in this issue

VOLUME 4 · NO. 2 · SEPTEMBER 2012

Dr. Ritchey speaks at

Baton Rouge Press

Club

Dramatically lower

readmission rates

achieved in MS

Dr. Trent James to

instruct Louisiana

leisure class

Our Forte in Illinois

Mississippi REC

helps providers lead

the country

Employee

Spotlight

REC recognizes 2

new MUVers

page 2

page 3page 4page 5page 6 page 7 page 8

WHERE WE CONNECTa publication of

eQHealth Solutions has

completed its first year

of work with the Florida

Agency for Health Care

Administration (AHCA) as

the manager of its Compre-

hensive Medicaid Utilization

Management Program, or

CMUMP. The contract was

signed in February 2011,

marking the beginning of

approximately 90 days of rigorous development and implementation to begin

the actual services that June.

During those first 90 days, staff was hired and trained, two offices were

opened and face-to-face meetings and webinar trainings were conducted for

providers throughout the state. Also, physician reviewers were recruited and

Continued on Pg. 2 - SUNSHINE

Success in the Sunshine State

Florida state capitol - Tallahassee

2

SUNSHINE - Cont. from Pg. 1

credentialed and a myriad other

critical tasks were completed.

On June 1, 2011, the doors were

opened. Our web portal went live,

and our phones lines lit up. We are

now conducting prior authoriza-

tion and retrospective reviews for

inpatient care, home health, private

duty nursing, personal care ser-

vices, occupational, physical and

speech therapies and prescribed

pediatric extended stay care.

During the first contract year,

there was a monthly average of

3,174,273 recipients who were

eligible for care. We reviewed re-

quests for 272,564 unique recipi-

ents (unduplicated count) or about

8.5% of the population.

The Florida location has developed

and submitted our first Annual

Report to AHCA. This document

details initial cost savings that our

program has helped generate,

provides an

overview of

of our

provider

education

efforts and our

customer service

achievements.

On June 9, Dr.

Ron Ritchey,

eQHealth’s Chief

Medical Officer,

was asked to

speak at the Baton

Rouge Press Club

on the Supreme

Court decision on

the Accountable

Care Act and how

it might affect

Louisiana Citizens on Medicaid.

The basis of his discussion was on a blog post he had written titled, “The

Supremes Sing at Surprise Party for Obamacare.” The “surprise” was an

upholding of the individual mandate in the act.

“This was a discussion about what the Supreme Court has determined, where

they think Obamacare should go and our predictions of who might win and

who might lose and beyond that what needs to be done to reduce health care

costs in the U.S.,” explained Ritchey.

“I think the winners would be anyone that is uninsured that is able to get into

an exchange,” said Ritchey. “The losers are likely to be the individuals that

experience increased costs under the Accountable Care Act. And, that would

be probably the majority of individuals in Louisiana.”

Healthcare IT News has shared a video on their website of Dr. Ritchey from

the press club appearance. “We believe it will resonate well with our audi-

ence. Thank you for the opportunity to share your video content,” said Eric

Bailey, Events Producer.

You can find the blog post on www.eqhssmarterhealthcare.org and a video

of Dr. Ritchey at the Baton Rouge Press Club can be found on our eQHealth

Solutions YouTube site.

Dr. Ritchey speaks at Baton Rouge Press Club

2 3

A new program to improve health

care quality in the Mississippi Delta

is showing success in its first year.

This care coordination program

in which hospitalized patients are

partnered with a health coach has

resulted in fewer re-hospitalizations

than the previous year.

In place at Bolivar Medical Center

since December 2011, readmission

rates for congestive heart failure,

pneumonia and heart attacks have

significantly decreased as shown in

the table below.

Readmission rates were not record-

ed for patients with diabetes, but

there were zero readmissions for

these patients, as well.

The health coach was introduced

to the patient immediately following

admission, working with the pa-

tients throughout the hospital stay

and until discharge. When a patient

returned home, the coach stayed in

contact throughout the next weeks

or months. It is period in which

a patient is most likely to need to

return to the hospital should their

condition worsen.

The patient-coach relationship en-

sures that follow-up doctor visits are

made, that prescriptions are filled

and that the patient complies with

other components of the recovery

plan. It is these steps that are cru-

cial to the patient’s full recovery.

JoAnn McCollum, Chief Nursing

Officer for Bolivar Medical Center,

said “the care transitions coach has

been an extremely positive addition

to the team.”

“The coach has made a differ-

ence! She works one-on-one with

the patients, and always follows

up. She makes sure our employees

are properly trained and know what

key health concerns to address

with each patient,” said McCollum.

