College of Nursing Teams up with the University of Arizona Health Plans to Benefit Medicare Advantage Plan Members

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CHAP Leadership Team
Audrey Russell-Kibble, DNP, FNP-C, FAANP, CHA Project Coordinator at the College (author), Theresa Allison, DNP, FNP-C, CHAP Assistant Project Coordinator, and Allen Prettyman, PhD, FNP-BC, FAANP, Director of Practice Innovations 

Background & History
The CHAP was the inaugural nurse practitioner (NP) faculty practice opportunity at the College of Nursing. The notion of a college providing practice opportunities for NP faculty was novel in 2012. To promote the vision and innovation of faculty NP practice, Dean Joan Shaver, PhD, FAAN outlined strategic plans to support unique faculty NP practice opportunities. Five years ago, during a lively discussion with Thomas Ball, MD, Medical Director of the University of Arizona Health Plans (UAHP) the vision of faculty NP practice at the UA CON became a reality.

CHAP Staffing Structure
The CON developed an agreement with the UAHP to perform Comprehensive Health Risk Assessments for their Medicare Advantage Plan members.  The CON nurse practitioner faculty are given workload credit and are assigned to the CHAP to accomplish the comprehensive health risk assessments in the community using a home health care delivery model.   Because the assessments are scheduled in the home they allow scheduling flexibility for the faculty allowing faculty members to work in the program part-time to accommodate faculty/teaching responsibilities. The part-time hours benefit the faculty by providing clinical practice hours required for APRN licensure. Most importantly the NP faculty mentor NP students and support Doctor of Nursing Practice (DNP) student projects.

CHAP Scheduling Efficiency
CHAP visits are scheduled for one hour with an additional hour allotted for completing the extensive documentation. The visits are clustered within a zip code to provide efficiency as the NPs travel from home to home.

Language translation services are provided by the UAHP through phone translation. If the faculty NP is fluent in the language of the member, they are matched for a visit. Various faculty NPs have demonstrated fluency in Spanish, German, and Russian languages. ASL translation services are also available with an ASL translator assigned to accompany the faculty NP to the home.

The CHA Documentation
The Office of Learning and Innovation Technology Innovations (LHTI) at the CON and CHAP developed an electronic documentation system to capture the elements of the member appointment. The data gathered to complete the CHA is entered into an electronic secured SQL database. The raw data is easily de-identified, stored, and is available for research activities.

CHA Data Elements

• Demographic data
• Health history
• Surgical history
• Listing of the member’s specialists
• Documentation of the member’s completion of advance health care directives
• Medications review
• Recent Emergency Department (ED) and hospital admission history
• Comprehensive social history
• Family history
• Screening Tools include the PHQ-4 to assess for depression and anxiety, the Timed Up and Go test that is a falls risk assessment, the CDC-HRQOL-4 Modified to assess quality of life, a Modified PAR to review physical activity, a MINI-COG to evaluate for changes in memory.
• Physical assessment data that includes a complete neurological examination
• Functional assessment of activities of daily living (ADL) and instrumental activities of daily living (IADL)
• Adaptive equipment used and needed
• Health maintenance: Screenings, tests, immunization review
• Chronic conditions: Screenings, tests, exams, medication review
• Case management referral options are reviewed

An Assessment is provided that outlines all diagnoses, problems, symptoms, and potential problems, for example: a high risk for falls. The assessment describes the current status of each problem, current meds used to treat the problem, and identification of further testing or assessment needed. Plans are formulated and specific follow-up is suggested.

A detailed Plan and Recommendations for the Primary Care Provider (PCP) are outlined and a copy of the entire CHA is sent to the PCP.

The Members
The health plan members are dual eligible for Medicare/Medicaid. This year the members range in age from 21 to 97 years. The majority (63%) are over 65 years of age and over half are female (57%).

Potential Savings to the Health Plan/Medicare
The nurse practitioners repeatedly refer members to case management in the health plan for assistance with care. Some examples of specific case management referrals are for members at risk of falls, members who need urgent home health care assistance, members who have severe depression. Within the home the NPs have helped members with the use of a Holter monitor, how to use DME, how to make their homes safe.

Members are educated on services available to them such as eye exams with optometry, dental services, transportation to care, and over the counter (OTC) medications.

There is no doubt that there are innumerable times that ED and hospital readmissions are averted by the timely accomplishment of the risk assessments by our faculty NPs.

Summary
The CHAP is providing excellence in assessment, caring, and collaboration with the UAHP to provide assessments that benefit: (a) the Medicare Advantage Plan members by way of a comprehensive health assessment visit at their home with knowledgeable faculty NPs, (b) the faculty NPs who have specific dedicated practice hours to fulfill the obligation of clinical practice hours for continued certification, (c) DNP students who are given the opportunity to have faculty NPs work with them one-on-one to tune up their assessment skills, as well as, increase their knowledge of complex care management of chronic disease, and (d) the UAHP by way of fulfilling their obligation to offer the risk assessment to their dual eligible members on an annual basis.

The UAHP is very pleased to have this collaborative care relationship within the University community. The CHAP and faculty NPs are given kudos by the UAHP leadership, case management, and members in the Medicare Advantage plan, for a job well done.