Healthcare Intelligence Network

Integrated health coaching's person-centric approach to health behaviors across the entire health risk continuum aligns with many of the key principles of post-ACA care delivery models like the patient-centered medical home and the accountable care organization (ACO), explains Dr. Dennis Richling, HealthFitness chief medical and wellness officer. Dr. Richling and HealthFitness Vice President of Service Delivery Kelly Merriman describe the population presenting the greatest opportunities for integrated health coaching, the key to discerning participant values during the coaching intervention, and the art of 'appreciative inquiry' --- an essential coaching skill that helps to define an individual's 'exceptionality.' Dr. Richling and Kelly Merriman presented during "Integrated Health Coaching: The Next Generation in Health Behavior Change Management," a 45-minute webinar on September 20, 2012, during which they shared key features of HealthFitness' integrated health coaching program, from how participants are assessed and assigned to coaches to the program's impact.

Before shifting from a disease-focused to population health management (PHM) approach, healthcare organizations need to do their homework, advises Patricia Curran, principal in Buck Consultants' National Clinical Practice --- from researching the population's culture to examining its patterns of healthcare usage and cost trends. In this interview, Ms. Curran describes the four key research areas, as well as some of the barriers encountered along the road to population health management. She also predicts what the no- or low-health-risk populations can expect in a population health management world that spans the health risk continuum --- from incentives to provider and payor contact. Patricia Curran presented during "Population Health Management: Achieving Results in a Value-Based Healthcare System," a 45-minute webinar on September 26, 2012, during which she shared the types of population health management programs and how these programs can produce tangible results in terms of improved outcomes and costs savings.

Although the healthcare industry is well-acquainted with the patient-centered medical home, the model is still quite new and novel to patients, notes, Jay Driggers, director of consumer engagement at Horizon Blue Cross Blue Shield of New Jersey. In this interview, Driggers describes what's at stake when moving from a reactive provider model to a proactive model. Driggers will present during "Patient Engagement in the Patient-Centered Medical Home: A Continuum Approach," a 45-minute webinar on August 22, 2012, during which he will describes some of Horizon BCBS's novel consumer engagement tactics that involve everything from smartphone apps to telemonitoring.

A value-based contract between Advocate Physician Partners (APP) and Blue Cross Blue Shield of Illinois (BCBSIL) has reduced inpatient admissions and emergency room visits and has bent the cost curve after its first year. In this interview, Dr. Carrie Nelson, APP's medical director for special projects, describes how APP's eight-year clinical integration of 4,000 physicians and 10 hospitals has laid the groundwork for this value-based contract. Dr. Carrie Nelson presented during "Bending the Cost Curve with a Commercial Value-Based Payment Contract: A Case Study from Advocate Physician Partners," a 45-minute webinar on July 18, 2012, now available for replay, during which she shared lessons learned from the first year of implementing the value-based contract between APP and BCBSIL.

The use of a disease-specific approach to improve health outcomes and self-management for patients with diabetes is utilized by 77 percent of organizations, according to HIN's 2011 survey on diabetes management programs. In this podcast, Melanie Matthews shares key metrics from the survey, including the role of the case manager, the use of incentives, the staff member responsible for diabetes management and the greatest challenge associated with the control of diabetes. Also, Kathy Brieger, Hudson River HealthCare chief operating officer, describes HRHC's four-pronged approach to weight management for the 3,400 adult patients it serves.

Aetna's Compassionate Care Program is a case management initiative that specifically targets health plan members with advanced illness, focusing on improving the quality of care they receive. As a result, explains Dr. Joseph Agostini, senior medical director of Aetna Medicare, these patients get more of the type of care that they want and spend less time in the hospital. Patient satisfaction with the program is high, he says, which reflects the strong bond between Aetna members and nurse case managers. In this interview, Dr. Agostini explains the key elements of the Compassionate Care program as well as some of the challenges the case managers may face in the management of advanced illness. Dr. Joseph Agostini presented during "Advanced Illness Care Coordination: A Case Study on Aetna's Compassionate Care Program," a 45-minute webinar on June 13, 2012, now available for replay, during which he shared the key features of the Compassionate Care Program at Aetna, along with the impact the program has had on healthcare utilization and quality outcomes.

Nurse educators provide essential support to physician practices in Florida Blue's rollout of a statewide patient-centered medical home, explains Barbara Haasis, RN, CCRN, senior clinical lead for Florida Blue's quality reward and recognition programs. They help practices meet key disease metrics within Florida Blue's performance scorecards, and can direct providers to both internal and external resources to help them resolve patient issues. Ms. Hassis also explains why providing after-hours access is a prerequisite for practices in the medical home program as well as the case manager's contribution to this program. Barbara Haasis presented during "The Patient-Centered Medical Home: Lessons from a Statewide Rollout," a 45-minute webinar on May 10, 2012, during which she shared how the health plan transitioned from the Recognizing Physician Excellence (RPE) program to a medical home model.

