Posts Tagged ‘Home Visits’

HINfographic: Home Visits Curb Readmissions and ER Utilization

March 15th, 2017 by Melanie Matthews

Seventy percent of healthcare organizations providing care to patients in their homes attributed a reduction in either hospital readmissions or in ER utilization to those home visits, according to the December 2016 Home Visits survey by the Healthcare Intelligence Network.

A new infographic by HIN examines the populations targeted by home visits, the primary purpose during a home visit and a promising home visit protocol.

2017 Healthcare Benchmarks: Home Visits Visiting targeted patients at home, especially high utilizers and those with chronic comorbid conditions, can illuminate health-related, socioeconomic or safety determinants that might go undetected during an office visit. Increasingly, home visits have helped to reduce unplanned hospitalizations or emergency department visits by these patients.

2017 Healthcare Benchmarks: Home Visits examines the latest trends in home visits for medical purposes, from populations visited to top health tasks performed in the home to results and ROI from home interventions.

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14 Protocols to Enhance Healthcare Home Visits

January 20th, 2015 by Cheryl Miller

Use of telemonitoring equipment, electronic medical records (EMRs), a staff dedicated to monitoring home visits and engaged caregivers are just some of the protocols used to enhance home visits, according to 155 respondents to the Healthcare Intelligence Network’s most recent industry survey on home visits.

Following are 10 more protocols used to improve the home visit process:

  • Inclusion of home visiting physician in hospital rounds; and the collaboration of home visit physician with primary care physician (PCP) and complex case managers.
  • Using our medication management machines with skilled nursing follow-up to increase medication compliance.
  • Proactive phone calls to determine if a patient’s condition is worsening and in need of home visits.
  • Daily workflow management algorithms with prioritization and mobile access to electronic case management records.
  • Using teach-back to assure comprehension.
  • Easy to use/wear multimodal, advanced diagnostics telemonitoring allowing patients total mobility and continuous real-time monitoring.
  • Medication reconciliation is crucial in eliminating confusion for the patient, and our electronic medical record (EMR) accurately reflects what the patient is taking, including over-the-counter (OTC) and supplements.
  • Hospital coach gathers information and prepares the patient for discharge, coordinates with home visit staff, home visit team (coach and mobile physician) and completes home visit.
  • Portable EMR to document and review medical information on the spot.
  • EHR-generated lists, community-based team, community Web-based tracking tool, telehome monitoring devices, preferred provider network with skilled nursing facility/long-term acute care (SNF/LTAC), home health and infusion therapy.

Source: 2013 Healthcare Benchmarks: Home Visits

http://hin.3dcartstores.com/2013-Healthcare-Benchmarks-Home-Visits_p_4713.html

2013 Healthcare Benchmarks: Home Visits examines the latest trends in home visits for medical purposes, from the populations visited to top health tasks performed in the home to results and ROI from home interventions.

Sentara Home Visits for High-Risk ‘VIPs’ Drive Hybrid Case Management Outcomes

November 13th, 2014 by Cheryl Miller

When the Sentara Medical Group evolved to a hybrid embedded case management model in 2012, case managers spent time in the practice, but also managed care through other touch points, including home visits, explains Mary M. Morin, RN, NEA-BC, RN-BC, vice president, nurse executive with Sentara Medical Group. How to identify high-risk patients for case management, and home visits in particular? Here, Ms. Morin addresses that question posed by The Healthcare Intelligence Network during a recent webinar.

Question: How does Sentara identify high-risk patients for case management in general and for home visits in particular? Do all patients in the case management program receive home visits?

Response: (Mary M. Morin) This program started as a pilot in 2012. It was targeted at patients that we called very important patients — high-cost, high-utilizers, the top of the pyramid. There are about 2,300 patients within 11 of our primary care sites. We kept it small, with five RN care managers. That population included all payors, most importantly our health plan patients. Because of our health plan, we were able to really study whether RN care management had an impact on the total cost of care — not unlike other organizations, if you can find a cost savings and justify the expense of having RN care managers, it makes the case much more solid moving forward with formalizing the program.

