Addus Partners with Two Illinois Plans to Provide Smartphones to Home Care Aides
By Steven W. Postal
Earlier this year, 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 the ICP Pilot study. The purpose of the study is to provide smartphones to home care aides (HCAs) serving Medicaid beneficiaries enrolled in Illinois’ Integrated Care Program (ICP). Launched in 2011, the ICP is mandatory Medicaid-managed care for Illinois seniors and disabled persons who live in Lake, Dupage, Will Kankakee, Kane, and suburban Cook counties. The program initially encompassed only acute medical services but effective February 1, 2013, the ICP expanded to cover long-term services and supports (LTSS) as well. The National Council on Medicaid Home Care interviewed representatives from both Addus and Aetna for details on the project and the ICP. Unfortunately, the Council could not reach IlliniCare in time for publication.
Addus continues to embrace new, innovative technology, including smartphones, as part of its electronic visit verification (EVV) system, designed to continually improve care outcomes. EVV is a timekeeping system in which home care workers can use smartphones to clock in and out of their appointments. The ICP Pilot uses smartphone technology for basic EVV and to enhance Addus’s methods for providing care. The ICP Pilot marks Aetna’s first partnership with a Medicaid home care network provider to use technology for improving care.
Aetna began managing waiver services for its members when the ICP began 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 launched 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 the pilot’s purpose is creating a partnership between provider and plan to improve clinical outcomes in home care. This is achieved by 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 encouraging clients to eventually make more preventive health care appointments.
Addus representatives found that smartphone technology has a great capacity for improving efficiency and care, as well as supporting basic EVV capabilities such as scheduling, payroll, and billing.
The smartphone’s most basic function is to communicate schedules with HCAs for both the current day and beyond. The schedule flows through the HCAs’ smartphones, tells them the addresses of their visits, and has them clock in and 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. HCAs click “yes,” “no,” or “client refused” to indicate whether a task was completed, and if not the reason why. By this means, HCAs are able to document specific tasks laid out in a care plan.
Change-in-condition questions: Another basic function of the smartphone is to pose a set of change-in-condition questions about a client. These questions allow HCAs to report on physical, cognitive, and environmental changes. As HCAs clock out of visits, smartphones prompt them to provide information on clients. This information flows back to Addus and clients’ health plans for evaluation and intervention.
Case Management: Aetna assigns a care coordinator who visits each of its members every 90 days, or more frequently in certain cases. The case coordinator reviews a member’s level of need, collaborates with the member to develop a service plan, and tells the member how many hours of care they will receive. Incremental services can be added in the event an HCA reports a change in condition.
Pending functionalities: There are several functionalities that are currently in a “roll out” phase, including the ability for HCAs to use smartphones to update their home address and request time off.
Dual Eligibles: Aetna wanted to start the ICP Pilot last year because it expects the number of participating members 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 a 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.
Besides adding value both from a workflow and delivery of care perspective, smartphones also serve 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 with their finger or a stylus in the field provided. 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 in to start a scheduled visit, a trigger will alert a scheduling coordinator who can then call the HCA, 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 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 also allows the provider and health plan case manager to communicate more efficiently about changes in conditions, the provision of care or the absence of it, 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. Besides the regular interface between Addus’s ICP supervisor and Aetna’s case management supervisor, Aetna and Addus hold bimonthly calls 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 Similarly 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’s Take
The Council supports the growing use of technology in Medicaid home care. As the Council has previously shown in the case of telehealth, such programs can be cost-effective and help produce better 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 more application of smartphone technology and reimbursement 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.