Archive for the ‘Medicaid’ Category

In Montefiore Social Determinants of Health Screening, Patients’ Needs Shape SDOH Workflow

July 11th, 2017 by Patricia Donovan
 Clinical factors drive 15 percent of a patient's well-being; social determinants of health like finances drive the rest.


Clinical factors drive 15 percent of a patient’s well-being; social determinants of health like finances drive the rest.

In Dr. Amanda Parsons’ twenty-something years in healthcare, she has never implemented a program as widely embraced as Montefiore Health System’s Social Determinants of Health (SDOH) screening.

“It was one of the few times in my career that I didn’t encounter physician resistance,” said Dr. Parsons, Montefiore’s vice president of community and population health. The health system’s screening assesses patients for a host of SDOH factors that drive 85 percent of their well-being, including housing, food security, access to care or medications, finances, transportation and violence.

Following assessment, the goal is to connect individuals who screen positively for SDOHs with assistance from the area’s robust network of community organizations.

Dr. Parsons outlined her organization’s SDOH screening process, findings, challenges, and future plans during Assessing Social Determinants of Health: Collecting and Responding to Data in the Primary Care Setting, a June 2017 webcast by the Healthcare Intelligence Network now available for rebroadcast.

To get started, Montefiore piggybacked on the efforts of a few provider sites already screening for SDOHs. It then offered providers a choice of two validated screening tools, the first developed at a fifth-grade reading level, the second a more sophisticated “stressor” screen. Thirdly, it built a two-tiered triage system that leveraged social workers for individuals with very high SDOH needs, and community health workers to assist with lower-level needs.

Referrals would come from existing data banks or a host of new online referral tools, many of which Dr. Parsons mentioned during the webcast.

Interestingly, while Montefiore is fully live on an EPIC® electronic health record, SDOH screenings are currently conducted on paper, noted Dr. Parsons. This decision was one of multiple considerations in workflow creation, including respect for patient privacy.

For the time being, each Montefiore provider site selects a unique population to screen—or opts not to screen at all, if staffing is lacking. For example, one site screens all patients scheduled for annual physicals, while another screens patients recently discharged from the hospital.

In an initial readout of both screens, SDOH positivity was highest for housing and finances.

By the end of 2017, Montefiore expects to have completed more than 10,000 screenings. The health system, which serves some 700,000 patients, also plans to boost its ranks of community health workers, broadening its referral network.

Looking ahead, Montefiore will address a number of key administrative and emotional barriers. Some patient issues, like overcoming the stigma of seeing a social worker, can be minimized with a simple scripting change. Others, like alleviating an individual’s financial pain or putting a roof over a family’s head, are much more complicated.

Also needed is a process to confirm a patient has “gone that last mile” and obtained the recommended support, Dr. Parsons added.

As it expands SDOH screening, Montefiore is banking on that swell of engaged providers. As part of its mission to provide comprehensive, ‘cradle-to-grave’ care for its mostly Medicaid and otherwise government-insured population, Montefiore “intervenes even when there is no payment structure for that work,” said Dr. Parsons.

Falling into that category is SDOH screening. “Much of the Social Determinants of Health work is not very billable in the traditional paper service model, but it is incredibly important to do, regardless.”

Listen to an interview with Dr. Parsons on adapting SDOH screenings for different populations.
TW_Montefiore_SDOH_webinar0617

Infographic: Medicaid’s Critical Role in the First 1,000 Days of a Child’s Life

July 7th, 2017 by Melanie Matthews

The first 1,000 days of a child’s life are a critical window for cognitive, physical, and social development. Exposure to adverse experiences during early childhood dramatically increases the potential for lifelong poor health and social outcomes, according to a new infographic by the Center for Health Care Strategies.

The infographic highlights the key role that Medicaid can play in increasing the odds that children get a good start in life.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex PopulationsAsked by its C-suite to quantify contributions of its multidisciplinary care team for its highest-risk patients, AltaMed Health Services Corporation readily identified seven key performance metrics associated with the team.

Having demonstrated the team’s bottom line impact on specialty costs, emergency room visits, and HEDIS® measures, among other areas, the largest independent federally qualified community health center (FQHC) was granted additional staff to expand care management for its safety net population.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations chronicles AltaMed’s four-phase rollout of care coordination for dual eligibles—a population with higher hospitalization and utilization and care costs twice those of any other population served by AltaMed.

