Case Management Program, Leonard J. Chabert Medical Center
At Leonard J. Chabert Medical Center, the Medicaid population is the largest payer source at 42 percent. A shining example of how the case management program is working to improve outcomes can be found in their program to reduce readmissions in patients with CHF. Upon review, it was noted that only 38 percent of the patients had documented discharge instructions. As a result, an action plan was created in which the quality management nurses would make daily rounds to identify CHF patients. The compliance rate rose to 97 percent. Furthermore, the facility’s readmission rate is 12.5 percent.
Medicaid Case Management, Network Health
Network Health’s integrated case management program offers a unique, multidisciplinary approach to managing healthcare services for members with complex care issues, as well as extensive screening of members at risk for complex care issues. Based on members’ most critical needs, a medical, behavioral health or social case manager is designated as the lead to work with them. This collaborative approach allows the integrated case team to jointly manage cases and to partner with members, their providers and their family caregivers throughout the continuum of care. Outcomes have shown increased in engagement rates and decreases in 30-day readmission rates of 11 percent and ED utilization of 4 percent.
Personal Assistance Line (PAL) Unit, SCAN Health Plan
Being poor, elderly and afflicted with chronic disease can be challenging enough. In addition, navigating the complexities of two government healthcare programs could break the will of even the strongest individual. To meet the diverse needs of this population, SCAN Health Plan created the “Personal Assistance Line” to help seniors get the care they need while relieving the anxiety of being a “Dual.” Experts provide case management services to dual-eligible members, and act as a central contact to provide assistance relating to eligibility and benefits, successfily working to resolve challenges.
Military Case Management
New Horizons’ AFW2, 48th MDG, RAF Lakenheath, USAFE
The “New Horizons” program was developed to assist Wounded Warriors (W2) to cope with issues related to post-traumatic stress disorders. This program provides support and education about the stressors that can be associated with being a W2. It covers topics such as trauma and recovery, PTSD, Veterans Affairs benefits and stressors related to being a W2 and the impact on a marriage. The positive benefits seen by the participants include giving the W2s tools to help transition back to full time duty while letting the servicemen and women know they were not along.
After a three-month period, the outcomes include improved relationships at home and work. Medical staff report feeling a renewed interest and energy in their job. The war on terrorism has forced the military to respond by sending the best and the brightest in harm’s way. Mrs. O’Garro, the person responsible for the development of the program, has assured the impact on our returning W2s is kept to a minimum by offering timely intervention. She saw the need and has answered the call to service by assuring our W2 have the necessary support and programs readily accessible and available.
Case Management Program, TriWest Healthcare Alliance
TriWest Healthcare Alliance, the West Region contractor for the TRICARE military healthcare program, maintains a 24/7 behavioral health crisis line service. This service provides a broad array of services to military beneficiaries. In addition to the 24/7 telephonic crisis line, services also include a behavioral health web portal, which has extensive information about various behavioral health topics relevant to the military population including post-traumatic stress disorder (PTSD), stress, depression and parenting. The crisis line services expanded to include non-medical, web-based, video-teleconferencing counseling services, accessible 24 hours a day, seven days a week.
Major Don Smith, United States Air Force
Major Smith is a problem solver. Knowing that documentation was critical, he instituted a collaborative tool to ensure his case managers had a way to document program planning, implementation, outcomes tracking, monitoring and evaluation. After determining significant challenges, he recruited an information systems officer to help with development of a “Medical Management Database” using Microsoft Access. A comprehensive set of CM documentation tools and tracking methods for patient volume and acuity was developed within six months. This ingeniously designed “Medical Management Database” not only improved CM metrics, but also helped to decrease documentation workload by 200 percent. This tool is currently being implemented Air Force-wide.
Rehabilitation Case ManagementOnsite Vocational Counseling, Cigna
It began with a simple question, “Why not be proactive?” Using its integrated medical and disability plan model as its foundation, Cigna developed a comprehensive plan to help employees with physical, mental and cognitive challenges to stay at work, remain productive and avoid extended absences. The central node of the program is the Cigna vocational counselor, who works with the multidisciplinary team to ensure wellness, individually assess employees, provide education and training, and help clients integrate onsite stay-at-work services.
In a telling example, a Cigna vocational counselor was faced with a tough situation: an employee was diagnosed with cancer and hypertension and was on intermittent leave. After performing a work wellness assessment, totaling slightly over $200, the vocational counselor was able to help the employee stay at work and provided services to help him cope with his health. Without the intervention, the employer would have incurred a loss of more than $11,000. For all parties involved, it turned out to be a win-win situation.
Auto Injury Case Management, Careforward
Careforward uses seasoned case managers with expertise in auto injury and recovery to help ease the burden of recovery by providing options, tailoring treatments, and managing the details of care for clients and their caregivers. As part of the comprehensive coverage, case managers coordinate with all providers as they advocate for the patient in meeting the plan of care and all transitions – whenever and wherever they occur.
Rehabilitation Case Management Program, Sheltering Arms
By combining innovative technology and techniques with a highly skilled staff, Sheltering Arms works with patients to face their challenges with vigor. Sheltering Arms’ case managers organize their patients’ entire courses of care, and they work together with physicians and caregivers every step of the way. Because of their positive interventions, more than 80 percent of patients are discharged directly to home rather to a skilled or other long-term nursing facility.
Galit Liffshiz & Associates Inc.
