Archive for the ‘Behavioral Health’ Category

Infographic: The Impact of Unmet Mental Health Services

July 3rd, 2015 by Melanie Matthews

Sixty percent of Americans with mental illness have unmet needs for the mental healthcare services they need, according to a new infographic by Best Social Work Programs.

The infographic examines the lack of coordination in mental healthcare services, mental health spending per capita and the impact of the lack of mental health treatment options.

2015 Healthcare Benchmarks: Integrating Behavioral Health and Primary CareBehavioral health conditions affect nearly one of five Americans, leading to healthcare costs of $57 billion a year, on par with cancer, according to a 2009 AHRQ brief. Despite this impact, and the ACA's provision for behavioral healthcare as an essential health benefit, progress toward total integration of behavioral healthcare into the primary care system has been slow.

2015 Healthcare Benchmarks: Integrating Behavioral Health and Primary Care captures healthcare's efforts to achieve healthcare parity and honor the joint principles of the patient-centered medical home, including a whole person orientation and provision of coordinated and/or integrated care.

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8 Things to Know about Telehealth and Telemedicine

April 28th, 2015 by Cheryl Miller

From early detection of impending heart failure from as far as 3,000 miles away, to the latest wearable wrapped around wrists or bodies, or simply sitting in pockets, telehealth is having a radical impact on the healthcare industry.

The range of telehealth and telemedicine services has expanded in the two years since the Healthcare Intelligence Network (HIN) last conducted its telehealth survey. While the majority of organizations had telehealth programs in place in both 2013 and 2015, of those that didn’t, the number of respondents who said they would launch a service in the next 12 months nearly tripled over two years (64 percent in 2015 versus 26 percent in 2013), according to new market metrics from the Healthcare Intelligence Network's (HIN) Telehealth & Telemedicine in 2015: Remote Monitoring, Wearable Devices Upgrade Burgeoning Industry survey, conducted in April of 116 healthcare organizations.

To address expanding population targets for telehealth services, the 2015 survey documented telehealth use for homebound, severe behavioral, at-risk for falls, and high-utilizers for the first time. Following are seven more facts about the burgeoning telehealth industry.

  • Three fourths of respondents (74 percent) said they expect Medicare to add remote patient monitoring to its list of covered telehealth services in the next 12 months;
  • Of clinical applications for telehealth, remote monitoring jumped from 57 percent to 63 percent;
  • Self-care/self-management tools and e-mail reminders remained among top telehealth tools for patients and health plan members;
  • The use of telephonic advice lines decreased from 55 percent in 2013 to 26 percent in 2015;
  • The nurse case manager has primary responsibility for telehealth, according to 32 percent of respondents;
  • Thirty-five percent of respondents said that bed days was the utilization metric most impacted by telehealth programs; and
  • Nearly 60 percent of respondents said they are reimbursed for telehealth from private payors.

Source: 2015 Healthcare Benchmarks: Telehealth & Telemedicine

Telehealth & Telemedicine

2015 Healthcare Benchmarks: Telehealth & Telemedicine delivers actionable new telehealth metrics on technologies, program components, successes and ROI from 115 healthcare organizations. This 60-page report, now in its fourth year, documents benchmarks on current and planned telehealth and telemedicine initiatives, with historical perspective from 2009 to present.

Making a Case for Embedded Case Management: 13 Factors Driving Onsite Care Coordination

April 16th, 2015 by Patricia Donovan

Compliance with Triple Aim goals, participation in CMS pilots to advance value-based care, formation of multidisciplinary teams and avoidance of CMS hospital readmissions penalties are among the factors driving placement of case managers at care points, according to HIN's 2014 healthcare benchmarks survey on embedded case management.

Participation in the Medicare Physician Group Practice Demonstration, the Comprehensive Primary Care Initiative, and the Multi-Payer Advanced Primary Care Practice demonstration has prompted a number of the survey's 125 respondents to embed case managers in primary care practices, hospital admissions and discharge departments and emergency rooms, among other sites.

