7 Ways to Stratify Patients for Health Coaching

July 24th, 2014 by Cheryl Miller

Recruiting patients for health coaching is a multi-faceted process, says Alicia Vail, RN, is a health coach for Ochsner Health System. Health coaches can enlist the services of physicians, case managers and transition navigators for referrals to those patients who would benefit from coaching post hospital or physician discharge.

There are several ways we recruit patients. First, we have created health coach referral criteria to help physicians and staff identify patients who would benefit from health coaching. These patients would need coaching on self-management of chronic health problems such as hypertension, diabetes and obesity. We also get referrals from physicians when they see a patient in their office and identify that the patient could benefit from health coaching. Second, we also identify patients through pre-chart reviews.

Third, we look at labs and other needed or outstanding screenings prior to their appointment and notify the physician.

Fourth, we utilize different lists to help us identify patients. The hemoglobin A1C list helps us reach out to our diabetic patients who have not reached their goal of hemoglobin A1C of 7 or below. The emergency department list allows us to prevent readmissions by having the health coach reach out and capture these patients.

Fifth, HEDIS® measures allow us to focus on needed health screenings or tests for patients.

Sixth, when we meet with our patients for glucometer or insulin training, we have an opportunity to explain and offer our health coaching program at that point.

And lastly, sometimes our in-patient case managers or transition navigators, who help with patient discharge preparation, will refer patients to the health coach for post-hospital follow-ups.

Excerpted from Stratifying High-Risk, High-Cost Patients: Benchmarks, Predictive Algorithms and Data Analytics.

Infographic: Daily Drug Use in the United States

July 23rd, 2014 by Melanie Matthews

Every day in America millions of young adults use illicit substances, ranging from marijuana, heroin, and cocaine, to hallucinogens and inhalants. Out of the 35.6 million young adult population (from 2012) in the United States, one fifth used an illicit drug in the past month, and the percentage of those users has increased from 2008.

The infographic below shows how often drugs are used daily in the United States and the number of first-time illicit drug users on an average day.

Daily Drug Use in the United States

Bringing the most comprehensive research and information available today to the mental health field, the Dartmouth Psychiatric Research Center and Hazelden have redesigned the innovative Integrated Dual Disorders Treatment: Best Practices, Skills, and Resources for Successful Client Care curriculum.

Far surpassing its predecessor in ease of implementation and ongoing usability in clinical settings, this updated and expanded curriculum is redesigned not only to more effectively teach clinical skills and provide practitioners with resources and tools for their practice, but to offer the guidance necessary to align the work of departments and transform agencies into integrated treatment providers.

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5 Models for Engaging Community Partners in Dual Eligibles Care Coordination

July 22nd, 2014 by Patricia Donovan

Since healthcare is local, it's vital that health systems engage local providers, enlisting both clinical and administrative champions, advises Julie Faulhaber, vice president of enterprise Medicaid at Health Care Service Corporation. Ms. Faulhaber offers a variety of guidelines for engagement of community partners in care coordination for Medicare and Medicaid beneficiaries.

Our community care coordination partners may employ different models of care coordination. First, some may have care systems, larger accountable care organization (ACO)-type organizations; many take full financial risk, including risk on home- and community-based services. There are also waivers.

Second, some of these large care systems also have nurse practitioner (NP) models that provide mainly facility-based care. Those can be extremely successful with outcomes for the numbers, as well as from a cost perspective. Third, we also work with care management organizations and providers. Another example would be the Triple A’s—Adult Areas Agencies on Aging—and other behavioral health organizations. In our experience, these organizations will take on some financial risk, but really for those care coordination services.

Fourth, there are many different financial models you can use with both groups, particularly for the care management organization providers. For example, looking at a risk on care coordination, gain sharing—potentially in a new program—helping to pay for some startup infrastructure cost, providing loans with some paybacks. There are many different opportunities to make it financially viable for those important community partners to work with health plans in order to provide community-based, social model services to the member to meet all of their needs.

Finally, when working with community partners, it is critical to have both a clinical and administrative champion for the program. Clinically, it helps to have a physician nurse who can talk with their peers in the organization to help them understand the program. Clinicians want to provide care in a very uniform way, but if there is an opportunity to provide additional benefits in lieu of services for members, it helps to have that clinician champion to be able to share that.

Administratively, it is also important to manage the enrollment and care coordination paperwork. The plans are putting significant faith in these organizations to meet their contractual obligations, so having someone to follow up for those types of things is critical. It is also important to provide reporting and feedback on the results for these groups. We have done quarterly meetings in the past, which I found to be very helpful.