“She really is a life coach and is a

necessity to our facility.”

Marina Brown, eQHealth’s project

manager for the initiative, is not

surprised the program is getting

results. “It was not until the cli-

ent provided this data that we have

seen the remarkable difference the

coaching model has made,” said

Brown. “The bottom line is the re-

admission rate for coached patients

with serious conditions dropped

from an average of 22.6 percent

when we started the program to 2.1

percent.”

National data shows that unneces-

sary re-hospitalizations occur in

Mississippi at a rate that exceeds

the national average. According to

the Commonwealth Fund, in 2009,

the readmission rate was 17.9

percent in Mississippi for Medicare

patients.

Bolivar Medical Center achieves dramatically lower readmission rates by partnering with eQHealth Solutions

DiagnosisBeginning Read-

mit Rate 2011Readmit Rate

2012 Q1 Reduction 1Readmit Rate

2012 Q2 Reduction 2

Congestive Heart Failure 43% 12% 50% 6.5% 73%

Pneumonia 12% 5% 58% 0 100%Acute Myocardial Infarction (Heart Attack) 13% 20% 23% 0 100%Readmission rates were not recorded for patients with diabetes, but there were zero readmissions for these patients, as well.

4

Dr. Trent James, associate medical director for eQHealth

Solutions, was asked to instruct a class for LSU Lagniappe

Studies named, “Pain, Plagues, Pestilences & Peoples:

Medicine in Louisiana in the Nineteenth Century.” The

class will be held Mondays from September 24 to October

2 at Broadmoor Methodist Church in Baton Rouge.

This course is a non-credit course being offered to mem-

bers of the Osher Lifelong Learning Institute at LSU. The

OLLI at LSU is one of 117 university-affiliated lifelong learn-

ing programs supported by The Bernard Osher Foundation.

The Osher Lifelong Learning Institute, which is open to

adults age 50 and above, provides university connection

and support, robust volunteer leadership, sound organi-

zational structure and a diverse repertoire of intellectually

stimulating courses.

Those taking the course will learn about the impact practi-

tioners of medicine had on the residents of Louisiana; from

the indigenous peoples to European settlers and Africans.

Other topics will include the challenges related to epidem-

ics, poor public

health, poor sanita-

tion, ignorance, the

Civil War and train-

ing of physicians.

Dr. James, will also

cover historical rem-

edies for diseases.

Dr. James volun-

teers as a docent at

the LSU Rural

Life Museum where

he portrays a nine-

teenth century

country doctor. He

is pictured in cos-

tume at right.

Dr. Trent James to instruct History of Medicine in Louisiana leisure class

Staff presents at AHQA Conference in BaltimoreAbstracts by eQHealth Louisiana staff Linda Harkey, Quality

Improvement Director, and Megan Schaefer, Communica-

tions Specialist, were selected for presentation at this year’s

American Health Quality Association annual conference in

Baltimore in late July. AHQA is the trade organization for

Medicare QIOs and the conference is attended by QIOs,

CMS and other health care entities.

Linda presented on eQHealth’s Learning and Action (LAN)

model, which is successfully engaging statewide organiza-

tions and physician offices in quality improvement projects.

Megan presented on the strategic relationships built

through our popular Louisiana Medicare Quality Summit

and Awards, and their opportunities for free media, includ-

ing the press kits eQHealth prepares for providers. The

media coverage benefits both eQHealth and the award

winning health care providers.

4 5

When speaking about our forte,

we are not referring to the great

Chicago Bears running back Matt

Forte (thanks Slidell, LA). Our

Illinois staff has their own powerful

playmakers who are continuously

providing rapid response and

implementation of special projects

and new utilization controls to

the Department of

Healthcare and Family

Services (HFS).

In June, the Illinois

General Assembly

passed Senate Bill

2840, Save Medicaid

Access and Resources

Together Act (known as

the SMART Act). This

Act includes $1.6 billion

in spending reductions,

utilization controls and provider

rate cuts for Medicaid services.

This is across 62 different services

and is requiring a coordinated

team approach from our Illinois

office. Listed below are some of the

initiatives that we are implementing.

Inpatient Detoxification Services

(Utilization Controls)

A provision of the SMART Act calls

for limiting inpatient detoxification

services. To implement HFS’ new

60-day readmission policy, eQHealth

developed a Detoxification Look-

up utility and employed eQSuite

edits to check patient eligibility for

detoxification services.

Cesarean Sections (Special Project)

In response to recent legislation, we

conducted an analysis, developed

a proposed sampling and review

methodology and submitted a

report recommendation to HFS

on prepayment review options for

C-section admissions.