We sorted those patients by high-risk, high-cost or high-cost, high-utilizers because of chronic diseases. We looked at patient with congestive heart failure (CHF), chronic obstructive pulmonary disorder (COPD), asthma, renal failure and diabetes. We excluded patients that had any traumatic event like a car accident or something that led to high-cost, or they had cancer or they were a transplant patient.

The purpose was to engage that population. It is voluntary. We studied that population for three years. It allowed us to measure our outcomes over time because we weren’t sure if there was seasonality to the patients with chronic disease: did they just not use services because of seasonal issues or because it’s a cycle issue within the chronic disease phase? After three years of data, we determined there is definitely a difference in the outcomes of this patient population and their utilization.

Home visits was one of the big differences in the model. The main reason to do home visits is not to do patient care, but to do an assessment of the patient’s environment. A lot of times, patients don’t share with us their actual living situation. They tell you that they’re walking, and then you find out they walk within a five-foot radius. The real emphasis for home visits was to get in and meet the patient in their environment.

We found that RN care managers in the home facilitated advance care planning. That is best done in the patient’s home with a family member present, not in the doctor’s office or waiting until the patient is admitted to the hospital. We found that patients appreciated the visits. The RN care managers who went in really cleaned up the medications. Patients will hold on to medications.

value-based reimbursement
Mary M. Morin, RN, NEA-BC, RN-BC, is a nurse executive with Sentara Medical Group, where she is responsible and accountable for non-physician clinical practice within the Sentara Medical Group (160 clinics/practices) to ensure integration and alignment with Sentara Healthcare, regulatory compliance, standardization of nursing practice/care, and patient safety.

Source: Hybrid Embedded Case Management: New Model for Cross-Continuum Care Coordination

7 Lessons from a Health Network’s Home Visit Program

September 23rd, 2014 by Melanie Matthews

Home visits to patients with complex care needs can provide huge returns by identifying patient compliance barriers that are only apparent when seeing a patient in their home. Dr. Larry Greenblatt, M.D., director for the chronic care program at Durham Community Health Network for Duke University Medical Center, shares organizational lessons from using home visits as part of a care transition program to reduce avoidable hospital readmissions and emergency room utilization.

With our patient population, none of these patients in the program have simple or single diagnosis. We learned that Care Partners providing intensive and frequent service with a strong face-to-face component backed by an interdisciplinary support team can help high-utilizing patients receive their care in more effective and efficient outpatient settings.

Second, when using previous programs that focused on telephone education and advice, we discovered that the face-to-face interactions have a direct impact on these patients and their ability to change their care model.

Third, we discovered that, if effective on a larger scale, our care model could be used nationally as a significant means of reducing healthcare costs.

Fourth, this intervention reduced unplanned admission days by 77 (71 percent) in three months. This reduction greatly benefits the medical patients and gives us increased capacity for new admissions. It also improves the life and the care of those patients who are involved in the program.

Fifth, most of our pilot patients had unmet mental health and substance abuse problems and had difficulty obtaining needed services. That was another benefit of having the multidisciplinary team sitting around the table as we did care conferences on our patients on a weekly basis. We actively addressed the mental health needs to help get a patient’s medical issues taken care of and result in higher benefits from our care being linked to all of the care.

Sixth, this multidisciplinary approach, direct face-to-face contact and ongoing telephone contact is the secret in making this program work.

And finally, patients often did not have a primary care provider at the beginning of the pilot and they benefited from being linked with one. Finding them a medical home was important and made the patients feel more comfortable with continuing to keep outpatient appointments.

home visits
Dr. Larry Greenblatt, MD, is the medical director for the chronic care program at Durham Community Health Network. Dr. Greenblatt is also an associate professor of medicine at Duke University Medical Center, where he has been on the faculty since 1994. Dr Greenblatt focuses on postgraduate medical education and primary care.

