Archive for the ‘Reducing Readmissions’ Category

Infographic: Focus on Care Transitions to Reduce Readmissions and Boost Your Bottom Line

May 30th, 2018 by Melanie Matthews

Decreased hospital readmissions leads to improved patient outcomes, which improves brand reputation, ultimately leading to increased patient volume and market share. Reducing readmissions begins with creating a seamless care transition plan for what will happen within the hospital as well as after discharge, according to a new infographic by the Studer Group.

The infographic examines how reducing readmissions impacts a hospital’s bottom line and techniques to improve care transitions.

The Science of Successful Care Transition Management: Leveraging Home Visits to Improve Readmissions and ROI A care transitions management program operated by Sun Health since 2011 has significantly reduced hospital readmissions for nearly 12,000 Medicare patients, resulting in $14.8 million in savings to the Medicare program. Using home visits as a core strategy, the Sun Health Care Transitions program was a top performer in CMS’s recently concluded Community-Based Care Transitions (CBCT) demonstration project, which was launched in 2012 to explore new solutions for reducing hospital readmissions, improving quality and achieving measurable savings for Medicare.

The Science of Successful Care Transition Management: Leveraging Home Visits to Improve Readmissions and ROI explores the critical five pillars of the Arizona non-profit’s leading care transitions management initiative, adapted from the Coleman Care Transitions Intervention®.

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10 Critical Care Coordination Model Elements for Medicaid Managed Care Members

May 17th, 2018 by Melanie Matthews

There are 10 critical elements of the care coordination model for Independent Health Care Plan (iCare) Medicaid managed care members, according to Lisa Holden, vice president of accountable care, iCare.

The first element and touchpoint for Medicaid managed care members is their care coordinator. “Every single one of our incoming SSI Medicaid members is assigned to a care coordinator,” Holden told participants in the May 2018 webinar, Medicaid Member Engagement: A Telephonic Care Coordination Relationship-Building Strategy, now available for replay. “That person is responsible for everything to do with that member’s coordination of care.”

Care coordinators are assigned to every Medicaid member and are responsible for engaging and coordinating member’s care needs.

“We want our care coordinators to make an initial phone call as early as a couple of days after the member is enrolled in our plan,” she said. “If the member is interested in having a conversation, we offer to conduct a health risk assessment. But if the timing isn’t right, then we offer to schedule another appointment. There’s no pressure except that we want them to feel engaged by us.”

Once completed, the health risk assessment forms the basis of an interdisciplinary individualized care plan created by the care coordinator with the member.

The care coordinator, who is a social worker by background, has access to a nurse, who is available for medically complex members, said Holden.

iCare also relies on health coaches. Health coaches are now teaming up with a care coordinator as much as, if not more than, the nurses are historically, Holden said.

“Our health coaches are literally assigned to work in the community to become very familiar with the resources that are available,” she added. “They are becoming steeped in the communities in which they serve. Each one is assigned to a neighborhood, and we’ve asked them, ‘Get to know the police. Get to know the fire. Get to know the food organizations and food pantries. Get to know the housing specialists in your area.'”

The health coaches also help the care coordinators locate difficult-to-contact members by being in the community as a boots on the ground force. They’re also focused on assessing and addressing social determinants of health.

“We really believe that health coaches are going to be the key to our success in this year and in years to come,” Holden explained.

In addition to the care coordinators, health coaches and nurses, the care coordination team includes two specialized positions…a trauma-informed intervention specialist and a mental health and substance abuse intervention specialist. “We brought those two specialties into this program for our Medicaid members because we know that there’s a high instance of behavioral health conditions, which usually has another diagnosis of alcohol and drug use, not always, but quite often. We wanted to have the team ready to engage the member,” said Holden.

Once the member is engaged, iCare’s care coordination team begins to identify unmet needs, she explained. “We want to know, ‘Is their life going well? Do they have appropriate medical care? Are they in a relationship with a primary care provider that they feel is co-respectful? Are they getting their answers to their questions?'”

