Difference between revisions of "E Interventions"
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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 that: | |
* receive no reimbursement from traditional health insurance | * receive no reimbursement from traditional health insurance | ||
* likely will improve patient outcomes and reduce overall cost | * likely will improve patient outcomes and reduce overall cost | ||
Revision as of 14:06, 16 May 2014
E Interventions are patient recovery interventions that:
- 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 (health plan) or Part D (medicines) reimbursement. Most health plans are based on Medicare fee schedules, so it is unlikely they will provide reimbursement either. Similar interventions may qualify for reimbursement (like home health), yet they comes with stipulations that may not suit the patient situation. It could mean a patient staying 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 General Patient Services
- 2 Clinical Condition Services
- 3 Functional Condition Services
- 4 Patient Behavior
- 5 Patient Preferences
- 6 Patient Activation Education
- 7 Patient Technology Adoption
- 8 Socioeconomic Status
- 9 Physical Environment & Setting
- 10 Access & Logistics
- 11 Recovery Team
- 12 Recovery Monitoring
General Patient Services
This is about how people can relate to the patient.
Clinical Condition Services
Behavioral Health
Deal with stress, health coach to help with change
Comorbidities (Disease Management)
Disease Management
Genome
Testing and analysis
Immunizations
Physiological Metrics
Problem lists
Non-emergency problems
Functional Condition Services
Basic Physical
Feeding, grooming, bathing
Basic Life Activities
Prepare food and clean home
- Meals on Wheels
- Adult Day Care
- PACE Program
Logistic Capabilities
Assist with walking, use of stairs, wheel chair
Work
Able to function at work
Passion
Abel to pursue passion
Mental
Not prevented from basic function (i.e., fear)
Patient Behavior
Patient behavior factors are elements of the social and behavioral factors in patient recovery.
Physical Activity
Physical Trainer, therapists, Exercise and Activity Levels
Nutrition
Dietitian - Diet and Nutrition
Social Interactions
Support groups and social activities, engagement with others
- Address Social Isolation
- Organized Communities - like PatientsLikeMe
Adverse Behaviors
Addiction programs, smoking cessation. Adverse Behaviors (use of alcohol, drugs, gambling, unprotected sex, smoking)
Patient Preferences
Authorizations
- Privacy and HIPAA
- Advanced Beneficiary Notice
- Recovery Team Access to Electronic Medical Records
Living Will
- Advanced Patient Directives My Directives offers a free online, HIPAA compliant service
Establish Treatment Preferences
- Home Based
- Recovery Team
- Technology Use
- Palliative Care and End of Life preferences
Patient Activation Education
Patient activation factors are elements of the social and behavioral factors in patient recovery.
Condition Management Aptitude
- Diabetic monitoring glucose and injecting insulin
- Self-care
Education
- Diagnosis
- Prognosis
- Treatments
- Understand Options and onboard with the treatment plan
Treatment Adherence
- Medication Adherence
- Nutrition
- Therapy, Physician Visits
- Recommended Activity levels
Intervention Activation
- Know when to ask for help
- Comfortable asking for help
- Know who to ask for help
Patient Technology Adoption
Device Aptitude
- Use of remote monitoring devices (Blood Pressure cuff)
- Use of remote diagnostic devices (ecg app)
- Use of tablet, computer or smartphone
Technology Aptitude
- Internet and Online Usage
- Education Videos
- Patient Portal Usage
- Use of Secure Texting, Video Conferencing, email
Online Personal Health Record
- Online Electronic Health Record
- Access Authorization (Recovery Team access)
- Patient Input History (Patient answer questions or inputs data into Personal Health Record)
Available Technology
- Broadband Internet
- Wifi Router
- Computer
- Smartphone or Tablet
- Remote Monitoring Devices (Blood pressure cuff, blood glucose monitoring)
- Remote Diagnostic Devices (ECG app)
Socioeconomic Status
Socioeconomic status factors are elements of the basic needs factors in patient recovery.
Financial Health
- Income,
- Resolve financial or debt issues
Job Status
- Getting a job
Education
- Continuing education
- Literacy
Medical Insurance Status
- Apply for insurance
Physical Environment & Setting
Physical environment & setting factors are elements of the basic needs factors in patient recovery.
Home
Location (proximity to services), Heat and Air conditioner, supportive Safety
- Home repair, renovations and maintanance
Facility - Supportive
- Evaluating Facilities Services (Nursing home, senior living center, etc.)
Temporary Housing
- Homeless Shelters, Victims Centers
Equipment & Technology Services
- Therapy Equipment (Oxygen equipment)
- Passive Sensors (wifi enabled weight scale, blue tooth enabled blood pressure cuff)
- Internet connection - wifi router
Temporary Housing Services
- Homeless Shelters
- Victims Centers
Access & Logistics
Necessities Access
(via delivery or going to the store)
- Medicines
- Food (via delivery or going to the store)
- Other
Transportation
- Physician Offices
- Special Transportation Needs (Wheel Chair Vehicle)
Clinical Services Access
- Same day access to Physicians
- Nights & Weekend Access to providers
- Clinical Care in area, region (i.e., dialysis)
Recovery Team
Clinical Providers
These are licensed professionals.
- Physicians
- Physician Assistants, Nurse Practitioners
- Pharmacists
- Therapists (Speech, Physical, Occupational}
- Behavior Health (Psychologist, Psychiatrist)
- Nurse (Care Manager)
- Dietitian
- Education Providers (Clinical)
Support (Social and Behavioral) Providers
- Care givers (Family or fried)
- Recovery Navigator (patient navigator)
- Recovery Coaches (included MSW Social Workers and Health Coaches)
- Education (Non-Clinical)
- Technical Support and technicians
Community (Basic Needs) Providers
- Financial Counseling
- Meals Delivery (Meals on Wheels)
- Transportation Assistance
- Programs (Smoking Cessation, Weight Loss, Alcoholics Anonymous)
- Delivery Services
- Transportation Services
- Other Services (handy man, plumber, etc.)
- Community Health Services (Community Health Centers, free flu shots, etc.)
- Convenient Care (Minute Clinics, 24 hour services)
Recovery Plan
Discovery
- Clinical Consults
- Qualified Option Development
- Testing
Treatments
- Medicine
- Procedures
- Surgery
- Therapies (Occupational Therapy, Speech, Physical Therapy)
Activities
- Nutrition
- Education
Recovery Monitoring
Activities Monitoring
- Track Recovery Plan to ensure activities, treatments are on track
Medication Monitoring
- Adverse Medication Events
- Prescriptions Filled
- Medication Adherence
- Medication Effectiveness
- Medication Interactions
Medication Monitoring Method
- Daily Calls
- Patient checks box or inputs data
- Passive sensor (wifi enabled pill boxes or caps)
Physiological Metrics Monitoring
- Blood Pressure
Recovery Reviews
- Status of Surgeries, Procedures, Tests, Therapies, etc.
- Effectiveness or Treatments and Activities
- Effectiveness of recovery team
- Effectiveness of Protocols
- Appropriateness of Recovery Goals