Source: Home Visit Handbook: Structure, Assessments and Protocols for Medically Complex Patients

3 Reasons Home Visits Critical During Care Transitions

February 20th, 2014 by Cheryl Miller

As far back as 2010, home visits were a vital component of the Durham Community Health Network (DCHN), a primary care case management program for Medicaid recipients who live in Durham County, NC, explains Jessica Simo, program manager with Durham Community Health Network (DCHN) for the Duke Division of Community Health. Conducted in three-month increments, and designed initially to better address Medicaid recipients’ needs and link them to their medical homes, the face-to-face visits helped establish a level of trust between case manager and patient, eventually leading patients to better outcomes, including improving medication reconciliation.

Why are home visits so important? Number one, it is very challenging to observe problems that individual patients may have with adhering to their medication regimens if providers can’t see the medicines in the bottle in the patient’s home. You need to be available to count the medicines and ascertain definitively that they are not missing. Trying to do medication reconciliation over the phone is nowhere near as effective as being in a patient’s home.

Another reason home visits are more effective is that you can physically see what activities of daily living (ADL) or instrumental activities of daily living (IADL) deficits the patient may be experiencing in their natural environment. This is something you can’t directly observe within the confines of an exam room.

The engagement of family or other support persons is also important. Home visits are an excellent way to see somebody in their natural environment, find out who the support people are for the patient, have a comfortable discussion in their home about an individual plan of care and get the people who can assist with that on board.

For all of the previous reasons, home visits were critical to the DCHN pilot. It’s especially important in a medically complex patient population where there are frequent transitions, whether they be from the acute care setting, from any emergency department (ED) visit or back into the home from an assisted living facility.

Excerpted from 2013 Healthcare Benchmarks: Home Visits.

Healthcare Business Week in Review: Home Visits; Patient Portals; Health Insurance Marketplaces; Hospital Pricing

January 17th, 2014 by Cheryl Miller

There is no place like home visits to address safety issues, and patient care concerns. Despite the explosion of mobile and telehealth technologies, there is no substitute for person-to-person contact — at least when it comes to populations at high risk of hospital admission or readmission, the results of the Healthcare Intelligence Network’s inaugural Home Visits study indicate. Three-fourths of healthcare organizations visit some percentage of their patients or health plan members in their homes in order to keep patients safer and healthier and to keep readmissions and costly utilizers at bay.

But there is a time and place for telehealth technology, and new research in the journal Medical Care shows that diabetics who used an online patient portal to refill medications and schedule their appointments, among other tasks, increased their medication adherence and improved their cholesterol levels by 6 percent, compared to occasional users or non-users. Researchers say the current study provides new evidence that patient portals may help patients adhere to their medications and achieve improved health outcomes.

About one-quarter of Americans potentially eligible for health coverage visited insurance marketplaces by December, up from 17 percent in October, according to a new Commonwealth Fund survey. Forty percent of these visitors were young adults; three-quarters said they were in good health; and more than half said they are likely to try to enroll by the March 2014 deadline. The survey, conducted between December 11 and 29, 2013, is the second in a series aimed at tracking Americans’ experiences with the marketplaces in the ACA’s first open enrollment period. The first Commonwealth Fund survey, conducted in October, found that 17 percent of people potentially eligible for coverage had visited the marketplaces during the first month.

Despite increasing scrutiny on hospital pricing practices, some U.S. hospitals are charging more than 10 times their cost, or nearly $1200 for every $100 of their total costs, according to new data released by National Nurses United (NNU) and the Institute for Health and Socio-Economic Policy (IHSP).

The 100 most expensive hospitals listed charge 765 percent and higher, more than double the national average of 331 percent, the report says. Fourteen U.S. hospitals charge more than $1,000 for every $100 of their total costs (a charge to cost ratio of 1,000 percent) topped by Meadowlands Hospital Medical Center in Secaucus, NJ, which has a charge-to-cost ratio of 1,192 percent. California, with a statewide average of 451 percent charge to cost ratio, ranks third overall in the United States. The detailed report includes the most expensive hospitals, the top 10 for each state, and the 50 most expensive hospital systems.

