Home Care Provider WebinarJune 2014

HSPRE0005-0614

Introduction

Welcome to the quarterly Home Care Provider Webinar

These webinars are open to all Connecticut Medical Assistance Program (CMAP) enrolled home health care providers and serve as a platform to optimize collaboration, identify opportunities to streamline and improve processes, and optimize quality of care.

You are encouraged to use the Home Care Provider Forum email box at HCProvForum@chnct.org to forward your questions regarding information provided at these forum meetings or to share recommendations for future Home Care Provider Forum agenda topics.

Please feel free to share your thoughts and ask questions at the end of today’s presentation.

Home Health Metrics

Calendar Year 2013

CY 2013 Home Health Authorization Requests by Service Type

Authorization Service Type Approved Denied Partial Denial TotalComplex Nursing 826 (88.91%) 15 (1.61%) 88 (9.47%) 929

Home Health Aide 1,804 (94.01%) 16 (0.83%) 99 (5.16%) 1,919

Home Health Therapy 634 (96.35%) 7 (1.06%) 17 (2.58%) 658

Medication Admin 4,966 (96.77%) 5 (0.10%) 161 (3.14%) 5,132

Skilled Nursing 8,840 (98.12%) 9 (0.10%) 160 (1.78%) 9,009

GRAND TOTALS 17,070 (96.73%) 52 (.29%) 525 (2.98%) 17,647

Home Health Requests CY 2013

Complex Nursing5%

Home Health Aide11% Home Health Therapy

4%

Medication Admin29%

Skilled Nursing51%

Home Health Requests CY 2013

Intensive Care Management Program

CHNCT Intensive Care Management

Intensive Care Management is a member centered program developed to support our members in reaching their own health goals through education and access to quality healthcare.

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A Snapshot of CHNCT’s Intensive Care Management

ICM

Care Coordination for High Risk

Members with Medical and

BH Conditions

Partner with Provider to

facilitate smooth

transitions

Member Empowerment

Continued Health

Coaching and Support

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ICM Coordination and Collaboration

Coordination

• Primary Care Providers• Inpatient and Outpatient Services• Rehabilitation Services• Dental• Transportation• Community Resources• Specialists• Behavioral Health Services

Collaboration

• Family/Designated Caregivers• State Agencies and Waiver Programs• Homecare• Durable Medical Equipment

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ICM Program Design

Regionalized Care Teams

Comprehensive assessment of needs

Culturally sensitive

Hybrid Model - F2F visits when appropriate

Specialized Care Management

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Regionalized Care Teams

Multi-disciplinary Care Teams service 5 regions of Connecticut

Registered Nurse and Advanced Practice Registered Nurse Medical Social Worker & Social Services Coordinator Human Services Specialist Registered Dietician Certified Diabetic, Child Birth, and Wound Care Nurses Care Coordinator Pharmacist Medical Director

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Regionalized Care Team Functions

Specialized teams to address the member’s unique needs:

Unstable conditions

Medical with behavioral health needs

Chronic diseases

Maternity, Newborn and Children with special healthcare needs

Medical with unmet social needs

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Comprehensive Assessment Adequate Food, Safety and Shelter

Identify Barriers to Care and Personal Strengths

Depression Screening

Stress Levels

Self Care Abilities (Functional)

Medication Understanding and Safety

Provider Access and Engagement

Condition Stability

Health Literacy

Self Care Understanding

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Community Support Services

Human Services Specialists

Comprehensive telephonic assessment for basic needs

F2F home visits with members

Social Service and Community Resource referrals

Assistance with completion of applications

Continued follow-up for 90 days

Ages and Stages Screenings

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ICM Coaching and Education

Chronic Condition Coaching

Preventive Care Coaching

Knowing their targets, triggers and action plans

Knowing their numbers (Blood Pressure, Blood Glucose, Cholesterol, Weight, Peak Flows, etc.)

