Difference between revisions of "E Interventions"

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(Created page with "==General Patient Services== This is about how people can relate to the patient. ==Clinical Condition Services== ===Behavioral Health=== Deal with stress, health coach to hel...")
 
(Comprehensive Patient Programs)
 
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==General Patient Services==
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[http://www.health3-0.com/reimbursement/healthcare-progress-depends-on-e-interventions/#sthash.u3CnPZD6.dpuf '''E Interventions'''] are patient recovery interventions which:
This is about how people can relate to the patient.
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* receive no reimbursement from traditional health insurance
 +
* likely will improve patient outcomes and reduce overall cost
  
==Clinical Condition Services==
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[http://www.health3-0.com/reimbursement/ready-for-medicare-part-e/ '''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.
===Behavioral Health===
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Deal with stress, health coach to help with change
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===Comorbidities (Disease Management)===
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Disease Management
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===Genome===
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Testing and analysis
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===Immunizations===
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===Physiological Metrics===
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===Problem lists===
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Non-emergency problems
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==Functional Condition Services==
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==Comprehensive Patient Programs==
===Basic Physical===
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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.
Feeding, grooming, bathing
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===Transitional Care===
===Basic Life Activities===
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Transition of care from a Emergency Room, hospital stay, skilled nursing or rehabilitation stay
Prepare food and clean home
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===Intensive Care===
* Meals on Wheels
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Intensive care team that addresses the needs of patients in the top 5% of healthcare spenders
* Adult Day Care
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===Chronic Care===
* PACE Program
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Chronic care support to address chronic conditions
===Logistic Capabilities===
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===Palliative Care===
Assist with walking, use of stairs, wheel chair
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Palliative Care is addressing what is most important to the patient to help enable their well-being rather then more aggressive actions or long term preventive therapies.
===Work===
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===Care Gaps & Follow-ups===
Able to function at work
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Identify and address gaps in care and followup to ensure actions are taken.
===Passion===
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Abel to pursue passion
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===Mental===
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Not prevented from basic function (i.e., fear)
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==Care Coordination==
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* Patient Navigator
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* Administrative support - book appointments, find services
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* Patient reminders
  
