Boston safety-net hospital adapting OneHealth behavioral platform to medical home

By: Neil Versel | Jul 25, 2013 

OneHealth Solutions, a company that largely has focused on employer groups, is for the first time applying its mobile and Web platform for patient behavior change to primary care, courtesy of a partnership with Boston Medical Center.

The safety-net hospital, an affiliate of Boston University School of Medicine, is adopting the OneHealth system, originally to treat substance abuse, depression and other behavioral issues, to its patient-centered medical home initiative. Boston Medical Center will offer low-income patients access to the OneHealth online and mobile platform to promote self-management of chronic diseases, offer peer support and engage them in between office visits.

“It will be an integral part of the medical home,” said psychologist Dr. Robert L. Sokolove, who is championing the rollout at the 496-bed hospital in Boston’s South End.

“BMC partnering with OneHealth was done to mitigate a very longstanding issue in disease management,” Sokolove told MobiHealthNews. Counseling patients on smoking cessation, obesity, stress reduction and depression is about teaching skills that lead to lifestyle changes. “After the skill sessions have stopped, maintaining the skills, especially a year out, becomes very, very difficult,” Sokolove said.

OneHealth, available through Android or Apple iOS apps or through the Web, is meant to provide patients with information and social support that leads to the maintenance of newly acquired skills, Sokolove explained. He said that upper-middle-class patients tend to have the social support they need, especially as they are treated for depression and diabetes, but the lower-income populations, including immigrants, that frequent BMC tend to lack such networks.

“This can be one small way for removing those barriers to access,” Sokolove said.

He called the social aspect of the mobile platform a “sort of Facebook for patients” that helps them self-manage chronic diseases and reduce anxiety that can lead to poor choices such as smoking or eating unhealthy foods. “Anxiety is reduced by two factors: attachment and mastery,” explained Sokolove. “We feel less anxious when things are predictable.”

What BMC patients do have are mobile phones, and many are starting to acquire smartphones as well, which makes a mobile platform a great means of outreach. “Many of our patients can’t use a desktop because they don’t have a desk, but they do have smartphones,” Sokolove reported.

Solana Beach, Calif.-based OneHealth, launched its OnTheGo native mobile apps, optimized for tablets, in February. “Our mobile has overtaken the Web experience,” according to CEO Bruce Springer.

The company, which was known as OneRecovery until a little more than a year ago, has its roots in treating substance abuse, but has since integrated medical resources with behavioral tools. Springer said that those with chronic medical issues such as diabetes are 50 percent more likely than others to have behavioral comorbidities like depression, and that can lead to poor lifestyle choices that exacerbate chronic conditions.

Springer said he is excited about working with an academic safety-net provider because he believes the OneHealth system works well with Medicaid and uninisured populations and because Boston University offers research opportunities to help validate the technology.

“It’s hard to reach them,” Springer said of patients BMC is trying to bring into medical homes. “It’s hard to get them activated in programs to improve their health.” With providers increasingly taking on financial risk, they have to manage patients outside the hospital or clinic, and mobile technology is an ideal way to do so, Springer added.

Sokolove said there will be a research element “eventually,” but for now, he wants to get the program launched by September for smoking cessation. “What I hope to do is build it out slowly,” Sokolove said, tailoring the language to the right health literacy levels and tweaking the interface so the OneHealth platform is easy to use.

Boston safety-net hospital adapting OneHealth behavioral platform to medical home

Health Care Clinic Director Sentenced for Role in $63 Million Health Care Fraud Scheme

U.S. Department of JusticeJuly 25, 2013

Office of Public Affairs(202) 514-2007/TDD (202) 514-1888

WASHINGTON—A former health care clinic director and licensed clinical psychologist at defunct health provider Health Care Solutions Network, Inc. (HCSN) was sentenced today in Miami to serve 135 months in prison for her central role in a fraud scheme that resulted in more than $63 million in fraudulent claims to Medicare and Florida Medicaid.

Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Special Agent in Charge Michael B. Steinbach of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the Miami office of the U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG) made the announcement.

Alina Feas, 53, of Miami, was sentenced by U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida. In addition to her prison term, Feas was sentenced to three years of supervised release and ordered to pay $24.1 million in restitution.

On May 7, 2013, Feas pleaded guilty to one count of conspiracy to commit health care fraud and one substantive health care fraud count. During the course of the conspiracy, Feas was employed as a therapist and clinical director of HCSN’s Partial Hospitalization Program (PHP). A PHP is a form of intensive treatment for severe mental illness.

HCSN of Florida (HCSN-FL) operated community mental health centers at two locations. In her capacity as clinical director, Feas oversaw the entire clinical program and supervised therapists and other HCSN-FL personnel. She also conducted group therapy sessions when therapists were absent, and she was aware that HCSN-FL paid illegal kickbacks to owners and operators of Miami-Dade County Assisted Living Facilities (ALF) in exchange for patient referral information to be used to submit false and fraudulent claims to Medicare and Medicaid. Feas also knew that many of the ALF referral patients were ineligible for PHP services because many patients suffered from mental retardation, dementia and Alzheimer’s disease.

Feas submitted claims to Medicare for individual therapy she purportedly provided to HCSN-FL patients using her personal Medicare provider number, knowing that HCSN-FL was simultaneously billing the same patients for PHP services. She continued to bill Medicare under her personal provider number while an HCSN community health center in North Carolina (HCSN-NC) simultaneously submitted false and fraudulent PHP claims.

