QUARTERLY NEWSLETTERTexting to Improve Healthcare CommunicationsSpring 2020
COVID-19 may be having a devastating impact around the world, but it is also prompting Medicaid Health Plans in Illinois to find new ways to communicate with their members.
During this time people need to know how to manage their health – finding testing sites, assistance with prescriptions, scheduling transportation etc. One unique approach is a text campaign that can engage members to better manage their health while communicating important information with members.
At a time when people can call, text or chat with their healthcare team, the value of text messaging to a person’s overall healthcare management is essential. Texting can be used to engage and connect with member about everything from health management to billing. It can notify Medicaid members of changes to their scheduled appointments and notify patients when they are due for routine exams, recommend specific preventive screenings, invite patients to attend community wellness events or share relevant wellness information.
Illinois Medicaid Health Plans are constantly looking for ways to improve the overall health of their members and text messaging has seen a high engagement rate among respondents.
QUARTERLY NEWSLETTEREnsuring Safety and Access to Medicaid During Covid-19Spring 2020
With over 98,000 cases and more than 4,300 deaths, Illinois has been hit hard by the COVID-19 pandemic. As federal and state officials work to flatten the curve of this disease, technical experts from IAMHP and our member plans have been working with HFS to find solutions to issues facing Illinois residents and providers. As a result, the following changes have been enacted to mitigate the impact and spread of the COVID-19.
MITIGATING THE IMPACT OF COVID-19
As the state reinforces shelter-in-place and social distancing guidelines, measures have been taken to halt the acceleration of the virus:
Expanded telehealth services to allow people to continue medical services from home and free up hospital space
Coordinating temporary housing as a Medicaid benefit for people experiencing homelessness for the 14-day quarantine period
Covering home delivered meals for Medicaid members who do not have access to meals during the directed social distancing period
Encouraging all Medicaid members to apply for or manage their coverage online at www.ABE.Illinois.gov to protect staff working in facilities.
SUPPORTING PROVIDERS:
IAMHP trained over 1,250 providers on telehealth and grants/small business loans
Member plans donated 150,000 KN95 masks
Assisted community-based providers, behavioral health and developmentally disabled providers to obtain critical PPE
Removed prior authorization and cost sharing policies related to COVID-19
Implemented payment advances and alternative payment models to ensure providers are paid faster
SUPPORTING MEDICAID MEMBERS:
Expanded home delivered meal services to Medicaid members in need
Removed restrictions on grants to give nonprofits more flexibility in utilizing donated funds
Provided grant support to Chicago COVID-19 response fund and the Greater Chicago Food Depository
Worked with Chicago Public Schools to enroll families in SNAP and Medicaid
Partnered with local laundry services to offer low-income families laundry services
QUARTERLY NEWSLETTERCovid-19 Pandemic and Mental HealthSpring 2020
Covid-19 has galvanized global action and ushered in big changes that have shutdown our usual day-to-day activities. While these steps may be critical to stop the spread of this disease, they have and will have consequences for mental health and well-being in both the short and long term.
Worries and anxiety about COVID-19 and its impact can be overwhelming. Social distancing makes it even more challenging. But you don’t have to do it alone.
People seeking assistance will remain anonymous and will provide only their first name and zip code, which enables the service to link you to a counselor in your area who is knowledgeable about available local resources.
The current spread of COVID-19 has impacted all of us in multiple ways, including mental health and wellness. Remember help is here, talk to someone.
Illinois Call4Calm Text LineText TALK to 552020 En Español, envie HABLARService is free. Available 24/7
Crisis Text LineText HELLO to 741741Trained crisis counselors available 24/7
MONTHLY REPORTImplicit Bias March 2020
In the United States, black women are three to four times more likely to die of a pregnancy related death than white women. Black women are also more likely to experience severe birth
complications. Why? More and more studies are now uncovering the role of implicit bias in worsening health outcomes and exacerbating health disparities.
Implicit bias affects a variety of other health outcomes and populations such as substandard pain management for black patients, unequal cardiovascular testing for women, and inadequate services for patients with mental illness.
Implicit bias, meaning attitudes or internalized stereotypes that affect our perceptions, actions, and decisions in an unconscious manner, is real and often contributes to unequal treatment of people. Populations most vulnerable to implicit bias in health care include racial and ethnic minorities, LGBTQ individuals, children, women, individuals who are overweight or disabled, and those experiencing behavioral health issues.