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Infographic: Medicaid’s Role in Behavioral Healthcare

May 19th, 2017 by Melanie Matthews

Medicaid restructuring as proposed in the American Health Care Act could limit states’ ability to care for people with behavioral health conditions, according to a new infographic by the Kaiser Family Foundation.

The infographic details how Medicaid currently enables people with behavioral health needs to access care and how reduced federal spending could limit behavioral health coverage and services.

Behavioral Health Patient Engagement: Using Motivational Interviewing Techniques and Strategies To Improve OutcomesAs the critical role of an engaged, activated healthcare consumer becomes more apparent in a value-based healthcare system, healthcare organizations are focusing on patient engagement and activation programs.

In a recent industry survey on trends in patient engagement, healthcare organizations reported that behavioral health conditions presented a particular challenge to patient engagement initiatives. However, there is robust evidence that motivational interviewing is a powerful approach for treating substance abuse, anxiety and depression.

Behavioral Health Patient Engagement: Using Motivational Interviewing Techniques and Strategies To Improve Outcomes, a 45-minute webinar now available for replay, Mia Croyle with the University of Wisconsin School of Medicine and Public Health shares key learnings from patient engagement initiatives targeted at patients with behavioral health conditions.

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Infographic: Physician Appointment Wait Times; Medicare and Medicaid Acceptance Rates

May 5th, 2017 by Melanie Matthews

The average wait time for a physician appointment in 15 mid-sized metropolitan areas was nearly 8 days longer than in l5 major metropolitan areas, according to a new infographic by Merritt Hawkins.

The infographic also examined rates of Medicare and Medicaid acceptance by physicians in these markets.

No matter which level of participation physician practices choose for the first Quality Payment Program performance period beginning January 1, 2017, CMS’s “Pick Your Pace” announcement means practices should proactively prepare for the impact of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) on physician quality reporting and reimbursement.

MACRA Physician Quality Reporting: Positioning Your Practice for the MIPS Merit-Based Incentive Payment System delivers a veritable MACRA toolkit for physician practices, with dozens of tips and strategies that lay the groundwork for reimbursement under Medicare’s Merit-based Incentive Payment System (MIPS), expected to begin in 2017 and one of two payment paths Medicare will offer to practices.

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Healthcare Reacts to AHCA: Providers ‘Cannot Support Legislation As Drafted’

March 13th, 2017 by Patricia Donovan

American Health Care ActLast week’s unveiling of G.O.P. legislation designed to repeal and replace the Affordable Care Act (ACA) triggered a flurry of concerns and criticisms from healthcare industry sectors.

The proposed American Health Care Act (AHCA) would eliminate Obamacare’s individual mandate and put in place refundable tax credits for individuals to purchase health insurance. It also proposes restructuring Medicaid and defunding Planned Parenthood. However, the bill seeks to maintain protections for individuals with pre-existing conditions and to permit children to remain on their parents’ insurance plans until they reach the age of 26.

As of last Friday, the proposed American Health Care Act (AHCA) had cleared two committees in the U.S. House of Representatives; a final House vote on the bill is expected the week of March 20.

In a letter to leaders of the House committees that will mark up the AHCA, the American Medical Association (AMA) rejected the ACA replacement bill. In the letter, AMA CEO and Executive Vice President James L. Madara, MD, stated that his organization “cannot support the AHCA as drafted because of the expected decline in health
insurance coverage and the potential harm it would cause to vulnerable patient populations.”

In particular, the AMA, the nation’s largest physicians’ group representing more than 220,000 doctors, residents, and medical students, objected to the bill’s proposed restructuring of Medicaid, claiming it “would limit states’ ability to respond to changes in service demands and threaten coverage for people with low incomes.”

The AMA’s position was also outlined in a statement issued by Andrew W. Gurman, MD, AMA president.

Meanwhile, the American Hospital Association (AHA), which counts 5,000 hospitals among its members, also opposed the AHCA. In a news release, Rick Pollack, AHA president and CEO, stated that the AHA “cannot support The American Health Care Act in its current form.” The AHA stated that it would be difficult to evaluate the bill without coverage estimates by the Congressional Budget Office (CBO).

Echoing AMA apprehension over proposed Medicaid restructuring, Pollack stated that the AHA feared the bill “will have the effect of making significant reductions in a program that provides services to our most vulnerable populations, and already pays providers significantly less than the cost of providing care.”

