CH_Mack_Overview_DDPA

Report
CH Mack, Inc.
MedCompass™ Overview
for
Developmental Disabilities Provider
Association (DDPA)
1
Company Overview
 65 Clients, 8500+ users
 14+ yrs serving Health & Human Services
− State & Local Govt. (SLG) Agencies
 8+ yrs serving Health Plans
 Serving all points on the Continuum of Care
 Managed Care Organizations (MCOs, HMOs, etc.)
 State & Local Govt. (SLG) HHS organizations
 LTC, HCBS
 75% use in support of government-sponsored
healthcare programs
2
Customer Experience
WA
ND
MT
MN
ME
SD
OR
ID
WI
VT
WY
MI
NH
NY
MA
IA
NE
IL
NV
UT
CO
IN
PA
OH
KS
MO
CA
OK
NM
NJ
WV
KY
AZ
RI
CT
VA
DE
MD
TN
NC
AR
SC
MS
TX
AK
AL
GA
LA
CH Mack Users
FL
HI
3
Representative Clients
 Arkansas Department of Human Services
 Xerox Government Healthcare Solutions
 BlueCross BlueShield of Tennessee
 Kaiser Permanente
 NevadaCare, The i/mx Companies
 California Dept of Aging (Multipurpose Senior Services Program)
 Many other leading Health & Human Services organizations
4
Real-time Collaboration
HHS Organizations,
Health Plans
Case Manager
Member Care Data
Physician
Home & Community
Based Services
(HCBS)
Member
Hospital
Collaboration Among Care Team Members
5
Integrating the Continuum of Care
Care Coordination
Tertiary Care
Center
Home Infusion
Enteral
Feedings
Personal Care
Aid
Home Maker
ICU/CCU
Home Health
Skilled Nursing
Durable Medical
Equipment
Wellness
Program
Consumer
Directed Care
Acute Care
Hospitalization
Intensive Care
Management
PT/OT/Speech
Health Coaching
Supported Self
Care
Community
Hospital
Skilled Nursing
Facility
Ambulance
Transportation
Disease
Management
Advanced
Directives
Outpatient
Hospital
Discharge
Planning
Public
Transportation
Fuel/Auto Repair
Hospice
Specialist – PCP- Behavioral Health Specialist – Social Worker - Caregiver
6
Member Centric Health Management
Reporting
Seamless Integration
Health
Management
 UM/UR
 Case Management
 Disease Management
 Outcomes
 Core Measures
 Clinical systems
 Claims systems
 Industry Std Criteria
Case
Management
UM/UR
 Clinical Data Repositories
 Productivity
 Many more
Health
Assessments
Member
Referrals
HIPAA
Electronic Record
Disease
Management
Performance
Reporting
Pro-Active
Care Planning
7
Business Function Overview
Utilization Management
Case Management

Referral management


Pre-authorization / Precertification
Assessment & referral
management

Care planning

Auto approvals

Task management

Letter generation


Medical review process
Documentation & letter
generation

Appeals & grievances

Mobile support

Embedded criteria

Third party integration

Care team coordination
Wellness Management

Health Risk Assessment (HRA)
integration

Educational mailing generation

Monitoring of preventive metrics

Scheduled wellness activities

Mobile support
Population Health
Analytics & Reporting
Disease Management
System consolidated
information

Opportunity identification

Gap in care alerts

Integration of data from multiple
sources

Stratification of members at risk
Ongoing monitoring

Ad hoc and standard reports

Utilization management

Documentation & letter
generation

Data export capabilities

Health coaching support


Third party integration
Industry leading BI platform,
Microsoft SQL Server Reporting
Services (SSRS)

