Healthcare Intelligence Network

Survey Finds Many Healthcare Organizations Use Physician Alignment Criteria in Incentive Plans

March 26th, 2012 by Cheryl Miller

Almost half of all healthcare organizations are using physician alignment criteria in their incentive plans, according to a new survey from Integrated Healthcare Strategies. The survey, which monitors trends in healthcare salary increases, incentive practices, and benefit changes, was expanded to include the prevalence of physician alignment goals, given the market’s increasing interest in it. The most popular goal is meeting CMS’s quality standards, followed by physician use of electronic patient records and readmission rates.

What incentives are you providing your physicians? Describe the physician reimbursement models in place at your organization by taking our Physician Reimbursement Models survey by April 15th and you will receive a free summary of survey results once it is compiled.

Nurses play a key role in a new initiative from CMS. The agency is seeking up to five hospitals working with nursing schools to train advanced practice registered nurses (APRN). Recognizing that nurses are crucial to a strong primary care work force, but that the cost of training APRNs has limited many hospitals and other healthcare providers from doing so, CMS will provide up to $200 million in funds for clinical training to those hospitals selected to participate in the program, which is expected to run for four years. Applications must be submitted by May 21, 2012.

Nurses could play a key role in another story we cover on the use of anesthesia providers to monitor sedation during colonoscopies and other gastro-intestinal-related procedures. The practice has more than doubled from 2003 to 2009, and is costing the United States more than $1 billion a year, says a new study from the RAND Corporation. Of particular concern is that most of the increase is coming from low-risk patients, who may not need the service. Instead, researchers point to current treatment guidelines that show that these procedures can be safely administered by physicians and assisting nurses if the patients are not at risk for anesthesia-related complications.

And, where is Gloria Steinem when we need her? A new report shows that women are paying more for the same healthcare coverage as men; inequities include policies that charge female non-smokers more than male smokers, and that provide no maternity coverage to women of child-bearing age. Variations exist in each state and across the country, researchers state.

These stories and more in this week’s issue of Healthcare Business Weekly Update.

Posted in Bundled Payments, Uncategorized | No Comments »

Demographics Drive 5 Dietary Patterns in U.S. Adults

March 21st, 2012 by Jessica Papay

You truly are what you eat, confirms new research presented at an American Heart Association (AHA) scientific meeting. Researchers identified five eating patterns for U.S. adults that are strongly influenced by age, race, region, gender, income and education.

According to an AHA press release, researchers provided 21,636 black and white adults ages 45 and older with a 110-food-item questionnaire designed to estimate the usual and customary intake of a wide array of nutrients and food groups. Based on the results of the food frequency questionnaires, the five dietary patterns are:

Southern — fried, processed meats, and sugar sweetened beverages.
Traditional — Chinese and Mexican food, pasta dishes, pizza, soup and other mixed dishes including frozen or take-out meals.
Healthy — mostly fruits, vegetables and grains.
Sweets — large amounts of sweet snacks and desserts.
Alcohol — proteins, alcohol and salads.

The researchers also found clear differences in dietary patterns across demographic and socioeconomic groups:

Blacks were more likely than whites to eat a Southern dietary pattern.
Men, people making less than $35,000 a year and those who weren’t college graduates were more likely to follow the Southern pattern of eating than women, those who made more money, or those who were more educated.
Blacks tended to not eat the alcohol dietary pattern.
People ages 45 to 54 tended to eat a traditional dietary pattern.
Those 75 years and older were likely to not eat the traditional dietary pattern.
College educated adults tended to not eat the Southern dietary pattern.

“We believe focusing research on dietary patterns better represents how people eat, compared to single foods or nutrients. We hope that understanding these patterns will be informative in understanding the role of diet in health and disease disparities,” said Suzanne Judd, Ph.D., study author and assistant professor of biostatistics at the University of Alabama-Birmingham.

Posted in Disease Management, Health Coaching, Uncategorized, Wellness/Prevention | No Comments »

Tackling 5 Care Barriers That Boost ER Use by Medicaid Patients

March 20th, 2012 by Patricia Donovan

Facing five specific barriers to timely primary care, Medicaid beneficiaries are twice as likely to visit the ER as their insured counterparts, according to a study published online in the Annals of Emergency Medicine.