Long Term Acute Care (LTAC) Quality

Transfer Program (Analysis)

HFS requested a evaluation of the

long term acute care (LTAC) hospital

program. We were instrumental

in HFS’s ability to implement this

complex program in October of

2010 and have been conducting

credentialing for new LTAC facilities.

We are also conducting the bi-annual

quality monitoring audits for all

Illinois LTACs for the past two years.

Assessment of Medical Necessity

Nursing Services (Special Project)

Our HCBS staff, including our

consultants from HCBS Strategies,

participated in two

weeks of intense

training for core

review training and a

new special project.

The HCBS team will

begin conducting in-

home assessments in

October and will collect

data for level of care

determinations and

resource allocation for

medical necessity nursing services.

Three HFS staff (including the

acting Bureau Chief) joined our field

nursing staff for training on the home

reassessment visit protocols, tools

and automated entry.

Our Forte in Illinois

The Illinois Rapid Response Team

6

More than 1,000 primary care physicians in Mississippi have

successfully updated their practices by implementing an

electronic health record, or EHR. According to an official with

the Office of the National Coordinator for Health Information

Technology, this makes Mississippi one of the first states to

reach its goal for EHR adoption.

Two years ago, the federal

government established

EHR adoption goals for

all states, and established

organizations known as

regional extension cen-

ters, called REC, to lead

the effort. In Mississippi,

the REC is run by eQHealth Solutions. The targets for EHR

adoption are different in each state, depending on the size

of the state and the number of physicians and other primary

care providers. The goal established for Mississippi is 1,000

primary care providers.

In an on-site visit this summer, Fadesola Adeto-

soye, project officer for the Office of the National

Coordinator, recognized the Mississippi REC for its

achievement.

“We have charged our nation’s 62 regional exten-

sion centers with providing the technical assistance,

training and support to providers who are serious

about improving care by adding an electronic health

record to their practice,” Adetosoye said. “Today,

the Mississippi REC has become the second in the

country to meet its goal of assisting 100 percent of

its targeted providers.”

The Mississippi REC was also the third state to

reach the first EHR milestone of providers making the commit-

ment to update their practices with this technology.

A key to the Mississippi REC’s success has been the relation-

ships established with other organizations that are committed

to the EHR movement. These organizations include the Mis-

sissippi Division of Medicaid, the Delta Blues Beacon Com-

munity program, the Mississippi Health Information Network,

the quality improvement organization (QIO) and many provider

organizations and associations.

Patsy Collins, CEO of Mantachie Rural Health Care Inc., also

praised the relationship they have formed with eQHealth Solu-

tions.

“As a result of the direct guidance the staff of the REC has

provided us, we will successfully be meeting all meaningful

use criteria within the next few months. The commitment to

helping a Federally Qualified Health Center take the steps to

improve our health technology shows the REC is focused on

improving health care on a larger scale,” said Collins.

Mississippi REC helps providers lead the country in EHR adoption

“Today, the Mississippi REC has become the second in the country to meet its goal of assisting 100 percent of its targeted providers.”

Fadesola AdetosoyeOffice of the National Coordinator

Pictured (l to r): Randy Bordelon, Program Manager, Audrey Stacy, Administra-tive Assistant, Fadesola Adetosoye, ONC Project Officer, and REC Regional Team Leaders, Kathleen Keeley and Chris Williams

6 7

EMPLOYEE SPOTLIGHT: Additions to the Business Development Team

Two new employees have joined eQHealth’s business devel-

opment team as regional directors of business development.

They spent a week in the Baton Rouge office for orientation

with process owners and interaction and direction from Gary

Curtis, Dr. Ron Ritchey and Mayur Yermaneni. A component

of the company’s plan to meet our aggressive five-year goals

is to market our care coordination

services and products nation-

wide.

Kingsley Smith is located in the

west coast region (Los Angeles).

Prior to joining eQHealth he spent

his career in software sales in

various companies with his immediate past experience being

with Allscripts. He specializes in working with IPAs, hospitals

and ACOs.

Donna Jablonski is located

in New Jersey and will cover

the east coast region. Prior

to joining eQHealth she spent

her career in software sales

in various companies with her

immediate past experience

with MEDai. She specializes

in working with health plans

and health systems.

In August, we signed a contract with national insurance broker,

BancorpSouth to provide predictive modeling analysis for their

self-insured clients.

According to Edie Castello, chief operating officer, “This

relationship has the possibility of allowing eQHealth to provide

services to the commercial market by not only providing the

backend data analysis but with the potential to provide care

coordination services.”

In partnership, eQHealth and Bancorp have developed a pack-

age of services that we are calling Total Medical Management.

