nahc annual meeting, phoenix az oct 19-22, 2014 · 2017. 10. 31. · nahc annual meeting, phoenix...
TRANSCRIPT
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(403) How to Improve Bottom Line and P4P Outcomes during Declining
NAHC Annual Meeting, Phoenix AZ Oct 19-22, 2014
Reimbursement:
Jeff Nyquist Ph D Executive Director / Chief Executive Officer of Upper Peninsula
Utilize Standardized Point‐of‐Care Workflows with Clinical Decision Support, QA and QI
Jeff Nyquist Ph. D., Executive Director / Chief Executive Officer of Upper Peninsula Home Health, Hospice and Private Duty, [email protected]
Lisa Van Dyck RN MS, VP Clinical Product Development, Eventium [email protected]
OutlineIntroduction
• State of affairs of homecare reimbursement, costs and challenges
Episode management – current typical activities
• Non‐revenue‐generating clinical and QI staff • Direct care clinicians
Financial impact: agency case study pre and post‐implementation of standardized step‐by‐step point‐of‐care clinical pathways
Demonstration of standardized care model with clinical decision support (CDS)
• Best practice integration, demo of workflow, clinical decision support, reports
Impact of standardized care and CDS on episode management activities/workflows
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NEED TO CHANGE
OUR Story: Implementing Clinical Pathways
Upper Peninsula Home
Health & Hospice
STAFF RESPONSE
QI / QA SAVINGSFAMILY
SURVEY DATA
MARKETING OUR
SUCCESS
Hospice
RESOURCE SAVINGSOASIS
PROCESS INDICATORS
OASIS OUTCOMES
Eroding MarginsBase 2011
2012 2013 2014 2015 2016 2017 2018
Rate Change
‐2.39% ‐2.00% ‐1.50% ‐2.00% ‐2.00% ‐2.00% ‐1.50%Change
Inflation in Costs
2.40% 2.30% 2.40% 2.50% 2.50% 2.50% 2.50%
Paymentper episode
$2,500 $2,440 $2,391 $2,355 $2,308 $2,262 $2,217 $2,250
Cost per episode
$2,200 $2,200 $2,200 $2,200 $2,200 $2,200 $2,200 $2,200episode
Margin per episode
$300 $240 $191 $151 $108 $62 $17 $50
Margin % 12.0% 9.8% 8.0% 6.6% 4.7% 2.7% 0.8% 2.2%
* calculated from ABT and Associates “Analysis in Support and Rebasing & Updating Medicare Home Health Payment Rates”, June 21, 2013,pg. 21, SN (131.51 * 9.39) rounded to dollar.
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Why We Needed To Change
• Paper Pathway Model and Less‐Integrated Our Previous Care Model p y g
Patient Education toolsCare Model & Tools
• Difficult & Costly to maintain content in current modelReasons for current model
• Moving from paper‐based to EMR‐based• EMR‐based Pathway was recognized best practice in the industry
• Needed to demonstrate evidence‐based, standardized care to potential partners
Selecting New Model of Care
Staff Response
• Staff Reaction– New SNs to home careNew SNs to home care
– Seasoned SN• Issues– Related to hardware issues and connectivity
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Results: QI / Education Time Savings
• Training / Orientation of new employees with NO home health experience is easier with the use ofhome health experience is easier – with the use of a standardized care model that directs care at the visit level
• Removes Major Source of Variance: Standardized Care Plans for all Nurses on all Visits
• Quality reviews are more efficient with the use of a standardized care model and associated reports within an electronic record
RESOURCE USE / COST OF CARE
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RESOURCE USE / COST OF CARE
d h ld• Moved Case Management to the Field– 2 FTE Office RNs (15% of all Nursing)
• Reduced Service Plan (Visit Frequency)
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SN Direct Costs per Episode
$1,344$1,600
$1,344 $1,207
$944 $813
$600
$800
$1,000
$1,200
$1,400
Q1 2011
Q1 2012
Q1 2013
$‐
$200
$400
Cost per Episode
Q1 2014
Decreased Episode Costs = $avings(Decrease from Q1 2011 to Q1 2014)
↓ $530/• x 1125 Episodes (2013)
↓ $530/ Episode
• $596 600/↓ $149 150/ •= $596,600/year•= 30% of all Costs!
