Archive for the ‘Behavioral Health’ Category

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.

‘Connect the Dots’ Transitional Care Boosts ROI by Including Typically Overlooked Populations

October 11th, 2016 by Patricia Donovan

Typically overlooked patient populations do benefit greatly from nurse-directed transitional care management.

Some typically overlooked patient populations do benefit greatly from nurse-directed transitional care management.

Determining early on that transitional care works better for some patients than others, the award-winning Community Care of North Carolina (CCNC) transitional care (TC) program is careful to allocate resource-intensive TC interventions to those patients that would benefit most. Here, Carlos Jackson, Ph.D., CCNC director of program evaluation, explains the benefits of including often-overlooked patients in TC initiatives.

Transitional care must be targeted towards patients with multiple, chronic or catastrophic conditions to optimize your return on investment. These patients are the ones that benefit the most. It’s the 'multiple complex' part that is the key; this includes conditions that are typically overlooked in transitional care, such as behavioral health or cancers.

We may pass over and not focus on these patients in typical transitional care programs, but actually, they do benefit greatly from our nurse-directed transitional care management.

For example, with a cancer population, transitional care keeps them out of the hospital longer. The transitional care is not necessarily preventing or curing the cancer, but it’s helping to connect those dots in a way that keeps them from returning to the hospital. Again, we are also talking about complex patients. This is not just anybody with cancer; this is somebody with cancer and multiple other physical ailments as well.

The same is true for people who come in with a psychiatric condition. Again, we’re talking about a very sick population. For every 100 discharges, without transitional care almost 100 of these patients will go back to the hospital within the next 12 months. That’s almost a 100 percent return to the hospital. But with transitional care, only about 80 percent return to the hospital within the coming year.

This translates to an expected savings of nearly $100,000 just in averted hospitalizations per 100 patients managed. We were able to demonstrate that the aversions happened not only with the non-psychiatric hospitalizations, but also on the psychiatric hospitalizations.

Even though nurse care managers often tend to be siloed, by doing this coordinated ‘connecting the dots’ transitional care, they were able to prevent psychiatric hospitalization. That certainly has implications for capitated behavioral health systems. We don’t want to forget about these individuals.

Source: Home Visits for Clinically Complex Patients: Targeting Transitional Care for Maximum Outcomes and ROI

http://hin.3dcartstores.com/Home-Visits-for-Clinically-Complex-Patients-Targeting-Transitional-Care-for-Maximum-Outcomes-and-ROI_p_5180.html

Home Visits for Clinically Complex Patients: Targeting Transitional Care for Maximum Outcomes and ROI describes the award-winning Community Care of North Carolina (CCNC) transitional care program, how it discerns and manages a priority population for transitional care, and why home visits have risen to the forefront of activities by CCNC transitional care managers.

Infographic: How State Budget Cuts Are Impacting Mental Healthcare Services

September 28th, 2016 by Melanie Matthews

State mental healthcare budget cuts have caused an increase in emergency room visits for patients seeking mental health treatment with a total of 5.5 million patients seeking care in these facilities each year, according a new infographic by the Cummings Institute.

The $38.5 billion it costs hospitals to take care of these patients could be significantly reduced by integrating mental health professionals within the ER and hospital settings. The infographic looks at the impact of these budget cuts and looks at possible solutions.

Behavioral 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.

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.

Infographic: Substance Abuse Trends

July 27th, 2016 by Melanie Matthews

Substance abuse—involving drugs, alcohol or both—adversely impacts individuals, families and communities. Stopping substance abuse before it begins can increase a person's chance of living a longer, healthier and more productive life, according to a new infographic by Healthy People 2020.

The infographic examines adolescent alcohol or illicit drug use trends and Healthy People 2020 targets for adolescent substance use and binge drinking in adults.

Behavioral 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.

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.

Infographic: Painkillers and Heroin in the United States

June 20th, 2016 by Melanie Matthews

The abuse of, and addiction to, opioids is a serious problem in the United States that affects the social, health, and economic welfare of the society. It is estimated that opiate abuse/addiction costs Americans approximately $484 billion annually. It is also responsible for 50 percent of serious crimes in the United States, according to a new infographic by the University of New England.

The infographic explores the opiate abuse problem, who is most at-risk of becoming addicted and the role of social workers in treating opiate addiction.

Relieving the Costs and Consequences of Chronic Pain: A Best Practice Multimodal Approach The financial, physical and emotional toll of pain on the United States is excruciating, but Relieving the Costs and Consequences of Chronic Pain: A Best Practice Multimodal Approach offers an antidote for the 25 percent of Americans suffering daily from chronic or persistent pain and the healthcare organizations that treat them. Featuring contributions from two of pain management's foremost experts, this special report offers multi-faceted strategies in pain assessment and management to improve quality of life for the chronic pain patient, reducing healthcare utilization in the process.