Discussions about end-of-life care for adults are never easy; they are even more difficult when they concern children. The National Institute of Nursing Research (NINR) has launched a new campaign, Palliative Care: Conversations Matter, that is designed to help children and families navigate a serious illness, and better inform them of supportive resources. A component of the National Institutes of Health (NIH), it brings together parents and palliative care clinicians, scientists, and professionals, who give their input and expertise on what they feel is needed in the field. Don’t miss the video which tells one mother’s story about her daughter’s bout with neuroblastoma and how palliative care helped them through it.

You can share your organization’s work in palliative care in our current e-survey: 10 Questions on Palliative Care. With more organizations focusing on palliative care as a means to enhance the patient experience during advanced or terminal illness, many are strategizing new ways to assess and address patients’ needs at this time, from consultations in the ED to face-to-face evaluations in outpatient clinics. Describe your organization’s efforts in palliative care by February 7, 2014 and you will receive a free summary of survey results once it is compiled.

Our congratulations to one of our survey participants, Timothy Price, a market research analyst with Caresource, who was randomly selected as the winner of our training DVD from our 10th annual Healthcare Trends & Forecasts webinar.

One-Minute Health Metrics Video: Home Visits for Medically Complex Patients

October 1st, 2013 by Jackie Lyons

Forget yesterday’s house calls; today’s home visits for homebound or medically complex patients enhance the patient experience by helping individuals meet everyday needs, avoid rehospitalization or an ER visit, and connect with community resources.

In fact, three-fourths of healthcare organizations visit some percentage of their patients or health plan members in their homes. This One-Minute Metrics video summarizes home visit practices of 155 healthcare organizations from HIN’s Healthcare Benchmarks market research.

You may also be interested in this related resource: 2013 Healthcare Benchmarks: Home Visits.

Q&A: Embedded Workplaces, Home Visits Emerging Trends for Case Managers

March 28th, 2013 by Cheryl Miller

As the healthcare industry continues to evolve in the wake of ACA reforms, case managers are taking on more standardized collaborative approaches to care coordination and its changing delivery systems.

Prior to her presentation during a February webinar on The Role of Case Managers in Emerging Care Delivery Models, we talked with Teresa Treiger, RN-BC, MA, CHCQM-CM/TOC, CCM, president, Ascent Care Management, about emerging trends in case management, including embedding case managers at large employer work sites, and the proliferation of home visits.

HIN: What advice do you have for case managers going into embedded workplaces and what are some of the obstacles those already embedded have encountered?

(Teresa Treiger): One of the most important things to keep in mind is that you’re walking into someone else’s territory, where dynamics and relationships are already established. There’s a trust amongst the staff that’s already there.

As a case manager, you need to survey the landscape to figure out how people relate to each other, and then just use good business etiquette, for lack of a better way of expressing it. It doesn’t mean that you change your case management process. Absolutely not. We know case management. But how we relate to the people around us is probably the number one thing.

You will be faced with a situation, without a doubt, that has challenged other people. It could be a difficult patient or a patient that’s labeled as being difficult. And that is where you are going to prove your worth, by leveraging the skills that you have to find out what really is the issue or issues going on, and finding ways of addressing them. You might not be able to solve all of them. But you can address them in a professional way, helping that individual to resolve something, to get a service they haven’t been able to, maybe obtain some equipment or get a community resource hooked up with them. That’s when you start to develop your own currency of trust with the people that you work with, and that’s what’s going to get you firmly ensconced as a part of the team.

HIN: Will we see more case managers called upon to do home based care?

(Teresa Treiger): I think so, for a couple of different reasons. There are already community-based companies that do home care. And (case managers) may be part of or leading the team of lay care workers for these companies, (acting as) main points of contact to their individuals, at least when the client, or a family member has the resources to engage a company like this. These are often for-profit companies that will step in and provide a network of community-based individuals who come in and help for those who don’t qualify for other services.

