What does a patient’s utility bill have to do with her medical care? On the surface, perhaps nothing, but the answers to many of healthcare’s challenges lurk beneath the surface. The story of a health plan member who couldn’t pay her water bill provides a powerful illustration of Lucent Health’s unique, creative approach to analyzing data to provide proactive care.
This patient “couldn’t worry about anything else but the fact that she may not have water,” says Cassie Kiernan, a 14-year registered nurse for Narus Health, the engine powering Lucent’s care management. Kiernan contacted the water company and arranged to keep the water flowing, thus setting the patient’s mind at ease. That extra initiative was crucial to seeing that the woman got the care—and the patient experience—that she needed.
In addition to being an experienced nurse, Kiernan is a clinical informatics guru. Her areas of expertise include total population health, disease and chronic condition management, and data analytics. And she loves to talk! Looking at the way these skills and passions come together provides a revealing overview of what we call the Lucent difference. It’s a difference built on:
- An internal care management team that meets patients where they are
- The timely sharing of data among all parties
- An internal utilization review team that facilitates real-time data sharing
- A commitment to use that data to deliver compassionate, human-focused care
How Data Analytics Helps
Data Holds It All Together
The best healthcare is integrated, not siloed, and data is the glue that holds it all together. We’re not talking about just any data. Proactive care requires a rich collection of actionable information from multiple sources—clinical, social, personal—shared freely among an interdisciplinary care team. This produces a fuller picture of the individual and their challenges and allows the team, with the help of trusted partners when necessary, to build an appropriate care plan. The earlier in the process this starts, the better.
From the birth of a member’s claim through treatment and follow-up, the ability to look at that claim promptly and with a clinical eye results in better care, a more positive patient experience and reduced costs. With these goals in mind, Kiernan conducted an intensive review of ICD-10 codes, the system that physicians use to classify diagnoses, symptoms and procedures. Her review of more than 70,000 of the codes included the assigning of a severity level, with 1 the lowest and 4 the highest, to each based on historical cost data. (Lucent Health’s internal severity rating system is flexible, allowing it to adapt to Centers for Medicare & Medicaid Services guidance or other factors.)
Kiernan ensured that Lucent maternity claims were coded as maternity, oncology as oncology, behavioral health as behavioral health. She was particularly vigilant in identifying the types of patients who tend to be overlooked as needing care management services. Her goal: Make sure that nothing—or, more accurately, nobody—“falls through the cracks.”
“Sometimes not seeing claims—not seeing that PCP visit, not seeing a mammogram or colonoscopy—is just as important as seeing them,” Kiernan says. “We want to better identify members sooner, because prevention and being proactive serves the client much better than waiting until they’re admitted into the hospital.”
Catching a member immediately after a diagnosis of diabetes or asthma or COPD, for example, can help ensure that they are on their standard-of-care medications, that they understand their treatment plan and what to do, that they know what constitutes an emergency and when to call the doctor. Such upfront education can help the patient avoid higher costs and spending. This approach can even help members who do not have a doctor navigate the process of finding the right one for their situation.
Here’s What Else Data Can Do
Data helps us:
- Meet the member where they are. Every member has a unique set of needs. Lucent’s data-driven interdisciplinary approach matches patients with the right clinician for their needs, whether it be a nurse, a therapist or an educator.
- Engage complementary partners. Lucent’s partners serve as an extension of its care team. Youturn Health provides peer-to-peer counseling for members dealing with behavioral health issues including substance abuse, grief and loss, anxiety, and depression. HealthJoy’s mobile app is our digital front door, keeping members informed about approvals and ensuring they get the right care at the right time. Together, Lucent and its partners help ensure that members engage in the way that the client wants them to engage.
- Grow our services. The review of the tens of thousands of ICD-10 codes, and the light it shone on member needs, has resulted in a significant expansion of Lucent Health’s offerings in behavioral health and maternity.
Lucent Health clients benefit from a data feed that is refreshed nightly, ensuring a timely response. Input from members, a key ingredient in the data that care team members share and act upon, is a product of relationships built on trust and empathetic communication. Member interviews elicit responses that offer insights into the member’s health literacy, socioeconomic background, home life and much more.
“It is a conversation,” Kiernan says. “It’s not speaking to someone; it’s speaking with someone. We gain a lot of initial details. We build a rapport. That allows us to hone in on the specific actions that we need to start working with them on.” Does the individual live alone, for example? Are there minors in the home? Is the individual a primary caregiver?
Information on social determinants of health may reveal issues such as the aforementioned water bill, a lack of transportation or childcare, or financial stressors related to a treatment plan. While such issues may appear outside the scope of healthcare, they often can have an outsize influence on a patient’s well-being. And care management can address them, with the help of on-staff social workers or a list of go-to help agencies.
“We take that extra initiative when people really need help,” Kiernan says. “We combine our knowledge to make sure that the member is helped in the way that they need help.”
Targeted Outreach and Timely Interventions
In one case, for example, the nurse was able to get a member’s prescription for an oral antibiotic filled late on a Friday afternoon—averting a hospital stay for an IV antibiotic and saving the health plan $40,000. Another time, Kiernan called 26 surgeons to find one who could see a truck driver with a tight schedule; her efforts enabled him to have the surgery without missing work. She quickly connected yet another member with a therapist to help him cope with the recent drug-related death of his son.
Care team members can see every day who has been to the emergency room or been an inpatient, even before a claim has been processed. This enables a prompt review and, if necessary, a timely intervention.
“We need to be good stewards of our service and our client’s time,” Kiernan says. “Having a nurse review the claim on top, in addition to all of the claim information we have, is key to our service. We don’t want to outreach to people who aren’t going to benefit.
“Claims don’t always paint the full picture. We’d rather be cautious and outreach, and the member can decline and say, no, the situation is handled now, versus not realizing we exist and not utilizing a program that can benefit them.”
While identifying patients who need care management, this approach reduces overutilization such as unnecessary ER visits and hospitalizations. It steers members to in-network providers when possible. And it provides a focus that spotlights opportunities to go above and beyond in meeting members’ needs. With this approach, the return on investment will follow, even if the cost savings is not immediate or the benefit measurable. After all, how do you put a price on peace of mind?
“We want our patients to know that we care about them as if they were our family,” Kiernan says. “That’s inherent to our culture: If this was your family member, what kind of care would you want them to receive?”
Lucent Health combines best-in-the-industry claims management with a compassionate, human-focused, data-driven care management solution. Find out more about Lucent Health and our approach to care management. Contact us today.