healthcare

Fall Priorities to Better Engage Healthcare Consumers and Prepare for a Healthy 2018

Happy Fall! Autumn is a time for closing those last quarter gaps in care, encouraging flu immunizations, and planning for the health plan 2018 benefit year. Here are some quickly-deployable Eliza health engagement management solutions that can reduce costs and improve outcomes and the member experience that you might find valuable this fall.

Welcome and Onboarding – First impressions are lasting. Timely and relevant conversations are designed to get to know your members and capture critical information to make the healthcare journey successful while building loyalty and enhancing satisfaction. The welcome outreach is also an optimal time to conduct a Health Risk Assessment and connect members to plan resources. Some results delivered to clients include:

  • 4x improvement in HRA completion
  • $625,000 in savings by using email instead of mail

Marketplace plans – don’t wait until January to start outreaching to new members. 15% of Marketplace enrollees fail to make their first premium payment and never effectuate their enrollment. Get ahead of this problem by welcoming members to the plan before their benefit year starts and remind them to make that first payment to ensure they’re covered on January 1. For more information on the importance of Marketplace Payment Reminders, check out this blog post.

Flu Shot Reminders – This preventive health reminder is a quick and effective way to drive behavior and address barriers around the vaccination. One client increased its CAHPS scores 12% over the previous year thanks to increased flu shot rates. Another client reported increasing flu shot rates by 34% over a control group. Eliza’s approach allows you to:

  • Debunk some persistent myths about the flu shot (46% of people asked believe the flu shot causes the flu).
  • Point members to appropriate resources, whether it’s their provider, a local drug store, or an on-site flu clinic.

Risk Surveys – Eliza offers off-cycle HOS and CAHPS surveys to support health plan interventions and member-specific information to create targeted actions for improvement. Some Medicare Advantage plans have seen 15 - 20% increases in HOS and CAHPS scores, and Star measure improvements by 2-3 Stars.

Year-end Gap Closure – Eliza’s year-end gap closure programs provide a last-minute push to close critical gaps in care and improve quality ratings. Members are notified of any care gaps and educated on the importance of health screenings. If they need help scheduling an appointment they can be transferred to plan resources or Eliza’s live agents. In just two months, Eliza assigned 162 members to PCPs and scheduled over 1,700 appointments to close care gaps.

For more information on these solutions or for help with any of your other health engagement management needs, contact us at eliza@hms.com or 1.844.343.1441.

Mental Health and the Weight of Depression

May is Mental Health Month and since psychiatric conditions affect one in every five U.S. adults and teenagers, every opportunity to build awareness and reduce the stigma that still surrounds them can be helpful.1,2 In this post, we focus on major depression, which affects nearly 7% of adults each year in the U.S., making it one of the most common psychiatric conditions in the country.3,4  

Depression is so widespread that its outsized economic impact hits the national wallet hard. One study found that depression costs society $210 billion each year when disorders associated with it are included in the calculation.5 About half of that amount is attributable to workplace costs, like presenteeism.5 Presenteeism occurs when a depressed employee goes to work, but has limited productivity due to his or her depression symptoms. Given that depression symptoms can make it difficult to stay motivated and can harm a person’s ability to maintain relationships, its workplace impacts are not surprising. Depression-related presenteeism causes a loss of about 32 annual workdays for the average person suffering from the condition.5 It represents more than a third of the economic burden of people who have major depression.5

The healthcare system also struggles under the weight of depression in the U.S. The supply of psychiatrists and inpatient psychiatric beds has been shrinking for years, even as the population of people with psychiatric disorders has grown.6 A study published last year found that from 2003 to 2013, the number of practicing psychiatrists in the U.S. declined by more than 10-percent.7 Between 2010 and 2016, the number of inpatient psychiatric beds available in the United States fell by around 17-percent.8 This translates into reduced access to mental healthcare even when barriers like cost, uninsurance, and a lack of transportation are adequately addressed.

The challenges don’t end there. When people are able to access the care they need, they often struggle to adhere to their treatment plans. About 50-percent of patients receiving antidepressant therapy discontinue treatment prematurely for a variety of reasons.9 And there are some unique treatment adherence hurdles associated with depression that aren’t generally issues in the treatment of physical conditions in the absence of psychiatric comorbidities. For example, depression can (although does not always) negatively affect a patient’s decision-making abilities and cognition. Stigma is a factor that can affect the way a patient perceives his or her condition. It can also impact whether patients believe medication could be useful to them. Fear that antidepressants are addictive or can alter personality adds additional potential for treatment nonadherence.10

Nonadherence in psychiatry is associated with poorer outcomes, such as suicide and costly inpatient hospital stays.11 The challenge is to help members improve their adherence to antidepressant treatment by attending to the distinctive challenges presented by stigma and the negative effects depression can have on motivation, cognition, and decision-making. While a trusting patient-provider relationship can protect against nonadherence,11,12 there are effective outreach strategies that can help close adherence gaps once they occur. Eliza’s health engagement management strategies and multi-channel solutions have proven to be successful in closing HEDIS antidepressant medication management gaps.  