The study cited five factors that hinder Medicaid patients’ access to primary care:

Inability to get through on the telephone;
Inability to obtain appointment soon enough;
Long waits in the physician’s office;
Limited clinic hours; and
Lack of transportation.

Twice as many people insured by Medicaid as by private insurance report these barriers to primary care, reported the researchers. More than one-third (39.6 percent) of Medicaid patients visited the ER within the last year versus 17.7 percent of privately insured patients.

A few years ago, Ohio ED use was nearing crisis proportions. ED utilization overall in Ohio was almost 30 percent higher than the national average, according to a 2008 data from the American Hospital Association, and about two-thirds of the utilization in Ohio EDs by Medicaid beneficiaries was considered non-emergent, PCP treatable and avoidable.

There sprung up a collaborative effort among five regions of Ohio to target the key reasons for avoidable ER visits among Medicaid beneficiaries and roll out test interventions in a rapid cycle quality improvement approach.

One intervention to reduce the number of upper respiratory infections (URIs) in children presenting in Ohio emergency rooms tackled some of the care access barriers that frustrate Medicaid patients. Its four-pronged intervention encompasses patient education, a nurse advice line, the engagement of primary care providers (PCPs) and health coach follow-up.

Ohio used a rapid cycle, quality improvement approach to reduce these visits, explains Mina Chang, Ph.D., chief, health services research and program development section of the Bureau of Health Services Research for the Ohio Department of Job & Family Services.

“Our program starts with a very upstream preventive intervention that provides patients alternative resources through a 24/7-nurse line,” explains Dr. Chang.

“The second leg of this intervention is that when patients or parents call into the nurse line, they will be able to get triage for their sick call for the sick kids.

“In this test intervention, a group of participating PCPs will make same day or next day appointments available. The triage nurse can refer those patients to those providers.”

The final leg of this testing intervention, she explains, is follow-up with parents by managed care health coaches to assess the effectiveness of an educational toolkit Ohio developed and the awareness of the parents of the 24/7 nurse line, as well as to conduct any follow-up that members might need.

Dr. Chang shares the preliminary results:

“After we sent out our kits, we followed up within two weeks. Approximately 231 kits were mailed to the families. We were successful in following up with half of those families; we were very impressed with that follow-up rate. If you have experience with the Medicaid population, typically they are very transient, so the follow-up rate is very low.

“Toolkit items that drew the most attention from the parents are the hand sanitizers, thermometers, tissues, medicine spoon, and a refrigerator magnet that included all the health points and nurse line numbers. Unfortunately, the printed material that we spent a lot of time working on, such as facts about colds, a letter from the PCP and some key phone numbers were not drawing a lot of attention from those parents at the time of follow-up.

“We also found that approximately half of those respondents had experience using the nurse line. And almost 98 percent are likely to use it again.”

Posted in Avoidable ER Use, Healthcare Costs, Patient-Centered Medical Home, Physician Practices | 3 Comments »

CMS Delays Enforcement of 5010 Standards

March 19th, 2012 by Cheryl Miller

CMS has postponed enforcement of its regulations requiring the use of the 5010 standards in all electronic healthcare transactions until June 30, 2012. It is two weeks before all healthcare providers and payors could have been penalized if they failed to comply and were not yet using the 5010 transaction set. Reaction to the news will be mixed, but there seems to be consensus that the delay is a welcome one.

In other CMS-related news, a new demonstration program to expand access to emergency psychiatric care for Medicaid beneficiaries could significantly cut state and hospital healthcare costs, reduce general acute care ED visits and help vulnerable patients get proper care. Federal law has prohibited Medicaid from paying for mental health services provided to Medicaid enrollees between the ages of 21 and 64. As a result, these patients have had to seek services in general hospital ERs, where they may not get the right care, or go to psychiatric hospitals where the care is appropriate but reimbursement is not provided, which has been a continued drain on healthcare resources.

