Archive for the ‘Behavioral Health’ Category

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.

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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 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

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.

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.

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

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.