It is also helpful to provide benchmarking data. We look at how one organization serving the same population in a similar environment shapes up in comparison to another. This has improved results overall; it makes those organizations leading the pack feel good, and provides those trying to catch up with some role models to look at.

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

Infographic: Physicians’ Salaries 2014

July 21st, 2014 by Melanie Matthews

Physicians are becoming more proactive in managing their incomes by being more selective about insurers and patients and providing ancillary services. In addition, a small but growing number of physicians are moving toward cash-only practices.

A new infographic from Medscape looks at these trends, along with details on how the Affordable Care Act is impacting physician practices, the income gender disparity among physicians and physician career satisfaction.

Physicians' Salaries 2014

In today's value-based healthcare sphere, providers must not only shoulder more responsibility for healthcare outcomes, cost and quality but also align with emerging compensation models rewarding these efforts — models that often seem confusing or contradictory. The challenges for payors and partners in creating a common value-based vision are sizing the reimbursement model to the provider organization and engaging physicians' skills, knowledge and behaviors to foster program success.

6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability examines a set of provider compensation models across the collaboration continuum, advising adopters on potential pitfalls and suggesting strategies to survive implementation bumps.

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Infographic: Rethinking Home Healthcare

July 18th, 2014 by Melanie Matthews

With more than 10,000 Americans turning 65 every day and a growing desire from seniors to age in place, there is a growing need for home healthcare services.

A new infographic from Barton Associates shows the growing need for home healthcare, as well as how home care improves the quality of life for seniors.

Rethinking Home Healthcare

Home Health Quickflips© can be used as a reference for documentation, patient eligibility and "how to" instructions for OASIS items which impact reimbursement and quality outcomes. This resource can be a teaching tool for new employees and home health managers.

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Telephonic Case Management Targets High-Risk, High-Cost Conditions

July 17th, 2014 by Cheryl Miller

While the complex comorbid are the primary targets of telephonic case managers, the newly discharged, those in acute stages of chronic illness, frequent utilizers and high-risk, high-cost patients also receive their fair share of attention from telephonic case managers, according to new market data from the Telephonic Case Management survey conducted in May 2014 by the Healthcare Intelligence Network.

To expand the scope of care coordination, telephonic case management is evolving as a cost-effective and efficient means of monitoring and engaging individuals with chronic illness or a weak circle of care, according to an inaugural survey on Telephonic Case Management by the Healthcare Intelligence Network (HIN).

More than 84 percent of respondents utilize telephonic case managers, according to this new market data, with more than half — 54 percent — making contact with patients from virtual home offices. And while the telephone is an essential tool of the trade, these case managers also draw on motivational interviewing and robust data from electronic health records (EHRs) and case management software to help them manage their populations.

The complex comorbid are the primary targets of telephonic case managers, the survey found, but the newly discharged, those in an acute stage of chronic illness, frequent utilizers and high-risk, high-cost patients also receive their fair share of telephonic attention from these case managers.

While charged primarily with the management of chronic illness and transitions in care, most telephonic case managers also find themselves in the role of patient educator and health coach, say 75 percent of respondents.

  • „„The case management assessment is the primary method of identifying candidates for telephonic contact, report 61 percent of respondents.
  • „„One-fifth of telephonic case managers work within a primary care practice.
  • „„Engagement of members in telephonic case management is the primary challenge of the program, say 43 percent of respondents.
  • „„Workloads of telephonic case managers fall into the 50-99 case range, say 30 percent of respondents.

Excerpted from 2014 Healthcare Benchmarks: Telephonic Case Management.

Infographic: Are You Ready for Sensors in Healthcare?

July 16th, 2014 by Melanie Matthews

The market for wearable sensors is increasing dramatically. Devices are being designed to help people manage chronic conditions, recover more quickly from injuries, analyze physical and environmental abnormalities that may lead to more serious health issues and detect unhealthy habits before they cause problems, according to Pathfinders Software.

A new infographic from Pathfinders Software takes a look at the types of wearables available, how they are used, their wireless capability and other details on this technology.

Are You Ready for Sensors in Healthcare

From home sensors that track daily motion and sleep abnormalities to video visits via teleconferencing, Humana's nine pilots of remote patient monitoring test technologies to keep the frail elderly at home as long as possible. When integrated with telephonic care management, remote monitoring has helped to avert medical emergencies and preventable hospitalizations among individuals with serious medical and functional challenges. In Remote Patient Monitoring for Enhanced Care Coordination: Technology to Manage an Aging Population, Gail Miller, vice president of telephonic clinical operations in Humana's care management organization, Humana Cares/SeniorBridge, reviews Humana's expanded continuum of care aimed at improving health outcomes, increasing satisfaction and reducing overall healthcare costs with a more holistic approach.

