Social determinants of health was the hottest topic at RISE West 2018, an indication that in the upcoming year health plans will likely pursue models of care that aim to improve the health and quality of life of their members. Speaker Aaron Horsfield, administrative fellow, UPMC Health Plan, predicted that the industry will see rapid change in this area as more plans collaborate with community partners to address the housing and food needs of their patient populations.
PALM SPRINGS, CALIF.—More than 350 participants gathered at the La Quinta Resort & Club last week to attend RISE West 2018, where they networked and learned tips to address risk adjustment, quality ratings, coding, financial compliance, and audit readiness.
Here are highlights from a few of the most popular sessions:
Models of care to address social determinants of health
While there were only a couple of sessions specifically devoted to initiatives that health plans have taken to address their members’ social determinants of health, the topic frequently came up in other speaker presentations and networking sessions.
More and more health plans are beginning to pay attention to the impact a person’s lifestyle, living conditions, and employment have on his or her overall health and outcomes. Indeed, interest in social determinants of health is now so strong, one speaker predicted it will drive rapid change throughout the health care industry, a business that typically takes a wait-and-see approach to new models of care.
“I think we will see speed in change,” said Aaron Horsfield, MHA, MHP, administrative fellow, UPMC Health Plan, which provides housing support for a select number of its adult members who are chronically ill and homeless. Over the past eight years, the program has been able to provide housing to 90 members.
He expects more plans will see the benefits of collaboration with community partners to address housing and food needs of their patient populations.
But April Canetto, manager, Cultural and Linguistic Services, Health Net Inc., which has had success reducing health disparities, warned attendees not to expect immediate cost savings. Instead, she said, focus on the quality perspective. The return on investment is membership growth, quality, and cost reduction of “bad” costs, such as unplanned hospitalizations and readmissions.
Geisinger Health Plan has seen a reduction in those bad costs since the launch of its Fresh Food Pharmacy a year and a half ago for its diabetic patients who have a problem with food insecurity. As part of a case study that looked at the social determinant health programs at Geisinger, Michelle Passaretti, director of health management clinical operations, said that the plan has seen a 50% drop in emergency room visits and a 25% decline in hospital admission rates among those patients who take part in the program compared to those who don’t participate.
Many members must choose whether to feed their families or treat their diabetes, Passaretti said. In addition to educating the patients on how to self-manage the disease, the program allows the patients to visit the pharmacy once a week to get enough food to feed their families two healthy meals a day for four or five days a week.
Another way that health plans can address the medical and social needs of its members is to consider the home-delivered meal services of Mom’s Meals NourishCare, which can support long-term care services to help adults age in place, provide post-discharge meals for the two- to three-weeks after discharge to prevent readmissions, and help patients manage chronic conditions, such as uncontrolled diabetes.
During a roundtable discussion, Catherine Macpherson, MS, RDN, vice president, product strategy & development, chief nutritional officer, said that many plans offer the service as a covered benefit or as part of a discount program. The food program is not only an inexpensive intervention, but also a strong patient engagement tool, she said.
Strategies to improve Star ratings
Shortly before Ana Handshuh, vice president of managed care services, Ultimate Health Plans, was set to take the stage to discuss innovative approaches to improve Stars performance, she learned her plan had earned a 4 ½ star rating.
She attributes the high ranking to the fact that the entire staff is responsible for quality and their goal is to see improvements in member satisfaction, retention rates, and outcomes.
The plan is also “member-centric” and not “measure-centric.” This means it focuses on member goals and worries. Because members trust doctors more than they do big insurance companies, Ultimate Health Plans coordinates with providers to send out reminders or information about member preventive care benefits.
For example, to encourage members to get their flu shots, the plan posted signs in doctors’ offices that encouraged patients to ask about the flu shots and had staff give out magnets that reminded members to make an appointment for a vaccination for the next flu season.
But Ultimate also took engagement to the next level at the annual member-only event by offering members a $10 gift card if they got their flu shots before they left the meeting. “You’ve got to do innovative things to capture their interest,” Handshuh said.