Feas was also aware that HCSN-FL personnel were fabricating patient medical records. Many of these medical records were created weeks or months after the patients were admitted to HCSN-FL for purported PHP treatment and were used to support false and fraudulent billing to government-sponsored health care benefit programs, including Medicare and Florida Medicaid. During her employment at HCSN-FL, Feas signed fabricated PHP therapy notes and other medical records used to support false claims to government-sponsored health care programs.

At HCSN-NC, Feas was aware that her co-conspirators were fabricating medical records to support the fraudulent claims she was causing to be submitted to Medicare on behalf of HCSN-NC. She knew that a majority of the fabricated notes were created at the HCSN-FL facility for patients admitted into the PHP at HCSN-NC. In some instances, Feas signed therapy notes and other medical records even though she never provided services in HCSN-NC’s PHP.

From 2004 through 2011, HCSN billed Medicare and the Medicaid program more than $63 million for purported mental health services.

This case is being investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. This case was prosecuted by Trial Attorneys Allan J. Medina, former Special Trial Attorney William Parente and Deputy Chief Benjamin D. Singer of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,500 defendants who have collectively billed the Medicare program for more than $5 billion. In addition, HHS’s Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.

Providers stumble after recent HIPAA audits | Contemporary OB/GYN

Publish date: JUL 25, 2013

By: Contemporary OB/GYN Staff

When it comes to securing and protecting patient health information, physician practices with fewer than 50 providers fared the worst in a recent audit by the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR).

In fact, Linda Sanches, MPH, an OCR senior adviser, reports that only two of the 64 healthcare providers in the audit passed without problems.

While OCR’s audit on privacy and security also included health plans and healthcare clearinghouses, the report says that significant compliance issues exist among physician practices.

OCR evaluated practices related to security (administrative, physical and technical safeguards), breach notification, and privacy [access to patient health information (PHI), administrative requirements, uses and disclosures of PHI, etc.]. Security problems accounted for 60% of the findings and observations. Data privacy problems were noted in 30% of the audits, while only 10% were attributed to data breach notifications.

Small practices, OCR notes, “struggled with all three audit areas.”

Nearly 50% of the smaller practices posted negative findings and observations related to compliance of uses and disclosure of PHI, another 30% were dinged for not having acceptable administrative requirements in place, 30% had compliance problems related to patient access, and another 31% had findings and observations related to notice of privacy practices for PHI.

Many of the audit problems, Sanches says, were triggered simply because providers were unaware of the requirements. She urged physicians to evaluate the regulations and conduct a compliance assessment to help protect PHI from breaches.

Providers stumble after recent HIPAA audits | Contemporary OB/GYN

What healthcare leaders can do to nurture innovation

• Peter Thomond
• Guardian Professional, Thursday 25 July 2013 03.30 EDT

Innovation is more than a shiny gadget. It is about identifying, developing and successfully exploiting new ideas. Photograph: CJ Burton/Corbis

The five top tips to harness potential and give staff a licence to suggest changes

To nurture innovation in healthcare, leaders must do less. This counter-intuitive advice draws on years of innovation research and the practices of the world's most innovative organisations, the ones that get 10 times more bang for buck on their innovation activities than the rest.

Innovation is more than a shiny gadget or an elegant new pathway. It is the organisation's process of identifying, developing and successfully exploiting new ideas, which is deceptively complex. I've worked with only 19 health providers and commissioners so far, yet I consistently see the same challenges which, if addressed, would lead to phenomenal leaps in innovation outcomes. Here are five top tips for leaders of health and care organisations:

Kill half your projects. A lack of clear focus leads ambitious people to try and do too much. Write an innovation plan to assert which quality, prevention, productivity and revenue objectives you wish to achieve, and then kill the projects that don't fit. It's likely that 20 to 50% will be stopped or paused, liberating resources and allowing you to fund the projects that align with your plan properly. This focus also helps to create a call to arms for your people and networks – a common goal around which they can all work.

Empower your people. The wisdom of your workforce is much greater than you might think. To harness this potential, your people need a licence to innovate. They need to know where to go when they have an idea and that, when they do, they'll be listened to and heard. The smart application of crowdsourcing tools and capability will engage and empower your staff quickly and cheaply. You'll be doing less of the work, but achieving much more.

Sack your 'blockers'. Close your eyes and ask yourself who the key person is that talks down all new ideas as soon as they are shared, and then sack them (or at least move them to one side). Almost every organisation has an influential character who consistently blocks innovation. Their voice is usually associated with responses such as: "That won't work here" and "The patients will never use that". Remove this person, and your people will be free to innovate.

Get disruptive. I first used internet banking in 2000. It seemed like a step backwards as it seemed to be doing less. But by starting small, choosing the right niches and proving the model, it has grown to transform the convenience, efficiency and security of consumer banking. Technology-enabled care models can drive the same transformation in health. New approaches can mature and eventually be good enough for a larger population.

Integrate patient experience and service improvement. You probably have a patient experience/public involvement/patient advice and liaison services team. They build genuine patient, family and public insight – deep data about the experiences and expectations of your service users. This data should be central to your service improvement and transformation efforts. I've sat in sessions with the likes of P&G andNissan where there's an empty chair in the room representing the customer. What would our customer think of this meeting, this idea, this proposal? Their customer insight people answer these questions and, in doing so, create a laser-sharp focus for service improvement. Are you genuinely patient centred? You've probably captured the insight, now it's time to use it.

Dr Peter Thomond is co-founder and managing director of Clever Together, an organisation that helps leaders empower people using crowdsourcing

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

http://www.guardian.co.uk/healthcare-network/2013/jul/25/healthcare-leaders-nurture-innovation