E Interventions

"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.

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

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)

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