↓ $149,150/
Quarter
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• Discuss productivity and staff usage
ADRs
ADRs
•# ADRs: 15•$ Returned: $0
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OASIS‐C – PBQIPROCESS INDICATORS
80
90
100
IMPLEMENTATION DATE
20
30
40
50
60
70 Timely Initiation of Care
0
10
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96
98
100
IMPLEMENTATION DATE
86
88
90
92
94
Pressure Ulcer Risk Assessment Conducted
84
86
99
100
101
IMPLEMENTATION DATE
94
95
96
97
98
99
Drug Education on High Risk Meds
92
93
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95
100
IMPLEMENTATION DATE
80
85
90
95
Potential Medication Issues Identified & Timely
75
Identified & Timely …
OASIS OBQI
OUTCOMES
Impact of Pathways on ER Use & Hospitalizations
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60
70National ReferenceImproved Management of Oral Meds
IMPLEMENTATION DATE
20
30
40
50
60
0
10
90National ReferenceImprovement in Dyspnea
IMPLEMENTATION DATE
20
30
40
50
60
70
80p y p
0
10
20
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120National Reference
IMPLEMENTATION DATE
40
60
80
100
120 Improvement in Surgical Wounds
0
20
90National Reference
f
IMPLEMENTATION DATE
30
40
50
60
70
80
90Improvement in Confusion Frequency
0
10
20
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90National ReferenceImprovement in Anxiety Level
IMPLEMENTATION DATE
20
30
40
50
60
70
80Improvement in Anxiety Level
0
10
20
25
National ReferenceER w/ Hospitalizationl
IMPLEMENTATION DATE
5
10
15
20
/ p
0
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40
45National ReferenceAcute Care Hospitalization
IMPLEMENTATION DATE
10
15
20
25
30
35
40p
0
5
0
HHQI – CAHPS – SATISFACTION
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CAHPS – Medications (Current Data)
120
40
60
80
100Medications & Pain
National
0
20
4. Talk About Medicines You Are Taking (% Yes)
Ask to See Medicines (% Yes)
Talk About Pain (% Yes)
Talk About Side Effects of
Medicines (% Yes)
CAHPS – Listening, Help, Respect (Current Data)
95100
60657075808590
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CAHPS – Informed or Problems w/ Care (Current Data)
95
100
70
75
80
85
90
60
65
70
Providers Informed and Up to Date (% Always)
Informed on Arrival Time (% Always)
Problem with Care (% No)
CAHPS – Satisfaction & Recommendation (Current Data)
95
100
75
80
85
90
70Rate Care from this Agency (%9 or 10)
Get Help When Contacting Office (%
Yes)
How Long to get help or advice (% Same
Day)
Recommend this Agency (% Definitely
Yes)
Rate Service on Person who
scheduled care (% Excellent/Very Good)
Use services of agency again (% Very Likely/Somewhat
Likely)
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MARKETING STRATEGIES & EXPERIENCES
Solution: Minimize Cost with Episode Management at the Point‐of‐Care
Standardized Step-by-Step Pathways with real-time CDS
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Success StrategiesDocumentation…Documentation…Documentation
• Assures compliance
E i dEpisode management
• Standardized step‐by‐step care• Point‐of‐care accountability via clinical and process alerts• Controlled, managed care• Patient‐driven, outcome‐driven• Insight into population management
• Real time alerts and reports during episode• G‐tag compliance• Physician order compliance• OASIS outcome decline• Population analysis reports – cost and variance• Case management reports – clinical severity vs productivity and outcomes
Example: standardized care model
Clinical Pathways – outcome‐driven, step byClinical Pathways outcome driven, step by step model:
• VNA FIRST Home Care Steps® Pathways & CoSteps
Patient Education Tools – outcome‐driven,Patient Education Tools outcome driven, Step by Step model:
• Step by Step Patient Education Guides
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Care Plans VS Pathways
• List of
Care Plan
• List of Interventions & Outcomes BY EPISODE Pathway
List of Interventions & Outcomes BY VISIT / ENCOUNTER
CHF Care Plan (Interventions – episode)
E l t k l d f S/S t t t RN/Ph i i d th th t d
PLAN for VISIT: Routine Visit, continue CHF Care Plan per care manager
Evaluate knowledge of S/S to report to RN/Physician and those that need immediate medical attention. (Refer to Zone/Red Flag Plan. Use Teach Back Method to determine comprehension. Ask patient to repeat in Their OWN WORDS.