This combines Bancorp’s health care analytics, nFORM, with

our predictive modeling and care coordination program. The

goal is to offer this package of services to existing Bancorp

clients and new commercial clients.

Here’s a brief description of each component of Total Medical

Management.

nFORM Analytics provides the ability to analyze client data,

resulting in information that allows for enhanced decision mak-

ing and subsequent actions.

Predictive modeling identifies high risk patients, allowing

patients to be categorized by illness, their severity and identify

any gaps in care.

eQCare, our care coordination program, is a unique approach

to care management that is founded on face-to-face patient

engagements by our care coordinators. The care coordinator is

linked to a high risk patient, and their interactions begin with

in-person sessions.

Edie reports that this is an exciting new relationship. “This part-

nership will provide eQHealth experience in working with com-

mercial health plan data, and developing our analytics modules

for our new product development initiatives.”

BancorpSouth becomes our newest client

8

North Mississippi Medical Center,

North Mississippi Medical Clinics

and Pratt Family Medical Clinic

have been recognized by the

federal government and the

eQHealth Mississippi Regional

Extension Center (REC) as

members of the Meaningful Use

Vanguard (MUV). This is an

exclusive group of health care

leaders who have demonstrated

their commitment to transforming

health care through the use of

health information technology.

Meaningful Use

Vanguard is a designation

established by the

federal Office of the

National Coordinator

for Health Information

Technology (ONC) and

the Mississippi REC,

operated by eQHealth

Solutions, to honor organizations

and primary care practices that

have made the transition to

electronic health records (EHR).

As well as receiving this honor,

Dr. Joseph Pratt was one of 82

providers invited to a recognition

event at the White House this

summer. MUVers throughout the

country have been recognized for

their leadership in local efforts that

will eventually move the nation

toward an electronically-

enabled health care

system.

“Although it was an

honor that Dr. Pratt

was recognized for

his leadership in the

movement for EHR

adoption, his story is

just the beginning of the

good work being done throughout

Mississippi” said Randy Bordelon,

program manager for our MS REC.

“His efforts and his successes are

also an indicator of the work of

hundreds of other physicians in

the state who have embraced this

technology that will make health

care healthier.”

As a 650-bed regional referral

center in Tupelo, the North

Mississippi Medical Center holds

the distinction of being the largest,

private, not-for-profit hospital in

Mississippi and the largest non-

metropolitan hospital in America.

The medical center serves more

than 700,000 people in 24

counties in north Mississippi,

northwest Alabama and portions of

Tennessee.

By October 1, North Mississippi

Medical Center and its clinics

will have 130 providers who can

demonstrate to Medicare that they

are meeting the Meaningful Use

Criteria.

Mississippi REC recognizes 2 new MUVers this summer

Dr. Pratt

North Mississippi Medical Center

8 99

FOR SUBMISSIONS TO eCONNECT, PLEASE CONTACT YOUR CORRESPONDENT:

Since June 2012, all four eQHealth locations have seen many new faces join the company. Please welcome these newest members to our company: HealthSystems of Mississippi: Clements, MackGregory, Glen HThomas, Makeba C

eQHealth Solutions Illinois: Degen, SheilaHillyer, GayleHughes, Vickie LKaufmann, CarolMusielak, Margaret MOve, DebraTribble, Dawn

eQHealth Solutions Louisiana:Anderson-Graves, SarahBroussard, DeeAnnDigman, DeborahGallion, Renee Gardner, Tamika Gatlin, ChristineHolmes, Ebony YJablonski, DonnaMcCall, DonaldMoore, Holley EPrice, CalendraSmith, KingsleyTraylor, Amy

eQHealth Solutions Florida: Bielawski, Dawn RBillups, Jacqueline A Bray, Joanne B Buckley, Maureen B Burke, Carla MFlood, Daniel KGriffiths, Kemesha NHayes, Sean PHorvath, Elizabeth AHoward, Caroline MHoward, Tanya BKarol, Adrienne LKrueger, Karin ALawrence, VeronicaLovick, Vivian NMarcos, YeslinMercado, MichaelPerez, RosalidiaReyes, Cindia JRamirez, SaraiRomero, AlinaRunick, ElizabethSegui, Sonia MTeele, Robert GWasik, Suzanne MWaters, Tanja T

WELCOME ABOARD

Bob JohannessenLouisiana

Rose SernoIllinois

Becky RauMississippi

Cheryl Collins Florida

ext. 3259 ext. 5113

ext. 4901

ext. 6805

s o l u t i o n s

Florida Illinois

LouisianaMississippi

Emily MastrantonioEditor

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