An interesting thing happened at AIMM today...

A client asked..."Should we do a health fair?"

2011-01-19T10:24:00.008-05:00

I like health fairs done at work-sites for many reasons. There's no better way to tell people you love them than to make it convenient for them to be healthy. But, I do believe that the "common" health fairs that are out there on the market have some typical short-comings - all of which can be avoided with some good information and planning!

1 - Are the right people attending? You really want those people who avoide the doctor to be the ones who participate, but what often happens is that the only people who show up are the ones who are already heath conscious! The result you are left with is "feel good" effect, and not true medical impact. So, how do you resolve this? Well, the simplest method is to use your claims data mining info to identify those members who most need to attend, and to target those individuals with promotion and marketing!

2 - So, you found a problem....what did the member do about it? We know that typically people don't act unless they feel pain. A borderline high blood pressure without any symptoms being felt can easily result in zero action on the patient's part. This results in your money being wasted, because no true medical impact has been generated. So, how do you resolve this? It's simple! Only work with vendors who are able and willing to provide you with a file listing each individual and the test results for that individual (this is allowable under HIPPA because the data will be used for the purposes of payment and other health care operations - namely case/disease/wellness management). Then have your AIMM RNs do outreach to those members to ensure that they are taking action. Usually members who receive a "gentle reminder" about the importance of follow-through, and who receive additional education about the potentially serious health events that can be avoided with appropriate early intervention, will take action.

3 - What issues should I focus on anyway? After all, it's unlikely you can afford to have every test under the sun done. But, there's an easy rule of thumb to use in making your decision. There are two areas where you should consider focusing your efforts. Use your claims data mining information to identify areas where your existing prevalence is outrageously HIGH and unbelievably LOW. Areas where your current issues are outside the expected norms are areas where you are most likely to a - get someone to finally take action on a problem and b - identify a problem that had previously gone undetected.

If you are already an AIMM client, this process is really simple. Just let Deb know that you are considering doing a health fair. We'll pull all your claims data mining information (as well as other AIMM reports, HRA reports, etc...), let you know which areas are most impactable, let you know how many members could benefit from targeted promotional efforts, and let you know what measurable outcomes can be expected. If you'll let us, we'll even do a lot of the work for you! AIMM doesn't really care which vendor you chose to provide the screenings/testing, just so long as the patient specific data can be provided back to us, but we've got existing integration with 8 different vendors.

So, should we do a health fair?

World's shortest blog (& world's shortest on hold time)

2010-11-12T11:32:00.002-05:00

‎92.5% of all inbound calls between 9a and 5p EST yesterday were live person answered by an RN in less than 5 rings.............get THAT with any other medical management vendor.....I'm just sayin'......... (and that wasn't even a record breaking day - our record is 98.2% accomplished on 3/31/2011.)

Why do patient's not want to participate in medical management programs? Well, let's think about that: 1 - your sick, 2 - you feel like "I'm not a medical expert and they're going to expect all that technical jargo", and 3 - have you ever tried to call an insurance company?!? (press 1 if this, press 2 if that, press 894 if___, etc) UGGGHHH! No wonder people don't want to 'engage'. So, how can we overcome that mindset? Well, how about minimizing (and whenever HUMANLY possible entirely eliminating) the "hassle factor"? That's exactly why AIMM strives to answer as many inbound phone calls as humanly possible with a live RN on the phone.....that's how we would want to be treated if we were calling our health plan!

WOW!

2010-10-22T10:50:00.012-04:00

It's amazing how much time and energy blogging takes! And things have been so very, very busy at AIMM lately that I haven't had much of a chance to get on here and update everyone. I appologize for not posting more frequently. Hopefully my followers will graciously forgive me!

As many of you know, one of our major initiatives for this year has been an edeavor to formalize and enhance our Wellness Program. We have been steadily working toward that goal, and are almost there. We should be ready to go for our 1/1/11 launch date. And, while much of this is still a work in progress, we wanted our "insiders" to have a first glimpse at one of the pieces we will be including in the new offering - through a strategic partnership with GlobalFit we will be able to give our patients the following services:
Basic Package
1 - Virtual Gym
2 - Discounted "Real Gym" memberships
3 - Discounted "Home Gym" equipment purchases
4 - Virtual Nutrition Counselor
5 - Discounted NutriSystem
Enhanced Package
Everything Above PLUS
6 - Destination You

Destination You is pretty exciting - you wear a "Tracker" on your shoe, and through the wonders of modern technology it uploads your fitness progress (it even tells whether those are walking, stair climbing, kick-boxing, etc). Via the web it reports back your progress. But that's not all! It also let's you take 'virtual trips' - stamps your passport, lets you send 'virtual postcards', and lets you work together as a team with your colleagues, issues challenges to other participants, or participate in sponsored challenges (that your health plan sponsor initiates and rewards).