Instruct on definition of disease process and basic treatment goals.
Instruct on importance of good skin care to edematous areas; s/s of skin breakdown and what to report.
Each clinician pick and choose from the list to assess, teach, etc
Instruct on causes of pedal edema and measures to control or reduce edema.
Evaluate ability to assess pedal edema and to appropriately notify physician/RN.
Instruct to record weight daily and to report weight gain of > 2 lbs. in 24 hours, > 3 lbs. in 48 hours, > 5 lbs. in 7 days or as per physician order.
Evaluate ability to take pulse, demonstrate as needed.PLAN FOR NEXT VISIT? “As per care plan”, “As per case manager”
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Step by Step Example – CHF Pathway
• Instruct on diet/ fluid restrictions
Nut/Hyd/Elim
√SafetyStep 2
Instruct on diet/ fluid restrictions• Verbalizes general dietary restrictions
Step 5
• Instruct on how to calculate sodium content of food/fluids• Verbalizes how to calculate sodium content of food/fluids• Demonstrates compliance with diet/fluid requirements
√ Disease Control
y
Step 8
• Instruct on selection of appropriate restaurant foods • Verbalizes knowledge of appropriate restaurant food choices√ Health
Promotion
CHF Step 3 Interventions
3
PLAN for VISIT: CHF Step 3
ALL interventions are expected to be completed and Outcomes met. If they are not, then need to indicate reason WHY with a Variance codeDefine variance from THE STANDARD= ACCOUNTABILITY every visit
PLAN for NEXT VISIT: Advance to Step 4
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Care Plans VS Pathways
• Care Plan– List of Interventions & Outcome BY
• Pathway• Planned Interventions that GUIDE the care && Outcome BY
EPISODEthat GUIDE the care & Outcomes that DRIVE the care BY VISIT / ENCOUNTER
Visit 2
Step 1 Step 2 Step 3
Care Plan
Visit 1 Visit 3
Underlying Standard + Defined Variance = Population Management
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Increase Audits, Paybacks, Penalties
QIC/PSC/ZPIC/ALJ/MAC/RAC/H.E.A.T• Face to face• Physician order compliance
State surveys
Accrediting body surveys
HHQI report cards P4PHHQI report cards, P4P• Outcome, Process, Satisfaction
Impact on viability, must be low risk• Marketing• Partnerships
Uncontrolled Episode Costs
Lack of standardization at the point‐of‐pcare
•→ Lack of population management•→ Excessive outliers, LUPAs•→ Unpredictable costs•→ Unpredictable outcomes
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Increase Cost
↑ QA, Oversight cost to ensure compliance• Education staff – orientation• Clinical management• QA/QI staff• ConsultantsConsultants
↑ Expense for third party scrubbers/analytics
Rebasing Success Strategies
• Reduce care variance• Reduce care variance• Reduce avoidable LUPA episodes• Improve discipline utilization and management
• Improve OASIS HHRG reflecting planned care
Opportunities to improve clinical,
operational, and financial
• Investigate DM programs that will enhance care delivery
outcomes:
Source: 7/15/2014 NAHC Financial Management Conference, McBee Associates Inc.