A community-based rehabilitation company based on Ontario, Galit Liffshiz & Associates prides itself on creating positive outcomes for clients with motor vehicle accidents so they can return to a productive life at their optimal ability. It achieves these goals by in-home assessments via occupational therapy and case management, strong care-planning, coordinating diverse healthcare professionals, educating family members, and securing community resources. Its rapid growth speaks to the company’s success, as does its unadulterated reputation for doing things the right way.
Navigator Program, Partners in Senior Care Inc.
The Navigator Program developed by Partners in Senior Care Inc. addresses how independent assisting living facilities approach individual wellness and transitions of care with a goal to improve resident’s health, prevent hospitalizations and rehospitalizations, decrease disease exacerbations and successfully navigate transitions of care. A personal navigator (geriatric care manager) meets with each resident along with family members to perform an assessment and review “COMPASS Points” (cognitive, occupational, mental, physical, active, social and spiritual needs). A collaborative roadmap, a Passport to Wellness is developed along with short- and long-term goals to enhance independence and promote successful aging.
The navigator program has encouraged patients to increase participation in standard and WOW activities including exercise and walking, brain function, religious services, volunteerism and hydration programs. Outcomes for this program have been impressive. During the first quarter, hospitalization decreased by 66 percent as compared to 77 percent one year ago. Movement to higher level of care (or death) decreased by 67.5 percent. Eighty-one skilled Medicare days were saved for two residents alone.
The Nebraska Medical Center Wellness Program
The goal of the Nebraska Medical Center Wellness Program is threefold: to help employees achieve and maintain good health; to help manage healthcare costs; and to identify current health risks in an effort to prevent future illness and disease. Overall, from 2009 to 2010, participation in the health questionnaire completion jumped from 50 to 75 percent. The results in participation have been realized again through savings in medical plan expenses when comparing employee medical plan participant vs. nonparticipant costs. Programs include onsite fitness centers, health awareness and intervention programs, weight and diabetes management program targeted to diabetic or pre-diabetic employees, annual health questionnaires and health screening, newsletters, healthy living incentive programs and onsite massage therapy center.
The health risk report in 2010 showed an improved health status by lowering the percentage of employees with the following risks: high blood pressure, high LDL, low HDL and blood glucose levels. The report indicated that a lower percentage of employees use tobacco or have no exercise program from 2009 to 2010.
The Prevention Plan from U.S. Preventive Medicine
U.S. Preventive Medicine is a leader in the global preventive health movement focused on saving lives and money by keeping people healthy and better managing chronic conditions before they progress. The company’s innovative program called The Prevention Plan™, offers a personalized, health management program based on the clinical science of preventive medicine: primary, secondary and tertiary prevention. The Plan’s fully integrated approach is a more cost-effective and scalable approach than traditional wellness programs and is clinically proven to achieve better outcomes.
The Prevention Plan averages 55 percent participation and has achieved participation rates as high as 100 percent of the eligible population. One of the primary factors contributing to this high level of engagement is the Plan’s proprietary Prevention Score. A subcohort of 1,298 employees measured at baseline and then after two years of being on The Prevention Plan (2009 and 2010) showed reduction from high risk in 14 of 15 health risk factors. There was also a net movement from higher to lower overall health risk levels illustrating that the participants were able to maintain – and in many cases accelerate – health improvements over the longer term. After two years on The Prevention Plan, 72 percent of participants in this subcohort were at low overall risk compared to 58 percent at baseline; 23 percent were at moderate overall risk compared to 30 percent at baseline, and 5 percent were at high overall risk compared to 11 percent at baseline
Employee Wellness Program, Community Renewal Team Inc.
Community Renewal Team Inc. is a large human service organization, with more than 800 employees. Keying in on health, they have implemented a wellness program to keep their employees healthy as well as improve their overall health and safety awareness. This initiative has included physical activities, inoculations, a marketing campaign to increase self-knowledge, safety training programs, and stress-reduction opportunities, to name a few. To make the events fun, there are prizes and incentives for those who participate. Engagement rates grow as more and more activates are added.
Fluvention™, Centene Corp.
Centene Corporation offered Fluvention as an annual campaign to all members of each of its health plans to prevent or reduce the risk of influenza. To share the information within the company, the community and physician practices, the company uses an integrated communication approach that includes information via websites, posting information on provider offices and pharmacies and collaborating with community groups to host events where flu prevention is provided.
My Way to Wellness, United Health Care
My Way to Wellness, created for the Clark County School District staff, is a 12-month program that starts with an online Health Risk Assessment. The tool is reviewed with the health educator and areas of focus are identified that can be worked on. A wellness visit is scheduled with a PCP and each month participants receive a mission card that keeps them on target with their task. They are also connected to a wellness consultant to help set realistic goals and address challenges. Those who reach their goals are featured in a success story that goes out to all employees. The program was designed to ensure quality, consistency and motivation throughout the year.
Preventour, MMM Healthcare, Inc.
In response to the impact of the Affordable Care Act and the support of the new CMS 5 Start program to ensure individual participation in wellness and preventive services, MMM developed the Preventour, an initiative focused on offering six preventive screenings annually for members. Preventour consists of a mobile unit that travels through Puerto Rican service area, visiting one city per day for a period of six hours. The program fosters behavioral changes among members through health education and the establishment of health goals to achieve better quality of life.