In this 35-page report, Marilee I. Donovan, Ph.D., R.N., regional pain management coordinator, Kaiser Permanente Northwest, and Cheryl Pacella, D.N.P., R.N., performance improvement advisor at MassPro, describe patient-centric pain management tactics that engage the patient as an active partner and employ creative and alternative therapies and interventions.

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.

The Care Plan Process: 15 Trends to Know

January 21st, 2016 by Patricia Donovan

Care planning begins with a needs assessment, say the majority of respondents to HIN's 2015 survey on Care Plans.

The use of care plans increases medication adherence, patient self-management and clinical quality ratings, say 70 percent of healthcare organizations engaged in care planning, according to newly published market metrics from the Healthcare Intelligence Network (HIN).

A majority of respondents—83 percent—incorporate care plans into value-based healthcare delivery systems, according to HIN's December 2015 survey, with more than half of remaining organizations planning to do so in the coming year.

High-risk health indicators derived from health risk assessments or the imminent transition of a patient from one care site to another are the chief triggers of the care planning process, said survey respondents.

Survey Highlights:

Other findings from HIN's Care Plans survey include the following:

  • First and foremost in a care plan strategy is an assessment of needs, say 87 percent of respondents.
  • The electronic health record is the care plan maintenance and distribution tool of choice for almost two-thirds of respondents, although the retention of paper records is reported by nearly half of responding companies.
  • The principal criterion for classifying patients in need of care plans is the data derived from health risk assessments (HRAs), say nearly two-thirds of respondents, but patients transitioning between care sites also are prioritized for care planning, note 61 percent.
  • The presence of a behavioral health condition poses the greatest challenge to care planning by a large margin, said 39 percent of respondents, as compared to diagnosis of physical health problems.
  • The typical tracking time for care plans ranged from one to two months, said 24 percent, while adherence to care plans is checked monthly by 37 percent of respondents.
  • Patient engagement is the most significant barrier to care plan success, say 44 percent of respondents.
  • Patients’ healthcare utilization patterns are the most reliable indicators of care plan adherence, say 29 percent.
  • About 13 percent report ROI from care planning efforts as between 2:1 and 3:1.

Download a complimentary executive summary of 2016 Care Plan metrics to learn the value of evidence-based care plans in following high-risk patients through health episodes and transitions of care.

The Impact of Patient Engagement: 10 Metrics to Know

October 6th, 2015 by Patricia Donovan

A formal patient engagement program elevates patient satisfaction, care plan adherence and overall quality scores, say three-fifths of healthcare organizations.

While more than 60 percent of healthcare organizations report their patient engagement programs have elevated patient satisfaction, care plan adherence and overall quality metrics, populations with low health literacy or behavioral health conditions are more resistant to efforts to engage them in self-care.

These findings were among the benchmarks identified by an inaugural survey on Patient Engagement by the Healthcare Intelligence Network. The August 2015 survey also determined that 79 percent of respondents are striving to improve patient engagement, employing an arsenal of tactics and e-tools.

Asked to identify some hurdles of engaging patients, half of the survey's 133 respondents reported that the behavioral health population is the most challenging to engage. And “high utilizers”—individuals with frequent ER visits or hospitalizations—are top candidates for engagement efforts, say 52 percent of respondents.

Today’s value-focused healthcare models theorize that engaged patients not only are healthier and more satisfied but may incur fewer costs than the non-engaged, which is why many programs make patient engagement a priority, such as Medicare’s mandate that accountable care organizations (ACOs) develop processes to promote patient engagement.

Patient and caregiver education is the top strategy deployed to engage patients, say 72 percent of survey respondents. In this area, technology plays a pivotal role, the survey found.

Whether patient engagement translates to good business remains to be seen. In the meantime, the HIN survey found that organizations are testing the impact of health coaching, embedded case management, a team-based approach and telephonic follow-up, among other tactics, on overall population health engagement.

Here are five more metrics from the 2015 Patient Engagement Survey:

  • Sixty-six percent of respondents have a patient portal, whose top use is education.
  • Almost half of respondents—48 percent—possess an electronic health record (EHR) that helps to identify patients most in need of engagement.
  • Low health literacy is the top barrier to patient engagement, say 20 percent of respondents.
  • The case manager has top responsibility for patient engagement efforts, say 28 percent of respondents.
  • Of those respondents with no formal initiative to foster patient engagement, 65 percent will launch an effort in the coming year.

Download an executive summary of the 2015 Patient Engagement survey results.

HINfographic: Trends in Integrating Behavioral Health & Primary Care

August 10th, 2015 by Melanie Matthews

Almost two-thirds of healthcare organizations have integrated behavioral health and primary care to some degree, with 31 percent achieving "close collaboration onsite in a partly integrated system," according to 2015 Healthcare Intelligence Network metrics.

A new infographic by HIN examines the level of integration achieved by healthcare organizations, plans to integrate within the next 12 months and the percent of organizations using telehealth for behavioral health consults.

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. Click here for more information.

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.

