Difference between revisions of "E Interventions"

Revision as of 16:05, 22 November 2016

E Interventions are patient interventions which:

• typically do not receive reimbursement from traditional health insurance
• likely will improve patient outcomes and reduce overall cost

Patient services that don’t qualify for Medicare Part A (hospital), Part B (physician), Part C (Medicare Advantage) or Part D (medications) reimbursement can be described as Medicare Part E Interventions or "E - none of the above". Most health plans are based on Medicare fee schedules, so they typically do not provide reimbursement for E Interventions. E Interventions may be delivered exactly the same way as clinical interventions that get reimbursed (like home health), yet they come with stipulations that may not suit the patient's situation. For example, a patient needs to stay 3 nights in a hospital to qualify reimbursement for home health services. If home health services are provided, they may not be reimbursed even if it is what the patient needed to improve their recovery. Another example is a physician speaking on the phone to their patient, which typically do not receive reimbursement for the physicians's time.

E Intervention Programs

New healthcare reimbursement models attribute patients to primary care physicians and healthcare systems for episodes of care. The following Care Management programs are often provided to patients to improve their overall health and healthcare outcomes. These programs include care plan development, administrative support in booking appointments, finding services, coordinating medical services and reminding patients.

Behavioral Health & Primary Care Integration

• Screen patient via Primary Care Physician Offices' Clinical Staff
• Engage patients to ensure followup with Behavioral Health providers
• Collaboration between Primary Care and Behavioral Health to ensure best treatment and patient activation

Chronic Care Management

• Identify patients with two or more chronic conditions
• Identify patients with behavioral health conditions
• Identify patients with functional limitations
• Chronic Care Plan Development that addresses chronic conditions and determinants
• Regular follow-up with patients to ensure treatment effectiveness and adherence

Episode Management

• Comprehensive programs for surgeries based on type of surgery (i.e., hip replacement)
• Understand and address patients unique conditions and determinants of health
• Patient Navigators to ensure patients efficiently get through the healthcare system
• 90 day program for patients being discharged from hospital
• Identify episode attributed patient population
• Transitional Care Plan Development with clearly defined care goals and outcomes
• Coordinate post discharge medical or support services

ER Case Management

• Assess and understand patient risk factors prior to discharging
• Address patients unique conditions and determinants of health prior to discharge
• Coordinate post discharge medical or support services

Exercise & Nutrition

• Diabetes prevention program
• Diabetes management program
• Nutrition Therapy

Health Coaching

• Motivational Interviewing
• Goal setting
• Develop Friendships and Trust
• Engage with patient to discuss progress and care plan effectiveness

High Need High Cost

• Defined as patients that are the 5% of healthcare service spending
• Address health conditions and determinants of health
• Assign a nurse, social worker, pharmacist and health coach to patients as required
• Care Plan Development with clearly defined care goals and outcomes

Home Care

• Address the needs of homebound patients that often skip care or physician visits
• Physician or Nurse practitioner visits to patients in the home
• Regular follow-up by nurse, social work, pharmacist and/or health coach as necessary
• Home Assessments
• Home Visits - Physicians, Therapist, Nurse Practitioner
• Home support services (i.e., cleaning, maintenance, repairs)
• Delivery services
• Other visits (Community Health Worker, Social Worker, Health Coach)
• Other Home Healthcare Services (i.e., services that don't meet reimbursement requirements, 1. Infusion or Wound Care or Therapy, and, 2. unable to physically travel to doctors office, and 3. had a hospital stay of 3 nights or more, and 4. 60 days of prescribes Home health has not been used).

Medical Home

• Annual Wellness Visits
• Quality Measures - Address quality measures for attributed primary care physician (PCP) populations
• Medication Reconciliations
• Preventive screenings - per recommendation of the US Preventive Services Task Force
• Coordinate - healthcare services and E Interventions
• Wellness Care Plan Development that wellness and preventive care recommendations
• Care Gaps & Follow-ups - Identify and address gaps in care and followup to ensure actions are taken.

Medication Management

• In-home Medicine reconciliation
• Pharmacist support
• Medication Adherence - reminders, electronic pill boxes
• Medicine home delivery

Palliative Care

Addressing what is most important to the patient to help enable their well-being rather then more aggressive actions or long term preventive therapies.