Although Pollack lauded recent Congessional efforts to address behavioral health issues, including the growing opioid abuse epidemic, he stressed that “significant progress in these areas is directly related to whether individuals have coverage. And, we have already seen clear evidence of how expanded coverage is helping to address these high-priority needs.”

Also seeking adequate Medicaid funding in the AHCA was America’s Health Insurance Plans (AHIP), a national association whose 1,300 members provide coverage for healthcare and related services to more than 200 million Americans.

In a letter to two key House committees, AHIP President and CEO Marilyn Tavenner stated that “Medicaid health plans are at the forefront of providing coverage for and access to behavioral health services and treatment for opioid use disorders, and insufficient funding could jeopardize the progress being made on these important public health fronts.”

However, AHIP commended the proposed legislation for its “number of positive steps to help stabilize the market and create a bridge to a reformed market during the 2018 and 2019 transition period” and “pledged to work collaboratively to shape the final legislation.”

“AHIP members are committed to reducing cost growth by using value-based care arrangements and other innovative programs to address chronic illnesses and better manage the care of the highest-need patients,” Tavenner concluded.

In a statement on Friday, Secretary of Health and Human Services Tom Price, MD, committing his agency to using its regulatory authority to create greater flexibility in the Medicaid program for states, including “a review of existing waiver procedures to provide states the impetus and freedom to innovate and test new ideas to improve access to care and health outcomes.”

Infographic: Economic Impact of the Medicaid Expansion in Michigan

February 6th, 2017 by Melanie Matthews

Economic Impact of the Medicaid Expansion in MichiganUnder its Medicaid expansion program, the Michigan state government will end up with more money than it spends, even as costs rise, according to a new infographic by the Institute for Healthcare Policy & Innovation at the University of Michigan.

The infographic looks at the impact of Michigan’s Medicaid expansion on job creation, tax revenue on increased economic activity and cost avoidance from other safety net programs.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex PopulationsAsked by its C-suite to quantify contributions of its multidisciplinary care team for its highest-risk patients, AltaMed Health Services Corporation readily identified seven key performance metrics associated with the team.

Having demonstrated the team’s bottom line impact on specialty costs, emergency room visits, and HEDIS® measures, among other areas, the largest independent federally qualified community health center (FQHC) was granted additional staff to expand care management for its safety net population.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations chronicles AltaMed’s four-phase rollout of care coordination for dual eligibles—a population with higher hospitalization and utilization and care costs twice those of any other population served by AltaMed.

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Infographic: Medicaid Expansion in Pennsylvania

August 19th, 2016 by Melanie Matthews

The Medicaid expansion has made it possible for more Pennsylvanians to access healthcare than ever before, according to a new infographic released by the Pennsylvania Department of Human Services. As of April 2016, the expansion had reached 625,970 newly eligible Pennsylvanians, ages 18 to 64.

The infographic provides a demographic snapshot of the newly insured.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex PopulationsAsked by its C-suite to quantify contributions of its multidisciplinary care team for its highest-risk patients, AltaMed Health Services Corporation readily identified seven key performance metrics associated with the team.

Having demonstrated the team’s bottom line impact on specialty costs, emergency room visits, and HEDIS® measures, among other areas, the largest independent federally qualified community health center (FQHC) was granted additional staff to expand care management for its safety net population.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations chronicles AltaMed’s four-phase rollout of care coordination for dual eligibles—a population with higher hospitalization and utilization and care costs twice those of any other population served by AltaMed.

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Infographic: Delineating Accountable Care Responsibilities

May 25th, 2016 by Melanie Matthews

States introducing accountable care organization (ACO) programs into an existing Medicaid managed care environment will need to assign responsibilities between ACOs and managed care organizations (MCOs). Successful delineation of responsibilities can support ACOs and MCOs in complementing one another and being better positioned to improve care delivery for Medicaid enrollees, according to a new infographic by the Center for Health Care Strategies Inc.

The infographic identifies five responsibilities that both ACOs and MCOs may share and outlines which entity may be better suited to perform each function.

2015 Healthcare Benchmarks: Accountable Care Organizations Even before CMS published its agenda for moving Medicare into value-based payment models like the accountable care organization (ACO), the number of public and private ACOs had exceeded 700, by a Leavitt Partners estimate. Already, more than 20 percent of healthcare organizations plan to participate in Medicare’s latest accountable care model, the Next Generation ACO, in the coming year.

