Q&A: Using data to target interventions for high-risk dual-eligible population




, Q&A: Using data to target interventions for high-risk dual-eligible population

In late July, knowledge from CMS urged dual-eligible sufferers—beneficiaries eligible for each Medicare and Medicaid—had among the many highest COVID-related an infection and hospitalization charges. Commonwealth Care Alliance in Massachusetts focuses on serving this high-risk inhabitants, with practically 40,000 members in its well being plan. The alliance additionally supplies direct affected person care at two clinics and through in-home and telehealth visits. President and CEO Chris Palmieri talked with Trendy Healthcare Managing Editor Matthew Weinstock about caring for this susceptible inhabitants. The next is an edited transcript.

MH: CMS reported seeing excessive charges of infections and hospitalizations amongst dual-eligibles. What have you ever seen amongst your members?

Palmieri: Our knowledge is preliminary as a result of we’re nonetheless very a lot concerned in COVID, however as we checked out knowledge on our 37,000 beneficiaries, we’ve had about 1,262 whole circumstances. And after we have a look at our circumstances primarily based on the identical groupings that CMS grouped its knowledge round—complexity—these with extreme and chronic psychological sickness, we had 1,399 circumstances per 100,000. CMS’ knowledge confirmed three,794. Our disabled inhabitants luckily did extraordinarily nicely. We had 300 circumstances in opposition to CMS’ knowledge of 1,663. And people with end-stage renal illness, we had 75 circumstances versus CMS’ knowledge of seven,665. So we did fairly nicely by this. Once more, I wish to warning that we’re nonetheless very a lot on this and proceed to be involved concerning the well-being of our populations.

MH: Have been there sure issues that you just had been capable of do to achieve these sufferers? You’ve been utilizing knowledge analytics to focus on providers, proper?

Palmieri: Philosophically, our strategy has been that we put individuals first as a company and we acknowledge that our populations are probably the most susceptible for being impacted by COVID-19. It was a battle to proceed routine operations at a time when the world was shutting down and socially distancing. We weren’t ready to try this. Our primary-care clinics, of which we’ve got two, remained open. Our inpatient psychological well being amenities remained open. We assembled a group that, with the suitable private protecting gear, was capable of proceed visiting our most susceptible in the neighborhood.

After which we did every thing telephonically, and we had been capable of attain our inhabitants fairly successfully and very often. We did use knowledge analytics to focus on providers. We have now, inner to our group, a predictive analytics group, and we created a COVID-19 dashboard, which allowed us to have up-to-date, risk-weighted steerage for our care groups. We constructed that on the Google Looker platform and knowledge from our digital well being document system, which included not solely medical info however claims and exterior knowledge. Social knowledge from LexisNexis is synthesized to provide this dashboard, which allowed us to first concentrate on these with the very best likelihood of a sentinel occasion. After which, clearly, we targeted on our whole inhabitants.

MH: Have been you pushing info out to caregivers within the subject?

Palmieri: That’s appropriate. And that was serving to us prioritize … to ensure that those that had been capable of exit into the sector knew precisely who they wanted to see and re-prioritize their days, in the event that they wanted to try this. These had been personalized for every of our care coordinators.

MH: How have you ever balanced telehealth versus at-home versus in-clinic visits?

Palmieri: We have now practically 40,000 shoppers and solely two primary-care clinics that bookend the state. So we’ve got to depend on a community of group sources. And one of many issues that has been taking place throughout COVID is the sources that had been obtainable again in January and February of this yr had been closing for quite a lot of causes. This (knowledge) device allowed us to determine if there have been entry factors for healthcare that had been not going to be obtainable. That helped us not solely stability the place we had been going to ship our workers, however how we reprioritize seeing individuals utilizing telehealth. Within the early days, we developed a protocol to search out the correct stability between care-at-home telehealth and the form of legacy in-person care that we had offered, both in a clinic or in one other outpatient setting.

We targeted on questions corresponding to what are probably the most pressing wants, what completely couldn’t be accomplished through telehealth. We needed to think about the availability of PPE as a result of we’re not an acute-care hospital system, so we weren’t the important group that was going to be receiving the identical stockpile as these treating individuals on an inpatient foundation. We discovered, fairly early on, luckily, that a lot of the vital at-home visits had been centered round skilled-nursing care, blood attracts, wound and dressing adjustments, remedy changes, or supply of medicines. Different issues might be accomplished over video channels that everyone knows at present as telehealth. We had been capable of leverage advanced-practice clinicians—nurse practitioners and doctor assistants—to take over prescribing medicines for members who couldn’t join with their conventional primary-care doctor. And we realigned that work in order that our clinicians who had been beforehand within the subject might take that on as telephonic care companions.

MH: You additionally arrange a $four million program to assist members with provides. How has that labored?

Palmieri: On an early day again in March, earlier than we had been working towards the social distancing that we’re all conversant in at present, I had our management group in our convention room, and as we had been debriefing from certainly one of our enterprise conferences about how we had been going to be executing in opposition to what we thought was coming at us, I requested a fairly easy query to our scientific management: “Are there issues that the group might be doing to ease this very traumatic transition for our members?”

Certainly one of our lead clinicians, Laura Black, stated: “Our members are going to want issues that the advantages don’t cowl. Gatorade, rest room paper, paper towels, hand sanitizer.”

Little did we all know then that lots of this stuff can be very tough to get however I left that assembly, known as our board chair and stated I would like $four million, or roughly $100 per CCA buyer, and we’re keen to take that out of our working surplus. We have to present that to our members as a result of they’re going to want some extra lifeline of provides at a time the place, and once more, we thought this was going to final for a couple of months, and right here we’re within the sixth month—40% of our members have taken benefit.