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TRANSCRIPT
Home Care Provider Webinar June 2014
HSPRE0005-‐0614
Introduc0on
Welcome to the quarterly Home Care Provider Webinar § These webinars are open to all ConnecAcut Medical Assistance Program (CMAP) enrolled home health care providers and serve as a plaHorm to opAmize collaboraAon, idenAfy opportuniAes to streamline and improve processes, and opAmize quality of care.
§ You are encouraged to use the Home Care Provider Forum email box at [email protected] to forward your quesAons regarding informaAon provided at these forum meeAngs or to share recommendaAons for future Home Care Provider Forum agenda topics.
§ Please feel free to share your thoughts and ask quesAons at the end of today’s presentaAon.
Home Health Metrics
Calendar Year 2013
CY 2013 Home Health Authoriza0on Requests by Service Type
Authoriza0on Service Type Approved Denied Par0al Denial Total Complex 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 MedicaAon 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 educaAon 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 Coordina0on and Collabora0on
Coordination
• Primary Care Providers • InpaAent and OutpaAent Services • RehabilitaAon Services • Dental • TransportaAon • Community Resources • Specialists • Behavioral Health Services
CollaboraAon
• Family/Designated Caregivers • State Agencies and Waiver Programs • Homecare • Durable Medical Equipment
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ICM Program Design
n Regionalized Care Teams
n Comprehensive assessment of needs
n Culturally sensiAve
n Hybrid Model -‐ F2F visits when appropriate
n Specialized Care Management
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Regionalized Care Teams
Mul0-‐disciplinary Care Teams service 5 regions of Connec0cut
n Registered Nurse and Advanced PracAce Registered Nurse n Medical Social Worker & Social Services Coordinator n Human Services Specialist n Registered DieAcian n CerAfied DiabeAc, Child Birth, and Wound Care Nurses n Care Coordinator n Pharmacist n Medical Director
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Regionalized Care Team Func0ons
Specialized teams to address the member’s unique needs:
n Unstable condiAons
n Medical with behavioral health needs
n Chronic diseases
n Maternity, Newborn and Children with special healthcare needs
n Medical with unmet social needs
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Comprehensive Assessment n Adequate Food, Safety and Shelter
n IdenAfy Barriers to Care and Personal Strengths
n Depression Screening
n Stress Levels
n Self Care AbiliAes (FuncAonal)
n MedicaAon Understanding and Safety
n Provider Access and Engagement
n CondiAon Stability
n Health Literacy
n Self Care Understanding
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Community Support Services
Human Services Specialists
n Comprehensive telephonic assessment for basic needs
n F2F home visits with members
n Social Service and Community Resource referrals
n Assistance with compleAon of applicaAons
n ConAnued follow-‐up for 90 days
n Ages and Stages Screenings
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ICM Coaching and Educa0on
n Chronic CondiAon Coaching
n PrevenAve Care Coaching
n Knowing their targets, triggers and acAon plans
n Knowing their numbers (Blood Pressure, Blood Glucose, Cholesterol, Weight, Peak Flows, etc.)
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Specialized Programs
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Specialized
Program
s
Pregnancy
Asthma
Diabetes
Transplants
Sickle Cell Disease
Chronic Diseases
Behavioral Services
Community Support Services
Asthma Example
n Focuses on MedicaAons, Home trigger assessment and EducaAon n Asthma AcAon plan is provided n Brochures n Provide resources to eliminate asthma triggers n F2F visits are conducted
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How Can We Help You?
n Assist with finding HUSKY providers n Assist with obtaining DME n Address Pharmacy issues n Facilitate/Coordinate MD appointments n Appointment reminder calls n Assist with transportaAon coordinaAon n F2F visits with you and members n Provide alternaAves to unnecessary Emergency Room visits
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Referral Process
n Go to http://www.ct.gov/huskyn Click on ‘For Providers’, Provider BulleAn & Forms and select ICM
Referrals Formn Contact Provider Line 1.800.440.5071 x2024 to request ICM servicesn Fax ICM Referral Form to 1.866.361.7274
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CHNCT Intensive Care Management Contacts
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Dawn Claveae, RN Manager
Specialized Intensive Care Management 203.949.6089
Nancy Sienkowski, RN Manager
Intensive Care Management 203.626.7274
Margy Roberts Manager
Community Support Services
203.626.7276 [email protected]
CHNCT Inpa0ent Discharge Management
Hospital Readmission and
ED Reduc0on Program Goals
CHNCT is collaboraAng with members and providers to:
• Develop approaches to support members and providers in effecAve discharge planning
• Improve member self-‐management skills to decrease exacerbaAon of chronic disease events
• Promote a trusAng and collaboraAve member/PCP relaAonship.
• Educate members on access to appropriate and available resources of care when faced with health related situaAons
Why is the Hospital and ED Reduc0on Program Needed?
Member’s with complex chronic medical condiAons and/or psychosocial needs receive health and homecare services from numerous providers in several types of healthcare sekngs.
Fragmented care olen results in: n DuplicaAon of services n Diminished quality of care n Avoidable hospital readmissions n Emergent care uAlizaAon
When possible, members should be treated by their Primary Care Provider for non-‐emergent condiAons in order to promote consistent, quality care.