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.

Geisinger Health Plan reduced the relative risk of all-cause 30-day readmissions by 44 percent compared to a matched control group using an interactive voice response (IVR) system developed by AMC Health. The IVR system targeted patients who were at high risk for readmissions following a hospital discharge. Care managers identified those complex patients that were at high risk for post-discharge complications that could lead to a readmission, explained Dr. Maria Lopes, chief medical officer at AMC Health. The IVR system makes one call per week for four weeks, using branching logic to identify issues with medication adherence, PCP follow-up, and complications, as well as a risk and falls assessment. The program is integrated into the care management workflow to make this impact, she added.

When looking for new hires for its embedded case management program, Bon Secours Health System looks for critical thinking skills and previous roles that are transferable, such as work with chronic disease patients, explains Irene Zolotorofe, administrative director of clinical operations at Bon Secours. Zolotorofe also describes the importance of matching personalities when placing a case manager in a physician practice, how to build a trusting relationship between an embedded case manager and the physician and Bon Secour's embedded case manager training process. Irene Zolotorofe will present during "Recruiting, Training and Case Load Management Strategies for Embedded Case Managers," a 45-minute webinar on May 3, 2012, sharing the process that Bon Secours has established for recruiting, selecting and placing an embedded case manager in their practices, along with details on case load management, tools used by case managers, benchmarks for measuring effectiveness and much more.

The use of nurse-only health advice lines to reduce avoidable ER visits is up 10 percent over 2010 levels, according to HIN's second annual survey on reducing avoidable emergency room use. In this podcast, Melanie Matthews shares key metrics from the 2011 survey, including program availability, health advice line use, new benchmarks on contributions from health coaches and health educators in this area and the biggest barrier to program launch. Also, Dr. Mina Chang describes the methodology behind Ohio Medicaid's interventions to encourage appropriate ED utilization by this population.

While telephonic sessions were the primary vehicle for health coaching in the last five years, Internet-based face-to-face coaching incorporating motivational interviewing techniques is one of the directions the industry will be taking going forward, says Melinda Huffman, partner in Miller and Huffman Outcome Architects, co-founder of the National Society of Health Coaches, and a cardiovascular clinical specialist, writer and author. Mobile applications will also become more widely used, enabling health professionals to quickly access their patients' personal records, and coach via internet-based in-person calls. There will also be a move toward standardizing health coaching in terms of definition, education, and training and skill validation, Huffman says.

With more than 100 case managers working in seven regional offices, Arkansas Blue Cross Blue Shield (BCBS) embraces any tools that can elevate care delivery and efficiency and reduce paperwork. Karen Black, RN, HIPAAP, HIA, Arkansas BCBS quality improvement coordinator, describes how an early interest in computers helped to drive development of two Web-based tools supporting Arkansas BCBS case managers today, the potential for these tools to support other areas of the company, and how one tool from the centralized portal is helping to standardize transitions of care for Arkansas BCBS members. Karen Black will present during Leveraging Case Management Tools and Technology to Improve Outcomes, a 45-minute webinar on April 11, 2012, during which Black will share how the Arkansas BCBS tools repository was developed, how it fits into the case manager's workflow and the key features that are directly attributed to improvements in patient care delivery.

In its 15-year existence, Highmark's Quality Blue physician pay for performance program has evolved from one strictly based on clinical measures to a payment model shaped by practices' needs, explains Julie Hobson, Highmark's manager of provider engagement, performance and partnership. Hobson describes how feedback from physicians resulted in its Best Practice quality improvement project, what CMS's recently announced stage 2 proposal for meaningful EHR use means for Quality Blue, and some lessons Highmark has learned about engaging physicians in pay for performance. Julie Hobson presented during Physician Pay-for-Performance: Refining the Bonus Structure To Meet Market Realities, a 45-minute webinar on March 22, 2012, during which Hobson will describe how Highmark's Quality Blue physician pay for performance program has evolved to meet today's healthcare market realities. Hobson will share new developments slated for 2012 to reflect meaningful use requirements; the bonus scoring algorithm currently in place that rewards physicians across the measure set and how this algorithm will change in 2012 to reflect market developments; and much more.

Medication adherence rates for patients enrolled in a collaborative program developed by the University of Pittsburgh School of Pharmacy, Highmark, RiteAid and CE City, a technology company, was significantly improved and continued to improve over time compared to a control group, according to Dr. Janice Pringle, director of the program evaluation research unit at the University of Pittsburgh School of Pharmacy. Dr. Pringle describes the intervention, which takes a patient-centered approach to pharmacy visits combined with motivational interviewing by the community pharmacists to improve adherence rates. Dr. Pringle also shares how the collaborative has evolved following its first year results, as well as her recent appointment to CMS' Innovation Advisors Program. As part of her focus on the Innovation Advisors Program, Dr. Pringle will be working with RTI to develop pay for performance models for the community pharmacist program.