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Episode Management: ↑ $
Focus: Outside visit episode management activities
History
• No Standardization ‐ variability in care • Inefficient and inconsistent care planning
Care Management
Care Management: Challenges
Inefficient and inconsistent care planning• Higher % of LUPAs or Outliers• Lack of accountability at the point of care
• Reactive care VS Proactive and Preventive Care• Retrospective Care Analysis (too late to take immediate action)• High Rate of ER and ACH during episodeg g p• Declines in OASIS outcomes• Ineffective visits, lack of change in care plan
• Lack of standardized patient education tools – limited participation in care
• Lack of continuity in care, difficult to quickly identify unique needs, re‐teaching same content = ineffective visits
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History
Care Management
Care Management: Challenges
Typical Workflow of a Case Manager
Resource Needs
Visit Frequency
IDT Care Coordination
OASIS SOC Episode Planning
Plan for Next Visit
Frequency
Physician Orders
Create Care Plan
Evaluate EOC & Discharge Readiness
Coordination
Implement Care Plan
Plan for VISIT
Assessment & Interventions
Visit Documentation
History
• Plan of Care often does not accurately reflect patient’s needs• Case Mix does not accurately reflect Service/Utilization
POC Oversight
Plan Of Care Oversight: Challenges
Case Mix does not accurately reflect Service/Utilization • Difficult to show compliance with G‐Tags, Physician Orders• Care is difficult to defend →penalties and pay‐backs
• Heavily utilized in‐office Case Managers, Clinical Managers, QA/QI staff
• POC analysis is delayed, retrospective at IDTM mtg, random or Post‐Discharge
• Identifying new documentation requirements, EBP and Best Practices is labor intensive and difficult to implement and enforce
• EHR technology limitations (internet/device reqs., clinical workflow and content doesn’t fit into existing EMR structure)
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History
POC Oversight
POC Oversight: Challenges
Typical Workflow
Extensive review of OASIS ensuring = correct Care Plan
Random, Retrospective Chart Audits
IF Patient is still in‐service: make change in care plan
Educate Clinician for future reference
Documentation of follow‐up communication and action is typically lacking.
History
• No standardization in criteria for use of disciplines (SN, PT, OT SLP MSS RD HCA)
Team Collaboration: Challenges
Team Collaboration
OT, SLP, MSS, RD, HCA)• Lack of evidence for need for specific disciplines
• Disciplines working in a silos• Hand‐offs between the same discipline or different disciplines are fragmented• Lack of continuity• Unnecessary re‐assessments, inefficient visitsy ,• Duplication of services
• Lack of accountability for interteam communication at POC• Overdue interdisciplinary communication
• Lack of documentation of telephone or in‐person interteam communication
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History
Team Collaboration
Team Collaboration: Challenges
Disciplines are Siloed
Resource Needs
Visit Frequency
IDT Care Coordination
Team CoordinationIDTM is Retrospective
Every 2 weeks
Siloed
Frequency
Physician Orders
Implement Care Plan
Evaluate EOC & Discharge Readiness
Coordination
Hand‐offs are fragmented
History
• Lack of consistent discharge (CARE TRANSITION) criteria• Lack of clinical decision support for discharge
Discharge Planning: Challenges
• Lack of clinical decision support for discharge recommendations based on clinical findings
• Lack of evidence supporting need for planned visits (resource use) or for continued services in higher LOS cases
• Payer, Agency or Clinician driven care VS Patient‐driven care
• Significant variance in number of visits or resources used gfor similar patients
• Significant variance in numbers of planned visits (resource use) vs actual visits (resource use)• Low predictability in resource needs / cost for similar patients
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HistoryDischarge Planning: ChallengesSubjective Clinician – Driven Discharge Planning
across Case Managers = Outlierswithout clear reason for variance
Similar Patient Discharged:
< 4 visits
Similar Patient Discharged:
