Health Provider Partnerships for OSA Management in Transportation. Paul S. Valentine Chief Executive Officer Sleep HealthCenters LLC

Transcription

1 Health Provider Partnerships for OSA Management in Transportation Paul S. Valentine Chief Executive Officer Sleep HealthCenters LLC Sleep Apnea & Multi-Modal Transportation Conference November 2011

2 Programs National Sleep Center Network 56 organizations, 400 centers Occupational Health Providers: 1) Large provider in numerous states. Sleep Evaluation Program operational since January 2011 and still in rollout phase. 2) Large provider in numerous states. Still in pilot phase. Trucking Company Mid-size trucking company operating in the continental U.S. with 11 depots in 8 states.

3 National Network

4 Network Provider Service Requirements Interpreting physicians must be Board Certified by the American Board of Sleep Medicine (ABSM) or by the American Board of Medical Specialties (ABMS) in the subspecialty of Sleep Medicine. Physicians must hold an active license and be in good standing to practice medicine in the state in which they agree to provide interpretation services. Be a participating provider in the top insurance companies in their state(s). Interpretation of HSTs within 48 hours (2 business days). Post HST office visit within five (5) business days from test completion. Consultations within five (5) business days of notification from SHC. In-lab sleep study scheduled within seven (7) business days of notification from SHC. Interpretation of in-lab sleep study within 48 hours (2 business days). PAP therapy set-up, if applicable, within 2 business days of prescription for PAP therapy.

5 Network Management Annual accreditation review Training on Client Program (audio / webinar) Clinical Review (audio / webinar) Future of Sleep Medicine symposiums 3x / yr Monthly Newsletter Website Technology Integration for Home Sleep Testing & PAP Compliance

6 Why would EMPLOYERS consider implementing a sleep wellness program? Offer a valuable health benefit to employees and dependents; poor quality sleep consistently ranks at the top of employee risk assessment studies Insufficient sleep has a significant impact on employee productivity and health Reduce healthcare costs for employees suffering from sleep disorders Improve safety, performance and quality of life for employees suffering from sleep disorders Establish policies and procedures for sleep disorder screening and treatment to mitigate risk and litigation exposure

7 Why would OCC HEALTH PROVIDERS implement a sleep medicine program? Occ Health provider as PCP? Integration of care: providers may already be managing other disorders affected by sleep, such as diabetes, hypertension, cardiovascular disease, mental health, and obesity Opportunity to expand services offered to existing employer clients Employees already visiting the organization for other purposes Technology improvements allow for sleep testing and compliance to be more patient-centered, therefore manageable at the provider clinic

8 Occupational Health Provider Perspective Addresses serious medical and safety problem Meets needs of public Provides consistent clinical evaluation for medical examiners Helps standardize certification assessment Meets needs of medical examiners Medical examiners still expected to use clinical judgment to identify drivers with more severe OSA and at higher crash risk Prevents variation among clinics Meets needs of companies Adapts to needs of companies Supports companies with established OSA programs Follow companies appropriate protocol for assessment, treatment and certification Assists companies in establishing an OSA Program Meet their needs Works with companies who have no OSA Program

9 What are we providing? Policy development assistance Mandatory v. Voluntary Screening criteria Testing methodology Treatment compliance requirements Sleep educational programs, materials and web content National program implementation, management and improvement, currently over 200 occupational health clinics supported with local accredited sleep providers Centralized Care Coordination with dedicated Occupational Health team Sleep testing on-site, at clinics or at local sleep centers Post-study consultations with board-certified sleep specialists Therapy and treatment for sleep disorders

10 What are we providing? Monthly reports on all referrals, appointments, location, unable to schedule Cumulative patient status, workflow and outcomes reporting Aggregated compliance tracking, providing reports to providers with objective compliance data Monthly report of new in-network providers within a 30 mile radius to an occupational health clinic Training of all new in-network providers on the requirements of the program QA/QI support and reporting

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15 SHC Sleep Evaluation Program CDL Medical Evaluation OSA Screen Positive Yes Sleep Study Sleep Clinic: Evaluation, Review Test No Occ Health Clinic Issue Certificate Occ Health Clinic No Test OSA+ Yes Yes Yes Compliant on PAP Improve PAP Compliance, Alternate Therapy No Compliant on PAP Initiate PAP Therapy No

16 HST at Network Provider HST at Network Provider Cloud Server SHC National Call Center 48 Office Visit to Deliver Results 24 HST Interp. by Network Partner

17 HST at Occ Health Clinic Occ. Health Clinic Cloud Server SHC National Call Center 48 Office Visit to Deliver Results HST Interp. by Network Partner 24

18 Process Preceding or following * clinical evaluation and/or exam, if a driver meets criteria for a sleep evaluation, worksheet completed (*) Driver from company with or without OSA program? Complete sleep evaluation worksheet Occ Health provider chooses pathway: HST, in-lab or consultation Occ Health clinic sends referral to Sleep HealthCenters National Care Coordination Center Sleep HealthCenters requisition form Completed sleep evaluation worksheet DOT long form Copy of patients insurance card

19 Process SHC National Call Center staff contacts patient to make introduction of process, locate nearest network provider and verify funding Identified network provider provides sleep medicine services for patient PAP therapy is treatment of choice given compliance documentation is required for renewal of DOT card Sleep HealthCenters tracks compliance, reports sent to Occ Health providers

20 Compliance Tracking

21 Compliance Tracking

22 Results Occupational Health Program Referrals: 351 Insured patients: 90% Self-pay: 10% Unable to Schedule: 62% Patients Tested: 88 In-lab: 78 HST: 10 AHI > 15: 61 Patients set up on PAP: 62 PAP Compliance: Jun, 74% Jul, 82% Aug, 93% Sep, 83% Oct, 82%

23 Results Trucking Program Referrals: 134 Insured: 75% Self-pay: 25% Unable to Schedule: 40% Patients Tested: 44 In-lab: 23 (4 in-lab following HST) HST: 25 AHI > 15: 25 Patients set up on PAP: 31 PAP Compliance: Jun, 77% Jul, 72% Aug, 74% Sep, 71% Oct, 88%

24 Questions