To help organizations make the case for embedded case management, here are nine more program drivers, in respondents' own words:

  • "Face-to-face contact with complex patients and their family to build trust and relationships, working directly with providers and staff."
  • "Five to 8 percent of patients account for 40 to 60 percent of costs. It is logical. Second, ED visits and discharges represent at-risk patients where interventions can make a difference. Third, focus needs to be placed on fostering better screening results. Effort to reduce utilization."
  • "Pursuing medical home model and team-based care, along with continuum care coordination."
  • "Integration work between medical and behavioral healthcare."
  • "Employer, health system, and payor collaboration to provide population health management in a medical home-like model. Also working on reducing readmissions for high-cost, high-risk conditions such as heart failure, and hospital wanted to develop an ambulatory component to reduce readmissions and improve patients’ quality of life and satisfaction."
  • "Increased care fragmentation related to transitions in care, challenges in utilization between military and civilian network access-to-care, increased need for complex care coordination, etc."
  • "We felt we needed to ensure the case managers were considered a part of the patient-centered medical home (PCMH) team."
  • "Research shows [case managers] embedded at the point of care caring for the whole person in all healthcare environments produces better outcomes."
  • "As a rural hospital, it made sense to make the best use of resources."

Source: 2014 Healthcare Benchmarks: Embedded Case Management

http://hin.3dcartstores.com/2014-Healthcare-Benchmarks-Embedded-Case-Management-_p_4985.html

2014 Healthcare Benchmarks: Embedded Case Management provides actionable data from 125 healthcare organizations leveraging embedded or co-located case management to improve healthcare quality, outcomes and spend—including those applying a hybrid embedded case management approach.

Behavioral Health Diagnoses Can Inflate Readmissions Rates, Hinder Self-Management

April 9th, 2015 by Cheryl Miller

Preliminary data from a Care Transitions Task Force found that when patients with behavioral health diagnoses are excluded from readmissions rates, those rates fall by nearly 4 percent, says Michelle Schneidermann, MD, task force member and Associate Clinical Professor of Medicine for the division of hospital medicine at the University of California, San Francisco, and Medical Director of the San Francisco Department of Public Health, Medical Respite and Sobering Center. Part of the reason for this is this patient population's inability to follow through on self-management instructions once they leave the hospital.

Question: Among your discharge patients there’s a number of behavioral health diagnoses. Are there any considerations, or challenges to this patient population during care transitions, and any unique follow-up that your organization is doing?

Response: (Dr. Michelle Schneidermann) Yes, this patient population provides a very distinct challenge. The patients are challenged by so many other competing priorities, in addition to having a significant and severe mental health disorder, that it interferes with their ability to organize and follow through with the self-management requirements we place on them when they leave the hospital and their ability to manage chronic illness in general. So, from the patient perspective, it’s incredibly difficult.

From the systems perspective, although we are an integrated network health system, there are limitations on the number of outpatient behavioral healthcare clinics and providers. Plus, we don’t always have providers who are culturally concordant or language concordant, although the network is trying very hard to make that happen.

One of the things we’re working on right now is to tease out what our readmission rate looks like when we pull out all patients who have a behavioral health code. Just initial, very crude, back of the envelope calculations show a significant difference in our readmission rate.

When patients with behavioral health diagnoses are included, our hospital-wide, 30-day all-cause readmission rate is around 12 percent. When you remove patients with the behavioral health diagnosis, the readmission rate goes down to about 8.5 or 9 percent. Again, preliminary data, but it shows you the impact that this patient population has on readmissions and tells the story about the challenges that they personally face when they’re leaving the hospital.

cross-continuum care transitions
Dr. Michelle Schneidermann completed her primary care internal medicine training at UCSF and joined the UCSF faculty in 2003, where she is a member of the Division of Hospital Medicine at San Francisco General Hospital (SFGH). Through her inpatient clinical work and work with ambulatory programs, she has been able to directly witness the successes and challenges of patients’ transitions and generate feedback to the providers and systems that manage their care.

