19.EQRTN.05.019

Meeting ObjectivesAs Tennessee’s designated External Quality Review Organization (EQRO), Qsource facilitates health plan meetings to benefit TennCare and its managed care contractors (MCCs). These triannual meetings provide opportunities for learning from guest subject-matter experts who can share success stories and best practices, for earning nursing and the Certified Professional in Healthcare Quality (CPHQ) continuing education units (CEUs), and for networking to stay abreast of pertinent topics to Medicaid and managed care. Objectives for June attendees were the following:

♦ Understand the impact of addiction in Tennessee and new ways to address it

♦ Explain how registered dietitians can improve outcomes and save costs

♦ Describe ways to improve the safety of patients and community-based staff

♦ Discuss best practices in using technology in the care of pregnant women and newborns

♦ Gain insight regarding patient-centered teams that include people with diverse backgrounds

Meeting HighlightsTennCare Health Plan Meeting, June 25, 2019

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19.EQRTN.05.019June 25, 2019, TennCare Health Plan Meeting

Program in Addiction Medicine and Free Clinic for the Underserved South MemphisDavid Stern, MD—Professor, UT Health Science Center; Peter Hossler, PhD—Assistant Professor of Urban and Community Health, Rhodes College; Drew Blackstock, MD, and Shawn Hamm, MD—Lead Physicians, Cofounders of IAC Associates, PLC♦ Addiction medicine specialists treat substance use disorder (SUD) as a chronic disease, providing

evidence-based treatment resources and accessibility to services that integrate SUD with other chronic medical conditions and comorbid mental health needs. This integration helps increase care retention, and reduce costly hospitalizations and lengths of stay for SUD patients.

♦ The double-hybrid model of care consists of a combination of nodes of service (in-office visits) and teleaddiction medicine (telehealth), as well as a dual approach to physical and behavioral health medicine. The model maximizes convenience for the patient and addresses multiple health needs within a single visit to facilitate care coordination.

♦ The Wellness and Stress Clinic of Memphis provides primary care services, educational courses, social workers, and legal consultations for uninsured patients, TennCare patients unable to access primary care physicians, socially isolated residents, and recently incarcerated individuals. Oakhaven was chosen as the location due to the residents’ high rates of diabetes, hypertension, obesity, poor health, and poverty, and because 64% were on public insurance or uninsured.

♦ On the grounds of the Healing Center Baptist Church, the clinic’s services are aligned with the mission to build community trust and ownership. The clinic has also been used to facilitate utility assistance enrollment and to host exercise/nutrition courses, which helped reduce social isolation. Future plans include helping eligible patients enroll in TennCare and find providers.

♦ Current challenges include moving patients smoothly along the care continuum, securing higher-level funding, expanding the clinic, and, for students providing services, balancing student learning with service delivery.

Dietitians Make a Difference in Reducing Healthcare Costs and Improving OutcomesDee Pratt, RDN, LDN—President and Co-Owner, Dietitian Associates, Inc.♦ Registered dietitian nutritionist credentials include advanced degrees, internships, licensure, and

continuing education. However, little/no reimbursement, insufficient referral visits, and efforts to educate the public are barriers to providing care.

♦ Standard patient outcomes resulting from medical nutrition therapy (MNT) include reductions in body mass index (BMI), weight, blood-glucose levels, cholesterol, beer and soda consumption, and medication usage, in addition to increases in exercise, water consumption, and eating regular meals.

♦ Studies have shown MNT also contributes to decreased doctor visits and hospitalization rates and cost savings, particularly for diabetics and patients with cardiovascular disease. Delivered via telehealth, MNT helps defray travel time and associated expenses that would have been necessary for onsite care, including wages that would have been lost.

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19.EQRTN.05.019June 25, 2019, TennCare Health Plan Meeting

Safety and Security for Community-Based Population Health TeamsFrances Martini, RN, MBA—Vice President of Population Health, BlueCare TN♦ The five guiding principles for advancing home care safety are

1. self-determination and person-centered care are fundamental to all aspects of care in the home setting;

2. every organization providing care in the home must create and maintain a safety culture; 3. a robust learning and improvement system is necessary to achieve and sustain gains in safety;4. effective team-based care and care coordination are critical to safety in the home setting; and5. policies and funding models must incentivize the provision of high-quality, coordinated care in the

home and avoid perpetuating care fragmentation related to payment.

♦ Preparation for home visits includes scheduling, medical record and case reviews, gathering of all needed information, cultural considerations, and member contact. Home visits require safety bags, identification badges, appropriate clothing, regular communication with supervisors, and being aware of challenges such as signs of violence and/or illicit drugs, pests, and aggressive pets.