CHNCT Resources CHNCT addresses ED uAlizaAon and readmissions with the following intervenAons:
¨ ED and InpaAent Discharge Care Management (IDCM)
¨ Primary PrevenAon (connecAng to Primary Care Providers)
¨ InformaAon Sharing-‐Data AnalyAcs
¨ Claims Analysis (Pharmacy MedicaAon Adherence)
¨ Secondary and TerAary IntervenAons
¨ Hospital Discharge CollaboraAve Rounds
¨ Intensive Care Management (ICM) post hospital discharge
¨ 24/7 Nurse Advice Line ¨ Enhanced access and conAnuity of care through collaboraAon 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 reducAon are available to:
• Facilitate communicaAon among hospital care managers, ahending physicians, primary care providers, specialists, health and community providers, paAents, and caregivers
• Assist in early idenAficaAon in gaps and barriers to care
• Address psychosocial issues
• Facilitate a coordinated plan of care
• Help paAents idenAfy and access resources within the community
• Reduce avoidable hospitalizaAons and ED visits
How is this achieved? ED and IDCM Focus CHNCT places InpaAent Discharge Care Managers (IDCMs) on site at the hospital to collaborate with the paAents, hospital care managers, social workers, primary care providers, and caregivers to:
¨ IdenAfy and address clinical and psychosocial gaps in care that contribute to readmission and ED recidivism
¨ Facilitate communicaAon 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
opAmal and effecAve transiAon of care to the most appropriate sekng
How is this achieved? (cont.) IDCM Collabora0on 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
¨ IdenAfy any resources the member is already receiving in the community and determine the member’s compliance and the resources’ effecAveness
¨ Outreach to providers to coordinate changes to exisAng services that may be appropriate in order to address idenAfied issues
¨ Facilitate the member/PCP relaAonship
¨ Educate the member on ED alternaAves such as: n Same day visits n Urgent care n 24/7 Nurse Advice Line
How is this achieved? (cont.)
IDCM Collabora0on Efforts (cont.) For inpaAent members with frequent readmissions, IDCMs collaborate with hospital Social Workers and Care Managers to:
¨ Perform onsite assessment of admihed members to ensure that appropriate discharge plans are in place to allow the member’s care to conAnue in the appropriate alternate sekng
¨ Assess the member’s ability to self-‐manage care and idenAfy gaps in current outpaAent services and the treatment plan which may be contribuAng to the need for readmissions
¨ Procure appropriate medical and psychiatric evaluaAons to determine member’s competency and ability to self-‐manage, where appropriate
How is this achieved? (cont.) IDCM Collabora0on in Discharge Planning
IDCMs assist in idenAfying and addressing barriers to safe discharge, including:
¨ Needs for housing, foster care, or alternate living arrangements ¨ Lack of compliance and/or poor therapeuAc 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
n IDCMs communicate barriers to safe discharge with the hospital care managers, ahending physician, and PCP and assist in implemenAng a safe discharge plan of care n For members requiring assessment and assistance navigaAng the behavioral healthcare system, IDCMs will refer to Value OpAons
How is this achieved? (cont.)
IDCM Collabora0on 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 aler office hours (including weekends) ¨ CoordinaAon and conAnuity of care across all areas of healthcare ¨ Primary care offices acAng as the main portal for all member’s post-‐
discharge follow-‐up needs ¨ Providers educaAng members and caregivers on self-‐management strategies ¨ MedicaAon management and reconciliaAon ¨ Open appointments dedicated to post-‐discharge follow up ¨ CoordinaAon of transportaAon to appointments
How is this achieved? (cont.)
IDCM Collabora0on with Other ASO Programs (cont.) n 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 uAlizaAon and readmissions.
n 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 navigaAng resources available within their community.
n 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
n CHNCT’s goal is to provide a complete and comprehensive plan for transiAon from inpaAent to the community
n CHNCT program goals are to facilitate communicaAon among the hospital
mulAdisciplinary team, primary care provider, specialists, members, their families and caregivers
n Prevent avoidable readmissions, ensure provider follow-‐up and assist to
address barriers to care n Engage members in Intensive Case Management and refer to Human
Services Specialist or CTBHP, when appropriate
Personal Automated Medica0on Dispensers
Coverage Guidelines and Prior Authoriza0on Process
Personal Automated Medica0on Dispensers
Clinically Appropriate for Individuals:
n With mild cogniAve impairment n With visual impairments n With previous hospitalizaAons or
ED visits n Who have been unable to adhere
to a medicaAon regimen
Contraindicated for Individuals:
n With potenAal to hoard medicaAons
n With potenAal to sell medicaAons
Prior Authoriza0on Informa0on Required for Review
n Prior AuthorizaAon Form
n DocumentaAon of a Home Visit
n DocumentaAon from requesAng Physician
n Medical records as requested
Authorization Form
n Request using code S5185: MedicaAon reminder service, non-‐face-‐to-‐face; per month
n S5185 covers both medicaAon box rental and monitoring services
n 1 unit = 1 month
n A request for authorizaAon of at least one skilled nursing visit should also be submihed on the prior authorizaAon request
If PA Request for Automated Medica0on Box is Approved:
n IniAal authorizaAon period is 30 days
n The agency will provide and oversee the use of the dispenser
n Skilled nursing visit(s) should occur during the first one to two weeks aler the individual receives the device to ensure the proper use of the device as well as to reinforce medicaAon educaAon including self management skills
n Subsequent requests must include clinical documentaAon that supports maintenance or improvement in compliance and may be approved for up to 6 months
Ques0ons/Comments