Source: Cross-Continuum Care Transitions: A Standardized Approach to Post-Acute Patient Hand-Offs

3 Emergency Department Interventions to Curb ‘Ultra-Utilizer’ Use

March 31st, 2015 by Patricia Donovan

Drawing upon an 18-month pilot to curtail wasteful utilization in Ohio ERs, especially by Medicaid beneficiaries identified as 'ultra-utilizers,' Mina Chang, Ph.D., chief, health services research and program development section of the Bureau of Health Services Research for the Ohio Department of Job & Family Services, looks at three ED-based interventions targeting this population.

The ED care team approach is very similar for the three targeted ultra-utilizer groups: severe mental illness, non-mental health conditions, and chronic back pain. It’s based on a strong medical and clinical leadership oversight. The integrated interdisciplinary teams include managed care and community providers, and care management or care managers. They came together based on the patients’ medical profiles, developing an individual care treatment plan for each of the patients including the testing. The team would continue to outreach to those patients, to address their social and medical needs and to coordinate care for those patients.

The treatment plan at the summary level was made available to older participating EDs in the past intervention. The patient will be also flagged at those EDs. And the intent is if the member showed up at the ED, the ED attending physician would be able to reference on the treatment plan and also communicate with the interdisciplinary teams as necessary.

For the mental health stream, the designated provider is a comprehensive mental health center that works together with the managed care claims to develop treatment plans. And the summary level of the treatment plan will be shared with the participating EDs from the two health systems.

For these streams we also have a 24/7 crisis center so the EDs can tap into them to have the most updated treatment plan faxed over as needed.

We also have another integrated care team for the non-mental health population led by Metro Health’s medical home team. These designated providers work with our managed care plans to develop a treatment plan for each participating patient and the summary will be shared with the participating ED from the three health systems.

Finally, similar of design was a back pain stream with a pain clinic as the designated provider. This designated team works with our managed care plan care managers. In turn, they built a care treatment plan for those participating patients, and shared the treatment plan summary with the participating ED and the three health systems.

We already have very encouraging results. Almost all members reported their outreach from the team has been excellent or good. And that’s after we instituted the intervention. The majority of the members reported they have input into treatment plans, so most of them slowly follow up with their providers.

The unique area noted by the mental health team is that transportation, fear and timely appointments are the most common barriers preventing ultra-utilizer patients from seeking follow-up care after ED visits.

We also observed increasing success for members keeping appointments. Our teams also noted that communication is key, not only between the participating test site, since there are so many moving parts, but also within the test site, such as the pain clinics or the emergency department.

Source: 5 Interventions to Reduce Avoidable ER Use by the Medicaid Population

Reducing Avoidable ER Use

5 Interventions to Reduce Avoidable ER Use by the Medicaid Population looks at the collaborative effort among five Ohio regions to target key reasons for avoidable ER visits among Medicaid beneficiaries and roll out test interventions in a rapid cycle quality improvement approach.

8 Effective PCMH Tools to Protect the Medical Home Investment

March 19th, 2015 by Cheryl Miller

The patient-centered medical home (PCMH) model is one of the top five investments in 2015, according to Accenture's recent analysis of government-sponsored State Health Innovation Plans. Researchers from Accenture found that states are investing in PCMHs in order to strengthen primary care integration with specialists and community health workers. Most will also integrate physical and behavioral care.

Embedding care coordinators in physician offices so they can work with case managers is one way to achieve this integration, according to respondents to the seventh comprehensive Patient-Centered Medical Home (PCMH) survey by the Healthcare Intelligence Network (HIN). We asked survey respondents what other tools they felt were most effective in implementing the medical home. Following are their responses:

  • Electronic communications that include actionable data and access to patients to initiate the change, and a focus on minimal hassle to physician office.
  • The NCQA PCMH tool.
  • Pre-visit planning and ‘huddles.’
  • Patient registries.
  • Monitoring. We fundamentally changed how we operate daily and monitor change. We incorporated our goal measures into the very fabric of what we do.
  • Using templates in electronic medical records (EMRs) for pre-visit planning and coordination of relevant visits.
  • Home care nurse management system.
  • Patient-centered scheduling.