Episode Management

• Understand and address patients unique conditions and determinants of health
• 90 day program for patients being discharged from hospital
• Identify episode attributed patient population
• Transitional Care Plan Development with clearly defined care goals and outcomes
• Coordinate post discharge medical or support services

Virtual Care

Patient Monitoring

• Monitoring patient information (physiological metrics, activities, etc.) by a support team
• Interactive Voice Response (IVR) System
• Personal Emergency Response System (PERS)
• Mobile Apps and user provided input
• Triggers, Notification, Associated Action, Escalation
• Recommended App
• Patient Provided Data

Home Services

• Home Assessments
• Home Visits - Physicians, Therapist, Nurse Practitioner
• Home support services (i.e., cleaning, maintenance, repairs)
• Delivery services
• Other visits (Community Health Worker, Social Worker, Health Coach)
• Other Home Healthcare Services (i.e., services that don't meet reimbursement requirements, 1. Infusion or Wound Care or Therapy, and, 2. unable to physically travel to doctors office, and 3. had a hospital stay of 3 nights or more, and 4. 60 days of prescribes Home health has not been used).

Virtual Services

• Telepsych visits
• Physician or Nurse Practitioner eVisits (informed and uninformed)
• Telecare Nurse

Care Team and Patient Dialog

• Office Visits
• Email-Text-Apps-Portal
• Phone
• Video
• In-Person Other

Coaching & Education

These are services provided by providers to their attributed patient populations to improve health outcomes.

Care Goal Setting and Planning

• Goal Setting -
• Alignment - ensure the interventions, activities and actions are aligned with patient, caregiver and determinants
• Qualified Option Planning - explore the many facets of healthcare decision making (i.e., Complex Cancer Treatment Options, End-of-Life)

Education

• Online education video
• One on one education
• Programs
• How to use technology
• Health Apps
• Decision Aids

Financial Counseling

• Disability or Medicaid Applications
• Medicine discount programs
• Debt, financial constraints
• Understanding complex medical bills and payment

Health Coaching

• Motivational Interviewing
• Develop Friendships and Trust
• Health Coach
• Goal setting

Services

Home Services

• Home Assessments
• Home Visits - Physicians, Therapist, Nurse Practitioner
• Home support services (i.e., cleaning, maintenance, repairs)
• Delivery services
• Other visits (Community Health Worker, Social Worker, Health Coach)
• Other Home Healthcare Services (i.e., services that don't meet reimbursement requirements, 1. Infusion or Wound Care or Therapy, and, 2. unable to physically travel to doctors office, and 3. had a hospital stay of 3 nights or more, and 4. 60 days of prescribes Home health has not been used).

Virtual Services

• Telepsych visits
• Physician or Nurse Practitioner eVisits (informed and uninformed)
• Telecare Nurse

Care Team and Patient Dialog

• Office Visits
• Email-Text-Apps-Portal
• Phone
• Video
• In-Person Other

Support Services

These are services typically provided by community and social services. These services are arranged and coordinated by providers to their attributed patient populations to improve health outcomes.

Caregiver Support

• Education
• Respite Care
• Family Caregiver certification

Community and Social Services

• Community Health Worker
• Legal Assistance
• Meals on Wheels
• Programs - Smoking Cessation Programs, Alcohol Anonymous
• Homelessness - temporary housing or shelters
• Jobless
• Food pantries, housing and utilities subsidies
• Support Communities - Online Patient Communities

Medication Support

• In-home Medicine reconciliation
• Pharmacist support
• Medication Adherence - reminders,electronic pill boxes
• Medicine home delivery

Nutrition Support

• Registered dietitians
• Education and cooking instructions and classes
• Assess/triage eating disorders and other barriers (i.e., financial, access to fresh food) preventing healthy nutrition

Technology and Equipment Support

• Technology could include use of blood pressure device, wifi router or laptop computer
• Durable Medical Equipment (DME) devices such as oxygen that are not reimbursed
• In home set-up, training and 24x7 support

Transportation

• Rides to physician offices or other need services