Archive for the ‘Behavioral Health’ Category

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.

3 Levels of Health Coaches

April 10th, 2014 by Cheryl Miller

While health coaches address the health risk continuum — keeping the healthy healthy without compromising the clinical support needed for high-risk, high utilization individuals, it is necessary to align individuals with the right coaching service at the right time, say Dennis Richling, MD, chief medical and wellness officer, and Kelly Merriman, vice president of service delivery for HealthFitness. Here they explain the three levels of heath coaches needed to address their clients' wide-ranging needs.

Our approach engages the individual with the right coach for their need. We use three types of professional coaches: there are health coaches, who are lifestyle coaches, individuals with bachelors, masters and doctoral degrees in health-related fields. There are also advanced practice coaches, skilled senior health coaches who have been trained in clinical conditions in chronic disease management. And then there are nurse coaches, who are registered nurses, who also have been trained in behavior change techniques. We take a look at what happens and who fits into which category.

First, there are those people with no chronic disease but who have health risks. They have issues trying to manage their healthy lifestyle and are seeking help. Those individuals go to health coaches.

Next, there are those individuals with chronic diseases but they’re managing their medication appropriately and complying with the preventive and control measures for their chronic disease. But their underlying lifestyle issues remain, and these individuals go to advanced practice coaches.

Lastly, there are individuals who are not following their care plan, their care is not coordinated, they are seeing multiple doctors, and their medication compliance is poor. They do have underlying lifestyle issues, but their biggest problem right now is managing their chronic disease and these individuals go to the nurse coach.

Excerpted from Integrated Health Coaching: Reducing Risk and Empowering Change across the Health Continuum.

Infographic: How the ACA Affects Mental Health

April 7th, 2014 by Jackie Lyons

In terms of medical care, missed days of work, chronic health issues and death, depression is estimated to have cost the United States $112 billion in 2013, according to a new infographic from Betterdoctor.com. The Affordable Care Act (ACA) mandates mental health coverage for millions of Americans and requires a free depression screening under all health insurance plans.

This infographic provides an overview of depression in America, including prevalence of depression, the average cost of a hospital stay, cost of medication, as well as how the ACA is expected to impact mental healthcare.

Illness Management and Recovery (IMR): Personalized Skills and Strategies for those with Mental Illness helps people with SMI identify personally meaningful goals and work to achieve these goals by addressing smaller, more manageable segments of those goals.

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3 Components of Geriatric Health Management for Dual Eligibles

March 27th, 2014 by Cheryl Miller

When designing care management programs for dual eligibles, you need to recognize the strong connection between the medical, the social and the behavioral, explains Timothy C. Schwab, MD, FACP, former chief medical officer of SCAN Health Plan. Ultimately, you are caring for the individual; one person in charge of the whole program.

I’d like to give a broad overview of the care management model that we’ve been using at SCAN. It begins with assessment care planning and care management. But we see it as a continuum — a cross between very traditional medical care management and traditional social care management. We’ve combined it into a centralized spot we call our ‘geriatric health management program.’

We meld all that into one care management program — the medical, the social, the behavioral. And then we utilize expertise from the medical sides; for instance, for a patient with diabetes, we use our diabetic disease management module by that geriatric care manager. Or for behavioral health issues, we use the behavioral health side of the program. But again, it all focuses on the individual; one person in charge of the whole program.

When you design for the dual eligible population, you can divide the population into those that are frail and disabled as a primary type of program, but also recognize that this is a low income population with multiple complex chronic conditions. Coordination is the critical link between the social and the medical. Incorporating the traditional things like disease management, utilization management, transition management and complex care management is essential, since all of these are very critical and interrelated.

Excerpted from Community Care Connections for Dual Eligibles: Closing Social Gaps to Improve Health Outcomes.

5 Community Partners Supporting HCSC Dual Eligibles Care Coordination

March 19th, 2014 by Patricia Donovan


From 'street case managers' that help locate and engage the homeless to tribal leaders who are liaisons to the Native American population, Health Care Service Corporation (HCSC) has assembled a dream team of community partners to support care coordination of dual eligibles.

Community mental health centers, public health agencies and community agencies round out the cadre of care coordination supports for Medicare-Medicaid beneficiaries, explained Julie Faulhaber, HCSC's vice president of enterprise Medicaid during a recent webinar on Moving Beyond the Medical Care Coordination Model for Dual Eligibles.

This safety net for dual eligibles is a hallmark of three duals care coordination models launched by HCSC in 2014—two in New Mexico and one in Illinois. Results from a home-grown health risk assessment, or HRA, (conducted telephonically in almost all cases) enables HCSC to risk-stratify duals and refer them to appropriate care teams.

Other care coordination elements include interdisciplinary teams, a whole-person rather than diagnosis-driven focus and novel care and services planning that encourages out-of-the box thinking—like the installation of a grab bar in the home of a senior somewhat unsteady on her feet.