Source: 2014 Healthcare Benchmarks: The Patient-Centered Medical Home

http://hin.3dcartstores.com/Remote-Monitoring-of-High-Risk-Patients-Telehealth-Protocols-for-Chronic-Care-Management_p_5008.html

2014 Healthcare Benchmarks: The Patient-Centered Medical Home is the Healthcare Intelligence Network's in-depth analysis of medical home adoption, tools, technologies, challenges, benefits and outcomes. Based on HIN's PCMH survey administered in February 2014, this resource takes the industry's pulse on patient-centered activity. Now in its seventh year, it is designed to meet business and planning needs of physician practices, clinics, health plans, managed care organizations, hospitals and others by providing critical benchmarks in medical home implementation and results.

5 Trends in Chronic Care Management by Physician Practices

March 17th, 2015 by Cheryl Miller

One hundred percent of physician practices rely on face-to-face and telephonic visits to administer chronic care management (CCM) services, according to respondents to the Healthcare Intelligence Network's 10 Questions On Chronic Care Management survey administered in January 2015.

A total of 119 healthcare organizations described tactics employed, 17 percent of which were identified as physician practices. A sampling of this sector's results follows.

  • Less than half of physician practices (46 percent) admitted to having a chronic care management program in place. But they overwhelmingly agree (100 percent) that CMS’s CCM initiative will drive similar reimbursement initiatives by private payors.
  • This sector’s criteria for admission to existing chronic care management programs is on par with other sectors except for asthma; just 17 percent of physician practices use this as an admitting factor versus 49 percent of all respondents.
  • Not surprisingly, this sector assigns major responsibility for CCM to the primary care physician, versus 29 of all respondents. This sector also relies on healthcare case managers (40 percent versus 29 of all respondents) and advanced practice nurses (APNs) (20 percent versus 8 percent overall) to assist with CCM.
  • This sector relies most heavily on face-to-face visits for CCM services (100 percent versus 71 percent for all respondents) and telephonically (100 percent versus 87 percent of all respondents).
  • Among the biggest challenges for this sector is reimbursement (33 percent versus 20 percent overall) and documentation (17 percent versus 2 percent overall). Unlike other sectors, patient engagement is not a major challenge (17 percent versus 33 percent overall).

Source: 2015 Healthcare Benchmarks: Chronic Care Management

http://hin.3dcartstores.com/2015-Healthcare-Benchmarks-Chronic-Care-Management_p_5003.html

2015 Healthcare Benchmarks: Chronic Care Management captures tools, practices and lessons learned by the healthcare industry related to the management of chronic disease. This 40-page report, based on responses from 119 healthcare companies to HIN's industry survey on chronic care management, assembles a wealth of metrics on eligibility requirements, reimbursement trends, promising protocols, challenges and ROI.

Risk Stratification Targets the High-Risk, Curbs Utilization Across Continuum

February 19th, 2015 by Cheryl Miller

Preventive care and utilizing hospital and discharge information are critical for stratification, say a number of thought leaders from organizations like Humana, Adventist Health, Taconic Professional Resources, Monarch Healthcare (a Pioneer ACO), and often lead to improved clinical and financial outcomes. Here, some advice from these thought leaders.

Across the healthcare continuum, improved clinical and financial outcomes at organizations like Humana, Adventist Health, Taconic Professional Resources, Monarch Healthcare (a Pioneer ACO), and Ochsner Health System were preceded by rigorous risk stratification of populations served.

“Humana encourages preventive care, and we are trying to prevent the most costly interventions by making sure we address things before they become big problems,” notes Gail Miller, vice president of telephonic clinical operations in Humana’s care management organization, Humana Cares/SeniorBridge. “It is successful so far. We have been able to reduce hospitalizations from what we expected by about 42 percent. We have been able to decrease our hospital readmission rate to 11 percent.”

Hospital admission and discharge information is critical for stratification, adds Annette Watson, RN-BC, CCM, MBA, senior vice president of community transformation for Taconic Professional Resources. “Depending on the model in a primary care practice (PCP), if a physician is not the admitting physician—if the admission is from a specialist, hospitalist, or through the ER—it cannot be assumed the PCP has the admission and discharge information. People may think physicians know about their patients being in the hospital, but that is not always the case.”

