Presentation on theme: "CH Mack, Inc. MedCompass™ Overview for Developmental Disabilities Provider Association (DDPA)"— Presentation transcript:
1 CH Mack, Inc.MedCompass™ Overview for Developmental Disabilities Provider Association (DDPA)
2 14+ yrs serving Health & Human Services 8+ yrs serving Health Plans Company Overview65 Clients, users14+ yrs serving Health & Human ServicesState & Local Govt. (SLG) Agencies8+ yrs serving Health PlansServing all points on the Continuum of CareManaged Care Organizations (MCOs, HMOs, etc.)State & Local Govt. (SLG) HHS organizationsLTC, HCBS75% use in support of government-sponsored healthcare programs
3 Customer Experience CH Mack Users CA NV OR WA ID MT WY UT CO AZ NM TX AKHICH Mack UsersNDSDNEKSOKMNIAMOARLAWIILINOHKYTNMSALGAFLSCNCVAWVPANYMEVTNHMIMACTRINJDEMD
4 Representative Clients Arkansas Department of Human ServicesXerox Government Healthcare SolutionsBlueCross BlueShield of TennesseeKaiser PermanenteNevadaCare, The i/mx CompaniesCalifornia Dept of Aging (Multipurpose Senior Services Program)Many other leading Health & Human Services organizations
5 Home & Community Based Services (HCBS) Real-time CollaborationHHS Organizations,Health PlansCase ManagerHome & Community Based Services (HCBS)PhysicianMember Care DataHospitalMemberCollaboration Among Care Team Members
6 Integrating the Continuum of Care Care CoordinationTertiary Care CenterICU/CCUAcute Care HospitalizationCommunity HospitalOutpatient HospitalDischarge PlanningSkilled Nursing FacilityIntensive Care ManagementHome Health Skilled NursingHome InfusionEnteral FeedingsDurable Medical EquipmentPT/OT/SpeechAmbulance TransportationPublic TransportationFuel/Auto RepairDisease ManagementHealth CoachingWellness ProgramPersonal Care AidHome MakerConsumer Directed CareSupported Self CareAdvanced DirectivesHospiceSpecialist – PCP- Behavioral Health Specialist – Social Worker - Caregiver
7 Performance Reporting HIPAA Electronic Record Member Centric Health ManagementReportingSeamless IntegrationHealth ManagementUM/URCase ManagementDisease ManagementOutcomesCore MeasuresProductivityMany moreClinical systemsClaims systemsIndustry Std CriteriaClinical Data RepositoriesCaseManagementUM/URHealth AssessmentsDiseaseManagementMemberPerformance ReportingReferralsHIPAA Electronic RecordPro-ActiveCare Planning
8 Utilization Management Business Function OverviewUtilization ManagementCase ManagementHealth Risk Assessment (HRA) integrationEducational mailing generationMonitoring of preventive metricsScheduled wellness activitiesMobile supportWellness ManagementReferral managementPre-authorization / Pre-certificationAuto approvalsLetter generationMedical review processAppeals & grievancesEmbedded criteriaAssessment & referral managementCare planningTask managementDocumentation & letter generationMobile supportThird party integrationCare team coordinationDisease ManagementAnalytics & ReportingPopulation HealthMember identificationCollaborative CareCare planningOngoing monitoringDocumentation & letter generationThird party integrationSystem consolidated informationIntegration of data from multiple sourcesAd hoc and standard reportsData export capabilitiesIndustry leading BI platform, Microsoft SQL Server Reporting Services (SSRS)Opportunity identificationGap in care alertsStratification of members at riskUtilization managementHealth coaching support
10 The Continuum of Healthcare * CMSA Standards of Practice for Case Management – 2010, p. 5
11 From 2010-2019*: Health Care Reform 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 ActMarch 23, 2010* Source: The Congressional Budget Office
12 Government Health Care Programs Deep History in Medicaid Managed Care Programs:Arkansas DHS – All Medicaid DivisionsDAAS, DDS, DMS, DBHS, DCOFloridaNeighborly Care Network, American ElderCareArizonaMedicaid LTCCaliforniaMSSP Program – 20 OrganizationsNew YorkSuffolk, Erie, Westchester County DSS’sWellCare Health Plans1,349,000 Medicaid Members246,000 Medicare Advantage MembersTennessee – TennCare CHOICES Program
16 Xerox Govt. Healthcare Solutions Xerox Government Healthcare SolutionsAfter a rigorous 12+ month vendor evaluation process, in May CH Mack was notified that Xerox Government Healthcare Solutions ( selected MedCompass™ as the new Health Management platform to serve all Xerox State & Local Government HHS customers going forward.
19 MedCompass™ automates the complete interRAI instrument system: Scope of AutomationMedCompass™ automates the complete interRAI instrument system:Data Collection Form (Assessment)Triggers (Algorithms)Clinical Assmt. Protocols (CAPs)Status and outcome measures(Scales)interRAI Instrument ModelAssessmentMinimumData SetOutcomeMeasurementScalesQualityIndicatorsCase Mix(RUG-III, RUG-IV)Clinical Assmt.Protocols
20 Key Components in MedCompass™ Key Components of interRAI Instrument that are automated in MedCompass™:Data Collection Forms – interRAI assessmentsClinical Assessment Protocols – “CAPs”ID – Collaborative Action PlansStatus and Outcomes Measures – “Scales”Algorithms developed by interRAIOutputs – Via MedCompass Reporting EngineMicrosoft SQL Server Reporting Services (SSRS)Tableau – Data Visualization / BI Technology
30 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, …”
33 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.
35 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.
36 Patient Centered Medical Home From H.R Patient Protection and Affordable Care ActTitle II Subtitle ISec 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 Product EvolutionThe convergence between advanced Microsoft technologies, industry best practices, and proven Health Management functionality..NET Framework,SilverlightHealthcare Management Best PracticesCH Mack Medical Mgt Solutions (QCS)
39 User FriendlinessMedCompass 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.
41 User FriendlinessSilverlight 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 Efficiency – Workflow Automation Patient-Centered WorkflowMedCompass, 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 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.).
45 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
46 System Configuration Functions System Admin Console
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 Comprehensive Assessment Builder System Admin Console
49 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 PrinciplesMITA 3.0 PrinciplesOpen ArchitectureService AutonomyStandardsStandardized ContractsModularityLoose CouplingReusable ComponentsReuseCollaborationAbstractionData SharingDiscoverabilityMedCompass™Security - SSOStatelessness
50 MedCompass™ and MITAMedCompass™ Alignment with MITA Technical RequirementsMITA Technical RequirementsMedCompass™Use open data and technical standards that meet MITA requirementsUse Commercial Off-the-Shelf products as far as possibleSolution must be built using component based modelShould meet accessibility standards – support thin client web browsers, Adobe for document sharing
51 MedCompass™ and MITAMedCompass™ Alignment with MITA Technical RequirementsMITA Technical RequirementsMedCompass™Must use industry standard data communication mechanism such as HL7, X12 (EDI), XML and LOINCPreferred that there is a workflow service spanning the entire applicationMust use a Rules Engine that is easy to maintain and changeMust meet security and privacy needs of MITA
52 Contact InformationFor additional information contact: Greg Silence x602