12 visits
Similar Patient Discharged:
>19 visits
History
• Lack of accountability at POC, delaying evaluation of effectiveness of care
Clinical Outcomes: Challenges
effectiveness of care• Lack of real‐time evaluation of findings, outcomes• Delayed or missed opportunity to intervene and modify
care that promotes outcome improvement• HHQI Outcome evaluation occurs AFTER OASIS submission,
eliminating ability to improve during episode• HHQI Process Indicator evaluation: discrepancies in documentation, time consuming and not evaluated until AFTER OASIS submission
• Lack of Patient‐Centric, Outcome‐Driven care• Payer, agency, clinician driven care • Lack of standardized patient education tools
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HistoryClinical Outcomes: Challenges
NoOutcome Reason Why:
?Improved
Unchanged
Declined Difficult to Improve
No Standardized
Care
Site A Site B Site C
Improved
Unchanged
Declined
History
• QA – Quality Assurance, Labor intensive, Costly• Best practice EBP Payer and Accrediting Agency
QA/QI: Challenges
QA/QI
• Best practice, EBP, Payer and Accrediting Agency requirements not embedded into the POC workflow• Compliance monitoring is time consuming• Retrospective, random auditing – too late to change care or improve outcomes or processes• Appropriateness of care, no standard• Effectiveness of care, no standard• Documentation best‐practice, no standard• Best‐practice, EBP compliance• Physician order compliance• Defensible care documentation• G‐Tag compliance
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History
• QI – Quality Improvement, difficult to focus on when QA is labor intensive and costly leading to preventable declines
QA/QI: Challenges
QA/QI
labor intensive and costly leading to preventable declines, poor documentation, care processes and clinical outcomes• $ is spent on QA activities, not on program, staff or patient improvement activities, equipment or necessary marketing/advertizing
• QI is not embedded into the workflow, retrospective after care processes have become a patternp p• Clinical – patient improvement• Process ‐ clinician improvement
HistoryQA/QI: Challenges
QA/QI
Typical distribution of QA vs. QI
ti iti
Back
QA Activities
QI Activities
activities
Retrospective Process
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CMS compliance G‐Tags
• G108 Advance notice of care & changes to plan of care
• G101 Inform, promote & protect patient rights
• G109 Participate in planning of care & treatment
• G144 Documentation shows effective care coordination
• 484.30 Condition: Skilled nursing services G‐Tags
HHQI ‐ Public Reported OASIS Outcomes
HOSPITALIZATION
ERR
AMBULATION
TRANSFERRING
BATHINGOASIS Outcomes
DYSPNEA
PAIN
SURGICAL WOUND
MEDICATIONS
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HHQI Reported OASIS Process Indicators
• MEDICATIONS
• TIMELY CARE
• FLU & PNEUMONIA
• WOUND RISK & PREVENTION
• FALL RISK
• Heart Failure S/S TREATED
OASIS Process
• DIABETIC FOOT CARE
• PRESSURE ULCER PREVENTION
• PAIN
• DEPRESSION
HHC CAHPS® Survey
• 2. Tell you what services you would get • 9. Did HH providers seem informed/up‐to‐date
Continuity / Plan
• 3. Talk with you about how to set up safe homeSafety
•4. Talk with you about all prescription and OTC•5. Ask to see all prescription and OTC meds•12. Talk about purpose of new/changed meds•13. Talk about when to take meds•14. Talk about side effects of meds
MedicationsCAHPS
• 10. Talk about painPain
• 17. Explain things – easy to understandEducation
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Demonstrate Evidence‐Based Practice (EBP)
QIOs, IHI, Etc.
Accrediting Organizations
Heart Failure
Prevention
Medication Diet
Exacerbation
S/S HFWT, Edema, Dyspnea, Ox
ActivitySafety
Self-Care
ActivityLabs
y
Condition –Specific EBP
Care Transitions
Best Practice
The Gold
Standard
Home Care Steps® Protocols
An Evidence Based Standardized Care Approach
Building BlocksBuilding Blocks
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Best Practices, Payer Requirements, Proactive Outcome Improvement
I t t d i t W kflIntegrated into Workflow
It’s not just about the expected or planned action,
it’s about how it gets prompted to be done within the workflow
=
checks and balances … on the fly!
