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Keys to Successful Care Organizations

It is imperative to carefully select data management and communications tools that benchmark performance and drive efficiencies. Discover how to optimize care management functions, value-based care delivery and revenue.

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Selecting data management & communications tools that benchmark performance and drive efficiencies  

While healthcare payers have steadily increased pressure on providers to achieve the Triple Aim — to build healthier populations, provide higher quality care with better outcomes, and lower costs — providers have resisted for many reasons, particularly the costs required to achieve these goals. Payer pressure to achieve the Triple Aim is expected to grow as they implement more value-based payment models. Healthcare organizations and practices that cannot adapt will suffer financially.

Patient-centered quality care management is an essential part of a practice’s transition from fee-for-service to value-based payments. Unfortunately, most electronic medical record (EMR) and other health information management technology does not enable effective and efficient care management, patient engagement, or documentation necessary to bill for the services. Making workflow adjustments and improving infrastructure will be necessary to achieve value-based payment success.

Although new Medicare billing codes offer incentives for doctors to implement care management for eligible chronically ill patients (from 2016’s CPT 99490 to 2017’s CPT 99487 and 99489), few practices have sought payment under the codes. Why? Even though they perform most of the mandatory care management steps as part of their everyday patient care, practices found the level of reimbursement did not justify the documentation burden and other required efforts.

Thousands of providers have recently agreed to be paid by Medicare under alternative payment models and,  over the next 10 years, providers will be required to participate in the Merit Based Incentives System (MIPS) as they are compelled by the incentives and penalties. This transition will gain traction as more payers implement value-based payments. Medicaid reimbursements will eventually, and almost certainly, have the same requirements as Medicare. In other words, the cumulative pressure to change will continue, and neither providers nor patients can afford to wait until “the dust settles” for technology to catch up with today’s practice needs.

Accountable Care Organizations (ACOs) and other care delivery innovators realize the need to adopt new tools to implement value-based care successfully. But new technology with poor functionality, expensive customization, limited interoperability, and a failure to support practice workflow and patient engagement has not only complicated treatment and care delivery but has also made providers wary about adopting such technology.

To select the best workflow, data, and communications tools for their needs, organizations must review their care management, documentation, and security policies and adopt best practices to ensure a smooth transition to value-based care delivery.

Developers of The Diary CarePro have worked closely with health information technology (HIT) and care managers to create an easy-to-use, cloud-based health solution that can help organizations optimize care management functions, value-based care delivery and revenue — while protecting sensitive data — to achieve the Triple Aim.

Changes In Models & Metrics Hamper Quality Improvement

Changes continue to be driven by the evolution to a consumer mindset and modifications to healthcare reimbursement models. Among the most resource-consuming changes are more demanding documentation requirements, increasing the administrative workload for caregivers.

Unfortunately, most EMRs do not support easy care management documentation, and many documentation methods require entry in multiple systems, increasing the risk of duplication and errors in records and reimbursements, ultimately reducing payments to the practice. Simultaneously, the need for highly personalized care has expanded. Organizations, medical providers, and care managers need reliable tools to manage and support billing for their services in the face of such changes.

The Diary CarePro is a care manager and patient-focused solution designed to maximize operational efficiencies, improve outcomes and reduce risk exposure in a complicated, highly-regulated environment.

“We use this tool daily,” says Karen Popp, director of care coordination at Arizona Connected Care. “It has improved our workflow and streamlined our documentation efforts. The tool is very easy to use. It keeps the patient at the center of the care plan and facilitates better care coordination and care advocacy for our patients.”

Read more about the recent changes by the Centers for Medicare and Medicaid Services to Chronic Care Management codes and policies.

Desirable data management and communications tools for ACOs, hospitals, and other care organizations include:

  • Ability to collect and analyze data based on changing needs: Customizable executive reporting allows tracking of time and productivity, services per patient populations, monthly outcomes-to-cost ratios, utilization, billing, and referral reports.
  • Personalized Care Management: CarePro can be customized at the individual patient level to take inpatient personal goals and expectations, social determinants, patient generated data and self-reported outcomes, etc.
  • A flexible cloud-based platform allows quick changes to payer information, quality metrics, evidence-based medical standards, service payment (e.g. CPT code 99490), etc.
  • Easy and secure remote monitoring improves patient engagement and medication compliance and offers better management of populations with multiple chronic conditions.
  • Security, HIPAA compliance and PHR privacy: The Diary Corporation partners with the most competent and respected security organizations, including Apple’s CareKit framework and Tresorit’s ZeroKit development tools, which provides end-to-end encryption and secure authentication.

Examples and Tools Used in Hospitals, Clinics Worldwide

In a hospital pilot studying hypertensive patients at Japan’s Keio University, doctors have found that more than 50 percent of patients have stayed actively engaged and using the tools following discharge from the hospital. The increase in engagement was an especially welcome result, considering the group is mostly older men—a segment historically less likely to adopt technology tools and self-monitor. After seeing a 40 percent increase in elderly patient engagement, the university is expanding its pilot using CarePro.

At Arizona Connected Care, in addition to increasing patient engagement, the organization saw a 50 percent improvement in workplace efficiencies. “[CarePro] takes the stress out of documenting in a patient’s record. It has basically everything I need to document and track a patient’s progress, without a bunch of unnecessary steps,” Popp said.

Learn more about CarePro and how it can help your healthcare organization become high performing.