Medicaid patients are the focus of another story, which details the barriers they face seeking treatment in primary care, making them twice as likely to visit the ED as their privately insured counterparts, according to a study published in the Annals of Emergency Medicine. Even those Medicaid enrollees who have primary care report significant barriers to seeing their doctor, and given that many of them are in poor health, they tend to visit the ER more. Researchers hope their study will bring about change in this area.

Changes in the rates of hospital-acquired infections could be imminent, given a new study that found that hospitals with board-certified infection prevention and control directors have significantly lower rates of bloodstream infections (BSI) than those that are not led by a certified professional. It is the first such report to study the association between certified program directors and rates of healthcare-associated infections, researchers say.

And lastly, location plays an important role when it comes to healthcare quality, cost, accessibility and outcomes, says a new, extensive study from the Commonwealth Fund. But these factors vary greatly not only from one community to the next, but within and across states, depending on the performance of the healthcare system available to residents.

These stories and more in this week’s issue of Healthcare Business Weekly Update.

Posted in Avoidable ER Use, Healthcare Costs, Healthcare Quality Ratings, Uncategorized | No Comments »

Meet Case Manager Victoria Powell: Father’s Cancer Diagnosis Renews Her Passion for Career

March 16th, 2012 by Cheryl Miller

This month we provide an inside look at a healthcare case manager, the choices she made on the road to success, and the challenges ahead.

Victoria Powell, RN, CCM, LNCC, CNLCP, CLCP, MSCC, CEAS II, Founder and President of VP Medical Consulting, LLC.
HIN: What was your first job out of college and how did you get into case management?

Victoria Powell: My first nursing job was working in a med-surg unit at a local hospital. I had worked at the facility as a nurse’s aide while I was attending nursing school and had been afforded some great educational opportunities. I did not know or understand anything about case management at the time. We had one nurse who worked in utilization review and I did not understand until many years later that this position was within the umbrella of this fabulous thing we call case management.

My first experience with case management was in 1999. I was working as the office administrator for a large orthopaedic group. Many orthopaedic issues are the result of injuries and I was introduced to various nurses who would come to our clinic and attend appointments along with employees who had been hurt at work. Even then I thought all case managers worked in workers’ compensation. I left this role to pursue another job, but made a contact at this time that eventually led to my case management career. One of the physicians’ wives was working as a case manager for a national case management company. They had an opening and she insisted (very strongly) that I consider joining the corporation. I was not interested, but she continued to call and email me about it regularly. I finally decided I would call the company to quiet her requests, but ended up being hired over the phone on that very first phone call!

Has there been a defining moment in your career? Perhaps when you knew you were on the right road.

My father was diagnosed with cancer six years ago. I was at the point in my career when I felt burned out and was looking to do something different. His diagnosis put my plans on hold and I began to manage his care through the spectrum of testing, specialists, surgery, rehabilitation, and so on. The services I provided were no different than I would have given to any other patient. The tasks were not difficult, but this time they were personal.

Somewhere about a month into his diagnosis and treatment, my parents thanked me profusely for my assistance. They explained they did not feel they could navigate the health system without me. With tears in her eyes, my mother stated she was in such a state of shock at his diagnosis that she could not think clearly for herself, much less for him. She described me as a life preserver. I tried to explain that I did not do anything; I just made some calls, collected some records, scheduled some appointments. I thought it was something any daughter would do, but they helped me to understand that their daughter just happened to navigate the healthcare system for a living. It was my training, education, and experience that made these “simple tasks” to me, but I found out just how much of a difference they could make in the lives of others.

Today I remain in case management because of my father’s diagnosis. I found a purpose and now I realize that my entire career has groomed me for the position I now hold.

In brief, describe your organization.

We are a nurse consultant organization providing a variety of nurse-related education and services. We began strictly by providing case management services to workers’ compensation patients, and later expanded into multiple areas including life care planning, Medicare Set Aside allocations, ergonomics and more. We are located in central Arkansas and have a new office opening soon in northwest Arkansas, but provide case management service to Arkansas and the contiguous states. We provide life care planning services nationwide and even abroad.

