Archive for the ‘Behavioral Health’ Category

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.

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

December 29th, 2014 by Patricia Donovan

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

October 24th, 2014 by Cheryl Miller

It’s all about the patient.

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

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

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

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

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

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

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

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

Listen to interviews with Robert Marchuk and Lisa Williams.

Adventist Population Health Management Incentives Engage Employees, Curb Costs

October 16th, 2014 by Cheryl Miller

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

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

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

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

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

Community Linkages Support HCSC’s Holistic Approach to Duals

September 25th, 2014 by Cheryl Miller

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

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

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

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

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

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

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

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

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