==[[Patient Behavior Factors|Patient Behavior]]==
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==Caregiver Support==
[[Patient Behavior Factors|Patient behavior factors]] are elements of the [[Social and Behavioral Factors|social and behavioral factors]] in [[Patient Recovery|patient recovery]].
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* Education
===Physical Activity===
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* Respite Care
Physical Trainer, therapists, Exercise and Activity Levels
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* Family Caregiver certification
====Nutrition====
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Dietitian - Diet and Nutrition
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====Social Interactions====
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Support groups and social activities, engagement with others
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* Address Social Isolation
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* Organized Communities - like [http://www.patientslikeme.com/ '''PatientsLikeMe''']
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====Adverse Behaviors====
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Addiction programs, smoking cessation. Adverse Behaviors (use of alcohol, drugs, gambling, unprotected sex, smoking)
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==[[Patient Preferences Factors|Patient Preferences]]==
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==Community Hub==
===Authorizations===
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* Community Health Worker
* Privacy and HIPAA
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* Legal Assistance
* Advanced Beneficiary Notice
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* Meals on Wheels
* Recovery Team Access to Electronic Medical Records
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* Programs - Smoking Cessation Programs, Alcohol Anonymous
===Living Will===
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* Homelessness - temporary housing or shelters
* Advanced Patient Directives [http://www.mydirectives.com/ '''My Directives offers a free online, HIPAA compliant service''']
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* Jobless
===Establish Treatment Preferences===
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* Food pantries, housing and utilities subsidies
* Home Based
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* Recovery Team
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* Technology Use
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* Palliative Care and End of Life preferences
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==[[Patient Activation Factors|Patient Activation Education]]==
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==Education==
[[Patient Activation Factors|Patient activation factors]] are elements of the [[Social and Behavioral Factors|social and behavioral factors]] in [[Patient Recovery|patient recovery]].
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* Online education video
===Condition Management Aptitude===
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* One on one education
* Diabetic monitoring glucose and injecting insulin
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* Programs
* Self-care
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* How to use technology
===Education===
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* Health Apps
* Diagnosis
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* Prognosis
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* Treatments
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* Understand Options and onboard with the treatment plan
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===Treatment Adherence===
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* Medication Adherence
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* Nutrition
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* Therapy, Physician Visits
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* Recommended Activity levels
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===Intervention Activation===
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* Know when to ask for help
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* Comfortable asking for help
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* Know who to ask for help
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==[[Patient Technology Adoption Factors|Patient Technology Adoption]]==
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==Financial Counseling==
===Device Aptitude===
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* Disability or Medicaid Applications
* Use of remote monitoring devices (Blood Pressure cuff)
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* Medicine discount programs
* Use of remote diagnostic devices (ecg app)
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* Debt, financial constraints
* Use of tablet, computer or smartphone
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===Technology Aptitude===
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* Internet and Online Usage
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* Education Videos
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* Patient Portal Usage
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* Use of Secure Texting, Video Conferencing, email
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===Online Personal Health Record===
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* Online Electronic Health Record
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* Access Authorization (Recovery Team access) 
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* Patient Input History (Patient answer questions or inputs data into Personal Health Record)
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===Available Technology===
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* Broadband Internet
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* Wifi Router
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* Computer
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* Smartphone or Tablet
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* Remote Monitoring Devices (Blood pressure cuff, blood glucose monitoring)
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* Remote Diagnostic Devices (ECG app)
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==[[Socioeconomic Status Factors|Socioeconomic Status]]==
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==Medication Support==
[[Socioeconomic Status Factors|Socioeconomic status factors]] are elements of the [[Basic Needs Factors|basic needs factors]] in [[Patient Recovery|patient recovery]].
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* In-home Medicine reconciliation
===Financial Health===
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* Pharmacist support
* Income,
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* Medication Adherence - reminders,electronic pill boxes
* Resolve financial or debt issues
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* Medicine home delivery
===Job Status===
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* Getting a job
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===Education===
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* Continuing education
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* Literacy
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===Medical Insurance Status===
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* Apply for insurance
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 +
==Nutrition Support==
 +
* Registered dietitians
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* Education and cooking instructions and classes
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* Assess/triage eating disorders and other barriers (i.e., financial, access to fresh food) preventing healthy nutrition
  
==[[Physical Environment & Setting Factors|Physical Environment & Setting]]==
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==Psychosocial==
[[Physical Environment & Setting Factors|Physical environment & setting factors]] are elements of the [[Basic Needs Factors|basic needs factors]] in [[Patient Recovery|patient recovery]].
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* Health Coach
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* Social Worker
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* Qualified Option development
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* Goal setting
  
===Home===
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==Remote Patient Monitoring==
Location (proximity to services), Heat and Air conditioner, supportive
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* Monitoring patient information (physiological metrics, activities, etc.) by a support team
Safety
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* Interactive Voice Response (IVR) System
* Home repair, renovations and maintanance
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* Personal Emergency Response System (PERS)
===Facility - Supportive===
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* Mobile Apps and user provided input
* Evaluating Facilities Services (Nursing home, senior living center, etc.)
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* Triggers, Notification, Associated Action, Escalation
===Temporary Housing===
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* Homeless Shelters, Victims Centers
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===Equipment & Technology Services===
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* Therapy Equipment (Oxygen equipment)
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* Passive Sensors (wifi enabled weight scale, blue tooth enabled blood pressure cuff)
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* Internet connection - wifi router
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===Temporary Housing Services===
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* Homeless Shelters
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* Victims Centers
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==Site of Patient Services==
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* Home Assessments
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* Nurse Practitioner visits
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* Home support services (i.e., cleaning, maintenance, repairs)
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* Delivery services
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* Other visits (Community Health Worker, Social Worker, Health Coach)
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* 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).
  
