Case management technology could cure some of state's healthcare ills

A card Vicky Vaughn carries in her purse promises better health for patients like her with diabetes, a solution to healthcare fraud, and a method for doctors and other providers to have claims processed and paid faster.

But what Vaughn cares most about is that using the card has brought back the color in her cheeks and the hope in her heart.

"She now has hope where before Vicky had all but given up hope," said her mother. "She is happy with being able to do more and to realize she does have control of her life."

By signing up for a "smart" card through the MyHealthTrack system, Vaughn joined about 70 other Putnam County patients with diabetes participating in a $500,000 grant project funded by the state of Tennessee. The program allows Tennessee Tech University and PMR of Cookeville to demonstrate how this use of their jointly owned technology encourages diabetics to seek preventative care and comply with a program of care.

The concept, disease case management, isn't new, but the application of technology is. MyHealthTrack uses a card, the Internet and provider networks to track patient care in real-time, not weeks or months later. George Massengill, president and CEO of MyHealthCard USA, says real-time tracking of a patient's compliance with lab tests, exercise classes, nutritional counseling, physician follow-up and other crucial medical services cuts healthcare costs, and more importantly, promotes healthier, longer lives.

"The core of this effort is to provide each patient with a smart card, which is simply an inexpensive, pocket-sized memory card that allows individuals to carry personal health information with them," said Frank Hadlock, the TTU computer science professor who developed the software and envisioned its impact almost 10 years ago.

"By using this card, we want each patient to benefit from having his or her case managed by a health professional, and we want patients to have access to care and information they may normally not be able to afford and/or benefits needed to control their diseases, but are not normally included in any insurance benefit package," he said.

How MyHealthTrack Works for Patients

"It's the difference between keeping a train on the track or cleaning up after the train wreck," Massengill said. "Untreated diabetes can lead to chronic hypertension, circulatory problems, vision loss and kidney failure. Real-time tracking means we can follow-up with patients, discover the barriers to preventative treatment and encourage them to make better choices."

The system features a case manager who creates care plans for each patient; participants receive $500 accessed through the card to buy or pay co-pays on recommended services and supplies, including exams and lab work, through network providers. Examples of preventative services include vision exams, foot exams, testing supplies, nutrition education and group exercise.

If a patient fails to make an appointment, the system flags the case manager, who then contacts the patient. One full-time case manager can oversee about 200 patients.

Paying for group exercise classes, which doctors often recommend for diabetic patients, is often not in an uninsured patient's budget.   Under the test program, the Putnam County YMCA has signed on to offer discounted classes to program participants and part of the $500 credit is earmarked for exercise.

Teresa Galey of the YMCA says Vaughn's commitment to exercise has made all the difference in her outlook.

"A lot of people struggling with diabetes don't have the incentive or motivation to exercise," said Galey, "Plus uninsured patients rarely come in because they assume they can't afford access to a facility like ours.

"But in two weeks, I saw a change in Vicky's emotional state that was so recognizable, it was unbelievable," said Galey. "This program broke down the barriers."

Cathy Hix-Cunningham, a registered dietician and TTU professor, formed a nutrition team with graduate students to provide affordable nutrition counseling to participants.

"Information is key in treating diabetes," said Bob Stubblefield, PMR vice president of corporate and government initiatives. "No other system pays for services like Cathy and her team can provide. If we can invest a little money to keep patients healthy and out of the hospital or off disability, we've saved a lot of money and given them better lives."

How MyHealthTrack Works for Providers

What is the upside for providers? Getting paid for services faster without having to generate a bill is one major advantage. It may take weeks or months for providers to code and generate a bill, but the system automatically alerts a third-party payer of services rendered, and the provider receives payment sometimes weeks faster than usual.

System providers currently participating include Dr. Joseph Tokaruk, Dr. Stephen Chapman, Dr. Vincent Longobardo, Satellite Med, Cookeville Primary Care Associates, Cookeville Regional Medical Center, Smith Pharmacy Wellness Center, YMCA and nutrition counselors. Mary Jane Howard, CRMC patient financial services manager, says the system works as promised.

"Don Calcote and Community Bank of the Cumberlands in Cookeville were instrumental in the development and operation of this unique claims payment feature," said Massengill. "Their insight, cooperation and imagination made this crucial and innovative function possible."

"When the patient swipes the card, the system automatically sends it to PMR," said Howard. "Last month, they had already sent me a check before I got the end-of-the-month bills in the mail."

But the benefit to providers isn't just in claims processing. Currently, disease case management is anecdotal -- patients provide the feedback. And there's too much lag time between one doctor's visit or lab test and the next for care providers to respond appropriately.

"They are just reacting to the condition the patient is in," said Hadlock. "With this system, care providers can make timely decisions and give advice based on real-time information. If a test result comes back troublesome, and a patient hasn't been following the care plan, the case manager will help get him or her back on track.

"Also, there's a continuity of records so that providers can see what a patient's care plan has been for years," he added. "This system complements and enhances current medical records systems."

How MyHealthTrack Prevents Healthcare Fraud and Abuse

One of the system's most effective security features stores a patient photo in, not on, the card.   Because a patient must be present, his or her card scanned, photo verified and password checked before the system recognizes a visit, it eliminates phantom billing, where providers enter information for patient visits they didn't make.

The system also discourages doctor or pharmacy "shopping," where patients try to get multiple services or prescriptions.

"There's a record trail in the system so that patients cannot receive duplicate benefits," said Stubblefield. "The card also encourages proper use of services so that uninsured patients don't make as many visits to the emergency room instead of making an office visit."

State Sen. Tim Burchett of East Tennessee, who supports the state's use of the technology, estimates that it could save the state about $300 million in fraudulent drug charges and physician visits alone.

How MyHealthTrack May Affect Future Healthcare

"There's no way we can attack all the healthcare problems, but we looked for a place where we could make an impact with information technology," said Massengill.

"Say we had a million dollars to put toward making Tennesseans healthier, how would we manage it?" he asked. "This system pinpoints the dollars. We target diseases, like diabetes, where information and preventative care is key. We use this disease control management tool. This system is unique in that it allows for tailoring benefits specific to a particular chronic disease, thereby optimizing use of available health care funds."

Hadlock, Massengill and Stubblefield agree that the same case management system can target patients with other diseases such as chronic obstructive pulmonary disease, heart disease, asthma and hypertension.

"This public and private joint venture is one we see making a marked difference in the health of Tennesseans, even people across the nation," Massengill said.


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