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1 CH Mack, Inc. MedCompass™ Overview for Developmental Disabilities Provider Association (DDPA)

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Presentation on theme: "1 CH Mack, Inc. MedCompass™ Overview for Developmental Disabilities Provider Association (DDPA)"— Presentation transcript:

1 1 CH Mack, Inc. MedCompass™ Overview for Developmental Disabilities Provider Association (DDPA)

2 2 Company Overview  65 Clients, 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

3 3 Customer Experience

4 4 Representative Clients  Arkansas Department of Human Services  Xerox Government Healthcare Solutions  BlueCross BlueShield of Tennessee  Kaiser Permanente  NevadaCare, The i/m x Companies  California Dept of Aging (Multipurpose Senior Services Program)  Many other leading Health & Human Services organizations

5 5 Real-time Collaboration Collaboration Among Care Team Members Case Manager Hospital Physician HHS Organizations, Health Plans Home & Community Based Services (HCBS) Member Care Data Member

6 6 Integrating the Continuum of Care Care Coordination Specialist – PCP- Behavioral Health Specialist – Social Worker - Caregiver Tertiary Care Center ICU/CCU Acute Care Hospitalization Community Hospital Outpatient Hospital Discharge Planning Skilled Nursing Facility Intensive Care Management Home Health Skilled Nursing Home InfusionEnteral Feedings Durable Medical Equipment PT/OT/Speech Ambulance Transportation Public Transportation Fuel/Auto Repair Disease Management Health Coaching Wellness Program Personal Care Aid Home Maker Consumer Directed Care Supported Self Care Advanced Directives Hospice

7 7 Member Centric Health Management  UM/UR  Case Management  Disease Management  Outcomes  Core Measures  Productivity  Many more Health Management UM/UR Disease Management Referrals Case Management Pro-Active Care Planning Health Assessments HIPAA Electronic Record Performance Reporting Member  Clinical systems  Claims systems  Industry Std Criteria  Clinical Data Repositories Reporting Seamless Integration

8 8 Business Function Overview  Assessment & referral management  Care planning  Task management  Documentation & letter generation  Mobile support  Third party integration  Care team coordination Case Management  Member identification  Collaborative Care  Care planning  Ongoing monitoring  Documentation & letter generation  Third party integration Disease Management  Referral management  Pre-authorization / Pre- certification  Auto approvals  Letter generation  Medical review process  Appeals & grievances  Embedded criteria Utilization Management  Opportunity identification  Gap in care alerts  Stratification of members at risk  Utilization management  Health coaching support Population Health  Health Risk Assessment (HRA) integration  Educational mailing generation  Monitoring of preventive metrics  Scheduled wellness activities  Mobile support Wellness Management  System consolidated information  Integration of data from multiple sources  Ad hoc and standard reports  Data export capabilities  Industry leading BI platform, Microsoft SQL Server Reporting Services (SSRS) Analytics & Reporting

9 9 CMSA Standards of Practice

10 10 The Continuum of Healthcare * CMSA Standards of Practice for Case Management – 2010, p. 5

11 11 Health Care Reform From *:  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. * Source: The Congressional Budget Office March 23, 2010 Affordable Care Act

12 12 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

13 13 Representative Clients

14 14 Representative Clients

15 15 Representative Clients

16 16 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. Xerox Govt. Healthcare Solutions

17 17 Xerox Govt. Healthcare Solutions

18 18 interRAI – Strategic Partner

19 19 Scope of Automation MedCompass™ automates the complete interRAI instrument system:  Data Collection Form (Assessment)  Triggers (Algorithms)  Clinical Assmt. Protocols (CAPs)  Status and outcome measures (Scales) Assessment Minimum Data Set Minimum Data Set Outcome Measurement Scales Quality Indicators Case Mix ( RUG-III, RUG-IV) Clinical Assmt. Protocols interRAI Instrument Model

20 20 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 Key Components in MedCompass™

21 21 interRAI HC in MedCompass™

22 22 CAPs

23 23 CAPs in MedCompass™

24 24 Scales

25 25 Scales in MedCompass™

26 26 Gartner Industry Validation

27 27 Gartner Industry Validation

28 28 HHS Strategic Plan

29 29 HHS Strategic Plan

30 30 “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, …” HHS Strategic Plan

31 31 CMS Innovation Center

32 32 Accountable Care Organizations

33 33 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. Accountable Care Organizations

34 34 Patient Centered Medical Home

35 35 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. Patient Centered Medical Home

36 36 Patient Centered Medical Home From H.R Patient Protection and Affordable Care Act Title II Subtitle I Sec 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.

37 37 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)

38 38 MedCompass™ Best-in-Class Functionality + Technology

39 39 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.

40 40 User Friendliness

41 41 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.

42 42 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.

43 43 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.).

44 44 Workflow Automation

45 45 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 System Configuration Functions

46 46 System Configuration Functions System Admin Console

47 47 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.

48 48 Comprehensive Assessment Builder System Admin Console

49 49 MedCompass™ and MITA MITA 2.0 Principles MITA 3.0 Principles Open Architecture Service Autonomy Standards Standardized Contracts Modularity Loose Coupling Reusable ComponentsReuse CollaborationAbstraction Data SharingDiscoverability MedCompass™ Security - SSOStatelessness Medicaid Information Technology Architecture CMS Initiative – A national framework to support improved systems development and health care management for the Medicaid enterprise.

50 50 MedCompass™ and MITA 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 MedCompass™ Alignment with MITA Technical Requirements

51 51 MedCompass™ and MITA MITA Technical RequirementsMedCompass™ 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 MedCompass™ Alignment with MITA Technical Requirements

52 52 Contact Information For additional information contact: Greg Silence x602


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