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Specialized Programs

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Spec

ializ

ed P

rogr

ams

Pregnancy

Asthma

Diabetes

Transplants

Sickle Cell Disease

Chronic Diseases

Behavioral Services

Community Support Services

Asthma Example

Focuses on Medications, Home trigger assessment and Education Asthma Action plan is provided Brochures Provide resources to eliminate asthma triggers F2F visits are conducted

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How Can We Help You?

Assist with finding HUSKY providers Assist with obtaining DME Address Pharmacy issues Facilitate/Coordinate MD appointments Appointment reminder calls Assist with transportation coordination F2F visits with you and members Provide alternatives to unnecessary Emergency Room visits

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Referral Process

Go to http://www.huskyhealth.com Click on ‘For Providers’, Provider Bulletin & Forms and select ICM Referrals

Form Contact Provider Line 1.800.440.5071 x2024 to request ICM services Fax ICM Referral Form to 1.866.361.7274

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CHNCT Intensive Care Management Contacts

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Dawn Clavette, RNManager

Specialized Intensive Care Management

203.949.6089dclavette@chnct.org

Nancy Sienkowski, RNManager

Intensive Care Management203.626.7274

nsienkowski@chnct.org

Margy Roberts Manager

Community Support Services

203.626.7276 mroberts@chnct.org

CHNCT Inpatient Discharge Management

Hospital Readmission and

ED Reduction Program Goals

CHNCT is collaborating with members and providers to:

• Develop approaches to support members and providers in effective discharge planning

• Improve member self-management skills to decrease exacerbation of chronic disease events

• Promote a trusting and collaborative member/PCP relationship.

• Educate members on access to appropriate and available resources of care when faced with health related situations

Why is the Hospital and ED Reduction Program Needed?

Member’s with complex chronic medical conditions and/or psychosocial needs receive health and homecare services from numerous providers in several types of healthcare settings.

Fragmented care often results in: Duplication of services Diminished quality of care Avoidable hospital readmissions Emergent care utilization

When possible, members should be treated by their Primary Care Provider for non-emergent conditions in order to promote consistent, quality care.

CHNCT ResourcesCHNCT addresses ED utilization and readmissions with the following interventions:

ED and Inpatient Discharge Care Management (IDCM)

Primary Prevention (connecting to Primary Care Providers)

Information Sharing-Data Analytics

Claims Analysis (Pharmacy Medication Adherence)

Secondary and Tertiary Interventions

Hospital Discharge Collaborative Rounds

Intensive Care Management (ICM) post hospital discharge

24/7 Nurse Advice Line Enhanced access and continuity of care through collaboration with providers

at Person-Centered Medical Homes and Federally Qualified Health Centers

How are these resources used?

CHNCT resources aimed at hospital readmission and ED reduction are available to:

• Facilitate communication among hospital care managers, attending physicians, primary care providers, specialists, health and community providers, patients, and caregivers

• Assist in early identification in gaps and barriers to care

• Address psychosocial issues

• Facilitate a coordinated plan of care

• Help patients identify and access resources within the community

• Reduce avoidable hospitalizations and ED visits

How is this achieved? ED and IDCM FocusCHNCT places Inpatient Discharge Care Managers (IDCMs) on site at the hospital to collaborate with the patients, hospital care managers, social workers, primary care providers, and caregivers to:

Identify and address clinical and psychosocial gaps in care that contribute to readmission and ED recidivism

Facilitate communication among the member, caregivers, interdisciplinary medical and behavioral healthcare team, and other community providers

Engage members with CHNCT’s Intensive Care Management Program and Human Services Specialists

Assist in the development of a comprehensive discharge plan to ensure optimal and effective transition of care to the most appropriate setting

How is this achieved? (cont.)IDCM Collaboration Efforts

For members with frequent ED visits for medical diagnoses (non-behavioral health) IDCMs collaborate with hospital Social Workers and Care Managers to:

Assess and determine underlying causes of frequent ED visits

Identify any resources the member is already receiving in the community and determine the member’s compliance and the resources’ effectiveness

Outreach to providers to coordinate changes to existing services that may be appropriate in order to address identified issues

Facilitate the member/PCP relationship

Educate the member on ED alternatives such as: Same day visits Urgent care 24/7 Nurse Advice Line

How is this achieved? (cont.)