"Putting in a grab bar might cost $150 to $200, but when you think about that in terms of having that member have a fall and having them hospitalized and the rehab cost, it just makes sense for the member's quality of life and comfort to know that there is something there to help them," noted Ms. Faulhaber.

HCSC takes great care to consider the needs of individuals with disabilities as well as those with behavioral health concerns, Ms. Faulhaber stressed, citing a 2006 study that found that individuals with severe mental health issues die 25 years earlier than those without.

While HCSC's duals care coordination interventions are new, Ms. Faulhaber believes efforts will pay off for the organization's Medicare-Medicaid members. In her more than 10 years experience with Medica Health Plans in Minnesota, where she was responsible for the dual eligible product suite, duals care coordination significantly enhanced quality and utilization metrics for that population.

Despite the efforts of HCSC and other payors to enhance duals' care coordination, significant roadblocks remain, such as transportation, a lack of integrated care, and the population's typical low scoring in risk adjustment, a common trend in groups with primary behavioral conditions, she explained.

Listen to an interview with Julie Faulhaber of Health Care Service Corporation here.

Readers, how are you rising to the challenge of duals care coordination? Are your case managers 'on the street' like HCSC's, or do you have other ways of identifying and assisting the dually eligible with their physical and behavioral health needs? Share your ideas with this community.

Technology Reshaping Behavior Change Business

February 25th, 2014 by Patricia Donovan

Technology, particularly mobile health, is reshaping the delivery of health coaching, as revealed by these select metrics from the 2013 Health Coaching survey conducted by the Healthcare Intelligence Network.

The prevalence of health coaching has climbed steadily in the last five years—from 60 percent five years ago to 75 percent today. Incentives to participate in health coaching are more plentiful, too, although participants have to do more than just sign up. Today’s trend is to hold the reward until the health goal is attained.

Technology, particularly mobile health, is reshaping coaching delivery. Telephonic coaching is still the most common coaching modality, but not as common as it was in 2008, when 86 percent of respondents reported the use of telephonic coaching. This year, that figure is 75 percent. Meanwhile, the use of smartphone coaching apps has nearly tripled in the last 12 months, from 4 percent in 2012 to 12 percent this year. Text messaging is up more than 50 percent, too, with 14 percent of respondents incorporating texting in their coaching programs.

health coaching technology
The effect of all of this technology? It remains to be seen. What we do know is that face-to-face coaching interactions are waning, down from 70 percent in 2010 to 59 percent in 2013, as are group coaching visits, which are now conducted by only 28 percent of respondents, versus 40 percent last year.

One constant: motivational interviewing remains the behavior change tool of choice. However, this year’s survey identified a near doubling in use of the Patient Activation Measure® to evaluate participants’ progress, from 10 to 18 percent. Interest in positive psychology has dropped steadily in the last five years, from 48 percent in 2008 to 26 percent this year.

Excerpted from: 57 Population Health Management Metrics: Assessing Risk to Maximize Reimbursement

3 CM Qualities That Engage Populations in Telephonic Case Management

February 12th, 2014 by Jessica Fornarotto

Beyond scripts and data, there are three qualities that a case manager should possess to successfully engage populations in telephonic case management, says Jay Hale, director of quality improvement and clinical operations at Carolina Behavioral Health Alliance (CBHA).

We have found that if case managers are more comfortable with a certain illness or population, they tend to engage members better. We are still trying to figure out the nuances within each population. People who have done more child/adolescent work engage parents better than substance abuse recovery individuals do. People that do a significant amount of substance abuse recovery do a better job with that population than with the adult mental health population. There is an X factor or a subdivision with this.

Second, case managers need to be extroverted people who do not mind making the outgoing phone calls. While we need scripts and data to drive our program, the people who make it most successful are the clinicians who are most comfortable engaging those individuals. However, they are the least comfortable with paperwork, which is why we make our paperwork as simple as possible. We want to be sure that they can point and click, and go straight through it. It is one flowing process for them.

Finally, management also supports engagement. It is important to talk to the staff about success stories and what happened that made them successful. They should use it as a learning opportunity for everyone, but also as a celebration opportunity. As long as we can keep case managers enthused about the program they are doing, that enthusiasm comes through in their voice when they are talking to individuals on the phone and it helps them go the extra mile. It helps them with the process of relating to members at the other end.

"At CBHA, we developed our telephonic case management program to find a way to support and improve the care of some of our most vulnerable members. We want to be good stewards of the monies that are given to us by our client companies to pay for their behavioral health claims," said Jay Hale.

Excerpted from: Telephonic Case Management Protocols to Engage Vulnerable Populations

Can Telemedicine Improve Patient Care and Reduce Hospital Readmissions?