Right now AIMM Staff are piloting the GlobalFit offering and so far the feedback is very, very positive. We hadn't realized just how sedentary tying ourselves to these phones & computers had made us! (And for those staff who are following the blog - here is your juicy tid-bit: On Monday morning I am going to issue a "Tracker Challenge" - the first full-time person to reach 30,000 steps, and/or the first part-time person to reach 60,000 steps is going to earn 4 hours of PTO.....sounds like a Friday afternoon of Christmas shopping waiting to happen!)

In addition to the GlobalFit partnership we will also be enhancing our partnership with AIPM. AIPM will be providing us with a really cool electronic newsletter.

We are also going to be formalizing marketing materials and promotional items, as well as enhancing the communication campaigns centered around wellness & prevention. Webinars/videos via links based on the "health topic of the month" are also under consideration! (Bringing brown-bag lunches up to a whole new level).

Of course all these things still follow the core AIMM philosophies of being:
1 - Patient Centric
2 - Reportable
3 - ROI capturing
4 - Nurse Supported & Enhanced
5 - Available a-la-carte
6 - Affordable

So, that's the current "interesting thing happening at AIMM".....Let me know if you have any interest in learning more!

Deb

A Rose By Any Other Name....

2010-03-08T17:34:00.005-05:00

Here at AIMM we are pretty convinced that Shakespeare had it wrong! We put a lot of time and effort into ensuring that both what we say and how we say it is as clear and accurate as possible. Every new person at AIMM gets immersed into a whole new literary world! First there is the mandatory Dale Carnegie training, and then the trip to Auburn University for Motivational Interviewing training, and then there is the call auditing that is done as a part of the learning process.

Did you know that at AIMM we even ensure that our RNs understand the difference between active voice verbs and passive voice verbs? Want to know why that subtle difference is so important? The rationale is pretty basic...if you talk in passive voice, then you probably act accordingly...change your tone/voice, and your actions will change too! Many of you have heard me get onto my soap box to complain about "paid historians" who track, follow, and sound as if they stand by watching as a catastrophic case management case unfolds. Not here at AIMM...it's lead, manage, assess, plan, implement, and evaluate, or get out of the way!

We've even got a list of "evil words" (things we NEVER say at AIMM). Among them are things like the words like authorize and deny. At AIMM we never authorize or deny anything - we simply certify or not...authorization implies some sort of permission, and since our model constantly emphasizes that we are not here to tell our patients what to do (or not to do for that matter) it wouldn't make sense for us to authorize or deny. We simply certify that a requested service meets the medical necessity & appropriateness criteria, or that it doesn't (in which case we issue a Lack of Certification decision, but that is a topic for a separate blog!). And that's just one small example.

When the company was first being founded we made a conscious decision to adopt a particular tone for all our communications. It was important that it be a tone that does justice to the model of medical management that we perform and that it would clearly reflect the overall philosophy of our approach. We do almost all of our communication over the telephone verbally. There are advantages and disadvantages to this form of communication, but because people can't see you, it's more important than most people could possibly imagine that both the tone and the words be very clear and concise. The tone of voice and the word choices our RNs use when talking with patients and health care providers over the phone becomes, essentially, the "non-verbal" communication of the conversation. The people with whom we are talking with can't see if we're smiling, and they can't see if our arms are folded in front of our chest, but they can hear a smile in our tone, and they can perceive our openness based on the word choices we make. It's probably one of the hardest parts of AIMM for new staff to learn and adapt to, but it's also one of the most important.

Another interesting tidbit: Do you remember the name Suellen? Some of you who have been with us a long time probably recall the name - she's fulfilled a variety of non-RN functions within our organization, and Suellen is our expert proofreader. She's a specialist in the English language. She reviews our formal written communications, and she also works with the RNs to teach them how to write effective case studies. She's an integral part of keeping our tone on track. (How many other Independent Medical Management companies have a resident proofreader?)

So, with all due respect to the great Shakespeare, at AIMM, a rose by any other name would smell a whole lot different!

Another Demonstration of our Techno-Savvy and Collaborative Endeavors!

