Improving Access Along the Care Journey
Holistic Support for Members, And Much More
The Agency for Healthcare Research and Quality defines “access” as “the timely use of personal health services to achieve the best health outcomes.” As a multi-faceted concept, access can encompass everything from how patients seek out care to the timeliness in which care is received. Mitigating the complex barriers to accessing healthcare services is key to improving the health of individuals and populations. HealthVine works to support members holistically while addressing prevalent barriers to accessing healthcare services, equipment, and other resources to improve their overall health and well-being.
Using Telehealth to Increase Access to Care
The HealthVine Care Management program, in partnership with the Cincinnati Children’s Telehealth team, continues to expand the use of technological tools to increase access to care for members.
To enhance the diagnostic capabilities of providers during telehealth visits, HealthVine members and families are invited to use TytoCare™ devices paired during their CincyKids Health Connect virtual urgent care visits—all free of charge. These services are not meant to replace visits with a primary care provider, but rather, they help to reduce unnecessary emergency department admissions and ease access to after-hours urgent care services for families in need.
The HealthVine Care Management team identifies families that may benefit from using the device and CincyKids Connect services. The team conducts proactive outreach to those families, offering additional education about the service, technology tools and TytoCare™ set-up. Since November 2022, HealthVine has distributed more than 282 TytoCare™ devices to members in Southwest Ohio.
Telemedicine is an innovation that allows families to access care, wherever they are, in a timely, cost-effective manner. HealthVine looks forward to further expanding telehealth services to members in the future.
Removing Barriers for Members with DME Needs
For members with complex health needs who require durable medical equipment (DME), prior authorizations and insurance barriers can compound existing challenges to accessing required care and services. Special consideration is needed when supporting specific populations of patients to ensure optimal health outcomes in the short- and long-term.
HealthVine’s Utilization Management program has a unique role in addressing access challenges for members in need. The program’s goal is to ensure members receive the right level of care, in the right place, at the right time. In partnership with the Cincinnati Children’s Urology and Home Care departments and the Population Health Quality Improvement team, the HealthVine Utilization Management team developed a project to identify specific barriers and opportunities for improvement when processing prior authorizations for DME and supplies—supplies that are critical and medically necessary for patients to receive in a timely manner to manage their care at home and outside clinical settings.
An element of the project focuses on streamlining the process to submit required prior authorization information for urology and home care supplies. Before the project launched, only 33% of all related prior authorization requests could be reviewed on the first attempt at submission. The remaining requests required additional information, thereby delaying the review and final approval or resulting in denial of the request and causing delays in accessing DME supplies for patients in need. After the program’s launch, some months allowed 70% of similar requests to be resolved after the first submission.
While interventions for this work are actively being developed and tested, this project is an example of the unique barriers members experience when accessing care and services, and the power of cross-collaboration when developing solutions to connect members to needed care.
Partnering with Community Practices to Connect Members to Care
HealthVine partners with local health systems and community practices to offer support and resources to organizations providing direct care to patients. In a pilot experiment conducted in partnership with a health system-affiliated practice, the question was simple: How can we increase access to care by re-connecting with patients who have not been seen by a provider recently?
The HealthVine Care Management team worked with this community practice to identify HealthVine members who had not been seen by the practice in 18+ months. The HealthVine team conducted outreach to these members to either schedule an appointment with the community practice or to identify a new medical home, if needed.
Of the 38 members and families identified in the pilot, outreach efforts resulted in 18 members being scheduled for an appointment with their provider for a well child visit, and 16 referrals were made for additional care management support from the HealthVine team.
Note: Loss to follow up refers to patients who were once seen by the practice but have not been seen within 18 months
As a continuation of the pilot, the HealthVine team is expanding member outreach initiatives to other local practices in the Greater Cincinnati area, helping to connect patients with care one member at a time.
Member Success Story: Accessing Diabetes Management Tools
A HealthVine community health worker (CHW) received a referral to work with a member experiencing diabetes-related complications, leading to repeated emergency department visits.
By building rapport and trust with the member’s family, who previously had negative experiences with the healthcare system, the CHW facilitated discussions with the family and providers at the Cincinnati Children’s Endocrine Clinic. This connection allowed the family to explore alternative options for managing the member’s diabetes.
After thoughtful discussion, the family chose to use an insulin pump, and use of the device reduced the member’s A1C levels and helped with ongoing management of the member’s diabetes. By fostering a trusting relationship, the CHW was able to connect the family to vital services within the healthcare system to support the member’s clinical needs, resulting in positive outcomes for the member and the family.