To begin talking about medical needs, the care coordination team has to establish trust, said Holden. “We have to talk with the member in an honest way that reflects our respect for them and also engages them in order for them to tell us how they really feel.”

iCare uses the Patient Activation Measure tool to help identify where the member is in a spectrum of four different levels of activation. iCare then tailors its member engagement approach to build a trusting relationship and provide member education by recognizing where they are in their activation level.

Following up on preventive measures are key for the iCare care coordination model. Care coordinators reach out to members for care plan updates. The care plan has to be alive and very member-centric, said Holden. The health risk assessment is repeated each year and the care plan is updated based on those results.

iCare is also focusing on social determinants of health with the recognition that they impact a members’ health more than clinical care. Clinical care attributes to only about 20 percent of somebody’s health outcomes; the rest of that 80 percent is made up of by health behaviors, social and economic factors, and physical environment. “If we don’t get underneath those issues, we can ask for things to improve, but we’re going to see minimal success,” Holden added.

During the webinar, Holden also shared: how the care coordinators helps Medicaid members overcome barriers to care; seven rising risk/acuity identification tools; readmission prevention initiatives for high-risk patients; three programs aimed at reducing high emergency department utilization; and details on a Follow-to-Home program for members who are homeless. Holden also shared: details on language to use…and not to use…when engaging members; advice on the best time to connect with members by phone, such as time of day, specific days of the months; the role of the specialist interventionist compared to the care coordinator; and the background of iCare’s care coordinators and health coaches.

Click here to view the webinar today or order a DVD or CD of the conference proceedings.

Infographic: Impact of Diagnostics on Healthcare Outcomes

April 20th, 2018 by Melanie Matthews

Diagnostic testing plays a key role in reducing hospitalizations, preventing infections, and improving healthcare outcomes, according to a new infographic by Health Industry Distributors Association.

The infographic explores the impact of diagnostic testing on healthcare utilization, infections, adverse health events, patient satisfaction and healthcare costs.

Healthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare IndustryHealthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare Industry, HIN’s 14th annual business forecast, is designed to support healthcare C-suite planning as leaders react to presidential priorities and seek new strategies for engaging providers, patients and health plan members in value-based care.

HIN’s highly anticipated annual strategic playbook opens with perspectives from industry thought leader Brian Sanderson, managing principal, healthcare services, Crowe Horwath, who outlines a roadmap to healthcare provider success by examining the key issues, challenges and opportunities facing providers in the year to come. Following Sanderson’s outlook is guidance for healthcare payors from David Buchanan, president, Buchanan Strategies, on navigating seven hot button areas for insurers, from the future of Obamacare to the changing face of telehealth to the surprising role grocery stores might one day play in healthcare delivery. Click here for more information.

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Essentia Health Virtual Telemedicine Services Support Rural Hospitals and Clinics

March 13th, 2018 by Patricia Donovan

Essentia Health conducts 5,000 virtual visits annually.

There may be some challenges associated with Essentia Health’s comprehensive telemedicine program, but provider engagement isn’t one of them.

“In the seven years I have been with Essentia Health, I have not gone to any provider to ask them to do telehealth,” notes Maureen Ideker, RN, BSN, MBA, the organization’s senior advisor for telehealth. Instead, physicians seek out Ms. Ideker, asking to be connected to any of Essentia Health’s six hospital-based and more than 20 clinic-based telehealth services.

Such robust telemedicine adoption among Essentia Health’s more than 800 physicians may be one reason why the organization averages 5,000 virtual visits annually, and why it has another 10 to 20 new telehealth offerings in development, according to Ms. Ideker’s presentation during Telemedicine Across the Care Continuum: Boosting Health Clinic Revenue and Closing Care Gaps.

The largely rural footprint of Essentia Health, which touches the three states of Minnesota, Wisconsin and North Dakota, is ideally suited to telehealth implementation. During this March 2018 webinar, which is now available for rebroadcast, Ms. Ideker outlined her organization’s telehealth program models, history of program development, and equipment and staffing requirements. She also shared key program outcomes, such as the impact of remote patient monitoring on hospital readmissions and clinic ROI from telehealth.

For example, the 30-day readmission rate for Essentia Health patients with heart failure remotely monitored at home is 2 percent, versus its non-monitored heart failure patients (9 percent) and the national 30-day readmissions average of 24 percent.

