CH Mack, Inc. MedCompass

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2 Νοε 2013 (πριν από 3 χρόνια και 9 μήνες)

103 εμφανίσεις


1

CH Mack, Inc.

MedCompass
™ Overview


for



Developmental Disabilities Provider
Association (DDPA)














2

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





3


Customer Experience

CA

NV

OR

WA

ID

MT

WY

UT

CO

AZ

NM

TX

AK

HI

CH Mack Users

ND

SD

NE

KS

OK

MN

IA

MO

AR

LA

WI

IL

IN

OH

KY

TN

MS

AL

GA

FL

SC

NC

VA

WV

PA

NY

ME

VT

NH

MI

MA

CT

RI

NJ

DE

MD


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


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


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 Infusion

Enteral

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


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


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


CMSA Standards of Practice


10


The Continuum of Healthcare

* CMSA Standards of Practice for Case Management


2010, p. 5


11


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.



* Source: The Congressional Budget Office

March 23, 2010

Affordable Care Act


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


Representative Clients


14


Representative Clients


15


Representative Clients


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

Xerox Govt. Healthcare Solutions


18


interRAI



Strategic Partner


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


Outcome

Measurement

Scales

Quality

Indicators

Case Mix

(
RUG
-
III, RUG
-
IV)

Clinical
Assmt
.

Protocols

interRAI

Instrument Model


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

interRAI

HC in
MedCompass



22

CAPs


23

CAPs in
MedCompass



24

Scales


25

Scales in
MedCompass



26


Gartner Industry Validation


27


Gartner Industry Validation


28


HHS Strategic Plan


29


HHS Strategic Plan


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


CMS Innovation Center


32


Accountable Care Organizations


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


Patient Centered Medical Home


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


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.



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


MedCompass


Best
-
in
-
Class Functionality + Technology


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


User Friendliness


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


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


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


Workflow Automation


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


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

MITA 2.0 Principles

MITA 3.0 Principles

Open Architecture

Service Autonomy

Standards

Standardized Contracts

Modularity

Loose Coupling

Reusable Components

Reuse

Collaboration

Abstraction

Data Sharing

Discoverability

MedCompass


MedCompass


Security
-

SSO

Statelessness

Medicaid Information Technology Architecture

CMS Initiative


A
national framework to support improved systems development
and health care management for the Medicaid enterprise
.




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


MedCompass
™ and MITA

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

MedCompass
™ Alignment with MITA Technical Requirements




52


Contact Information

For additional information contact:





Greg Silence

513
-
936
-
6000 x602

gsilence@chmack.com