E Interventions
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
The new healthcare reimbursement models attribute patients to primary care physicians. These are services provided by providers to their attributed patient populations.
Care Coordination
- Patient Navigator
- Administrative support - book appointments, find services
- Patient reminders
Care Plan Development
- Communication - within the Care Team members
- Alignment - ensure the interventions, activities and actions are aligned with Care Goals
- Integration - ensure the interventions are integrated
- Care Team - identification (including Social Workers, Pharmacists, Social Services, etc.), planned actions, roles and communication
- Qualified Option development - explore the many facets of healthcare decision making (i.e., Complex Cancer Treatment Options, End-of-Life
Care Team and Patient Dialog
- Office Visits
- Email-Text-Apps-Portal
- Phone
- Video
- In-Person Other
Comprehensive Patient Programs
These are patient programs that address the entire patient. They facilitate care decision making and setting defined patient goals. They leverage each of the the E Interventions described.
- Transitional Care - Transition of care from a Emergency Room, hospital stay, skilled nursing or rehabilitation stay
- Intensive Care - Intensive care team that addresses the needs of patients in the top 5% of healthcare spenders
- Chronic Care - Chronic care support to address specific chronic conditions
- 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.
- Care Gaps & Follow-ups - Identify and address gaps in care and followup to ensure actions are taken.
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 Health 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
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
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