What are two or three important concepts or rules that you follow in case management?

Patient advocacy is always first! Advocacy is the basis of not only case management, but nursing in general. A huge part of patient advocacy involves education. A patient cannot realistically expect to know what he or she wants to do unless they fully understand their options. Once the information is understood, the patient is allowed to make a decision on the direction of their medical care.

That does not mean however, that the carrier with which one contracts is responsible for the payment of those services. This is the most difficult thing for our nurses to understand. They are required by their nursing license to advocate for the patient, but at the same time they are responsible for understanding that just because a service is needed does not mean that our client is responsible for providing that service. This is why I prefer to hire nurses with excellent critical thinking skills who are comfortable ‘outside the box.’

Another rule in our company is that we are always working to establish rapport with our patients. Since we work in a highly litigated area (workers’ compensation) establishing rapport is essential in the reduction of litigation expenses. Many times cases are brought into the courtroom because the patient does not understand the process or feels forgotten. Allowing him or her to have a sounding board helps as does having a case manager to help them to understand complex processes or issues. We educate our patients on medically related issues as well as their rights and responsibilities under the state workers’ compensation system. This is just another way that our legal background and training helps to minimize expenses of the cases for which we manage.

What is the single most successful thing that your organization is doing now?

The one thing VP Medical Consulting does better than most other case management firms has to do with the way in which we approach each case. We have experience in the legal system both within and outside of workers’ compensation. The experience gleaned from working in the legal system means a new way of managing claims. Rather than focusing just on the situation as it stands before us, we are also looking toward the future. It is like a game of chess. Each case decision made now may result in a different outcome and open up new issues which need to be addressed in the future.

In our current state of medical care, the healthcare providers have limited time to talk with the patients face-to-face. The training and experience of our nurses means that in preparing for an appointment, we have fully assessed the situation and have documented the issues in an outline complete with the history of the complaint or condition, the dates and locations of all treatment, and have listed the questions which need to be addressed by the provider at the time of the next face to face meeting. This results in confidence from those we care for and allows the physician to get to the heart of the matter quickly so that all face-to-face time is spent focused on the issues and questions at hand. By reviewing the medical reports following the face-to-face meetings, we also point out discrepancies and have them corrected in a timely fashion rather than allowing misinformation to invade the medical record.

What is the most satisfying thing about being a case manager?

I love being a case manager! Education is such a fun part of my job and I get to meet people of all walks of life with all sorts of issues. I am always learning, whether it be about a disease or condition, a new treatment option, a new resource for information or even traveling to conferences and networking with colleagues all over the United States. Meeting new patients from all walks of life and discovering what makes them special and unique is also satisfying to me.

Where did you grow up?

I grew up right here in central Arkansas in the same neighborhood where I now reside. In fact, my parents built a home in 1976 in what used to be considered ‘the country.’ I graduated high school while living in that home and despite every plan to leave, I never did. I have lived on the same street for 36 years, just moving from one home to the next as our family grew. The neighborhood has grown by leaps and bounds and we are certainly not in the country anymore!

What college did you attend? Is there a moment from that time that stands out?

I began my education at Baptist School of Nursing in Little Rock. It continues today as a diploma program and is one of the best in our state. When I left school to begin work the adage was that a Baptist grad would always get the job before one of the candidates from one of our many other schools. It worked for me. I was so glad to finally be out of school, but as soon as I entered the workforce I suddenly wanted to return to school and listen to my professors once again. I felt like I missed so much and now that I had begun work, the light bulbs were turning on and things like pathophysiology suddenly made sense. I just wanted to return and scoop up the things that slipped passed me the first go around (just without all the exam anxiety).

Are you married? Do you have children?
I am married and we have four adult children; two boys and two girls. Our youngest boy is attending college to become a mechanical or bio-mechanical engineer. The youngest daughter has returned to school and is in a BSN program. Three of our children still reside in Arkansas while our oldest daughter and her family are in Virginia. We are currently expecting our ninth grandchild! Considering neither of the boys are married yet, there could be many more grandchildren in years to come.