Member identification

Collaborative Care

Care planning


8
CMSA Standards of Practice
9
The Continuum of Healthcare
* CMSA Standards of Practice for Case Management – 2010, p. 5
10
Health Care Reform
From 2010-2019*:
 Spend $938 billion on expanding insurance coverage, including
$464 billion in subsidies to help uninsured people buy coverage.
 Expand Medicaid coverage to 16 million additional people.
 Reduce the number of uninsured by 32 million people.
Affordable Care Act
March 23, 2010
* Source: The Congressional Budget Office
11
Government Health Care Programs
Deep History in Medicaid Managed Care Programs:
 Arkansas DHS – All Medicaid Divisions
− DAAS, DDS, DMS, DBHS, DCO
 Florida
− Neighborly Care Network, American ElderCare
 Arizona
− Medicaid LTC
 California
− MSSP Program – 20 Organizations
 New York
− Suffolk, Erie, Westchester County DSS’s
 WellCare Health Plans
− 1,349,000 Medicaid Members
− 246,000 Medicare Advantage Members
 Tennessee – TennCare CHOICES Program
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Representative Clients
13
Representative Clients
14
Representative Clients
15
Xerox Govt. Healthcare Solutions
Xerox Government Healthcare Solutions
After a rigorous 12+ month vendor evaluation process, in May CH Mack
was notified that Xerox Government Healthcare Solutions
(http://www.acs-inc.com/healthcare.aspx) selected MedCompass™ as
the new Health Management platform to serve all Xerox State & Local
Government HHS customers going forward.
16
Xerox Govt. Healthcare Solutions
17
interRAI – Strategic Partner
18
Scope of Automation
MedCompass™ automates the complete interRAI
instrument system:

Data Collection Form (Assessment)

Triggers (Algorithms)