EBP ‐ Core Disease Management Content
Assumptions (ACH, Fall, Med, Comorbids)Assumptions (ACH, Fall, Med, Comorbids)
Core Disease Management Interventions & OutcomesCore Disease Management Interventions & Outcomes• Disease process• Tests/Treatments•Medication management
Meds
• Nutrition/hydration/elimination• Activity• Safety• Psychosocial• Interteam/Community
Source: VNA FIRST Home Care Steps® Protocols
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EBP – Condition‐Specific Content
Integration of Condition‐Specific Best Practice
• Examples ‐ Diabetes• Diabetes Medical Practice Guidelines from the Agency for• Diabetes Medical Practice Guidelines from the Agency for Healthcare Administration
• American Diabetes Association Clinical Practice Recommendations &Standards of Medical Care for Patients with Diabetes
• American Dietetic Association• American Association of Clinical Endocrinologists
• AHRQ ‐ Agency for Healthcare Research and Quality (EBP)• CHAP, JCAHO, ACHC• CoP G Tags, HHQI Outcome and Process, CAHPSCoP G Tags, HHQI Outcome and Process, CAHPS• QIO, Care Transition, Teach Back, AIM, Project RED, etc
Visit Note: Compliance with best practice, requirements
Step by Step: Consistency in care, focused care, predictable care
Source: VNA FIRST Home Care Steps® Protocols
Disease Management Model
High Level of Self-CareHealth Promotion
Disease Control
Patient Empowerment
Disease Control4-7
8-9
Safety
Safety1-3
Source: VNA FIRST Disease Management Model
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‐ Demo ‐Workflow
P
CDS
EBPDM
Payer, Accred
Pathways: standardized managed care tools & robust data = ↓ $, variability, risk
Robust Point‐of‐Care Documentation CDS Al ith
‐ Demo – Reports
+ CDS Algorithms =
Alerts, Recommendations, and Effective Dashboards
Proactive
R l TiReal – Time
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EMPOWER THE PATIENTPatient Education Tools
Clinical
Step by Step
Pt
EdPathway
Standardized Tools
↑ Pt – driven care
EMPOWERED
ACTIVATED PATIENT
↑↓ ACH↓ $ episode
Achieve goals, less resources w/Standardized Patient Ed Tools
√
√ Health Promotion
√ Disease Control
√Safety
A Pathway for the Patient/CG!
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CHF Step 3TEACH BACK!
S/S
Meds
S/S
CAHPS ‐Meds
Goals mirror Outcomes within Clinical Pathways
Moving patients from dependent care to independent disease management
Meds
Transitional Care
OASIS Outcomes
OASIS Process
Source: Eventium’s Step by Step Guides
G109
Symptom Logs:Critical Aspects of Self Management
• Symptom Logs –included in Step by Step BooksStep Books
• Patient tracks own– Symptoms– Activity Level– Diet– Dyspnea– Pain
• Keeps patient activeKeeps patient active in their care
• Can take to their physicians
Source: Eventium’s Step by Step Guides
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Episode Management: ↓ $olutions
Focus: Point‐of‐Care episode management activities
History
Care Management
Care Management: At the Point-of-Care
Typical Workflow of a Case Manager
Back
Standardized Care: Clinical Pathways
Resource Needs
Visit Frequency
IDT Care Coordination
OASIS SOC Episode Planning
Plan for Next Visit
Frequency
Physician Orders
Create Care Plan
Evaluate EOC & Discharge Readiness
Coordination
Implement Care Plan
Plan for VISIT
Assessment & Interventions
Visit Documentation
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History
POC Oversight
POC Oversight: Workflow Alerts, Reports
Typical Workflow
Back
StandardizedWorkflow
Extensive review of OASIS ensuring = correct Care Plan
Random, Retrospective Chart Audits
IF Patient is still in‐service: make change in care plan
RT Clinical & Process alerts in WORKFLOW
CM Dashboard RT Clinical Alerts with Escalation to QI
CM RT Process Best Practice Alerts with Escalation to QI
Educate Clinician for future reference
Documentation of follow‐up communication and action is typically lacking.
