Posts Tagged ‘duals’

Community Linkages Support HCSC’s Holistic Approach to Duals

September 25th, 2014 by Cheryl Miller

Meeting the holistic needs of the individual, and not treating them as a diagnosis has been key to Health Care Services Corporation’s (HCSC) work with dual eligibles. Here, Julie Faulhaber, HCSC’s vice president of enterprise Medicaid, describes the organization’s innovative use of community care connections to engage the unique challenges of this largely older adult and disabled population in population health management.

Question: What are some examples of HCSC community connections and how do these linkages benefit Medicare-Medicaid beneficiaries?

Julie Faulhaber: Our community connections are really critical to the success of our program. We work with a number of different community agencies in our state: the community mental health centers, the public health agency, and also with those types of agencies that deliver long term care services or have worked with those with mental health concerns.

We work across the board. All of these agencies catch our members, and we try to have relationships with them in order to gain access to our members, for example to better understand the types of services and support that our members truly need and where to access them. That’s been a key component of our program. We also look for community health workers who have backgrounds in the cultural needs of our members, which helps to engage them initially and maintain engagement.

HIN: What are the most common behavioral health issues your duals face and how has HCSC addressed these issues?

Julie Faulhaber: Our members have the full range of behavioral health issues that one would expect in a dual eligible population. Of course, the majority of individuals are experiencing depression and those types of concerns are often in conjunction with some physical disability. Referring back to the previous question on community linkages, we develop relationships with community agencies that support people with mental illness.

Other behavioral health concerns include those agencies that help people with recovery from addiction. We also worked with an integrated team in our own model of people with behavioral health backgrounds as well as our traditional physical healthcare model. That integration has been important for us in meeting the holistic needs of the individual and not treating them as a diagnosis.

dual eligibles care
Julie Faulhaber, vice president, enterprise Medicaid for Health Care Service Corporation (HCSC), a $52 billion health insurance company with 13.2 million members operating in five states, is responsible for the leadership and oversight of HCSC’s Enterprise Medicaid Business. This includes expansion of Medicaid programs across HCSC’s Blue Cross Blue Shield plans in Illinois, Montana, New Mexico and Texas.

Source: Dual Eligibles Care and Service Planning: Integrative Approaches for the Medicare-Medicaid Population

New Market Data: Physicians Ahead in Dual Eligibles Care Management

October 23rd, 2013 by Patricia Donovan

Health coaching, home visits, case management and transitional care are key components of care coordination for the dually eligible.

Physician practices are more advanced in care coordination of Medicare-Medicaid beneficiaries and much further along in duals program development than the industry as a whole, according to physician practices that responded to the 2013 Healthcare Intelligence Network Survey on Dual Eligibles Care Coordination.

Not only do nearly 86 percent of participating practices have a care coordination program tailored to dual eligibles (versus 54 percent of overall respondents), but fully 100 percent of remaining respondents in this sector say they’ll launch a duals-focused care effort in the coming year.

The physician practice sector, which comprised 17 percent of overall respondents, is more dedicated to disease management and transitional care, with 100 percent of responding practices offering these services in duals care coordination, versus 77 percent and 68 percent, respectively, in programs of overall respondents.

With physician practices so far ahead in this area, reporting significant impact and ROI from interventions aimed at Medicare-Medicaid beneficiaries, their approach merits a closer look. An examination of the data reveals that it’s not so much that the practices are doing things differently; certainly, the majority of respondents are using case management, educational tools and transitional care to improve population health in dually eligibles.

However, practices are doing a great deal more of everything — from being fully engaged in disease management and coordination of care transitions to employing health coaching and visiting patients at home. These strategies are translating into improved outcomes and less utilization on the part of these patients. And the physician is taking the lead on care coordination interventions.

A word about the home visits: in a concurrent survey on Home Visits, 75 percent of responding healthcare organizations say they visit their health plan members and patients in their home — mostly to check on these individuals following discharge from the hospital but also to perform home assessments. For the dually eligible, these assessments can be essential in uncovering some of the unique psychosocial issues these beneficiaries face.

“Critical to this population is the home component,” notes Dr. Timothy Schwab, the former chief medical officer of SCAN Health Plan and now president and CEO of Tim Schwab Healthcare Solutions, Inc. SCAN, a not-for-profit California-based health plan, has a history of successful care management of dual eligibles, having developed a multi-pronged, member-specific approach to reaching dual eligibles that has earned kudos from the healthcare industry.

“You must develop a model that includes what’s happening in the home,” continues Dr. Schwab, “Because the social and home environment impacts everything, including compliance with medications and the physician’s medical advice. It encompasses nutrition and transportation issues. If the person lives where they have no access to transportation, you’ll have to be able to provide that.”

The community connection is essential as well, contributes Pamme Taylor, WellCare’s vice president of advocacy and community-based programs. The philosophy that healthcare is local — and therefore, care needs to be local and community-based — forms the core of WellCare’s efforts to connect its dually eligible population to health services, Ms. Taylor explains. The Tampa-based healthcare company takes a culturally competent approach to assessing duals’ unique personal circumstances, insuring their “soft landing” into WellCare’s care coordination system.

Care managers at the heart of WellCare’s multidisciplinary team, conducting a comprehensive needs assessment with each Medicare-Medicaid beneficiary and driving the resulting care plan, ensure duals’ complex care needs are met at the most appropriate time and level.

Click here for an executive summary of the Dual Eligibles survey results.