What is your favorite hobby and how did it develop in your life?

I have so many hobbies, but rarely have time to pursue them. Currently some friends and I host a monthly “Pinterest Party” where we get together and craft something we saw pinned on Pinterest.com. My husband and I like to travel and we try to get away to a new locale at least once a year. I also love movies, photography, reading, and of course playing with the grandchildren.

Is there a book you recently read or movie you saw that you would recommend?

I usually read nonfiction, but new movie releases got me started on a few fiction pieces recently. I completed the Hunger Games series by Suzanne Collins and also The Help by Kathryn Stockett. As for my non-fiction I have just finished Dave Ramsey’s EntreLeadership. All were excellent and I give them 5 stars each.

Posted in Behavioral Health, Case Management, Case Manager Profile, Disease Management, Uncategorized | No Comments »

Can Reality Programming Help to Prevent Diabetes? Stay Tuned

March 15th, 2012 by Patricia Donovan

Think “The Real Patients with Diabetes:” a reality series follows six patients with Type 2 diabetes.

While it may not draw the legions of viewers of a “Real Housewives” franchise, UnitedHealth Group hopes this type of programming can impact a more dire reality: the number of individuals who will develop type 2 diabetes.

To pilot the power of television as a diabetes prevention medium, the Minnesota-based payor and Comcast are seeking viewers in the Knoxville, TN area to watch the 16-episode NOT ME ® video on demand (VOD) programming. NOT ME uses a reality TV format to follows six adults with prediabetes as they go through the Diabetes Prevention Program.

Each VOD episode will feature a health and wellness coach leading a class of real participants who are working to reach a healthier weight and reduce their risk of developing type 2 diabetes. Between each episode, participants in the UnitedHealth Group study will practice at home the skills they learn from the program.

Participants in the pilot also will be given tracking assignments each week and opportunities to put what they learn into action.

NOT ME is based on the CDC-led National Diabetes Prevention Program, which brings evidence-based lifestyle interventions to communities by working through organizations that adhere to CDC-recognized, evidence-based standards.

Meanwhile, new market research by the Healthcare Intelligence Network indicates that successful diabetes management necessitates a delicate balance of primary care, patient education, case management and medication monitoring.

The 80-some healthcare organizations that responded to the 2011 e-survey report that while the primary care physician is still the primary influencer in diabetes care, case managers and certified diabetes educators (CDEs) increasingly round out the care team.

Also supporting the plan of care are health coaches (live and via telephone) and support groups.

Respondents’ efforts appear to be working: one-fifth of respondents report program ROI of between 2:1 and 3:1.

Since the goal of any diabetes management program is to guide the patient toward successful self-management of the disease, education is paramount. Many respondents reported the presence of case managers and/or nurses who have trained as CDEs. One respondent even offers patients a choice between a pharmacist, a registered dietician or a CDE.

Printed materials were overwhelmingly the most common educational component, reported by 78 percent of respondents. Thirty-five percent offer Web-based education tools.

With all of the challenges facing patients with diabetes, should patients be incentivized for successful self-management of their disease? Three-quarters of survey respondents say yes.

In fact, almost a third of respondents — 30.4 percent — already offer patients and health plan members incentives for compliance with their plans of care.

Posted in Case Management, Disease Management, Healthcare Trends, News, Telehealth & Telemedicine, e-Health | No Comments »

Hospitals Will Spend More on IT, Move Toward ACOs in Near Future

March 14th, 2012 by Jessica Papay

Hospital budgets are on the upswing but cost pressures and changing healthcare models are dictating how hospital leaders are determining their strategic priorities. Sixty-one percent of U.S. hospital executives expect budget increases in 2012, a trend that is expected to continue during the next five years, according to an L.E.K. Consulting Strategic Hospital Priorities Study.

Information technology (IT) is a top area for investment, with 57 percent of hospitals planning to increase their IT spending in this area through 2016, according to the study. During the same time period, one-third of executives are planning to increase spending for large medical devices after several years of delaying medical technology equipment purchases due to financial constraints. Other spending increases during the next five years include facilities (35 percent) and small medical devices (18 percent). Hospital leaders are also willing to pay a premium for disposable products that prevent infections and reduce medical errors — and they expect a 23 percent spending rise in this category.

