Anxiety caused by the wait for a non-urgent appointment or lack of awareness that they are assigned a primary care physician are just two barriers to appropriate ER utilization by a diverse Medicaid population, explains Laura Linebach, director of quality improvement at L.A. Care Health Plan. As part of a health plan-hospital collaboration with a goal of reducing non-acute ER use by children ages 1 to 19, L.A. Care Health Plan has launched a Nurse Advice Line and developed a range of materials to educate parents about appropriate use of the ER. Ms. Linebach describes these tools as well as a metric in L.A. Care Health Plan's pay for performance program that measures group providers' appropriate resource use. Laura Linebach presented during "Reducing Avoidable Medicaid ER Visits With a Community Partnership Approach," a 45-minute webinar on May 9, 2012, during which she shared the inside details on how the health plan worked with the hospital to target avoidable ER use and results from the initiative.

Reducing Avoidable Medicaid ER Visits With a Community Partnership Approach

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Humana's remote monitoring pilots go beyond traditional targets of heart failure, diabetes and COPD to observe functionally challenged members, explains Gail Miller. This novel approach uses a Personal Emergency Response System (PERS) with a built-in accelerometer to monitor members challenged by activities of daily living (ADL), says the VP of telephonic clinical operations in Humana's care management organization, Humana Cares/SeniorBridge. Another pilot, a collaboration with HealthSense, places sensors around the member's home to study algorithms of normal movement so Humana can detect changes and intervene before a member's crisis.  All Humana remote monitoring pilots engage the circle of care surrounding the member --- be it home health, a family member, or a spouse.  Gail Miller will share more details of Humana's telephonic care management and how remote monitoring pilots will enhance care coordination during a March 19, 2014 webinar, "Integrating Mobile Health Remote Patient Monitoring with Telephonic Care Management for Improved Care Coordination Results," a 45-minute program sponsored by The Healthcare Intelligence Network.

Humana Remote Monitoring Pilots Engage Circle of Care Surrounding Member

Relationships with community organizations that support mental health as well as recovery from addiction are essential to care coordination of Medicare-Medicaid beneficiaries, notes Julie Faulhaber, vice president of enterprise Medicaid at Health Care Service Corporation (HCSC). These collaborations enable HCSC to address the needs of duals as "a whole sick person, and not just as a diagnosis," she explains, noting that duals often suffer from depression along with some physical disability. HCSC also has its own integrated team with behavioral health expertise.  Julie Faulhaber will share her organization's approach to designing a care coordination model for dual eligibles and initial findings from these new programs during a March 12, 2014 webinar "Moving Beyond the Medical Care Coordination Model for Dual Eligibles," a 45-minute program sponsored by The Healthcare Intelligence Network.

HCSC's Community Behavioral Health Links Essential to Duals Care Coordination

There are three key benefits to prudent sharing of performance data among physicians, notes Cynthia Kilroy, senior vice president of provider strategy and business development at Optum, who suggests a four-step systematic approach for data dissemination that moves companies away from simply creating "metrics in a box." Besides the electronic health record, she recommends three other data sources to mine for provider performance metrics.  Cynthia Kilroy explored the key structure, issues and challenges in these evolving reimbursement models during a January 29, 2014 webinar, "Accountable Care Reimbursement Models: Moving from Productivity to Population-Based Incentives," a 45-minute program sponsored by The Healthcare Intelligence Network.

3 Key Benefits to Prudent Sharing of Physician Performance Data

Given changing reimbursement incentives and collaborative models for physicians and hospitals, Greg Mertz, managing director of Physician Strategies Group, LLC, discusses why the Congressional proposal "Better Care, Lower Cost Act" of 2014 is financially more attractive to providers than ACO models and whether he thinks it will be passed. He also deconstructs CMS' recently reported financial results for such health reform delivery initiatives as Medicare ACOs, Pioneer ACOs, and the Physician Group Practice demonstration, and weighs in on which, if any, model he considers the most sustainable.  Greg Mertz helped healthcare organizations assess which value-based healthcare delivery model is right for their organization during "Physician Alignment: Which Model Is Right for You?," a February 19th, 2014 workshop at 1:30 p.m. Eastern.

Deconstructing Health Reform: 3 Reasons Medicare and Pioneer ACOs May Not Survive

With hospital readmission rates under close scrutiny by CMS, Torrance Memorial Health System launched a readmission program in early 2013 that has been recognized as a program of excellence for its innovation and impact on the community. Navigators work with patients prior to discharge from the hospital to educate them on the hospital's Care Transitions program, which includes a network of Skilled Nursing Facilities, or SNF's and one home health agency. And once the patient is discharged, ambulatory case managers keep watch on the patients after the 30-day penalty phase is over.  Josh Luke, Ph.D., vice president of post acute services at Torrance Memorial Health System and founder of the California Readmission Prevention Collaborative and the National Readmission Prevention Collaborative, shared the key features of the program during "Award Winning Readmission Prevention Protocols: Navigating Care Transitions with Preferred SNF and Home Health Providers," a 45-minute webinar on January 8th, 2014, at 1:30 pm Eastern.

Reducing Avoidable Medicaid ER Visits With a Community Partnership Approach

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