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Replicating Home Care Telehealth for Non-Homebound Curbs Readmissions

July 15th, 2014 by Patricia Donovan

Community Health Network considers it a failure of the system if a patient with chronic illness has to go to the hospital. Deborah Lyons, Community Health Network's disease management executive director, describes how the integration of telehealth into care of heart failure patients is helping to keep hospital readmission rates down for this population.

It’s all part of Community’s network strategy. That’s really a failure of the system if a patient has to go to the hospital—at least for those with chronic diseases. Our strategy has been to keep patients out of the hospital regardless of disease type. We want to keep patients out of the hospital.

As part of an integrated strategy, we’ve used our experts in home care to do high-risk home visits rather than creating a siloed entity to do this. Home care was doing telehealth for their homebound patients in home care, and we didn’t want to recreate this functionality. We chose to work with our home care telehealth experts and expand this to the non-homebound population.

This network strategy helps us to better manage the health of patients by looking at what expertise exists and then expanding it to meet the population needs.

When we first started developing the strategy, we also started with heart failure originally because we have a lot of heart failure patients and an issue with readmissions.

When we looked at the heart failure patients, we found that first, about 43 percent of our patients that were readmitted were patients that were discharged home to self-care, meaning they didn’t qualify for traditional home care. They weren’t going into a facility. These were people that were going home alone. And this group was driving 43 percent of our readmissions.

When we looked at what was occurring in our own network, we also found that our home care agency was doing telehealth with their home care patients and had a national best readmission rate. We asked ourselves how we could replicate this for our non-homebound patients. There are experts there that are getting great results. Now we want to apply this to our non-homebound population. And that’s where we decided to do this with IVR, the automated telephonic system that calls the patients at home.

Excerpted from: New Horizons in Healthcare Home Visits

Infographic: Trends in Account-Based Health Plans

July 14th, 2014 by Melanie Matthews

High deductible health plans and HSAs have been in the market for over a decade and adoption rates (particularly for HDHPs, HSAs and HRAs) continue to accelerate rapidly, according to a new survey by Alegeus Technologies.

The survey also found a significant consumer education gap and a need for enhanced decision-support resources to help consumers better manage their ever-growing responsibility for healthcare. An infographic by Alegeus Technologies highlights the survey findings, including details on market penetration of account-based plans, consumer proficiency in these plans and account perceptions and enrollment barriers.

2014 Consumer and Employer Healthcare Benefits Survey

As health plan operators last year were preparing to offer plans on the state-run and federally facilitated health insurance exchanges, they could only guess at the age and health of the population that would enroll, and they had no information about how their competitors would price their plans. Now that open enrollment is over, Public Exchanges Data: Premium Analysis and Carrier Participation for 2014 takes a look at how it all played out. This report offers a highly detailed overview of where carriers participated, the types of products they offered and how their prices stacked up against their competitors.

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Infographic: The Rising Cost of On-Call Physicians

July 11th, 2014 by Melanie Matthews

Nearly twice as many physicians were paid for time devoted to being on-call this year than last -- with some earning more than $1,000 per day, according to the Medical Group Management Association's On-Call Survey: 2014 Report Based on 2013 Data, reflected in a new infographic.

More than 60 percent of physicians reported receiving a daily stipend for taking call, a stark contrast to last year, when only 35 percent did. Additionally, primary care physicians saw their median daily on-call compensation rate soar in the past year, up to $250 in 2013 from the $150 claimed in 2012. PCPs in the western geographic section of the United States reported making as much as $1,103 per day in on-call compensation.

Even physicians who were not monetarily rewarded for their on-call duties received some sort of benefit. Of the 37 percent of physicians who said they received no additional compensation for taking on-call coverage, 33 percent reported being rewarded with time off.

This infographic looks at on-call compensation by practice size and compensation methods.

The Rising Cost of On-Call Doctors

Shifting reimbursement models are forcing hospital executives to rethink their approach to physician relationships. New cost and quality demands require hospitals to explore all alternatives—including tighter alignment with physicians. The New Hospital-Physician Enterprise: Meeting the Challenges of Value-Based Care provides expert advice on structuring and sustaining hospital-physician relationships in the post-reform environment.

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