Most respondents (89 percent) reported increased budgetary pressures during the past year. As a result, 80 percent of hospital administrators continued their aggressive supplier negotiations to better manage costs. Despite their best efforts, there is a concern that rising costs from manufacturers and suppliers, and added costs associated with new regulatory requirements, may raise overall supply costs.

To make the most of their budgets, the study found that 62 percent of hospital executives plan to increase their current Group Purchasing Organization (GPO) use in 2012, up from 52 percent last year. Hospital GPO use is expanding beyond low-cost, high-volume supplies and is increasingly used to purchase higher-priced medical equipment. And smaller hospitals anticipate using GPOs more than larger hospitals because larger hospitals can use their size to negotiate volume discounts with many of their suppliers.

Additionally, many hospital executives are centralizing purchasing to make the most of their buying power, which illustrates a departure from individual physicians taking the lead in procuring key medical products. The development of accountable care organizations (ACO) is also likely to push more centralized purchasing. Currently, less than 20 percent of respondents are pursuing some form of an ACO-like model today. However, 61 percent said they are likely to move toward this model within the next three years.

Other study findings show that a majority of hospital executives (71 percent) are allocating budgets to address operational priorities such as controlling costs, increasing efficiency and improving the profitability of their patient mix. Respondents reported that they are looking for medical device companies to help them address new healthcare insurance reform care and reporting mandates by clearly articulating product cost-benefit value propositions, providing clinical data, sharing risk and offering full solutions.

Posted in Accountable Care Organizations, Affordable Care Act, Health IT, Healthcare Administration, Healthcare Costs, Healthcare Trends, Physician Practices, e-Health | No Comments »

Physician Incentives Go Beyond the Paycheck, Finds New Survey

March 13th, 2012 by Patricia Donovan

Want to attract good physicians to your practice and retain them? Make part-time scheduling and flexible workweeks part of the incentives mix, recommends a new survey on physician retention trends.

Close to half of female physicians and 22 percent of male physicians — are reported to be working part-time, according to the results of a 2011 survey by Cejka Search and the American Medical Groups Association (AMGA).

According to the survey, female physicians entering the workforce and male physicians approaching retirement — the two fastest growing populations in the physician workforce — are the most likely groups to look for part-time and flexible scheduling options.

Flexible work options are apparently key to physician retention: 75 percent of groups offer a four-day full-time work week.

Respondents were less certain about the evolution of performance-based incentives, according to these survey findings:

Pay structures and incentives have changed in the past five years to focus on outcomes for quality, efficiency and satisfaction, yet the survey found no clear indicators show a consensus about the role of incentives toward these outcomes.

About half the survey respondents indicated that primary care physicians are incented “somewhat more” or “significantly more” for both quality (52%) and satisfaction (50%) than they were five years ago.

Incentives to achieve efficiency will need to become more compelling: 44 percent of respondents think that driving changes in practice efficiency outcomes would require incentive compensation of at least 10 percent.

In contrast, respondents believe that incentive compensation of less than 5 percent will drive desired quality and satisfaction outcomes.About75 percent of groups offer a four-day full-time work week.

For the first time, survey results include staffing and turnover benchmarks for both advanced practitioners and physician staffing:

More than two-thirds (67 percent) of respondents from the 2011 survey reported that the involvement of advanced practitioners in their groups has grown “somewhat” or “significantly” in the past five years. This response increases to 75 percent when looking ahead toward the next five years. The respondents also indicated that they identified 21 percent and 13 percent growth in new positions, respectively, for physician assistants and nurse practitioners in their groups in the past twelve months.

The survey also found that the turnover rate for both nurse practitioners and physician assistants is 12.6 percent.