Essentia Health’s hospital-based telemedicine began with an emergency room platform, which includes pediatric ER and pharmacy and toxicology and a soon-to-be-added behavioral health component. Today, hospitalist and stroke care are the largest of Essentia Health’s hospital-based telemedicine programs, explained Ms. Ideker. These virtual services support Essentia Health’s rural hospitals in five key ways, including the avoidance of unnecessary patient transfers.

On the outpatient side, the 20-something tele-clinic based services developed by Essentia Health over the last seven years run the gamut from allergy and infant audiology to urology and vascular conditions, she explained. Her organization’s telemedicine approach to opioid tapering is catching on across Minnesota, she added.

And while it is appreciative of its providers’ enthusiasm, Essentia Health approaches telehealth development with precision, consulting data analytics such as metrics on annual health screenings to create target groups for new services. The launching of a new telemedicine service can take up to twelve weeks, using a 75-item checklist and an implementation retreat and walk-through, Ms. Ideker explained.

In closing, Ms. Ideker shared several innovation stories from its portfolio of telehealth offerings, including Code Weather, employed during hazardous weather for patient safety reasons and to reduce cancellations of appointments, and a gastroenterology initiative designed to reduce no-show rates.

Listen to Maureen Ideker explain how Essentia Health pairs remote patients with hospital- and clinic-based telehealth services.

Infographic: Coded Severity and Readmission Reduction

December 27th, 2017 by Melanie Matthews

A federal program that has been shown to reduce hospital readmissions may not have been as successful as it appears, according to a new infographic based on a study by University of Michigan researchers.

The infographic examines how the reduction in patients heading back to the hospital could be attributed to how the diagnoses were coded.

A Collaborative Blueprint for Reducing SNF Readmissions: Driving Results with Quality Reporting and Performance Metrics
Concerned about escalating hospital readmissions from skilled nursing facilities (SNFs) and the accompanying pinch of Medicare readmissions penalties, three Michigan healthcare organizations set competition aside to collaborate and reduce rehospitalizations from SNFs.

To solidify their coordinated approach, Henry Ford Health System (HFHS), the Detroit Medical Center and St. John’s Providence Health System formed the Tri-County SNF Collaborative with support from the Michigan Quality Improvement Organization (MPRO).

A Collaborative Blueprint for Reducing SNF Readmissions: Driving Results with Quality Reporting and Performance Metrics examines the evolution of the Tri-County SNF Collaborative, as well as the set of clinical and quality targets and metrics with which it operates.

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Infographic: Food Insecurity Among Medicaid Seniors

October 2nd, 2017 by Melanie Matthews

There’s an estimated 5.2 million seniors who are eligible for the Supplemental Nutrition Assistance Program (SNAP) but are not enrolled, according to a new infographic by Benefits Data Trust.

The infographic examines the impact of food insecurity on seniors’ health and healthcare costs and quality.

2017 Healthcare Benchmarks: Social Determinants of HealthInitiatives such as CMS’ Accountable Health Communities Model and other population health platforms encourage healthcare organizations to tackle the broad range of social, economic and environmental factors that shape an individual’s health. To underscore the need to address social determinants of health, Healthy People 2020 included “Create social and physical environments that promote good health for all” among its four overarching goals for the decade.

In one measure of their impact, 2015 research by Brigham Young University found that the social determinants of loneliness and social isolation are just as much a threat to longevity as obesity.

2017 Healthcare Benchmarks: Social Determinants of Health documents the efforts of more than 140 healthcare organizations to assess social, economic and environmental factors in patients and to begin to redesign care management to account for these factors.

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Empathy Interviewing Elicits Patient’s ‘Story,’ Uncovers Social Determinants of Health

September 26th, 2017 by Patricia Donovan

social determinants of health

Healthcare must mitigate patient risk factors outside of the hospital, referred to as social determinants of health (SDOH).

If healthcare hopes to move the needle on runaway expenses and improve the health of its communities, it must first focus on patients’ social and environmental circumstances, also known as social determinants of health (SDOH).

