Healthcare Intelligence Network

The use of nurse-only health advice lines to reduce avoidable ER visits is up 10 percent over 2010 levels, according to HIN's second annual survey on reducing avoidable emergency room use. In this podcast, Melanie Matthews shares key metrics from the 2011 survey, including program availability, health advice line use, new benchmarks on contributions from health coaches and health educators in this area and the biggest barrier to program launch. Also, Dr. Mina Chang describes the methodology behind Ohio Medicaid's interventions to encourage appropriate ED utilization by this population.

While telephonic sessions were the primary vehicle for health coaching in the last five years, Internet-based face-to-face coaching incorporating motivational interviewing techniques is one of the directions the industry will be taking going forward, says Melinda Huffman, partner in Miller and Huffman Outcome Architects, co-founder of the National Society of Health Coaches, and a cardiovascular clinical specialist, writer and author. Mobile applications will also become more widely used, enabling health professionals to quickly access their patients' personal records, and coach via internet-based in-person calls. There will also be a move toward standardizing health coaching in terms of definition, education, and training and skill validation, Huffman says.

With more than 100 case managers working in seven regional offices, Arkansas Blue Cross Blue Shield (BCBS) embraces any tools that can elevate care delivery and efficiency and reduce paperwork. Karen Black, RN, HIPAAP, HIA, Arkansas BCBS quality improvement coordinator, describes how an early interest in computers helped to drive development of two Web-based tools supporting Arkansas BCBS case managers today, the potential for these tools to support other areas of the company, and how one tool from the centralized portal is helping to standardize transitions of care for Arkansas BCBS members. Karen Black will present during Leveraging Case Management Tools and Technology to Improve Outcomes, a 45-minute webinar on April 11, 2012, during which Black will share how the Arkansas BCBS tools repository was developed, how it fits into the case manager's workflow and the key features that are directly attributed to improvements in patient care delivery.

In its 15-year existence, Highmark's Quality Blue physician pay for performance program has evolved from one strictly based on clinical measures to a payment model shaped by practices' needs, explains Julie Hobson, Highmark's manager of provider engagement, performance and partnership. Hobson describes how feedback from physicians resulted in its Best Practice quality improvement project, what CMS's recently announced stage 2 proposal for meaningful EHR use means for Quality Blue, and some lessons Highmark has learned about engaging physicians in pay for performance. Julie Hobson presented during Physician Pay-for-Performance: Refining the Bonus Structure To Meet Market Realities, a 45-minute webinar on March 22, 2012, during which Hobson will describe how Highmark's Quality Blue physician pay for performance program has evolved to meet today's healthcare market realities. Hobson will share new developments slated for 2012 to reflect meaningful use requirements; the bonus scoring algorithm currently in place that rewards physicians across the measure set and how this algorithm will change in 2012 to reflect market developments; and much more.

Medication adherence rates for patients enrolled in a collaborative program developed by the University of Pittsburgh School of Pharmacy, Highmark, RiteAid and CE City, a technology company, was significantly improved and continued to improve over time compared to a control group, according to Dr. Janice Pringle, director of the program evaluation research unit at the University of Pittsburgh School of Pharmacy. Dr. Pringle describes the intervention, which takes a patient-centered approach to pharmacy visits combined with motivational interviewing by the community pharmacists to improve adherence rates. Dr. Pringle also shares how the collaborative has evolved following its first year results, as well as her recent appointment to CMS' Innovation Advisors Program. As part of her focus on the Innovation Advisors Program, Dr. Pringle will be working with RTI to develop pay for performance models for the community pharmacist program.

Though adult mental health patients, substance abusers and children and adolescents may face different behavioral health issues, there's a common reason behind their frequent hospital and ER visits, explains Jay Hale, LPC, CEAP, director of quality improvement and clinical operations at Carolina Behavioral Health Alliance. Hale's organization uses a set of telephonic case management protocols to reduce avoidable inpatient and ER use by these populations. He describes some of the barriers telephonic case managers might face during member outreach, red flags that indicate a physician visit is warranted, and the role of primary care providers in the member's care continuum. Hale will present during a March 7, 2012 webinar, Telephonic Case Management: Protocols for Behavioral Healthcare Patients, during which he will share the case management protocol developed by his organization, including using scripts and surveys to assess patients' engagement in the treatment process and identify patients at-risk.

Hudson River HealthCare (HRHC) takes a team approach to disease management in the 3,400 adult patients with diabetes it serves, explains Kathy Brieger, RD, CDE, HRHC's chief operations officer. Ms. Brieger describes the multiple levels of care available to patients served by the HRHC Diabetes Collaborative, a four-point strategy for weight management that targets the most challenging aspect of managing diabetes, and HRHC's upcoming trial of telepsychiatry at selected FQHCs. Ms. Brieger presented during "Diabetes Management in the Medical Home," a 45-minute webinar on January 26, 2012, providing the inside details on HRHC's diabetes management program and the program's impact on its diabetic patients. Brieger shared how to: identify and assess patients for diabetes management, including an analysis of literacy and learning and social barriers that could impact outcomes for complex patients; train staff and report quality data to drive further performance improvement; and much more.

The mapping between ICD-9 and ICD-10 code sets will have two major impacts on healthcare, predicts Dennis Winkler, ICD-10 technical program director for Blue Cross Blue Shield of Michigan, which has created a roadmap for the transition that it is sharing with the industry. Winkler describes where health plans should be on the ICD-10 timeline at the start of 2012, and defines the two major challenges the health plan expects to face as it enters the testing phase of the transition. Dennis Winkler presented during, "Mapping the Way to ICD-10 Readiness: Blue Cross Blue Shield of Michigan's Approach," a 45-minute webinar, during which he shared BCBS of Michigan's mapping strategy along with other organizational readiness tactics for ICD-10. Winkler addressed: BCBSM's six dimensions of neutrality and how the BCBSM plan incorporates these aspects into ICD-10 readiness; working with external vendors and constituents; ICD-10 systems testing and training; and more.

When healthcare providers and health plan case managers join forces in the physician practice, the end result is "care completion," explains Dr. Randall Krakauer, medical director for Aetna Medicare. In his second HealthSounds interview, Dr. Krakauer describes how the meshing of complementary patient data and knowledge from payor and provider improves the "completion factor" of care that is ordered and provides feedback on the impact of this care. Dr. Krakauer will be presenting during the November 30, 2011 webinar, "Demonstrating the Value of the Embedded Case Manager for the Medicare Population," during which he will share the strategy supporting Aetna's embedded case management initiative, along with results from the program relating to healthcare utilization and member satisfaction.

HIN's fifth annual survey on the patient-centered medical home (PCMH) recorded the highest PCMH adoption levels to date, reports Melanie Matthews in this benchmarks podcast. A substantial number of medical homes expect to participate in an accountable care organization (ACO); Ms. Matthews also shares key metrics from the 2011 survey, including time required for medical home conversion and the PCMH effect on medication adherence and patient satisfaction. The survey also identified an impressive jump in the embedding of case managers in medical homes. Dr. Bruce Nash, senior VP of medical affairs and CMO for CDPHP, where embedded case managers are at the heart of CDPHP's clinical transformation, describes what sets his program apart from other medical home pilots.