IDCM Collaboration Efforts (cont.)

For inpatient members with frequent readmissions, IDCMs collaborate with hospital Social Workers and Care Managers to:

Perform onsite assessment of admitted members to ensure that appropriate discharge plans are in place to allow the member’s care to continue in the appropriate alternate setting

Assess the member’s ability to self-manage care and identify gaps in current outpatient services and the treatment plan which may be contributing to the need for readmissions

Procure appropriate medical and psychiatric evaluations to determine member’s competency and ability to self-manage, where appropriate

How is this achieved? (cont.)

IDCM Collaboration in Discharge Planning

IDCMs assist in identifying and addressing barriers to safe discharge, including:

Needs for housing, foster care, or alternate living arrangements Lack of compliance and/or poor therapeutic response to Home

Services that are currently received Inability to receive homecare or other medical services in the

member’s current living environment Inadequate level of oversight and/or clinical services available Poor ability to access medical care in the community

IDCMs communicate barriers to safe discharge with the hospital care managers, attending physician, and PCP and assist in implementing a safe discharge plan of careFor members requiring assessment and assistance navigating the behavioral healthcare system, IDCMs will refer to Value Options

How is this achieved? (cont.)

IDCM Collaboration with Other ASO Programs

Elements of CHNCT’s Person-Centered Medical Home Program that directly impact readmission and ED rates include:

Availability of access during and after office hours (including weekends) Coordination and continuity of care across all areas of healthcare Primary care offices acting as the main portal for all member’s post-

discharge follow-up needs Providers educating members and caregivers on self-management strategies Medication management and reconciliation Open appointments dedicated to post-discharge follow up Coordination of transportation to appointments

How is this achieved? (cont.)

IDCM Collaboration with Other ASO Programs (cont.)

Member’s who require ongoing support post hospital discharge are referred to CHNCT’s Intensive Care Management Program (ICM) to address member’s specific issues related to their high ED utilization and readmissions.

Member’s who also face barriers related to immediate, unmet basic human needs are referred to Human Services Specialists, an extension of ICM, for assistance in navigating resources available within their community.

IDCMs will also refer members who have funding needs for services not covered under their benefit program to Waiver Programs and other community resources.

In Summary

CHNCT’s goal is to provide a complete and comprehensive plan for transition from inpatient to the community

CHNCT program goals are to facilitate communication among the hospital multidisciplinary team, primary care provider, specialists, members, their families and caregivers

Prevent avoidable readmissions, ensure provider follow-up and assist to address barriers to care

Engage members in Intensive Case Management and refer to Human Services Specialist or CTBHP, when appropriate

Personal Automated Medication Dispensers

Coverage Guidelines and Prior Authorization Process

Personal Automated Medication Dispensers

Clinically Appropriate for Individuals:

With mild cognitive impairment With visual impairments With previous hospitalizations or

ED visits Who have been unable to adhere

to a medication regimen

Contraindicated for Individuals:

With potential to hoard medications

With potential to sell medications

Prior Authorization Information Required for Review

Prior Authorization Form

Documentation of a Home Visit

Documentation from requesting Physician

Medical records as requested

Authorization Form

Request using code S5185: Medication reminder service, non-face-to-face; per month

S5185 covers both medication box rental and monitoring services

1 unit = 1 month

A request for authorization of at least one skilled nursing visit should also be submitted on the prior authorization request

If PA Request for Automated Medication Box is Approved:

Initial authorization period is 30 days

The agency will provide and oversee the use of the dispenser

Skilled nursing visit(s) should occur during the first one to two weeks after the individual receives the device to ensure the proper use of the device as well as to reinforce medication education including self management skills

Subsequent requests must include clinical documentation that supports maintenance or improvement in compliance and may be approved for up to 6 months

Questions/Comments