That’s the advice of Cindy Buckels, director of population health for TAV Health, which helps healthcare organizations navigate the challenges of SDOHs.

“When we don’t address these issues as we’re addressing someone’s health, we get high readmissions, negative outcomes and dissatisfaction. There’s also increased cost and increased risk,” noted Ms. Buckels during Social Determinants of Health: Using Empathy Interviewing To Help Care Teams Understand Factors Impacting Patient Health, a September 2017 webinar now available for rebroadcast.

To encourage individuals to open up about economic, educational, nutritional, or community deficits they face that drive 60 percent of their health outcomes, TAV Health recommends care teams employ empathy interviewing, also known as motivational interviewing (MI).

“With motivational interviewing, you’re entering into a relationship with a person, not as the expert, but as a partner coming alongside to help them find their own strengths, and affirming them as a person in order to affect positive change,” said Ms. Buckels. Her presentation included a review of the four core skills of motivational interviewing (“Listen for that positive nugget,” she urges), as well as ‘back pocket’ questions to ask when the conversation stalls.

Finally, she outlined traps for care teams to avoid during an MI session, such as the urge to give advice. “Always ask permission to give information or advice. Don’t just assume that’s something that you can do, because you’ve picked up the phone and called them.”

It may take time to master, but ultimately, motivational interviewing is more effective than healthcare’s typical “Chunk-Check-Change” education approach in transforming patient ambivalence and effecting positive behavior change, she said.

Information gleaned from motivational interviewing, even minor details like a patient’s nickname or the presence of a cherished pet, should become part of the patient’s record so that every person along the care continuum who ‘touches’ that patient can access it.

“For example, if a patient’s legal name is Charlene, but she goes by Michelle, if you really want to build a relationship with her and gain her trust, you start by calling her what she goes by, which is Michelle.”

In closing, Ms. Buckels outlined a patient-centric workflow connecting all supportive organizations, healthcare providers, community organizations and family and friends within the patient’s circle of care, which places more eyes and ears on the individual. With communal oversight to report anything worrisome, the likelihood is much less that a socially supported patient will visit the ER or be admitted to the hospital.

Listen to Cindy Buckels explain the advantages of motivational interviewing over the “Chunk-Check-Change” educational approach.

Infographic: Real-Time Communication Is Key to Improving Post-Acute Care Transitions

September 11th, 2017 by Melanie Matthews

When it comes to transitions between inpatient, post-acute, and home environment settings, nearly three quarters (71%) of the NEJM Catalyst Insights Council respondents to its Care Redesign survey on Strengthening the Post-Acute Care Coordination believe that improved real-time communication is the biggest opportunity to improve post-acute transitions. Survey results are highlighted in a new infographic by NEJM Catalyst.

The infographic also examines other strategies for improving post-acute care transitions.

A Collaborative Blueprint for Reducing SNF Readmissions: Driving Results with Quality Reporting and Performance Metrics
Concerned about escalating hospital readmissions from skilled nursing facilities (SNFs) and the accompanying pinch of Medicare readmissions penalties, three Michigan healthcare organizations set competition aside to collaborate and reduce rehospitalizations from SNFs.

To solidify their coordinated approach, Henry Ford Health System (HFHS), the Detroit Medical Center and St. John’s Providence Health System formed the Tri-County SNF Collaborative with support from the Michigan Quality Improvement Organization (MPRO).

A Collaborative Blueprint for Reducing SNF Readmissions: Driving Results with Quality Reporting and Performance Metrics examines the evolution of the Tri-County SNF Collaborative, as well as the set of clinical and quality targets and metrics with which it operates.

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Food for Thought: Nutrition Programs Reduce Hospital Visits and Readmissions by Vulnerable Populations

August 18th, 2017 by Patricia Donovan

Malnutrition is a social determinant of health that negatively impacts health outcomes.

It’s a difficult statistic to digest: one in three people enter the hospital malnourished or at risk of malnutrition, a state that impacts their recovery and increases their risk of health complications and rehospitalizations.

Two studies this week highlight the clinical benefits of addressing patients’ nutrition needs before and during hospital stays as well as savings that can result from identification of social determinants of health (SDOH) like access to nutrition that drive 85 percent of health outcomes.

