do at their leisure," Grey says. It incorporated a monitored discussion board that allowed kids to communicate with others like them. Teens with diabetes overcome their fear of being stigmatized by logging onto the Web site,­ called TeenCope, ­with other teens with diabetes and engaging in self-management exercises. The online program simulates situations teenagers with diabetes might encounter by using graphic novel animations that illustrate coping skills lessons from the animated characters. “As kids transition to adolescence, they require more effort and thought,” Grey says.

Peer support is an important component of maintaining a healthy lifestyle, as adolescents face pressures such as not wanting to reveal medical equipment in a social setting, or reveal their medical conditions in a social situation.

In addition, the program will also integrate an online educational program aimed at problem-solving for teens with diabetes. Adolescence is a time when patients neglect self-monitoring, dietary recommendations, and pharmacologic treatments — not because of a lack of knowledge, but due to the decision-making difficulties characteristic of this life stage. Studies show that poor metabolic control in the teen years correlates to reduced self-management in adulthood, making adolescence a key period for developing healthy behaviors. And once teenagers can get a handle on their diabetes, they improve not only their own health, but their families’ quality of life.

“This is a way to give them the skills to think about their condition in a different way,” Grey says.

7 Ways to Stratify Patients for Health Coaching

July 24th, 2014 by Cheryl Miller

Recruiting patients for health coaching is a multi-faceted process, says Alicia Vail, RN, is a health coach for Ochsner Health System. Health coaches can enlist the services of physicians, case managers and transition navigators for referrals to those patients who would benefit from coaching post hospital or physician discharge.

There are several ways we recruit patients. First, we have created health coach referral criteria to help physicians and staff identify patients who would benefit from health coaching. These patients would need coaching on self-management of chronic health problems such as hypertension, diabetes and obesity. We also get referrals from physicians when they see a patient in their office and identify that the patient could benefit from health coaching. Second, we also identify patients through pre-chart reviews.

Third, we look at labs and other needed or outstanding screenings prior to their appointment and notify the physician.

Fourth, we utilize different lists to help us identify patients. The hemoglobin A1C list helps us reach out to our diabetic patients who have not reached their goal of hemoglobin A1C of 7 or below. The emergency department list allows us to prevent readmissions by having the health coach reach out and capture these patients.

Fifth, HEDIS® measures allow us to focus on needed health screenings or tests for patients.

Sixth, when we meet with our patients for glucometer or insulin training, we have an opportunity to explain and offer our health coaching program at that point.

And lastly, sometimes our in-patient case managers or transition navigators, who help with patient discharge preparation, will refer patients to the health coach for post-hospital follow-ups.

Excerpted from Stratifying High-Risk, High-Cost Patients: Benchmarks, Predictive Algorithms and Data Analytics.

Infographic: Daily Drug Use in the United States

July 23rd, 2014 by Melanie Matthews

Every day in America millions of young adults use illicit substances, ranging from marijuana, heroin, and cocaine, to hallucinogens and inhalants. Out of the 35.6 million young adult population (from 2012) in the United States, one fifth used an illicit drug in the past month, and the percentage of those users has increased from 2008.

The infographic below shows how often drugs are used daily in the United States and the number of first-time illicit drug users on an average day.

Daily Drug Use in the United States

Bringing the most comprehensive research and information available today to the mental health field, the Dartmouth Psychiatric Research Center and Hazelden have redesigned the innovative Integrated Dual Disorders Treatment: Best Practices, Skills, and Resources for Successful Client Care curriculum.

Far surpassing its predecessor in ease of implementation and ongoing usability in clinical settings, this updated and expanded curriculum is redesigned not only to more effectively teach clinical skills and provide practitioners with resources and tools for their practice, but to offer the guidance necessary to align the work of departments and transform agencies into integrated treatment providers.

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.

Telephonic Case Management: Tips to Keep the Conversation Going

July 8th, 2014 by Patricia Donovan

Individuals with behavioral health issues pose some unique challenges to case managers trying to connect with them telephonically. Jay Hale, director of quality improvement and clinical operations at Carolina Behavioral Health Alliance, addresses some barriers to successful telephonic case management of behavioral health populations.

Question: What barriers may a telephonic case manager encounter when contacting someone with a mental health issue? What advice do you give the case managers on establishing rapport during these calls?

Response: (Jay Hale) One big barrier we see is making sure we have the member’s correct phone numbers. We want to make sure we have updated information so that we’re calling the correct people.

Another barrier is having the member on the other end trust us enough to accept our help, or accept our support, in their care. I advise our case managers to work with other people who are working with the member early on. We want to work with the hospital earlier, before the person is discharged, to get correct contact information and to let the member know we’re going to be contacting them. We want to be part of that discharge plan and operation, and we want our case management program to be part of that plan as well—a plan that shows the patient is going to the psychiatrist, or a therapist, and that they’re going to be followed up by us telephonically.

When one of our case managers calls a member to invite them to be part of our program, we want to talk to the member about how the program helps them. We want to emphasize how this helps them in their recovery for either a mental illness or for a substance abuse episode. With substance abuse individuals, we want to make sure we use the language they are comfortable with in early recovery—language where we’re making sure we’re supporting their recovery program, they’re working their steps, they’re following through with their meetings, etc. We let them know we understand their situation and we’re supportive of them in their recovery.

With mental health individuals, we want to make sure they feel comfortable with us, that we are understanding their situation, and that we are not here to do counseling. Rather, we are here to support them in their recovery and to help them see the improvements that they’re seeing as they follow through with treatment.

With our child/adolescent population, we’re usually working with the parents. Many parents are appreciative of the support we can give them as they try to help their child or adolescent do better in school, do better at home and have a more successful life early on. We let the parent know we’re not here to blame anyone for any situation the child is in, but rather to support them in having a healthier family and a healthier child.

Excerpted from: Telephonic Case Management Protocols to Engage Vulnerable Populations