The American Medical Association (AMA) recognized racial and ethnic health disparities as a major public health problem creating barriers to effective medical diagnosis and treatment. As a result, the AMA has stated that the elimination of racial and ethnic disparities in health care is an issue of highest priority.
HB 5522, sponsored by House Representative Emanuel Chris Welch, amends the Medical Practice Act of 1987, the Nurse Practice Act, and the Physician Assistant Practice Act of 1987 to require persons licensed under the Acts take a continuing education course that includes implicit bias training.
To satisfy the requirements of this subsection, continuing education courses shall address at least one of the following:
strategies to address how unintended biases in decision making may contribute to health care disparities by shaping behavior and producing differences in medical treatment along lines of race, ethnicity, gender identity, sexual orientation, age, socioeconomic status, physical, intellectual or developmental disabilities or other characteristics.
At the time of publication, IAMHP lobbied and secured three chief co-sponsors and a diverse coalition of sixteen co-sponsors:
Rep. Emanuel Chris Welch - Camille Y. Lilly - Elizabeth Hernandez, Gregory Harris, Bob Morgan, La Shawn K. Ford, Kelly M. Cassidy, Carol Ammons, Robyn Gabel, Rita Mayfield, Deb Conroy, Jennifer Gong-Gershowitz, Theresa Mah, Norine K. Hammond, Michelle Mussman, Michael J. Zalewski, Natalie A. Manley and Jonathan "Yoni" Pizer
QUARTERLY NEWSLETTERLowering the Cost of ComplianceUsing E-SignaturesFebruary 2020
From grocery stores to office visits, online shopping to online banking, consumers no longer sign a carbon triplicate or receive paper copies of their receipts. Email, signature pads, voice activation, fingerprint, and digital signatures have replaced the pen and paper. This has paved the way for faster, more reliable commerce while lowering the cost per transaction.
So why should it be different for Illinois Medicaid members?
When it comes to individual care plans, the state of Illinois allows for a member’s signature “by hand, e-signature, or voice recording.” After researching Illinois law as to what constitutes an “e-signature” I would like to suggest that video recording could meet the same definition. This is an area where telehealth solutions can be leveraged, not only to deliver medical interaction via video conference, but also to meet state requirements for member sign-off and engagement.
As with hand-written or digital signatures, video recordings would need to satisfy the same privacy, security, legal, and compliance requirements, such as verification of the member’s identity, retention of the video, encryption and authentication, member access to the recording, and other HIPAA safeguards. Furthermore, the member would need to consent to the use of the video recording as a legal instrument.
In addition to compliance and cost benefits, video recording as an e-signature also results in an increase in member satisfaction, as it simplifies their care experience, leverages technology they already utilize, can be scheduled any time of the day or evening, and relieves their burden of additional steps to sign documentation by hand and/or return it via mail or fax.
As the Illinois Medicaid program continues to evolve and innovate with its partners, let’s seek creative, low-cost opportunities and policy changes to allow 21st century technology solutions to pick up much of the administrative and compliance workload.
QUARTERLY NEWSLETTERThe CMS Interoperability Challenge and YouFebruary 2020
In 2019, CMS issued a proposed rule to require participating health actors to exchange health data elements throughout the United States using a standardized format, participate in a trusted information network, and make health information readily available for the public to consume via secure interfaces.
The government and private sector have been struggling for over a decade to solve the interoperability puzzle on a national (or even regional) level. And while there have been some successes on local and regional levels, nation-wide interoperability doesn’t exist. Really?? What is so hard about getting IT systems to talk to each other? True, some of the challenges are technical in nature, like being able to exchange data in a standardized or consumable format, ensuring the integrity of the data, and the use of common definitions between systems. But there are also major challenges on the policy side. Privacy tops the list of concerns, such as ensuring the data stay confidential. Legal considerations are also high on the list, such as data ownership, whom to hold accountable in the event of a breach, records retention, consent, and power of attorney. Also, let’s not forget that not all actors in healthcare have electronic health records, so requiring everyone to participate may not be feasible. And of course, there’s the financial aspect – who is going to pay for upgrading, maintaining, and programming all systems to meet a national standard, and what’s the incentive? Lastly, who will authoritatively govern and lead such a program, monitor for compliance, and hold all parties accountable on the federal, state, and local levels?