♦ Safety interventions are appropriate in situations that threaten the health and safety of the patient, home care worker, and/or family caregivers, such as adverse events linked to treatment, injuries related to physical home hazards and/or equipment, pressure injuries, infections, nutrition concerns, and neglect/abuse of patients. Ongoing support for home care workers includes safety and self-defense training, 24-hour security, and compassion fatigue and employee assistance program (EAP) resources.

Using Technology to Facilitate Quality Improvement and Care of Pregnant Women and NewbornsSarah Rhoads, PhD—Professor, Department of Health Promotion and Disease Prevention at UT Health Science Center♦ Rural health patients face many obstacles concerning obstetric care, such as greater travel distance

and inadequate transportation options, late prenatal care, low birthweight, pregnancy-related complications and hospitalization, limited access to hospitals with obstetrical (OB) units, preterm birth, increased infant mortality rates, inadequate family planning, and unplanned pregnancies.

♦ In 2017, 85% of pregnancy-related deaths in Tennessee were preventable and, after controlling for maternal race, age, marital status, and education, the risk of maternal death was 16% higher in the Delta region of the U.S., which includes 21 counties in West Tennessee.

♦ Telemedicine uses video and audio to facilitate delivery of healthcare services such as ultrasounds, fetal echocardiography, patient monitoring, resident education, virtual home visits, and consults with obstetricians, case managers, and lactation specialists.

♦ Mobile health (mHealth) monitoring with postpartum women reduces perceived barriers, and increases facilitating of conditions and perceived benefits. HIPAA-compliant apps can provide virtual support for pregnant and new moms, along with prenatal virtual visits, remote monitoring devices for high-risk pregnancies, telemedcine high-risk OB consultations, virtual consultations for rural hospitals, home visiting services, and onsite education/training of the workforce.

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19.EQRTN.05.019June 25, 2019, TennCare Health Plan Meeting

While our shared goal has always been to improve the quality of care and services provided to TennCare members, this program was informed by your feedback and suggestions, and carefully designed by Qsource and TennCare to cover topics relevant to the requirements, needs and concerns of your health plan. It is our hope that you will find the presentations both helpful and informative when preparing procedures and crafting policies. This document contains highlights for a quick refresher on the day’s speakers and topics. Contact Qsource with suggestions or questions at 615.244.2007.

Meeting materials will remain available through the event webpage briefly, and through our EQRO Division Webpage.

Next Time: We look forward to seeing you at Qsource’s next TennCare Health Plan Meeting on September 11, 2019.

♦ The Advanced Nursing Education Workforce for Healthy Delta Moms and Babies initiative is funded from July 1, 2019–June 30, 2023, with the goals of enhanced innovative academic-practice partnerships; Doctor of Nursing Practice (DNP) student support and placement in rural and underserved areas; enhanced education for students/preceptors; and a DNP Certified Nurse Midwife (CNM) concentration track beginning in 2021, with diverse student enrollment to better represent the patient population in Memphis and rural areas in the Delta.

Integrating Patient and Family Caregivers into the TeamPaige Powell, PhD—Assistant Professor and MHA Program Director of the Division of Health Systems Management and Policy, University of Memphis School of Public Health♦ The Patient-Centered Outcomes Research Institute (PCORI) brings individual patients and their

caregivers, family members, healthcare providers, and researchers together as a care team to answer questions about health issues, help improve quality of care, and establish trust within the group.

♦ The UNITE Project created a Patient-Stakeholder Council (PSC) in Shelby County that included cancer patients and their care teams. Within the PSC, focus groups identified patients’ priorities for comparative effectiveness research (CER) and met monthly to develop communication tools that facilitated collaboration through the PCOR process.

♦ The first focus group participants discussed patient-provider relationships, while the second focus group discussed the participant-researcher relationship. Both groups created training materials with the objectives of describing PCOR, how research information is used, and the roles that the care team members have in research. The third focus group evaluated and edited the materials for two pilot training modules. Training results showed that participants found the materials organized, useful, and applicable.

♦ Brainstorming sessions resulted in interventions that would help patients feel more comfortable with their providers and treatment, such as provider shadowing, welcome packets, social worker assignments, a patient review website, and a “family care” model. For lasting success, interventions must take into account disparities in patient-centered outcomes affected by ethnicity, income, health literacy, and/or disabilities.

♦ Patient engagement via member councils, training, and member-run meetings can provide an outlet for them to provide input and see it used to strengthen trust within care teams and to influence the quality of care.