In the first, a study of elderly Maryland residents by Benefits Data Trust, a national nonprofit based in Philadelphia, found that when it comes to low-income seniors, access to quality food via food stamps can also save money by reducing the number and duration of hospital visits and nursing home admissions.

In the second, research published in American Health & Drug Benefits journal and supported by Abbott found that when Advocate Health Care implemented a nutrition care program at four of its Chicago area hospitals, it showed more than $4.8 million in cost savings due to shorter hospital stays and lower readmission rates.

The Benefits Data Trust research found that participation by low-income seniors in the federal Supplemental Nutrition Assistance Program (SNAP) cut their odds of hospital admissions by 14 percent. The food stamps also reduced the need for ER visits by 10 percent, and cut their likelihood of going into a nursing home by nearly one quarter.

Finally, SNAP participation also led to an 8 to 10 percent drop in the number of days a patient who was admitted remained in one of these facilities.

As a result, hospitals and health care systems such as Advocate Health Care are looking at the value of nutrition to improve care and help patients get back to living a healthier life.

Starting in 2014, Advocate Health Care, the largest health system in Illinois and one of the largest accountable care organizations (ACO) in the country, implemented two models of a nutrition care program for patients at risk of malnutrition. The nutrition-focused quality improvement program, which targeted malnourished hospitalized patients, consisted of screening patients with a validated screening tool at admission, rapidly administering oral nutritional supplements, and educating patients on supplement adherence.

The leader in population health found that by doing so, it reduced 30-day readmission rates by 27 percent and the average hospital stay by nearly two days.

More recently, to evaluate the cost-savings of the Advocate approach, researchers used a novel, web-based budget impact model to assess the potential cost savings from the avoided readmissions and reduced time in hospital. Compared to the hospitals’ previous readmission rates and patients’ average length of stay, researchers found that optimizing nutrition care in the four hospitals resulted in roughly $3,800 cost savings per patient treated for malnutrition.

Given the healthcare industry’s appetite for value- and quality-based programs, SDOH screenings and the fortification of nutrition programs in both community and inpatient settings appear to be just what the doctor ordered. However, while a 2017 study on Social Determinants of Health identified widespread adoption of SDOH screenings by providers, it also documented a scarcity of supportive community services for SDOH-positive individuals.

5 Practitioner Tactics for Tackling the Opioid Epidemic

August 15th, 2017 by Susan Butterworth, PhD, and Amanda Sharp, MPH, Q-Consult LLC
opioids

There is promising evidence that motivational interviewing can successfully reduce both the use of non-medical opioid use and overdose risk behaviors for prescription opioids.

Despite evidence and guidelines to the contrary, including significant risk of addiction, there remains a widespread belief among many clinicians and patients alike that opioid medication is a viable and effective first option for multiple chronic pain conditions. Practitioners feel pressure to provide opioids upon patient request, yet many have neither the resources nor the skill set to manage the physiological and psychological complications that can arise when treating a patient with opioids long-term.

As one qualitative study found, it can be awkward at best, and confrontational at worst, when refusing a patient’s request for opioids. Thus, clinicians are faced with the challenging balancing act of providing pain relief for their patients while simultaneously managing the potential for addiction and misuse – with most clinicians ill-equipped for the herculean task.

“Not providing the [opioid] prescription is very hard. It takes time to do the research on the patient. Confronting the patient with a problem is emotionally draining. Doing it 5-10 times in one shift is not only a reality, it is downright crippling. It sucks out [sic] last bit of energy out of your soul. Rather than confronting patients and arguing, it’s far easier to write a prescription for narcotics and move on to the next patient. This is the mindset of thousands of physicians.”
Anonymous Physician, April 25, 2013

Along with knowledge about alternative treatments, a valuable skill set for clinicians in this situation is an effective communication approach to address the possible scenarios that emerge:

  • Engaging patients in discussions about the risks of opioids;
  • Validating the frustration of chronic pain;
  • Evoking commitment to try alternative modalities;
  • Eliciting honesty about unhealthy/drug-seeking behaviors; and

Sharing concerns and resources for opioid addiction.