Posted in Healthcare Trends, Patient-Centered Medical Home, Physician Practices | No Comments »

6 Features of CMS’s Redesigned Medicare Summary Notice

March 12th, 2012 by Cheryl Miller

In light of ongoing healthcare reform there is a push for clarity, as several of our stories illustrate this week. Medicare claims forms have been redesigned so that beneficiaries and their caregivers can better understand them, check for important facts and potential fraud. The subject of fraud is particularly timely given the story that has been circulating for the last week involving the arrest of a physician, the office manager of his medical practice, and five owners of home health agencies. They’ve been charged with allegedly participating in a nearly $375 million healthcare fraud scheme involving fraudulent claims for home health services.

When given the option of choosing a high or low cost health plan, consumers will most likely choose the higher cost plan because they associate it with better quality, says a new study funded by the AHRQ. But researchers caution that this isn’t necessarily true: higher costs could be attributed to unnecessary services or inefficiencies. A push is underway to simplify public physician and hospital report cards, and make them clearer for consumers to understand (not unlike the redesigned Medicare claim forms) so consumers can make better informed decisions about their health coverage.

The Robert Wood Johnson Foundation and Group Health Research Institute have launched a new national project intended to shed light on what makes a successful health practice tick. Designed in response to the burgeoning shortage of primary care practices, the project will identify successful practices that improve patient and practice outcomes, and share the information so they can be replicated.

And lastly, a study debunks the long held belief that HIT will improve cost savings by reducing the need for diagnostic testing; instead, the study shows that having computerized access to EHRs in the ambulatory setting could result in a 40 to 70 percent increase in testing.

Don’t forget to take our latest survey: Physician Reimbursement Models. Describe the physician reimbursement models in place at your organization by April 15th and you will receive a free summary of survey results once it is compiled.

These stories and more in this week’s Healthcare Business Weekly Update.

Posted in Affordable Care Act, Avoidable ER Use, Behavioral Health, Consumer-Driven Healthcare, Health IT, Uncategorized, e-Health | No Comments »

Focus on Progress Engages Behavioral Health Clients Telephonically

March 10th, 2012 by Patricia Donovan

Emphasizing that the call is to monitor how well the individual is doing is one way telephonic case managers can engage behavioral health clients in the process, says Jay Hale, director of quality improvement and clinical operations for Carolina Behavioral Health Alliance (CBHA). CBHA uses telephonic case management to impact a wide geographical area from a central location.

Hale shared this strategy and other aspects of CBHA’s telephonic case management program during a March 7 webinar on Telephonic Case Management: Protocols for Behavioral Healthcare Patients.

The use of computer-based surveys by CBHA telephonic case managers has dramatically reduced paperwork, allowing the case managers to make the most of the typical 20-minute phone interaction with a client. The surveys were developed in-house and target vulnerable individuals in three distinct populations — adults with mental illness, adults in substance abuse recovery and children or adolescents with mental illness.

Rating scales in the surveys use words, not numbers, explains Hale, a tactic he says works better over the phone. For example, when asked to rate the presence of symptoms, clients must choose from None, Mild, Moderate or Severe, rather than assigning a numeric rating.

Case managers follow the scripts while engaging patients telephonically, clicking through responses on the screen.

But even with the help of standardized scripts, case managers must employ a conversational style, Hale adds. And it’s not necessarily the length of the phone call, but the frequency of calls, that cements the relationship with the client, as well as the ability of the telephonic case managers to stay on task.

“We’re not here to counsel, but to problem-solve, case-manage, find resources and support the client’s relationship with provider,” says Hale.

CBHA utilizes one case manager for every 40,000 health plan members, and estimates that one of six eligible members engages with a case manager (i.e. completes a survey). CBHA case managers must interact with all three populations, but often admit to relating best to a single group, like adolescents or individuals in recovery from substance abuse.

Although unable to directly tie results to its telephonic case management program, CBHA has seen improvement in 7-day and 30-day follow-up after inpatient stays.

Telephonic case management is crucial at discharge; outreach can include calls to the client, hospital and provider to ensure follow-up appointments are kept.

Listen to an interview with Jay Hale.

Posted in Avoidable ER Use, Behavioral Health, Case Management, Medication Management, Telehealth & Telemedicine, Transitions in Care | No Comments »