To improve on some of its measures, the plan has also reviewed its supplemental benefits and for 2019 increased its hearing benefit of $750 for hearing aids to $2,000 to remove access barriers. The decision is based on research about the likelihood of untreated hearing loss among patients with conditions such as diabetes, thyroid disease, chronic kidney disease, cardiovascular disease, and Alzheimer’s. Handshuh cited a Johns Hopkins study that found older adults with hearing loss were 32% more likely to have been admitted to a hospital than their peers with normal hearing.
“We think if they can correct their hearing loss, people will be happier with the plan,” she said. “We are working really hard to work with providers to push people to use the benefit and get a hearing test.”
Blue Cross Blue Shield of Michigan has had a 4-star rating since 2012. In a session on how to enhance your risk program and achieve 4+ Stars, John Fong, senior vice president & chief clinical officer, senior health services, said that providers have an impact on more than 70% of the health plan’s measures so it had to find a different way to connect with providers and educate them. This was especially important with CAHPS, he said, because those measures impact 17% of the total Star rating.
The health plan worked with Tessellate, which is owned by BCBS of Michigan, to conduct CAHPS mock surveys and share the results with providers. The organization worked with 1,200 practices and set up focus groups to share the results and discuss how provider perceptions may differ from their patients. “We let practices tell us what their biggest pain point was and what was the big pain point in patient experience, and from there we built a program for them,” said Gerri Cash, vice president of quality, Tessellate.
For example, one provider's office continually got a lot of calls from patients after their visits because they forgot they needed a refill of their prescription medicine. So, the organization created a campaign to remind patients to ask about the refills during the visits. Staff wore buttons that said, “Do you need a refill?” And signs were also posted on the back of exam room doors asking patients to ask about a refill. At check out, there was a plaque that said, “Did you remember to ask for a refill?”
“This is just one example. You need to find the right campaigns for you. The refill one can be used for multiple providers. You may find if it’s a pain point for one, it’s likely a pain point for the other. Just constantly build on that relationship with the provider,” Cash said.
Innovative ways to engage providers
In a session on provider engagement, Shannon Decker, executive director, risk adjustment, NAMM California, UnitedHealth Group, explained how the health plan not only wanted to achieve the Triple Aim goals to provide better care, improve population health, and lower costs, but also a fourth goal—to help providers find meaning in their daily work.
To better engage providers, the organization conducts monthly “lunch and learns” the same day each month. The meeting included a chart review and a discussion of what was working well for them and what wasn’t working well. The health plan made changes based on that feedback.
Colleen Gianatasio, AAPC fellow, risk adjustment quality and education program manager, Capital District Physicians’ Health Plan, said her organization focuses on quality care and combines education of all programs and measures together. But she offers training in smaller segments. For example, her team created a 15-minute webinar that gave an overview of risk adjustment that physicians can watch on demand, whenever they have downtime. Training is conducted throughout the year and the team provides physicians with monthly feedback on all performance measures.
And Laura Sheriff, director, risk adjustment, Molina Healthcare, explained how she got physicians on board prior to the launch of a new Medicare Advantage plan. Like Decker, Sheriff conducted meetings over lunch or breakfast and she always provided the food. Her goals for those meetings were to help providers better understand Medicare Advantage plans and which quality measures were required for the year, the importance of correct documentation, and which HCC diagnoses were usually missed.
She found that group learning worked well and saved valuable time because she could educate all providers in a clinic at one time. It also helped to review an HCC or ICD-10 code with real-life examples during the meeting. Sheriff also recommends asking a few providers who are willing to teach others to serve as “RAF champions.” To help improve provider engagement, Sheriff also suggests that health plans use facts and data to influence providers, be respectful of their time, offer solutions to problems, and recognize positive results.
RISE has planned several upcoming live events that will delve even deeper into these topics. The 8th Annual HEDIS® & Quality Improvement Summit on Oct. 29-30 in Miami; The 12th Risk Adjustment Forum on Nov. 11-13; The 9th Annual RISE Star Ratings Master Class on Dec. 11-12 in San Diego; The 2nd Annual RISE Symposium on Partnering to Address Social Determinants of Health on Jan. 28-29 in Ft. Lauderdale; and RISE Nashville on March 17-19, 2019.