Archive for the ‘Behavioral Health’ Category

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.

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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.

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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

5 Ways to Reach, Engage Dual Eligibles

May 15th, 2014 by Cheryl Miller

It takes a village — and more — to locate, stratify and engage dual eligibles, says Julie Faulhaber, vice president of enterprise Medicaid at Health Care Service Corporation (HCSC), especially when they can range from school-aged children to elderly Native Americans. Here, she discusses how to best engage the company's diverse population.

Here’s an example of a Centennial Care outreach plan, which includes our dual eligibles. It has our Medicaid adults and children. There are not very many school-based children that are dual eligibles, but there are some, so working with the school-based clinics, the nurses’ association, etc., helps us engage.

In the New Mexico market, working with the Native American community is very important in engagement and sometimes actually for locating our members. Working with the tribal government and their leadership, some of the urban health centers, Indian health organizations, and other community organizations under the Native American groups can be extremely helpful. And some of our populations work with our behavioral health groups so again, those community mental health centers and other community organizations serving those with mental health and behavioral health concerns are of value to us.

We also work with community and public health outreach in this market. Promotoras or community health workers are critical elements for us to not only engage, but then also to maintain our relationship with members. With some of these outside agencies, we often have contractual relationships, and are able to share personal health information back and forth. That makes it much easier for us to locate members, and also have some of the staff in these organizations be part of our interdisciplinary care team.

Excerpted from Dual Eligibles Care and Service Planning: Integrative Approaches for the Medicare-Medicaid Population.

Value, Convenience Key to Successful Use of Telehealth Technology

May 8th, 2014 by Cheryl Miller

The most sophisticated technology in the world will not engage patients and members in health improvement if they are not convinced of the value of the program to their health, the commitment of their providers to the process and the credibility of the entire care team says Dr. Randall Williams, chief executive officer for Pharos Innovations. Here, he discusses the importance of convenience when it comes to engaging members or patients into a daily self-care program.

AHRQ performed a technology assessment looking at the use of information technology (IT) and the adoption of IT by patients and members of health plans who were elderly and had chronic illness, or who were underserved and had chronic illness. This technology assessment focused on looking at interactive consumer technologies that were geared toward helping consumers improve their health. This assessment describes several factors that influence the use, usefulness and usability of these technologies, in particular in populations that we as a company and others would describe in their populations, which are the elderly or the underserved and who have chronic illness.

This review concludes that from a consumer’s perspective, programs and technologies that are used to support those programs need to have a perception of benefit to the individual who will be using them. Also, they have to be perceived as convenient and as something that can be easily integrated into the daily activities of that individual patient or member.

Ultimately, the successful use of these interactive technologies is predicated on engagement into the use of that program or technology. That is directly linked to the amount of value that the consumer might perceive about the intervention that’s being offered to them — that those technologies will have a positive impact on the health and wellness of those populations if indeed there’s a feedback loop that’s provided. This feedback loop is something that’s also crucial to the design of the engagement and ultimate intervention programs. The feedback loop may include an assessment of the current health status, interpretation of that status in light of established treatment plans and treatment goals, adjustments made to that treatment plan as needed and communication back to the patient or the member with targeted recommendations or advice. This cycle then repeats.

Lastly, this report also notes the importance of convenience. Convenience is critical when it comes to engaging members or patients into a daily self-care program. Engagement is higher when that intervention is delivered via technologies and resources that the consumers are use to using on a daily basis for other purposes. We have been fortunate to take advantage of some of that learning in our program design and in our technology design as well.

Excerpted from Health IT in Care Management to Improve Health and Effect Behavior Change.

3 ACO Opportunities to Improve Patient Engagement

April 17th, 2014 by Cheryl Miller

Patients are 30 percent more likely to enroll in care management during or immediately after an acute event if they are contacted directly and introduced to a program and services, as opposed to being contacted via telephonic outreach, says Colin LeClair, executive director of ACO for Monarch HealthCare, which was a top performer in year one of the CMS Pioneer ACO program.

Through trial and error we found three opportunities to identify opportunities to yield patient engagement. First, getting the principal caregivers’ endorsement or that of the physician staff was by far the most effective means of earning the patients’ trust and getting them actively engaged. If we can say to a patient that ‘your physician has asked us to speak to you’, we get a ‘yes’ from the patient 80 to 90 percent of the time.

The second most effective means of enrolling patients in our care management program is during or immediately after an acute event. The idea is to catch them in the hospital if you can — immediately after they are admitted — and introduce them to the accountable care organization (ACO), our services, and what we can do to help them stay out of the hospital in the future. We found that patients are 30 percent more likely to enroll in care management during or immediately after an acute event, versus the cold telephonic outreach alternative. But this approach requires partnerships with hospitalists or with other hospital staff to notify you of those admissions because we don’t receive those from care management services in real-time data.

And finally, we find that patients are also somewhat receptive to care management services following a new diagnosis and we’re looking for those markers in the claims data as we receive it.

Excerpted from Tactics from a Top-Performing Pioneer ACO: Engaging Patients and Providers in Accountable Care.