Using theory- and focus group-informed, targeted outreach, an Eliza solution achieved a 13-percent increase in antidepressant adherence for a payer with a large Medicaid population by delivering the right message to the right members at the right time.

Antidepressant medication management is just one of Eliza’s behavioral health solutions that helps payers improve outcomes and engage members. For more information on Eliza’s behavioral health programs, contact us at info@elizacorp.com or 1.844.343.1441.
 

Dr. Gaiser holds a PhD and MA in Health Policy, both from Brandeis University, an MPH with a concentration in Health Communication from Tufts University School of Medicine, and a BA in Journalistic Communication from Purdue University. Her doctoral research examined shared medical decision-making (SDM) for antidepressant treatment. The study also examined how SDM and patient-provider trust affect treatment acceptance for 3 chronic conditions. Melanie has additional content expertise in behavioral health and healthcare cultural competence. Her work in broadcast and print journalism spanned more than a decade in the local (Boston), national, and international arenas.

In her role as Manager of Engagement Research and Strategy at Eliza, Melanie focuses on strategic research and development for Eliza’s Health Engagement Design group. She combines her diverse experience in research methodology, sales, and communication to serve as a boundary spanner, facilitating collaborative partnerships between Eliza’s technical, science, and creative groups.

A dog-obsessed Francophile, Melanie enjoys gardening, traveling, writing, and hiking in search of alpine waterfalls. She geeks out by reading about food policy issues and behavioral economics.

 

References

  1. National Institute of Mental Health. (n.d.). Any mental illness (AMI) among U.S. adults. Retrieved from https://www.nimh.nih.gov/health/statistics/prevalence/any-mental-illness-ami-among-us-adults.shtml
  2. National Institute of Mental Health. (n.d.). Any disorder among children. Retrieved from https://www.nimh.nih.gov/health/statistics/prevalence/any-disorder-among-children.shtml
  3. National Institute of Mental Health. (n.d.). Major depression among adults. Retrieved from https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml
  4. National Institute of Mental Health. (n.d.). Depression. Retrieved from https://www.nimh.nih.gov/health/topics/depression/index.shtml
  5. Greenberg, P., Fournier, A., Sisitsky, T., Pike, C., & Kessler, R. (2015). The economic burden of adults with major depressive disorder in the United States (2005 and 2010). Journal of Clinical Psychiatry, 76(2), 155-162. doi: 10.4088/JCP.14m09298
  6. American Hospital Association. (2012). Trendwatch – Bringing behavioral health into the care continuum: Opportunities to improve quality, costs and outcomes. Washington, DC: author.
  7. Bishop, T., Seirup, J., Pincus, H., & Ross, J. (2016). Population of US practicing psychiatrists declined, 2003-2013, which may help explain poor access to mental health care. Health Affairs, 35(7), 1271-1277. doi: 10.1377/hlthaff.2015.1643
  8. Fuller, D., Sinclair, E., Geller, J., Quanbeck, C., & Snook, J. (2016). Going, going, gone: Trends and consequences of eliminating state psychiatric beds, 2016. Arlington, VA: Treatment Advocacy Center. Retrieved from http://www.treatmentadvocacycenter.org/storage/documents/going-going-gone.pdf
  9. Sansone, R., & Sansone, L. (2012). Antidepressant adherence: Are patients taking their medications? Innovations in Clinical Neuroscience, 9(5-6), 41-46. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398686/
  10. Chakraborty, K., Avasthi, A., Kumar, S., & Grover, S. (2009). Attitudes and beliefs of patients of first episode depression towards antidepressants and their adherence to treatment. Social Psychiatry and Psychiatric Epidemiology, 44(6), 482-488. doi: 10.1007/s00127-008-0468-0
  11. Chapman, S., & Horne, R. (2013). Medication nonadherence and psychiatry. Current Opinion in Psychiatry, 26(5), 446-452. doi: 10.1097/YCO.0b013e3283642da4
  12. de las Cuevas, C., de Leon, J., Penate, W., & Betancort, M. (2017). Factors influencing adherence to psychopharmacological medications in psychiatric patients: A structural equation modeling approach. Patient Preference and Adherence, 11, 681-690. doi: 10.2147/PPA.S133513

Health Engagement: One Size Doesn’t Fit All

If you spend more for something, you expect better quality, right?

