E Interventions

E Interventions are patient interventions which:

• receive no reimbursement from traditional health insurance
• likely will improve patient outcomes and reduce overall cost

Medicare Part E are patient services that don’t qualify for Medicare Part A (hospital), Part B (physician), Part C (Medicare Advantage) or Part D (medicines) reimbursement. Most health plans are based on Medicare fee schedules, so it is unlikely they will provide reimbursement either. 'E Clinical 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. It could mean a patient that only needs 2 nights in a hospital, would need to stay a 3rd night to qualify for Medicare (or other health plan) reimbursement for home health services. It could be telemedicine that is only reimbursed if the patient is in qualified physician office communicating to physician in a qualified physician office, thus no reimbursement for telemedicine into the home.

Care Coordination

• Patient Navigator
• Administrative support - book appointments, find services
• Patient reminders

Care Plan Development

• Communication - within the Care Team members
• Goal Setting -
• 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

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

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.

Education

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

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

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).

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

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 Apps

Patient Provided Data

• Well-Being Assessment
• Devices - Activity, Blu-tooth enabled blood glucose, blood pressure and weight scale devices and apps
• Recommended Apps

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

Virtual Services

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