Support for CMS’s latest alternative payment offering is just one of the ACO metrics contained in 2015 Healthcare Benchmarks: Accountable Care Organizations. HIN’s fourth annual compendium of metrics on ACOs captures how ACOs are faring in an industry rapidly shifting away from fee for service to one that rewards quality, the patient and population experiences, and cost efficiencies. Click here for more information.

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CCNC Home Visits in Transitional Care: Payoffs of Targeting Priority Patients

April 7th, 2016 by Patricia Donovan

Timely and appropriately targeted home visits for priority Medicaid beneficiaries significantly reduced hospital admissions and readmissions.

The philosophy behind Community Care of North Carolina’s award-winning care transition management program is simple: transitional care works better for some than others.

Before investing in home visits, pharmacist involvement and early outpatient follow-up, healthcare organizations should discern the patients most likely to benefit from these resource-intensive interventions as well as those who won’t, advised Carlos Jackson, PhD., CCNC director of program evaluation.

“Transitional care often becomes a one-size-fits-all intervention, where providers feel they have to do the same thing for everybody coming out of the hospital,” Jackson noted during Measuring and Evaluating the Impact of Home Visits for Clinically Complex Patients, a March 2016 webinar now available for replay.

In outlining the CCNC approach, Jackson recommends transitional care be targeted towards patients with multiple, chronic or catastrophic conditions to optimize an organization’s return on investment.

His organization’s dexterity in determining and managing a priority population for transitional care (TC) helped to earn CCNC the inaugural Hearst Health Prize for Population Health earlier this year. With a presence in all one hundred North Carolina counties, CCNC manages 1.5 million Medicaid beneficiaries, among other populations.

Statistically, CCNC determined that only a quarter of its Medicaid discharges were likely to meaningfully benefit from transitional care, and that even within that priority population, only a smaller segment would benefit meaningfully from resource-heavy interventions.

Of all face-to-face encounters with CCNC priority patients, include hospital bedside and office visits, appropriately targeted home visits reduced this population’s likelihood of being readmitted to the hospital most significantly, noted Jackson.

“Of course, you can’t do a home visit with everybody. If you want a positive return on investment to cover the cost of the home visit, you need to focus on the highest risk patients.”

Modeled on the Coleman Transitions Intervention Model®, the eight-year-old CCNC program has elements common to many transitional care initiatives—data analytics, embedded care management, telephonic and face-to-face follow-up. But CCNC has reexamined some traditional transitional care tenets, such as the notion that this type of care is necessary for all.

“Actually, most patients don’t benefit,” Jackson noted. “Lower risk patients don’t benefit. The evidence for benefit is much weaker if you are not one of these high risk, multiple chronic patients.”

His organization has also widened its transitional care lens beyond a focus on reducing readmissions. “It’s sometimes myopic to focus on just serving the 30-day readmissions,” Jackson continued. “If you can deliver good transitional care, you can keep them out of the hospital for a very long time and affect their outcomes way into the future.”

The CCNC transitional care approach for North Carolina Medicaid beneficiaries with multiple chronic conditions resulted in more than 2,200 fewer readmissions and 8,000 fewer inpatient admissions in 2014 as compared to 2008, Jackson concluded.

Infographic: Medicaid Readmission Rates

February 19th, 2016 by Melanie Matthews

Many hospitals are working hard to lower readmissions among Medicare patients. But another patient group—adults covered by Medicaid—have readmission rates that are just as high, or even higher, than Medicare patients, according to 2012 data from AHRQ, illustrated in a new infographic.

The infographic compares 30-day readmission rates for Medicare and Medicaid patients for acute myocardial infarction, congestive heart failure, pneumonia, and hip and knee replacement.

Asked by its C-suite to quantify contributions of its multidisciplinary care team for its highest-risk patients, AltaMed Health Services Corporation readily identified seven key performance metrics associated with the team. Having demonstrated the team’s bottom line impact on specialty costs, emergency room visits, and HEDIS® measures, among other areas, the largest independent federally qualified community health center (FQHC) was granted additional staff to expand care management for its safety net population.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations chronicles AltaMed’s four-phase rollout of care coordination for dual eligibles—a population with higher hospitalization and utilization and care costs twice those of any other population served by AltaMed.

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.

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