2010-03-08T17:24:00.002-05:00

Many of you are aware that AIMM staff participate in routine "Fireside Chats" where the staff choose a topic, and Deb does a presentation - delivering in-depth detail about the topic. You may also be aware that those seminars are recorded. They are available as a training resource for staff, they are available to select industry partners (brokers, consultants, and others who work directly with AIMM), and they are available to interested clients. AIMM is in the process of making these seminars available via the web. If you are interested, please contact Deb and she will set you up with access (which requires a user id and password).

WOW! That's a lot of snow!

2010-02-10T16:06:00.007-05:00

In Florida it's huricanes, in California - wildfires, in Atlanta - flooding. It seems that Mother Nature has a little something special in store for you no matter what part of the world you're in. Here in Ohio, it's snow....and boy, oh boy, we've had a lot of it the last few days! I'm sure that most of you have seen the news about the debilitating snow - it's even shut down the Federal Government! How, then, you might ask, does AIMM ensure that services continue, despite Mother Nature's attempts to foul things up? Well, it's a very good question, and you might be surprised to know that you're not the only one curious for the answer - URAC, our accrediting agency, gets pretty interested too! Ensuring that AIMM has a solid "Disaster Recovery Plan" is a part of what URAC looks at when we go through the accreditation process.

First, let me say, that AIMM isn't concerned just about snow - we've got plans for it all - starting with the most simple "disaster" scenario like a computer malfunction, all the way up to the most catastrophic scenario like the office building burning down and all our equipment being lost!

Second, I would point out that we're all a bunch of "old ER & ICU nurses" (not old in terms of age, just in terms of experience :-)...we're really all truly young, pretty, etc :-) ) We're a pretty tenacious and resilient bunch. We know that people get sick even when the weather is bad - sometimes it even feels like people are more likely to be sick when the weather's bad. All in all, we're pretty used to working through any adverse conditions - and neither snow, nor rain, nor heat, nor gloom of night, nor the winds of change... (well, when a slogan's good, you've just got to adopt it, right?!) And, fortunate for us, we use only RNs (old ER & ICU RNs - old enough to remember the days of charting on - dare I say it - charting on paper with a pencil (gasp!!!) - if worse came to worse we'd break out the papyrus and graphite...whatever it takes to get the job done and the patient taken care of!).

Thirdly, we are an extremely techno-savvy organization. We LOVE technology, and if you've gotten to know us at all, you've probably seen firsthand that we're "all over" the computer stuff....every piece of equipment in our organization is the latest, greatest, most nimble, and most user-friendly, piece of technology on the market. (It helps that our COO is a techie/geek :-) ) I am able to control every aspect of our operation remotely. Need a phone system change, or a routing change made on the fly - no problem! Need a key piece of information, call me. It doeesn't matter if I'm in Timbukto or the office. I can get you what you need, and I can do it quickly!

Fourth, we've got back-ups for our back-ups! We back up our data in multiple different ways...some of those are immediate backups, some are hourly, some are nightly. We've got the main server in the office, and we've got TWO back-up servers. If the building burned down and "everything" was lost, we still wouldn't have lost everything - we've got servers and computers stored offsite! All we'd have to do is load the backup data onto one of the spare servers, and we'd be live in a matter of minutes!

Fifth, we test, and test, and re-test, and on and on and on! We try to break the system. We're constantly challenging the technology to make sure that it isn't going to fail us.

Those are just the "highlights" that I have room to describe here - there's even more! AND YES - it's all 100% secure, encrypted, HIPAA compliant, etc....

So, as one of my favorite Christmas carols says...let it snow, let it snow, let it snow!

