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
Interventions 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.
Contents
- 1 E Intervention Programs
- 1.1 Behavioral Health & Primary Care Integration
- 1.2 Chronic Care Management
- 1.3 Episode Management
- 1.4 ER Case Management
- 1.5 Exercise & Nutrition
- 1.6 Health Coaching
- 1.7 High Need High Cost
- 1.8 Home Care
- 1.9 Medical Home
- 1.10 Medication Management
- 1.11 Palliative Care
- 1.12 Transitional Care Management
- 1.13 Virtual Care
- 2 Services
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
- Episode 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.
Transitional Care 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
- Remote Monitoring of 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
Services
Digital Health Applications
- Mobile Apps and user provided input
- Recommended App
- Patient Provided Data
Education
- Online education video
- One on one education
- Programs
- How to use technology
- Health Apps
- Decision Aids
Home
- 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).
- Technology Support - In home set-up, training and repair
- 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 Medicine reconciliation
Support
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.
Financial Counseling
- Disability or Medicaid Applications
- Medication discount programs
- Debt, financial constraints
- Understanding complex medical bills and payment
Caregiver Support
- Education
- Respite Care
- Family Caregiver certification
Community and Social Services
- Community Health Worker
- Legal Assistance
- Programs - Smoking Cessation Programs, Alcohol Anonymous
- Jobless
- Food pantries, housing and utilities subsidies
- Support Communities - Online Patient Communities
Housing
- Homelessness - temporary housing or shelters
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
- Meals on Wheels
Transportation
- Rides to physician offices or other need services
Technology
- Virtual Visits technology
- Secure Email-Text-Apps-Portal
- Interactive Voice Response (IVR) System
- Personal Emergency Response System (PERS)
- Triggers, Notification, Associated Action, Escalation to care team
- Patient Provided Data Input
- 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
Virtual Services
- Telepsych visits
- Physician or Nurse Practitioner eVisits (informed and uninformed)
- Telecare Nurse