QI Review RT Order Compliance
QI Review RT G‐tag Compliance
History
Team Collaboration
Team Collaboration: prompted in field
Disciplines are Siloed
Patient – Driven Standardized Care
Resource Needs
Visit Frequency
IDT Care Coordination
Team CoordinationIDTM is Retrospective
Every 2 weeks
Siloed
IDT Communication
Loop Resource Needs
Visit Frequency
IDT Care Coordination
Team CoordinationOn the Fly –Workflow
Frequency
Physician Orders
Implement Care Plan
Evaluate EOC & Discharge Readiness
Coordination
Hand‐offs are fragmented
Frequency
Physician Orders
Implement Care Plan
Evaluate EOC & Discharge Readiness
Coordination
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HistoryDischarge Planning: At Point-of-CareSubjective Clinician – Driven Discharge
Planning across Case Managers = Outliers
Back
Standardized Patient‐Driven Discharge Criteria = Controlled Results Across
Similar Patients
Si il P i
Similar Patient Discharged:
< 4 visits
Similar Patient
Similar Patient Discharged:
10 visits
Discharged:
12 visits
Similar Patient Discharged:
>19 visits
HistoryClinical Outcomes: At Point-of-Care every visit
No
Standardized Care
Outcome Reason Why:
?Improved
Unchanged
Declined Difficult to Improve
No Standardized
Care
Site A Site B Site C
Clinical Pathways (Standard)
RT Clinical Alerts of decline or lack of progress
Variance Trend Report – how
Improved
Unchanged
Declined
patient varied from Standard
Variance Report by Site, by CM, By Clinician
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HistoryQA/QI: At Point-of-Care every visit
QA/QI
Typical distribution of QA vs. QI
ti itiWork Flow:•Process Alerts
Standardized Care Paradigm Shift of QA
vs. QI activities
QA Activities
QI Activities
activities•Process Alerts•Pathway/Care Plan best practice•Payer/accrediting body requirements
•Clinical Alerts•Observation finding decline•Outcome decline or lack of progress•Clinical decision support
•Recommendation for PRN telephone visit•Recommendation for new
Retrospective Process
Recommendation for new discipline
•Escalation to CM•Escalation to QA/QI/Manager•Reports
•Adverse Events•HHQI Outcomes •Physician order compliance•G‐tag compliance
Proactive, Real Time –Workflow QA & QI Processes
Episode management at point‐of‐care
Reduce variance in care and resource use
Clinical Alert Notices of declines, lack of progress that trigger recommendations and follow‐up
Recommendations for change in disciplines, visit frequencies, on the fly
Clinical, Process & Best Practice alerts in the workflow, escalation to Manager/QI – no need for random chart reviews
No waiting for case manager in office to identify issue/need,No waiting for case manager in office to identify issue/need, field staff are triggered to take action TODAY
Ensures compliance: $$ No penalties, paybacks
$$ Episode management at point‐of‐care, reduce layers non‐revenue generating staff for care management and QA
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Standardized care via Clinical Pathway= Focused visits, higher levels of DM,
+ CDS, QA/QI = Population management↓ tli l↓ outliers, less resources
= ↓episode $
Decrease cost, increase margin Mid‐sized organization ADC ~ 200
Cost savings: $596,600 annual per episode cost
savings
Increase margins, happy owner
Improve outcomes, happy patients
More $ for marketing to grow business
More $, benefits for staff, happy
employees
Episode management with standardized care and documentation , disease management at the point‐of care resulting in confident, profitable, low‐risk organization
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Thank You! Questions ?
Standardized Care
Clinical Decision Support
Quality Care
• Proactive Care• Transitional Care Expertise
• Clinical PathwaysB t P ti
Predictable Care
• Predictable Outcomes
• Sustained Outcomes• Preventive Care Focus
Cost Effective Care
• Efficient, focused care
• Decline in Hospitalizations and ER Visits• Best Practice
• Step by Step Patient Education• Patient’s drive the care
Focus• Empowered, Activated Patients!
ER Visits• Controlled, standardized care• Less outliers
Booth #: 1412