ACO Evolution from 2011-2015: 8 Year-Over-Year Trends

July 21st, 2015 by Patricia Donovan

ACO Trends 2011-2015

Today's ACOs are larger, busier and better staffed than they were four years ago, according to a HIN year-over-year analysis.

Adoption of accountable care organizations (ACO) has more than tripled in four years and clinical integration continues to challenge non-adopters, according to a Healthcare Intelligence Network analysis of accountable care organization benchmarks from 2011 to 2015.

According to year-over-year ACO metrics published in 2015 Healthcare Benchmarks: Accountable Care Organizations, the percentage of healthcare organizations in ACOs has climbed from 14 to 50 percent in the last four years.

Leadership of ACOs by payor-provider co-ops or health plans has slowed to a trickle during this period, while the percentage of physician-hospital organization (PHOs) firmly grasping administration reins has nearly doubled—from 15 percent in 2011 to 28 percent among 2015 respondents.

ACO Staffs Support Healthcare Integration

The ACO staff has become more diverse, boasting more specialists, health coaches and clinical psychologists to support integration of behavioral health and primary care, the ‘sweet spot’ of patient-centered medicine. Watchwords are care coordination and care management, according to 2015 respondents who shared ACO success stories.

Staffing within ACOs has swelled as well: 29 percent of 2015 survey respondents support 500-1,000 physicians within its ACO, nearly double the 17 percent reporting this staffing ratio in 2011.

The average ACO is also busier than ever, with 61 percent encompassing 10,000 covered lives or more, up from 42 percent in 2011, perhaps reflecting consolidation occurring across the healthcare landscape.

Today, healthcare organizations are more conservative about time required to adequately frame an ACO, with 20 percent of 2015 respondents reporting that two years or more was needed, up from 4 percent in 2011, while the percentage requiring 12 to 18 months for ACO creation dropped from 50 percent in 2011 to 37 percent this year.

Reimbursement Shifts from Volume- to Value-Based

The retrospective data supports the industry's transition from the traditional fee for service payment environment to the value-based reimbursement structure favored today, with 45 percent of 2015 respondents favoring a FFS + care coordination + shared savings payment model, up from 15 percent in 2012. (Note: 2011 respondents were not surveyed on reimbursement models).

This handwriting is on CMS’s wall, in the form of its pledge to move half of Medicare payments into value-based payment models by 2018. More than half of 2015 respondents—54 percent—expressed faith in the federal payor's ability to meet this financial goal.

Despite the latest benchmarks, operational ACOs insist no two accountable care organizations are alike. In the experience of Steward Health Care Network, a top-performing Medicare Pioneer ACO, “When you’ve seen one ACO, you ‘ve really seen...one ACO.” Having ended Pioneer performance year two with gross savings of $19.2 million, Steward still must scale the perennial hurdles of physician engagement, performance improvement and care management, explained Kelly Clements, Steward’s Pioneer program director.

This year’s ACO survey benchmarks bear this out. Clinical integration, which can only succeed with the support of an engaged physician population, is still the biggest barrier to ACO formation, say 17 percent of 2015 survey respondents with no plans for accountable care.

Source: 2015 Healthcare Benchmarks: Accountable Care Organizations

Integrating Behavioral Health & Primary Care: Colocation Breaks Down Patient Resistance

July 16th, 2015 by Patricia Donovan

Integration of behavioral health and primary care fosters 'warm handoffs' between providers.

Behavioral health conditions affect nearly one of five Americans, leading to healthcare costs of $57 billion yearly, notes a 2009 AHRQ brief. Integration of behavioral and physical health services helps to ensure access by all individuals to preventive, ongoing and appropriate behavioral health services as part of a whole-person healthcare approach.

According to 2015 metrics from the Healthcare Intelligence Network (HIN), 62 percent of healthcare organizations have integrated behavioral health and primary care to some degree, with nearly one third—31 percent—reporting they have achieved “close collaboration onsite in a partly integrated system,” one of six integration levels defined by the Center for Integrative Health Solutions (CIHS).

The greatest benefit from integrated care is easy access to behavioral health providers, say numerous respondents to HIN’s 2015 survey on Integrating Behavioral Health and Primary Care. Their on-site presence facilitates everything from daily huddles of psychologists and primary care physicians for reviewing candidates for behavioral health interventions to warm hand-offs by doctors who schedule patients with behavioral health at the end of a primary care appointment.

Colocation also helps to break down patient resistance and reduce the stigma associated with seeking behavioral health services. One respondent stated the physical presence of a psychologist in the primary care office increased patients’ willingness to engage with a behavioral health professional.

When colocation isn’t possible, telehealth can help to fill the gaps. Twenty-one percent of respondents conduct behavioral health consults via telehealth.

“Psychiatrists and independently licensed practitioners are hard to find in our rural area,” said a respondent. “Telehealth is consistently used to meet demand, often with staff sitting in ‘live’ with the member.”

Source: 2015 Healthcare Benchmarks: Integrating Behavioral Health and Primary Care