Motivational Interviewing (MI) is an evidence-based communication approach that has been adapted for the brief healthcare setting to address many lifestyle management issues, including chronic pain. There is one promising clinical trial that used a single MI session in an emergency department to successfully reduce both the use of non-medical opioid use and overdose risk behaviors for prescription opioids as compared to a control group. Even beginning proficiency in MI equips practitioners with the confidence and skills needed to engage patients in conversations that generally lead to outcomes of being able to maintain rapport and successfully incorporate best practice guidelines for chronic pain treatment.

Consider the following two scenarios:

Scenario 1: Your patient has recently hurt their back and has requested strong pain medication.

Scenario 2: You suspect your patient may have an addiction to opioids.

In both cases, a practitioner, competent in the MI approach, would be able to use the following strategies to successfully navigate these challenging waters. These principles and strategies are based on Miller and Rollnick’s description of MI practice.

Engage and Partner

Taking a minute or two to build rapport with the patient may be counter-intuitive to a busy clinician. However, consider the time that is spent in unproductive arguments and power struggles. Research has shown that taking a more patient-centered approach is more time-efficient in the long run. Although the clinician is an expert in clinical aspects, the patient is the expert of their life, and the only one with the ability to commit to the suggested treatment plan. By stepping out of the authoritarian role, ideally, the clinician can partner with the patient in a collaborative way to problem-solve together. When a person helps to identify the best treatment course for themselves, they feel more ownership and are more committed; thus, are more likely to follow through.

Express Empathy

A core component of engaging is being able to express empathy, or the ability to convey accurate understanding through the eyes of the patient. This takes compassion, effort, genuine interest, and reflective listening. The clinician does not need to become a counselor to provide a meaningful statement that lets the patient know that the practitioner “gets it”. When the patient feels understood and accepted, they are more receptive to the clinician’s advice and guidance.

Share Concerns while Supporting Autonomy

In MI, the clinician is not simply following the patient but is a full partner. After establishing rapport and trust, it is not amiss to share any concerns that the provider has, if patient autonomy is concretely verbalized. The patient can always go to another doctor to get what they want; by acknowledging that it is the patient’s choice to pursue what they feel is best for them, the patient relaxes. This allows the clinician to share their concern in a way that does not elicit defensiveness.

Manage Expectations

It is important to manage the expectations of the patient. By clearly and transparently stating up front what the clinician feels is best practice and ethically viable, the patient is not disappointed later. Openly share that alternative treatment options may not address the pain as completely as opioids might initially, or, in the case of addiction, that there may be withdrawal symptoms when discontinuing the medication. Honesty preserves trust and conveys the clinician’s desire to support the patient as fully as possible, while still maintaining his integrity of practice.

Provide Decision Support with Menu of Options

Now the patient is ready for a menu of options with the pros and cons succinctly laid out. These include therapies such as non-opioid meds, stretching, and alternative treatments. Some of these options may be those that the clinician is not prepared to provide; e.g., if the patient is still favoring the option of more opioids. The clinician has been transparent about which options he feels are best and is willing to provide; however, the patient is in the driver’s seat to choose the best treatment course for himself. In most cases, the clinician can positively influence the patient’s decision. If not, the discussion remains professional, rapport is not lost, and the patient will feel comfortable returning to this provider. This keeps the door open to further dialogue about the situation.

There are many resources available for those who are interested in getting trained in MI, and the approach can be used for any lifestyle management or treatment adherent situation. However, a fair warning that MI is a complex skill set and cannot be learned in a one-and-done workshop. Just like learning to speak a foreign language or play a musical instrument, it takes practice and feedback from an expert over time to develop a meaningful proficiency. As many clinicians can attest though, this is one hard-earned competency that is more than worth it — for the practitioner, the patient and society!

Susan Butterworth, PhD

Amanda Sharp, MPH

About the Authors: Susan Butterworth, PhD, is principal and Amanda Sharp, MPH is program manager for Q-Consult LLC. Both are both members of the Motivational Interviewing Network of Trainers. Please visit Q-Consult, LLC their blog and find out more about patient-centered initiatives that increase patient engagement and improve clinical outcomes.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.