DorlandHealth

When Coordinating Care Isn’t Enough

Coordinating care for patients continues to grow more and more complex. With health care reform officially signed into law and transparency an increasingly popular topic, it’s necessary not only to help patients navigate our complicated health care system but to be able to provide concrete data showing improved outcomes as well. Care managers want to improve the delivery of care, while health insurance plans want to add value to available services. But how can either of these be accomplished without tangible evidence demonstrating how members are truly benefiting from care management?

This article shows how one health insurance plan has found a way to address this challenge. BlueCross and BlueShield of Kansas City (Blue KC) has teamed up with i3 QualityMetric, an organization that measures and analyzes outcomes, to integrate more comprehensive outcomes measurement into member care.

A New Approach

“Our goal of care management is to get the member back to an optimal state of wellness,” says Tanya Salyer, RN, CDE, the manager of care management at Blue KC. “Many members may never return to their previous state of function, but our priority is for them to become as independent as possible and able to function.”

Blue KC has collected data on member health for years. However, it recently recognized a need to measure overall functional health and well-being while also being able to screen for depression. To satisfy this need, Salyer began working with i3 QualityMetric in the spring of 2009 to establish a plan for incorporating a scientifically valid outcomes measurement tool into Blue KC’s care management function.

Current care managers with Blue KC’s care management program, which includes case and disease management, total 21, with approximately 4,000 members involved with the program. Primarily, these members have chronic co-morbid illnesses or catastrophic conditions, such as brain and spine injuries, high-risk pregnancies or multiple trauma. These members all share a need for a multitude of care and assistance with coordination.

Integrating Outcomes Measurement

Since October 2009, Blue KC has been using an enhanced version of i3 QualityMetric’s SF-12v2® Health Survey. The tool has been successfully incorporated within Blue KC’s disease management programs, and by the fall of 2010 will be integrated within the case management function as well.

Because mental health is just as much a concern as physical health in these cases, i3 QualityMetric recommended that Blue KC use its SF-12v2 MH Enhanced, a modified version of the SF-12v2 that contains three additional mental health questions from the SF-36v2® Health Survey. This enhanced tool not only measures overall health from the patient’s point of view but also contains the full mental health scale of the SF-36v2 due to the additional questions. Salyer is thrilled with the ability of this tool to streamline Blue KC’s care management function.

“The SF-12v2 MH Enhanced creates the benefit of a shorter survey while comprehensively capturing more specific mental health functioning information,” she says.

The SF-12v2 MH Enhanced is administered at various points along the care continuum. These points include at baseline and six months and when the case is about to be closed. Blue KC has opted to administer the survey to members via i3 QualityMetric’s Smart Measurement® System. This technology enables the data to be collected and scored automatically through an i3 QualityMetric website (www.amihealthy.com), where a variety of customized reports can be generated in real time. Blue KC has selected the eForm mode of administration, which uses an Adobe Acrobat electronic version of the paper/pencil form of the health survey that consists of a single page of questions.

Improving the Delivery of Care

Once the survey is completed, nurses review the survey reports and determine the next steps in care. They use the results as a guideline, “looking heavily at the mental health piece, but also looking to see if physical function has improved and where members stand with their total health,” says Salyer. Certain steps in individual member care are taken—or avoided—based on the results. If the results show that a member is not doing well physically, Blue KC then determines what intervention services, if any, need to be established in order to help the member improve functioning.

Blue KC also uses the SF-12v2 MH Enhanced as a screener for depression, via the tool’s depression severity indicator capability, to triage members and make decisions regarding care. For those with minimal or mild depression, Blue KC recommends they be sent to a community health specialist for further assessment, which includes determining whether mental health services are needed. Those showing moderate to severe depression are directly referred to a mental health provider for follow-up care.

Everybody Wins

Blue KC plans to replace other outcomes measurement tools used within its care management function with the SF-12v2 MH Enhanced. It simplifies the process for care managers, provides information necessary to properly care for members, and limits member response burden by having a fewer number of questions than other tools previously used.

“It’s a tool that is much more palatable to people who are taking it than some other tools that assess mental health issues. Members are very accepting of it,” says Sayler. Acceptance is vital, especially since minimizing member response burden is so important to the success of an outcomes measurement tool.

Blue KC chose i3 QualityMetric’s SF-12v2 MH Enhanced for a variety of reasons, including its brevity, efficiency and reporting capabilities, as well as its reliability due to the science behind the tool. Also a key factor in Blue KC’s selection of this tool was that employers are now “asking for more concrete data and want more specific outcomes,” says Salyer.

“The SF-12v2 MH Enhanced will give us the concrete, reliable information necessary to show the employers that we have in fact made a difference in the health of their employees.”

Tanya Salyer, RN, MA, CDE, a manager for Care Management at Blue Cross Blue Shield of Kansas City, is responsible for the Healthy Companion Program addressing the management of chronic disease.
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Kristin Wystepek is a marketing communications specialist at i3 QualityMetric. She has extensive knowledge of health survey usage across markets and vast experience in the outcomes measurement field. ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it )