“Our first step in launching Monarch’s Pioneer ACO program was to develop a population disease profile in risk stratification analysis,” contributes Colin LeClair, executive director of accountable care at Monarch HealthCare. “With the help of Optum Actuarial Solutions, we identified the eight most prevalent and costly conditions in our population. We then identified the largest cohort of high-risk patients best suited for Monarch’s care management programs. Ultimately we isolated the top 6 percent of high-risk patients with a diagnosis of diabetes, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), or renal disease and found that of those patients, 6 percent account for 43 percent of total medical cost across the entire population. That analysis resulted in us targeting about 1,200 high-risk patients who have a similar constellation of issues.”

“You want to look at your high utilizers of care, because they’re using a great deal of care,” concludes Elizabeth Miller, RN, MSN, vice president of care management at White Memorial Medical Center, part of Adventist Health. “There’s potential for decreasing procedures, tests, ED visits, hospitalizations.”

Source: 2014 Healthcare Benchmarks: Stratifying High-Risk Patients

http://hin.3dcartstores.com/2014-Healthcare-Benchmarks-Reducing-Hospital-Readmissions_p_4786.html

2014 Healthcare Benchmarks: Stratifying High-Risk Patients captures the tools and practices employed by dozens of organizations in this prerequisite for care management and jumping-off point for population health improvement—data analytics that will ultimately enhance quality ratings and improve reimbursement in the industry's value-focused climate.

Healthcare Payor Strategies for Co-Located Case Management

January 29th, 2015 by Cheryl Miller

How to best strategize the co-location of case managers at points of care? The key is to understand the population you’re serving, be very targeted, and direct your services appropriately, says Dorothy Moller, managing director in the government healthcare solutions business unit of Navigant Healthcare.

Question: New market data on embedded case management found that two-thirds of respondents have co-located case managers at points of care, including primary care practices, hospital ERs and patients’ homes. What are some payor strategies for matching case managers with providers, and how do health plans benefit from co-location?

Response: (Dorothy Moller) I must acknowledge the safety net payors, who have been co-locating case managers for a number of years — in particular in hospital ERs. Very often the case managers you co-locate are not healthcare case managers, but behavioral health or social services case managers.

In terms of strategies for co-location, it depends on the population you’re serving and what you’re trying to accomplish with that population. There are a number of places where you can co-locate case managers — not so much case managers as case or care coordination services. Very often in large multi-specialty or primary care practice settings such as federally qualified health centers (FQHCs), community clinics, or multi-specialty clinics, case managers are sometimes nurses, sometimes social workers, sometimes physician assistants performing various functions. They may link members with specific services that are non-health related or coordinate care.

The key is to understand the population you’re serving and to make sure you include case management and care coordination services appropriate for that population. If you have a very acute population with high risks or readmission or other health complications, clearly you’re going to have a different kind of co-located service and you’re going to place them in a different location than you would otherwise. If you’re trying to encourage more effective access of services, use of preventive services, use of nurse call lines, and so on, you might place those services in a primary care practice. Those are going to be very different.

Embedded case managers could even be community health workers. In fact, I’ve worked with payors in the Southwest using community health workers in that role. They are sometimes co-located within the practice but then go into the community and deliver education services there as well, sometimes in collaboration with medical and education specialists.

It depends on the population you’re serving, the types of services you want to encourage or direct members to, and the most efficient staffing model for those services. Ultimately, you must remember you’re trying to develop a better staffing pyramid within the practice so that physicians do the most complex work — where a physician’s skills and capabilities are most needed. Nurses and other staff deliver care and services appropriate for their skills, education and capabilities. Be very targeted, understand your population, and direct the services appropriately.

healthcare trends
Dorothy Moller, MBA, is a managing director in the Government Healthcare Solutions business unit of Navigant Healthcare. She has nearly 30 years of experience specializing on a wide range of strategic issues from business intelligence and competitive analysis, to market, business and product strategy and design, business and product innovation, and business and operations turnaround and repositioning.

Source: Healthcare Trends & Forecasts in 2015: Performance Expectations for the Healthcare Industry

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.