Top 5 reasons you want AIMM to do your Cancer Case Management

2010-02-08T12:25:00.006-05:00

Well, it was another fine "Fireside Chat" for the AIMM staff this past weekend. One of the topics we covered was Chemotherapy. Of course, I don't want to give away all our "secrets", but I thought this might be an appropriate forum to share some key things that AIMM does differently than other medical management vendors when handling cancer cases:
1 - AIMM uses only RNs (and MDs too, but never laypeople, never LPNs, etc...)....recently a new client joined us, and the previous medical management vendor had an LPN handling Case Management on a cancer patient. I'm not entirely certain that it was just the fact that the Case Manager was an LPN, but I feel pretty sure that her being an LPN certainly contributed to her handling of the case (and the fact that she didn't recognize that the plan of treatment was worthy of aggressive questioning / experimental / not a covered benefit).
2 - AIMM investigates the following on every chemotherapy agent: Name of the drug being utilized, route/administration method, dosage, for the treatment of what specific type of cancer, and at what billed cost. We also investigate FDA approval status of the medication (as it is being used (dose, route, single/combo agent, etc), and for the condition it is being used to treat).
3 - AIMM investigates & communicates with patients and providers about whether there specific plan design considerations/constraints - For Example: what if there are no FDA approved drugs for this type of cancer (because it's a rare type, as an example)? What if this is an "off label" use of an FDA approved medication? What if this is a clinical trial? We feel strongly that patients deserve to have all the facts up front - cancer is devastating enough...they don't need any payment surprises happening 3 to 12 months from now!
4 - AIMM uses a variety of methods to ensure that the billed costs coupled with any applicable discounting (aka PPO discounts) results in the cost of the medication being reasonable (close to AWP).
5 - AIMM ensures that the patient has every possible resource at their disposal, including facilitating use of community resources, obtaining case reviews from experts, accessing governmental (and other) financial assistance, and providing an enormous amount of both verbal and written education items.
6 - AIMM ensures that contact happens with the patient - we never close a cancer case simply because we can not reach the person by phone - instead we will seek out assistance from the designated plan representative to assist us in connecting with the patient. (We once discovered an identify theft situation because of this - our patient's identity had been stolen, and was being used by someone else who was seeking cancer treatment. Had we not gotten the plan representative to assist us in connecting with the member (the member had ignored out telephonic outreach to her because she was healthy and didn't feel she needed us), we (and she) would never have known that the person getting cancer treatment wasn't really her! Her lifetime maximum would have been used up by an identity thief!

These are just a few of the ways that AIMM is "special" when it comes to handling Cancer and Chemotherapy cases. If you would like more information, please feel free to contact me! (I'm sure you noticed that there are 6 reasons, when the title says "5 reasons"....that's because AIMM always strives to give you more than you expected, and to "under promise over deliver" - not just in Cancer Case Management, but in everything we do.)

PS - Nurse Kelli was the presenter for the chemotherapy fireside chat. It was her first time doing a presentation like this. She did an AWESOME job, we all learned a lot :-)

I'll answer to anything....

2010-02-05T10:52:00.000-05:00

A funny thing happened yesterday....
Nurse Belinda retrieved a very garbled voice mail message...she was able to barely make out the phone number to return the call, and thought that the caller had said his name was Andy. Well, she called Andy back, and said "May I speak with Andy please?". The man who answered the phone said something that essentially conveyed he was Andy. She explained who she was and that she was returning his call, and inquired about how she could help him. He said he was responding to one of our outreach calls, and she searched in vain to try and find a record for Andy so that she could see what we wanted to talk with him about. After a few seconds of searching she asked him to spell his name and he responded "T O M"....Well, needless to say she was a little bit flustered by this...she asked "then why'd you say yes you were Andy?" He got the better of her, though, because his reply was "Well, I'll answer to anything when a pretty girl is calling". We all LOVED this little anecdote, and thought you might enjoy it too. We thought it was a good example of what we mean when we talk about "building a rapport with our patients"...a little humor goes a long way :-)

By the way - this is Nurse Belinda (she's one of our newer nurses), and she is a pretty girl.

Preparing for this week's "Fireside Chat"

2010-02-04T08:10:00.001-05:00

Want to know another thing that makes AIMM special? Did you know that the AIMM staff gather together once a week via Webinar (usually Saturday mornings) and spend time focusing on a single medical management topic? We began doing this recently as a part of our 2010 "New Year's Resolution". So far, everyone has loved it, and we've even opened it up now to key industry partners (brokers, consultants, etc...). So far we have covered the following topics:

Stop Loss - the who, what, when, where, why, and how
Behavioral Health Precertifications
Transitions between levels of care
Basic AIMM Sales Presentations - what clients hear & expect, and what make AIMM special in the market-place

This week we are covering the topics of:

Chemotherapy
Dialysis

Nurse Kelli, the VP of Care Management is presenting the chemotherapy course. I am presenting the dialysis course. In preparation for my portion I am doing some research, and I came across this great article that shows empirically some of the things that we in medical management have strongly suspected for a long time: PRINCIPAL FINDINGS: The study results show that patients in for-profit dialysis facilities tend to receive significantly lower quality of care (average quality score: 0.7588) than those in not-for-profit (0.8764) or government-owned facilities (0.8283) (p<0.05).>

I share this with you because I wonder how many medical management company's invest time ensuring that all their staff are up to speed on these kinds of issues?

Of course, as a part of our dialysis training we will also be talking about renal repricing and other new laws/programs that ensure cost-effectiveness.

If you're interested in joining us, let me know!

Deb