Like the famous answer to how to eat an elephant, it’s clear that tackling this challenge should be in small increments. Perhaps successful state-led Health Information Exchanges – like Colorado, Iowa, Ohio, and Wisconsin – provide a microcosmic model for scaling into a national program. Or successful multi-state sharing of data can teach us valuable lessons learned about crossing state lines. So, while rolling this out on a national level may still be 3-8 years away, dedicating people, process, technology, and governance within your own organization towards interoperability is a safe investment and worth the reward.
QUARTERLY NEWSLETTERArtificial Intelligence Seeks To Enhance Human ProductivityFebruary 2020
Now that the health community has spent over a decade digitizing electronic health records, patients, providers, payers, and governments are seeking ways to leverage the data. Though the technology may sound like something out of a futuristic sci-fi dystopia, artificial intelligence is quickly sweeping through the healthcare industry under the promise of reducing gaps in care, decreasing costs, and improving health outcomes.
There is a concept called “Moravec's paradox” which plainly states that what’s easy for computers is hard for humans, and what’s hard for computers is easy for humans. Despite the fears that computers will replace humans, it has demonstrated exactly the opposite – computers have provided people the means to make better, more informed decisions. Though the application of artificial intelligence may be complicated, costly, and complex, here are a few simple ideas of where artificial intelligence can achieve efficiencies in the industry:
Providers can improve revenue cycle management by leveraging historical payment data as well as external sources to determine which patients are more likely to pay and which will leave a balance. This still leaves the decision of how much to collect and when to collect up to the provider.
Payers can identify high-risk members who frequent the emergency room and are suffering from social/ environmental determinants of health based on the claim data rather than a cumbersome and subjective questionnaire which takes hours to complete. This allows payers to prioritize outreach to members who require care coordination and community services.
Patients can benefit from artificial intelligence solutions that identify irregular health patterns and can notify primary care physicians. Also, when applied in a customer service environment, patients can be routed to the correct group based on medical data, customer sentiment, frequency of calls, and other factors.
Government health agencies can reduce fraud by combining enrollment data, claim data, and reimbursement data to identify anomalies and overpayment. In some cases, combining social media data (such as photos and posts) can enhance results. Agencies can then prioritize those suspicious cases and investigate accordingly.
There are literally hundreds of ways to apply artificial intelligence and machine learning to your organization, but it will never replace the most important element in healthcare – the human touch.
QUARTERLY NEWSLETTERState Government LeadHealth Tech InnovationFebruary 2020
As the role of state government becomes more pronounced in leading health tech innovation, let’s take a look at five technology initiatives carried out by other states in the past year:
Georgia’s Medicaid agency partnered with FitBit to offer the state’s 4,000 members with type-2 diabetes a way to manage their condition. The FitBit device was offered an incentive for members who complete their annual diabetic retinal exam (DRE). Though the data collected by the FitBit was not be captured by any state health agency, it will allow for future interoperability if members consent to data sharing.
Medicaid agencies in Arizona, Georgia, Michigan, Tennessee, Virginia and Missouri partnered with Lyft to offer non-emergency medical transportation. Texas and Florida are currently in talks with Lyft to offer service to their populations. Other ride-share companies, like Uber, are also seeking partnerships in order to expand their market share in the healthcare industry.
Oklahoma’s Medicaid agency launched a program utilizing artificial intelligence to monitor medication use and identify gaps in care, focusing on its highest risk members. Early results show a 40% reduction in hospitalizations for members in the program.
North Carolina launched a free online service connecting public health departments, doctors, and hospitals in an effort to close the gap on social determinants of health for people in need.
Instead of handing out brochures, the online service directs patients to nearby community services such as food pantries, homeless shelters, and allows health departments a way to track if a patient utilized the service.
HHS awarded nearly a million dollars to San Diego’s Regional Health Information Exchange (HIE) to launch a program to integrate open-source prototypes and utilize the HL7 Fast Healthcare Interoperability Resources (FHIR) standard. The new application will simplify consent management, advance care directives, and take interoperability to the next level.