==[[Access & Logistics Factors|Access & Logistics]]==  
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==Technology and DME Support==
===Necessities Access===
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* Technology could include use of blood pressure device, wifi router or laptop computer
(via delivery or going to the store)
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* Durable Medical Equipment (DME) devices such as oxygen that are not reimbursed
* Medicines
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* In home set-up, training and 24x7 support
* Food (via delivery or going to the store)
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* Other
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===Transportation===
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* Physician Offices
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* Special Transportation Needs (Wheel Chair Vehicle)
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===Clinical Services Access===
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* Same day access to Physicians
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* Nights & Weekend Access to providers
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* Clinical Care in area, region (i.e., dialysis)
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==[[Recovery Team Factors|Recovery Team]]==
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==Transportation==
===Clinical Providers===
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* Rides to physician offices or other need services
These are licensed professionals.
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* Physicians
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* Physician Assistants, Nurse Practitioners
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* Pharmacists
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* Therapists (Speech, Physical, Occupational}
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* Behavior Health (Psychologist, Psychiatrist)
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* Nurse (Care Manager)
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* Dietitian
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* Education Providers (Clinical)
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===Support (Social and Behavioral) Providers===
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* Care givers (Family or fried)
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* Recovery Navigator (patient navigator)
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* Recovery Coaches (included MSW Social Workers and Health Coaches)
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* Education (Non-Clinical)
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* Technical Support and technicians
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===Community (Basic Needs) Providers===
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* Financial Counseling
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* Meals Delivery (Meals on Wheels)
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* Transportation Assistance
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* Programs (Smoking Cessation, Weight Loss, Alcoholics Anonymous)
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* Delivery Services
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* Transportation Services
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* Other Services (handy man, plumber, etc.)
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* Community Health Services (Community Health Centers, free flu shots, etc.)
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* Convenient Care (Minute Clinics, 24 hour services)
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+
 
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===[[Recovery Plan Factors|Recovery Plan]]===
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===Discovery===
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* Clinical Consults
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* Qualified Option Development
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* Testing
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===Treatments===
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* Medicine
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* Procedures
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* Surgery
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* Therapies (Occupational Therapy, Speech, Physical Therapy)
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===Activities===
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* Nutrition
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* Education
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===Recovery Navigation===
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==[[Recovery Monitoring Factors|Recovery Monitoring]]==
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==Virtual Consults==
===Activities Monitoring===
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* Telepsych visits
* Track Recovery Plan to ensure activities, treatments are on track
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* Physician or Nurse Practitioner eVisits (informed and uninformed)
===Medication Monitoring===
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* Telecare Nurse
* Adverse Medication Events
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* Prescriptions Filled
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* Medication Adherence
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* Medication Effectiveness
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* Medication Interactions
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===Medication Monitoring Method===
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* Daily Calls
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* Patient checks box or inputs data
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* Passive sensor (wifi enabled pill boxes or caps)
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===Physiological Metrics Monitoring===
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* Blood Pressure
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===Recovery Reviews===
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* Status of Surgeries, Procedures, Tests, Therapies, etc.
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* Effectiveness or Treatments and Activities
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* Effectiveness of recovery team
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* Effectiveness of Protocols
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* Appropriateness of Recovery Goals
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Latest revision as of 11:20, 12 July 2014

E Interventions are patient recovery 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.

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 chronic conditions

Palliative Care

Palliative Care is 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.

Care Coordination

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

Caregiver Support

  • Education
  • Respite Care
  • Family Caregiver certification

Community Hub

  • 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

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

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

Psychosocial

  • Health Coach
  • Social Worker
  • Qualified Option development
  • Goal setting

Remote 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

Site of Patient Services

  • Home Assessments
  • Nurse Practitioner visits
  • 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).

Technology and DME 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 Consults

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