Addus Partners with Two Illinois Plans to Provide Smartphones to Home Care Aides
January 24, 2014 02:46 PM
Earlier this month, Aetna Better Health of Illinois (Aetna) and IlliniCare Health Plan (IlliniCare, a subsidiary of Centene Corp.) issued press releases announcing respective partnerships with Addus HealthCare (Addus) for a pilot study (the ICP Pilot) to provide Smartphones to home care aides (HCAs) serving Medicaid beneficiaries enrolled in Illinois’ Integrated Care Program (ICP).
The ICP is mandatory Medicaid managed care for Seniors and Persons with Disabilities in Illinois, covering Lake, Dupage, Will, Kankakee, Kane and suburban Cook counties when launched in 2011. The program initially encompassed only acute medical service but effective February 1, 2013, the ICP was expanded to cover long-term services and supports (LTSS) as well. The National Council on Medicaid Home Care – a NAHC affiliate - interviewed representatives from both Addus and Aetna for details on the project and the ICP. IlliniCare could not be reached in time for publication.
Addus continues to embrace new, innovative technology including Smartphones as part of an Electronic Visit Verification (EVV) system to continually improve client care outcomes. EVV is a time keeping system in which home care workers can clock in and out of their appointments using these devices. In the ICP Pilot, Smartphone technology is used for basic EVV but also expanded to support Addus’ methods to improve client care. The ICP Pilot marks Aetna’s first partnership with a Medicaid home care network provider to use technology to improve care outcomes.
Aetna began managing waiver services for its members when the ICP expanded to include LTSS in February 2013. Aetna recognized that Addus had deployed a unique technology-enabled model of care for its HCAs and sought to develop an innovative partnership, leveraging technology deployed for EVV as relevant for new applications, such as supporting the HCA workforce to improve client care. Addus and Aetna implemented the launch of the pilot in the fourth quarter of 2013.
Currently, the pilot is active in the original counties that went live with ICP LTSS on February 1, 2013: DuPage, Kane, Kankakee, Lake, Will, and suburban Cook counties. Aetna intends to expand the pilot into Chicago this spring when the ICP program expands.
In the ICP Pilot, Addus has approximately 175 HCAs working with over 200 clients enrolled in the two health plans. Of these, Aetna has approximately 110 members served by 85 different Addus HCAs who use Smartphones.
Both Aetna and Addus agree that purpose of the pilot is to create a partnership between provider and plan to improve clinical outcomes in home care. This is achieved through best preparing HCAs to observe, identify, and report timely changes in condition. Clinically, the ultimate goal is to improve care outcomes by decreasing hospitalizations, readmissions, and ED visits. Additional goals include promoting better client compliance with care plans, and to eventually encourage more preventative health care appointments by the client.
Addus representatives found that the Smartphone technology has a great capacity for improving care efficiency, as well as supporting basic EVV capabilities such as scheduling, payroll, and billing.
The Smartphone’s most basic function is to communicate schedules with the HCAs, not only for the day, but going forward. The schedule flows through the Smartphone and tells HCAs the address of their visits, and has them clock in and clock out for each appointment. For every client, an Addus employee inputs the individualized care plan and particular tasks (Activities of Daily Living, or ADLs, and Instrumental Activities of Daily Living, or IADLs) into the central database. This information flows through the system, and appears on the Smartphone. To indicate whether the tasks were completed, the HCA clicks “yes,” “no,” or “client refused” for each task, as well as why a task, if applicable, was not completed. By this means, the HCA is able to document specific tasks according to care plan.
Change in condition questions
Another basic function of the Smartphone is a set of change in condition questions. These questions allow the HCA to report on a change in client condition that could include physical, cognitive, or environmental conditions. As the HCA clocks out of a visit, the Smartphone prompts her or him to provide information on the client. This information flows back to Addus and the client’s Health Plan for evaluation and intervention.
Aetna assigns a care coordinator for its members, who visits each member every 90 days. Some subsets of members receive more frequent visits as needed. The case coordinator reviews the level of need the member has, develops a service plan in collaboration with the member, and communicates to the member the number of hours of care she will receive. Incremental services can be added in the event the HCA reports a change in condition.
There are several functionalities that are currently in a “roll out” phase, including the ability for HCAs to use the Smartphone to update their home address and request vacation time off.
Aetna wanted to start the ICP Pilot last year because it expects the number of members participating to increase dramatically as Illinois begins its dual eligible demonstration. Both Addus and Aetna do not foresee the functionality of the Smartphone (both from an EVV and managing conditions perspective) materially changing with the duals. Instead, they foresee a wider deployment of the ICP Pilot including such capabilities as sending pictures or videos.
In addition adding value both from a workflow and delivery of care perspective, the Smartphone also serves key program integrity functions.
Signature verification: After the visit is complete, the HCA documents tasks, and answers the change in condition questions. The client must then sign the Smartphone in the field provided, either with their finger or with a stylus. The signature then flows through to the central database.
Scheduling: The Smartphone can be set up with a variety of alerts, enabling Addus to monitor and adjust schedules in real time. So if, for example, the HCA has not logged into start a scheduled visit, a trigger will alert a scheduling coordinator who can then call the HCA or the client or both. There are a variety of alerts to help monitor daily activities as they occur, giving Addus great visibility into its direct to care workforce.
GPS: The Smartphones have GPS capability, so Addus can monitor the locations of its HCAs. This also helps with program integrity and quality assurance.
Care plan task reporting: Before using EVV technology, Addus found that care plan task reporting was quite cumbersome. Addus believes that this function significantly helps providers remediate and challenge audit findings.
This functionality enables more efficient communication between the provider and the health plan case manager to clarify changes in conditions or the provision or absence of care, rather than having to sift through large amounts of documentation.
Recommendations to Providers
For providers seeking to engage in a similar partnership with plans, Aetna maintains that frequent dialogue between the organizations is critical to success. Outside of the regular interface between Addus’ ICP supervisor and Aetna’s case management supervisor, Aetna and Addus hold bimonthly calls together to update each other on the pilot. Other important recommendations include: developing a successful operating model, having a good workflow for communication, having a good reporting tool, and agreeing on what metrics to evaluate.
Plans to Publish
Addus and IlliniCare hope to publish results of the pilot this year, while Aetna and Addus also intend to publish program results. Aetna will evaluate data from 0, 3, 6, and 12 months following implementation of the pilot, and specifically look at hospitalizations, readmissions, ED visits, and office visits (both specialty and PCP visits).
To see Aetna’s press release, click here. To see IlliniCare’s press release, click here.
The Council supports the growing utilization of technology in Medicaid home care. As the Council has previously shown in telehealth, such programs can be both cost-effective and contribute to greater outcomes. Home care providers should note that the Council will continue to pursue greater payments for Medicaid home care generally. The Council also calls on state associations and other stakeholders to advocate on a state level to promote an increased application and reimbursement of Smartphone technology to HCAs in Medicaid home care. Home care providers are encouraged to keep abreast of such developments, and to contact the Council with any questions or concerns.
The Council would like to thank the following people for their assistance in writing this article: Darby Anderson, Senior Vice President, Addus HealthCare; Kimberley Cox, Midwest North Regional Director, Addus HealthCare; William Gerardi, MD, Chief Medical Officer, Aetna Better Health of Illinois; and Diane Kumarich, VP National Contracts and Acquisitions, Addus HealthCare.