Health Management Plan: A Better Way to Care for Patients

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Do you know how to maximize the Health Management Plan (HMP) feature of your Allscripts TouchWorksTM EHR?  Have you utilized the best build and configuration processes to meet your organizational goals?  Are you training your physicians and other end users on workflows that will help you reap the available benefits?  Not sure?  Then you have come to the right place.  HMPs have been around for years.  They are definitely not the cool, cutting edge technology of HIEs, E-calcs, or e-referrals, but Health Management Plans are a reliable, tried, and tested option to maximize patient care.  Most importantly, they are patient-centered and preventative in nature.

As the healthcare landscape shifts away from the reactionary care model we have all grown accustomed to and moves towards one where patients must become more involved in their own care, HMPs offer a great way for providers and organizations to generate patient reminders and get them in the door to take those preventive steps.  The cost of a mammogram, colonoscopy, or an influenza shot pales in comparison to the bills that can quickly pile up with a diagnosis of breast cancer, prostate cancer, or even a short hospital stay to manage flu symptoms.  With a well-thought-out configuration, utilization of the HMP functionality will provide care givers with a singular location within the application to track patient testing and procedures in order to alert the provider when these items are due, near due, or overdue.

If you would like to hear more about Health Management Plans and how to configure to maximize patient care and end user satisfaction, please join our free webcast on March 13th, Health Management Plan:  A Better Way to Care for Patients.  http://www.galenhealthcare.com/events/

Are You Ready for the Shift to Value-Based Payment Models?

A recent conversation with my almost 70 year old father went something like this:

Dad: The orthopedist thinks it’s time to start planning on doing a total knee replacement.

Me: Yeah, how much is that going to run you out of pocket?

Dad: I have Medicare, it should be minimal.

Me: Did you speak to anyone in the business office to see if they could provide you with some numbers?

Dad: Uh….no?

Me: Well, did you find out what the cost is going to include after surgery follow up care?  What about physical therapy?  Is that included in the price or is that additional?  How many sessions will you get if it is included?  What if there are complications and you need additional surgery?  How much of that comes out of your pocket?  There seem to be quite a few hospitals in your area, is one of them cheaper than the others?

Dad: I’ll have to call you back.

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Unfortunately, it’s all too common to forget that not only are we patients, but consumers and customers in the medical setting.  As such, we need to understand the fee and payment models that are being utilized.  No, they are not all the same at every organization, and yes, we all want to receive the best care.  But no one wants to pay an extra $5,000 out of pocket for the exact same service and level of care that they could have received at another facility.

How do organizations go about setting fees for service anyway?  Traditionally these schedules have been created with a Fee-For-Service (FFS) model, where charges were dictated by and large by providers employing UCR (Usual, Customary, or Reasonable) methodology.  Outcomes were never really tied to the fee schedule billed to patients and payers, which resulted in a model driven by volume versus favorable outcomes for patients.  Instead providers were free to set their own rates with little correlation between experience or expertise, and adjustments were never made as new procedures and techniques simplified and streamlined providers’ day-to-day work.  Regrettably, this has led to charges spiraling upwards for decades, despite the fact that patient satisfaction has headed in the opposite direction.

However, because the FFS model is simply not sustainable moving forward, the payment model being pushed by large commercial payers, including Medicare, is one of Value-Based Care (VBC).  A variety of programs including Pay for Performance, Clinical Integration, Shared Savings, Bundled Payments, Capitation Full Risk, Accountable Care Organizations, and Patient Centered Medical Homes are being utilized in an attempt to bring costs for both patients and payers in line with the work and risk being offered by providers.  Essentially, payers and patients are pressuring providers and hospitals to provide care in a more cost-controlled manner with better outcomes in a standard format.

As a patient and a consumer, it is important to know where your provider and organization fall on this spectrum.  Going back to the total knee replacement example, actual billed costs could vary wildly between $20,000 and $35,000 based on provider, location, and coverage; the portion of the bill the patient could be responsible for varies even more.

As a provider or organization, it’s important to understand the shift in the reimbursement models in order to leverage these newer models to remain competitive in the market.  Realistically, what model(s) are viable options for your organization?  How are you going to demonstrate the required benchmarks for these quality payment models?  More importantly, how are you going to manage the internal costs of implementing these changes while maintaining day to day operations?

Interoperability and data manipulation will be key for organizations moving forward.   A recent McKesson white paper examining the move to the VBC model states, “The key obstacles to implementing these value-based models, payers and providers agree, are a lack of standards, analytical tools, and the need for better business IT infrastructure and systems that support these models—all while taking action to reduce administrative burdens and costs to remain financially sound.”  The McKesson white paper goes on to state, “The primary obstacles payers and providers ‘urgently need’ to address in order to enable VBR are technology related. This is led by the need to integrate internal, vendor, and collaborative IT systems (41% payers, 23% providers); and data collection, access, and analytics (22% payers, 20% providers).”

