Difference between revisions of "E Interventions"
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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. | [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. | ||
| + | |||
| + | ==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== | ==Care Coordination== | ||
| + | * Patient Navigator | ||
| + | * Administrative support - book appointments, find services | ||
| + | * Patient reminders | ||
| − | == | + | ==Caregiver Support== |
| + | * Education | ||
| + | * Respite Care | ||
| + | * Family Caregiver certification | ||
| − | ==Community | + | ==Community Hub== |
| + | * Community Health Worker | ||
| + | * Legal Assistance | ||
* Meals on Wheels | * Meals on Wheels | ||
| − | * Smoking Cessation Programs | + | * 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== | ==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 | |
| − | ==Remote Monitoring== | + | |
| − | * | + | |
| − | * Interactive Voice Response System | + | |
* Personal Emergency Response System (PERS) | * 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== | ==Transportation== | ||
| + | * Rides to physician offices or other need services | ||
| + | |||
| + | ==Virtual Consults== | ||
| + | * Telepsych visits | ||
| + | * Physician or Nurse Practitioner eVisits (informed and uninformed) | ||
| + | * Telecare Nurse | ||
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.
Contents
- 1 Comprehensive Patient Programs
- 2 Care Coordination
- 3 Caregiver Support
- 4 Community Hub
- 5 Education
- 6 Financial Counseling
- 7 Medication Support
- 8 Nutrition Support
- 9 Psychosocial
- 10 Remote Patient Monitoring
- 11 Site of Patient Services
- 12 Technology and DME Support
- 13 Transportation
- 14 Virtual Consults
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