There’s also the Visiting Nurse Associations (VNAs.) I’m not entirely sure what they’re going to be doing with case managers, but there is definitely an opportunity for them.

Accountable care organizations (ACOs) will also be using case managers that are assigned into a practice, or a group. It doesn’t matter where the patients of that group are, in the hospital, in the skilled nurse facility, at home. That case manager is part of that individual’s team. If the individual is at home, and hopefully most of them will be, they’re going to be helped there. It’s very resource intensive, because not only is the case manager not in the office, where other people may need him or her, there’s travel time, and the issues that go with that. And so while it sounds like a really great plan, the reality is there’s a cost involved, of both money and human resource.

The bottom line is that the Affordable Care Act (ACA) already highlighted community-based care. So the opportunities will be and continue to be out there for case managers to be more involved with their communities at a community level.

UPMC Home Visits Target Unplanned Care in Emergency Departments

June 18th, 2012 by Jessica Fornarotto

UPMC members who treat the ER as a primary care provider can expect a home visit from the health plan’s community teams of nurses and social workers. Community teams visit these members at home to perform assessments and care management.

That’s one of the ways UPMC Health Plan is reducing the rates of avoidable emergency room use, according to Debra Smyers, senior director of program development at UPMC, who presented these strategies during a recent webinar on Identifying, Engaging and Breaking Down Patient Barriers To Reduce Avoidable ED Use.

UPMC developed community teams to engage members who were having “unplanned care” — members who thought of the ER as their own personal PCP. These teams focus primarily on the Medicaid and special needs populations. UPMC sends health plan nurses and social workers into the community to visit the targeted members in their homes. These visits continue for a few months. Then, the nurse or social worker hands the member over to a different caregiver to continue the care.

UPMC calls it a “real team approach;” they even have nurses located in the patient-centered medical home (PCMH) who can link members to an appropriate caregiver, explains Ms. Smyers. For instance, if the member is a smoker and wants to quit, the nurse would link that member to the lifestyle health coach who helps with smoking cessation.

UPMC Health Plan has also placed a patient navigator in the ER to educate patients on appropriate ER use. These navigators ask patients coming into the ER for a minor illness, such as for a sore throat, if there are any care alternatives they could use instead, such as visiting their PCP. Should the patient not have a PCP, the navigator will then help the patient to find one.

Originally, to identify patients using the ER inappropriately, UPMC would go through a monthly stratification process that included data from previous months. However, this identified patients too long after their ER visit, when it was irrelevant to help the patient. The health plan now uses actual registration data from the ERs to find their targeted patients.

With this new plan, UPMC was then able to reach the patient about their ER use on the actual day of the hospital visit. Also, to have a more direct focus on the different patients that were coming into the ER, UPMC stratified all patients into three targeted groups: those with high ER use, those with ER visits for conditions, and those patients with level 1 or 2 ER visits.

Smyers also discussed UPMC’s Connected Care Program to help improve care coordination for patients with serious mental illnesses. The health plan based this program on the PCMH model of care to address how physical and behavioral healthcare providers can manage the care of this specific population.

One of the components of this program is integrated care team meetings with staff members to focus on how to support patients with their personal and social needs. For instance, if a patient is constantly going to the ER for an illness only because the ER staff treats them well, the patient needs to understand why that constitutes inappropriate use of the ER.

This UPMC program engaged 2,500 members over two years.

In 2010, UPMC added an ER measure to their pay-for-performance (PFP) program. This measure is made up of two parts: one looks at utilization of the ER in comparison to other practices in the PFP program, and the other part looks at the rate of the practice’s improvement from the previous year.

One of the many outcomes from the ER measure was that in 2011, the PFP practices had a rate of ER visits of 34/1,000 less than the overall performance and 145/1,000 less than the non-PFP practices.