Clinical Assmt. Protocols (CAPs)
interRAI Instrument Model

Status and outcome measures
(Scales)
Assessment
Case Mix
(RUG-III, RUG-IV)
Minimum
Data Set
Clinical Assmt.
Protocols
Outcome
Measurement
Scales
Quality
Indicators
19
Key Components in MedCompass™
Key Components of interRAI Instrument that are
automated in MedCompass™:
 Data Collection Forms – interRAI assessments
 Clinical Assessment Protocols – “CAPs”
• ID – Collaborative Action Plans
 Status and Outcomes Measures – “Scales”
 Algorithms developed by interRAI
 Outputs – Via MedCompass Reporting Engine
• Microsoft SQL Server Reporting Services (SSRS)
• Tableau – Data Visualization / BI Technology
20
interRAI HC in MedCompass™
21
CAPs
22
CAPs in MedCompass™
23
Scales
24
Scales in MedCompass™
25
Gartner Industry Validation
26
Gartner Industry Validation
27
HHS Strategic Plan
28
HHS Strategic Plan
29
HHS Strategic Plan
“At the heart of HHS’s strategy to transform and
modernize the healthcare system is the use of
data to improve healthcare quality, reduce
unnecessary healthcare costs, decrease
paperwork, expand access to affordable care,
improve population health, …”
30
CMS Innovation Center
31
Accountable Care Organizations
32
Accountable Care Organizations
What are Accountable Care Organizations?
The Term Accountable Care Organization (ACO) describes the
development of partnerships between hospitals and physicians to
coordinate and deliver efficient care. The ACO concept envisions
multiple providers assuming joint accountability for improving health
care quality and slowing the growth of health care costs. The
concept was included in national health care reform legislation as
one of several demonstration programs to be administered by
Medicare (Patient Protection and Affordable Care Act, 2010).
The success of the ACO model in fostering clinical excellence and
continual improvement while effectively managing costs hinges on
its ability to incentivize hospitals, physicians, post-acute care
facilities, and other providers involved to form linkages that facilitate
coordination of care delivery throughout different settings and
collection and analysis of data on costs and outcomes.
33
Patient Centered Medical Home
34
Patient Centered Medical Home
What is Patient Centered Medical Home?
In a set of standards that describe clear and specific criteria, NCQA’s
Patient Centered Medical Home (PCMH) program gives practices
information about organizing care around patients, working in teams
and coordinating and tracking care over time.
The Patient Centered Medical Home is a health care setting that
facilitates partnerships between individual patients, and their
personal physicians, and when appropriate, the patient’s family. Care
is facilitated by registries, information technology, health information
exchange and other means to assure that patients get the indicated
care when and where they need and want it in a culturally and
linguistically appropriate manner.
35
Patient Centered Medical Home
From H.R. 3590 Patient Protection and Affordable Care Act
Title II Subtitle I
Sec. 2703. State option to provide health homes for enrollees
with chronic conditions. Provide States the option of enrolling
Medicaid beneficiaries with chronic conditions into a health home.
Health homes would be composed of a team of health professionals
and would provide a comprehensive set of medical services,
including care coordination.
36
Product Evolution
The convergence between advanced Microsoft technologies, industry best
practices, and proven Health Management functionality.
.NET
Framework,
Silverlight
Healthcare
Management
Best Practices
CH Mack
Medical Mgt
Solutions
(QCS)
37
MedCompass™
Best-in-Class Functionality + Technology
38
User Friendliness
MedCompass is built using the latest Microsoft technologies,
to include Silverlight – delivering the next generation of .NET
based media experiences and rich interactive applications
for the Web. User experience engineering (UXE) has been
core to CH Mack’s development of MedCompass,
understanding the importance of low learning curves and
high adoption rates to deliver high ROI in large-scale Care
Management technology initiatives.
39
User Friendliness
40
User Friendliness
Silverlight is a powerful development tool that lets .NET
developers rapidly develop and deploy applications for the
Web, and mobile devices.
Using Silverlight, developers can create applications with
richness and interactivity out of reach of traditional web
technologies while retaining the simple deployment and
update model of web applications.
41
Efficiency – Workflow Automation
Patient-Centered Workflow
MedCompass, by enabling comprehensive workflow(s)
across caregivers, optimizes the efficient use of resources to
achieve specific patient and organizational goals.
MedCompass’ Workflow Management tools increase
efficiency and effectiveness through the maximal integration
and use of relevant, timely information.
42
Efficiency – Workflow Automation
MedCompass’ patient-centered workflow automates:
•
Identifying a target process (e.g., case management program).
•
Defining both clinical and administrative tasks to be performed by a work
group.
•
Breaking down tasks into more specific actions that can be performed by
different individuals but which, when completed together, accomplish the
original tasks.
•
Deciding on the skill set required to perform each task or action (e.g., skills of
a physician, nurse, case manager, patient, caregiver, etc.).
•
Understanding the sequence in which the tasks are to be performed.
•
Recognizing and applying conditional rules and logic branching, so that only
necessary and indicated tasks are performed.
•
Planning the sequence of tasks, assigning the tasks to individuals, and then
documenting the process so that others can understand and follow it.
•
Creating the forms, documents, and instructions needed by individuals at
each step to perform the tasks (e.g., care plans, service plans, etc.).
43
Workflow Automation
44
System Configuration Functions
MedCompass includes easy to use System Configuration
functions, in the Admin Console, that allow authorized users to
configure and maintain dozens of system features and
functions. Examples include:
● Lookup Table Configuration
● Program Configuration
● General System Configuration Items
● Print Configuration
● User Management
● ISP Configuration
● Assessment Management
● Rules Setup
● Automated Task Configuration
● Time Tracking Configuration
● Service Auth Configuration
● Case Note Configuration
● Contact Management Configuration
● And many other Configuration functions
● Metrics Configuration
● Document Template Administration
● Fax Management
● PGIM Administration
45
System Configuration Functions
System Admin Console
46
Comprehensive Assessment Builder
CH Mack customers are able to control their own
assessments, surveys, etc. using our industry leading
assessment configuration tool. This functionality allows
clients to build their own assessments and associated
rules into the application without CH Mack professional
services assistance.
47
Comprehensive Assessment Builder
System Admin Console
48
MedCompass™ and MITA
Medicaid Information Technology Architecture
CMS Initiative – A national framework to support improved systems development
and health care management for the Medicaid enterprise.
MITA 2.0 Principles
MedCompass™
MITA 3.0 Principles
Open Architecture
Service Autonomy
Standards
Standardized Contracts
Modularity
Loose Coupling
Reusable Components
Reuse
Collaboration
Abstraction
Data Sharing
Discoverability
Security - SSO
Statelessness
MedCompass™
49
MedCompass™ and MITA
MedCompass™ Alignment with MITA Technical Requirements
MITA Technical Requirements
MedCompass™
Use open data and technical standards that meet
MITA requirements
Use Commercial Off-the-Shelf products as far as
possible
Solution must be built using component based
model
Should meet accessibility standards – support thin
client web browsers, Adobe for document sharing
50
MedCompass™ and MITA
MedCompass™ Alignment with MITA Technical Requirements
MITA Technical Requirements
MedCompass™
Must use industry standard data communication
mechanism such as HL7, X12 (EDI), XML and
LOINC
Preferred that there is a workflow service spanning
the entire application
Must use a Rules Engine that is easy to maintain
and change
Must meet security and privacy needs of MITA
51
Contact Information
For additional information contact:
Greg Silence
513-936-6000 x602
[email protected]
52

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