Be honest and take a good hard look at your organization.  Do you have the internal staff, skill set, and knowledge base to make these changes?   Do you have the analytical skills and understanding of these various models to make an informed, accurate decision as to which of these models would best fit your organization, payer mix, and patient base?  Galen currently offers a variety of assessments and tools to assist with the implementation and management of VBC models.

In Part II of this series, we will go into further detail on the various payment models, the benefits, and constraints of each and the next step your organization needs to be looking at in the immediate future.

 

References:

http://mhsinfo.mckesson.com/rs/mckessonhealthsolutions/images/MHS-2014-Signature-Research-White-Paper.pdf

Which of these Allscripts TouchWorks EHR™ integrations would benefit your organization the most?

Galen Healthcare Solutions provides a variety of products that incorporate into the Allscripts TouchWorks EHRTM.  This poll is intended to find out which of these products you would consider most useful to your organization.

We appreciate your input and if you have used one or more of these products please feel free to leave a comment on how it has worked for your organization or if you have not used one of these products, why you feel that it would be beneficial for you.

Are Electronic Notes a pain point for your Physicians?

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“I spend too much time doing data entry and not enough with my patients” is the modern day physician’s lament.  The computer looms in every encounter and the click-scroll-click of completing the clinical note seems to take an eternity.  Most often when I hear physicians saying these words it is with a resigned voice, like they feel there is not much that can be done to change the situation.  A well-built clinical note combined with an efficient clinical workflow should take a physician 4-5 minutes to complete for a routine clinical visit, while patients with unique presentations understandably might take a little longer.
If clinical notes are taking more than 10 minutes for each encounter to complete, then it is time to take a close look at how the notes have been delivered and review them for inefficiencies.  Some of the most common issues with EHR notes are listed below as well as steps to help remedy them.

First, many providers are simply entering too much data.  This is something I have seen in many settings and there can be some workflow remedies for this.  In the most efficient clinics I have worked in, the clinical staff will start the note for the provider, entering the vitals, complete the review of systems, and sometimes the history of present illness.  The note is then open for the physician and in front of them when they walk into the room so they can review the information and update it accordingly.

Most large-scale EHR rollouts involve an “out of the box” note template solution.  These notes are designed to be all-encompassing and cover everything that you might ever want in that kind of note.  The end result is an over-cluttered note with multiple templates, sometimes with important details being buried three layers deep into subforms.  By reviewing notes with the clinicians that use them and vetting out what they chart on a daily basis, we can bring forward the critical information they want to chart on each patient and remove excess data points that cause needless clicking and scrolling.

While removing the clutter from notes and making them more efficient for the providers, we also need to provide them with an “out”.  Not every patient will present with problems that are easily represented in a point-and-click format, so providing a free text box in each note section to allow physicians to record impressions that don’t fit the norm is a win/win for the patients and the providers.

When building out the Review of Systems templates, we can again cut this down to only those items the physicians chart regularly.  We recommend holding build meetings to reach a consensus on what should be included in general, and what items are included in the “All Normal” rendering, especially with shared notes.  Once there is agreement on the build and design for the “All Normals”, we have found that using visual cues for such “Normals” is a great way to cut down physician documentation time when charting by exception.

The Plan and Discussion/Summary sections of the note are often where the provider wants to spend their time and tell the story of their patient.  Templates can work for some providers, while others may want to use free text and Dragon Voice Recognition Software.  If the rest of the note is built and completed efficiently, the provider is not left feeling frustrated by the time they reach this section.

If your physicians are feeling the pain of data entry, it could be time for a comprehensive review of documentation standards and practices in your EHR.

Galen ranked #2 in KLAS for Technical Services

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Galen ranked #2 in KLAS for Technical Services

Along with Galen Healthcare Solution’s award-winning Products and premier Professional Services, we’re honored to announce ranking #2 on the 2014 Best in KLAS Awards: Technical Services. Each year KLAS releases “accurate, honest, and impartial ratings of healthcare technology to help providers make informed decisions,” and we are excited to be listed alongside today’s leading organizations. At Galen, we are dedicated to ensuring that technology enables a better patient experience, and our technical service expertise is at the core of every conversion, integration, and care team communication platform.

Visit us at HIMSS15, and see how we are helping to build a better healthcare experience.

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Please stop by our booth at the Annual HIMSS Conference in Chicago, Illinois

APRIL 12-16, 2015
Booth #5423

 

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