Archive for the ‘Behavioral Health’ Category

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.

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.