According to the Commonwealth Fund’s latest view of Medicare spending per capita vs. overall quality score, the data says otherwise for many states.  For example:

  • Louisiana has 25% higher spending than the national average, but their quality is 14% lower than the average
  • In New Jersey, the per capita spending is $9,587 vs. Oregon is only $6,380

What about those states that score high (average 4-5 STARS) on Medicare Advantage STAR scores such as Michigan, Massachusetts, and Illinois?  Their overall numbers may not be as low as Texas, Louisiana, and Florida, but their costs are still high versus quality.

  • Michigan: $9,521 per capita spending with 11% higher in spending, for only 1% improvement in quality over the national average.

The overall view that combines hospitals, doctor’s offices, home health, and nursing home numbers is below.  You can see there is almost a slight tip to the south and east- a bit of a corridor. Blog - 7.16_1

It gets even more interesting when you look at the subgroups like home health.  Some of the states that had a normal rating overall, quickly slip when you look at home health on its own. See below: Blog - 7.16 (2)

When home health is viewed on its own a few staggering data points float to the top:

  • Texas: 182% higher spending and 2% lower quality
  • Florida: 148% higher spending for only 5% higher quality

How are payers, providers, and other healthcare entities changing the game?

Interestingly enough, PBS just published a series on a quiet revolution that has a goal of improving care while at the same time lowering cost.  In fact, the caregivers they highlighted focus on listening and putting the patient at the center of care from Maine to Mississippi, all the way to Alaska, and they are caring in the way that makes sense for their community.  This means house calls in small town Maine, a mixture of traditional and spiritual methodology in Alaska, and a hospitable approach in San Francisco.

Eliza takes a similar approach to solving client and patient problems.  Through conversations- whether on the phone, over email, or through a text, Eliza uncovers barriers to better quality, better outcomes, and improving costs.  We do this by tailoring our programs to meet the needs of our clients and the people they serve.

At Eliza, we know that one size does not fit all.

For example, in a recent preventive screening outreach to Medicare members, Eliza was able to not only improve completed screenings, but also uncover barriers such as transportation challenges, concerns about comfort, and even apathy.

Blog - 7.16 (2) 

By taking a conversational approach to healthcare, a laser-focus on peoples’ motivations, their concerns, and their reactions to the initiatives supported, Eliza knows what makes people “tick” – and the technology and content constantly are fine-tuned to honor consumers’ unique challenges and preferences to effect small changes in behavior across different populations. These small changes lead to better engagement and better outcomes. As a result, Eliza is uniquely qualified to deliver more granular data to clients about how people are behaving. Eliza also is able to refine recommendations and implement strategies that leverage this data in order to drive desired outcomes for clients.

To learn more about Eliza’s preventive screening solution, or any of our Eliza for Medicare solutions, please contact us at info@elizacorp.com or 1.844.343.1441.

 

King v. Burwell: As we get closer, the top 5 things to know

Despite it not being its own agenda item, the topic of King v. Burwell is being discussed over coffee, in the exhibit hall, and during Q&A sessions at AHIP Institute 2015.  Here are the top 3 items to know about King v. Burwell and the impact on millions of Americans:

  1. Small plans that operate in federally subsidized states are at risk of staying afloat, and members receiving those subsidies will more than likely be unable to afford coverage.
    1. “If the Court rules against the administration and says that language in the Affordable Care Act only provides subsidies to people enrolled in coverage in states that set up their own marketplaces, some 7.5 million people in the 34 states relying on the federal exchange would lose their subsidized coverage.
  2. Populous states like Texas and Florida will see an average premium increase if tax credit is not available of 294%-382%
  3. Most Americans who may lose their coverage are not fully aware of what may change in their payments, or what this means for the health of them and their families
  4. According to McKinsey’s 2015 Insight into consumer behavior report, those who are newly insured under the ACA want to be insured and they see value. They have a positive attitude towards health insurance and want their kids to get the preventative care they need.

KvB_blog_6.5.15  

  1. The states that will be impacted if the Supreme Court in favor of King represent a huge population and will impact the financial health of the states they live in.

Number of People at Risk of Losing Subsidies

KvB2_blog_6.5.15

Eliza has solutions for qualified health plans no matter which way the Supreme Court rules. These solutions include retention, payment reminders, and more. Request a mini-case study on any of these topics.

Julie Viola joined Eliza’s Product Marketing team in the fall of 2014.  Prior to Eliza, Julie was at Philips Healthcare for 9 years where she honed her expertise in ER utilization, Patient Safety, and emerging Population Health Management topics such as Community Paramedicine,Care Coordination, and Condition Management.

Julie has a Bachelor’s of Fine Art from the University of Massachusetts at Amherst. She serves on several non-profit board of directors and advisory boards including the Trustees of Reservations and The Massachusetts Oyster Project.

 

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