February 6th, 2014 by Cheryl Miller

Where technologies such as videoconferencing for remote diagnostics are deployed, adopters report impressive gains in the care of remote and rural patients, as well as a decrease in health complications, according to responses to the Healthcare Intelligence Network's Telehealth in 2013 survey.

Take, for example, the numerous initiatives in the area of remote monitoring, the top clinical telehealth application reported by this year’s respondents. Fifty-seven percent monitor patients or members remotely; fully 100 percent of those employing this technology track vital signs and weight in monitored individuals, two critical red flags in treatment of individuals with chronic illness.

Active users of telehealth and telemedicine also experience fewer hospitalizations, hospital readmissions, emergency room visits and bed days, respondents reported.

Researchers at UC Davis Children’s Hospital recently found that telemedicine consultations with pediatric critical-care medicine physicians significantly improved the quality of care for seriously ill and injured children treated in remote rural ERs, where pediatricians and pediatric specialists are scarce.

The study also found that rural ER physicians are more likely to adjust their pediatric patients’ diagnoses and course of treatment after a live, interactive videoconference with a specialist. Parents’ satisfaction and perception of the quality of their child’s care also are significantly improved when consultations are provided using telemedicine, rather than telephone, and aid ER treatment, the study found.

Excerpted from 2013 Healthcare Benchmarks: Telehealth & Telemedicine.

Infographic: Cost of Mental Illness in Children

January 3rd, 2014 by Jackie Lyons

Individuals under age 24 with mental disorders cost the healthcare system $247 billion every year. Approximately one in five children has a mental disorder, and one in two will never receive help, according to a new infographic from Top Master in Education.

This infographic also identifies mental disorders common in children, at-risk populations, disorder identification rates based on gender, mental disorder myths vs. facts, and more.

Cost of Mental Illness in Children

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You may also be interested in this related resource: Illness Management and Recovery (IMR): Personalized Skills and Strategies for those with Mental Illness.

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Engaging Members in Health Management Post-Discharge with Case Managers, Outreach Calls

December 17th, 2013 by Jessica Fornarotto

"Member engagement is always the challenge, and it is no different for telephonic engagement," states Jay Hale, director of quality improvement and clinical operations at Carolina Behavioral Health Alliance (CBHA), as he discusses how CBHA engages members in their telephonic case management program post-discharge. "We've found multiple venues to attract attention and begin the engagement process, including letters, outreach calls to members, and partnering with the discharging hospital. We want to be part of the discharge process, so telephonic case management is as much a part of the discharge plan as their visit with the doctor or therapist, medication regime, etc.

In HIN's special report, Telephonic Case Management Protocols to Engage Vulnerable Populations, Jay Hale further describes the engagement process for CBHA's telephonic case management program.

We are a small regional managed behavioral healthcare organization (MBHO), so our case managers also do utilization management. They identify the cases early and are able to talk to the utilization review (UR) people at the hospital and say, "This is someone that we have identified," which helps with that discharge process. The earlier we can talk to members, the better. We want to talk to members as quickly after discharge as possible. Having the support of that hospital adds weight to what we do, so it is key that they do not receive a random call. We want it to be something that is related to their treatment process. That is why we want to be part of that discharging.

The next step is to call the member once they have been discharged. We obtain contact information from our records or from the hospital. Our records are based on what the person gave to human resources at some point along the line, so they may not always be updated. The hospital frequently has the most recent phone contact information.

We obtain the discharge recommendation, which is part of our UR process, including appointment times. I contact the member and engage them in the process to assure that they attend their appointments. We also call their providers to say that we want to make sure that the individual attends their appointment. We are the people who are authorizing the care, and these are in-network providers for us. Therefore, that is a relatively easy process. I feel comfortable with that because it is part of the treatment payment healthcare operations process. It also lets our providers know that we are doing this, so they should support us. It also lets them know we are not there just to plan, but also support what they do.

Once we get in contact with someone, we are going to describe this service in the way of how it can help him or her. "This is a service that helps you see how well you are doing." Other phrases we use include, "We are here to support you in your recovery," or "We are here to help you and your son/daughter." We speak in a positive way, and we let them know that there is no cost to them for the program. This is part of their health plan, and we provide this service to help them see how well they are doing. That phrase works for them because it has a positive tone to it.

We also want to match case managers to the members as much as possible. As we manage care, we can see that individuals are more comfortable with a male or a female based on our UR information. They may be more comfortable with someone based on their issues, so we want to try to have the appropriate person do an outreach call to them. Because of that, we may learn about varying times of day to call.

We also found it is important for the case managers to know the therapeutic language that the member has learned. Specifically in substance abuse, we want people who are familiar with that language so that they can talk about supporting recovery, working a program, avoiding old playmates and playgrounds, working the steps, the big book and sponsors. There are certain words that are very specific to that language and to that program. If we can use that language comfortably, then that increases member engagement.