Software Tools that Empower Healthcare
- 1. Technology Connects Case Managers to Better Processes, Improved OutcomesChris Boue, President & CEOCH Mack
- 2. ObjectivesEvaluate current healthcare environment and demands on case managers.Analyze how technology advances can streamline productivity, while cutting administrative costs and improving quality of care in a managed care environment.“This is so cool…I’m flying this thing with my Palm Pilot.”Evaluate your own organization and consider how technology can improve quality of care for your membersContent to CoverIdentify healthcare IT landscape from different points of view: employer, government, and private payer perspectives.Explain how technology and tools, specifically workflows and dashboards, can enhance productivity.Discuss a specific case study, detailing how collaboration technology helped a managed-care provider eliminate paper-based systems and improve productivity and customer service.
- 3. Technology in Today’s Healthcare OrganizationsTechnology advances in the past few decades have revolutionized the way health care organizations:Relate to their customers,Conduct business operations, and Organize themselves
- 4. Looking Forward, Looking BackIncentivesPerformanceOutcomes
- 5. Technology’s role in Care Management
- 6. U.S. Healthcare Performance and Future Challenges
- 7. Healthcare Economics
- 8. New Incentives and Processes: Pay for Performance….A work in progress
- 9. Pay for Performance….A grading challenge
- 10. Pay for Performance….It’s about improvement
- 11. BusinessCost managementDemand managementValue management
- 12. GovernmentCMS (Medicare and Medicaid)Special Needs Plans (SNPs)Medicare Part D
- 13. Long Term Care - Service Delivery
- 15. The view of care management has been revolutionized
- 16. In many ways…..
- 17. Home and Community Based Services (HCBS) Care CoordinationSpecialist - PCP - Behavioral Health Specialist - Social Worker
- 18. Case ManagementConsumer-centered marketCreating valueIntegration
- 21. Stakeholder communication via portalsIntegrating data from multiple sources Eligibility, Medical/PBM claims, Care management, Profile/PHR , FSASelf Service Tools Web Portals, IVR/FAX ServicesDelivering multiple applications Enrollment, Disease Management, Wellness, Decision Support, Predictive ModelingImplementing data enabled communication services Sending email, text, automated phone calls, live voice notifications based upon user profile Turning paper based solutions into paperlessSupporting Member and Provider Communication and Engagement Strategies
- 22. Software application: portalsData SourcesDataExchangeApplication MarketplaceEnd UsersDeliveryNetworkPortalAppPortalAppPortalAppCare Management
- 23. Databases
- 24. Text
- 25. Web
- 26. Email
- 28. US Mail
- 29. Fax
- 30. Live VoicePortal Example- Providers
- 31. Integrated Portal - Providers
- 32. Portal Example- Patients (wellness)Four main features:Interactive online software: fitness tracker, workout generator, calorie counter, meal plans and more.Website content that is regularly updated by in-house experts.Advanced social networking community features including: personal homepages, teams, and more.Regular email newsletters.
- 33. Portal Example- Patients (wellness)
- 34. Software ApplicationsUtilization ManagementCase ManagementClaims
- 35. Role Based Design
- 37. WorkflowsWith workflows, the right job goes to the right people, at the right timeWorkflows helps the user to:Reduce the number of pended claimsMaximize team efficiencyProcess more workExceed service commitmentsMonitor and adjust work tasks in real timeProactively identify backlogs or bottlenecks
- 41. The technology battlefield:Siloed dataIntegration
- 42. Integration
- 43. Integrated Case Management: Connected Care Integrated Care ManagementFunctionsPREDICTIVEMODELMEMBERPROFILINGIMPROVEDOUTCOMESClaimsDataCaseMgt.Chronic ConditionsRX DataServiceMgt.ReferralMgt.ClinicalDataReportsOperationalInsightQ ContinuumDataOtherData
- 44. Case Study: 800 users Automating key business process and workflows provides consistent delivery and contract compliance for a Fortune 500 managed care organization. A Fortune 500 company focusing on Medicaid and Medicare that offers a variety of health plans for families, children, the aged, blind, and disabled, as well as prescription drug plans. The company served more than 2.5 million members nationwide as of December 31, 2008. The priority for this company was to automate processes, eliminate redundant data entry, improve productivity and accuracy, while reducing support costs and increasing efficiencies. The Company wished to “retire” multiple, dispersed legacy systems in place and focus on:
- 45. Case Study: 800 users Key Drivers: • Centralizing information • Improving member and provider satisfaction • Enhancing the interactivity of medical management • Improving the accuracy of information and authorizations • Supporting new programs and markets, as the Company grows
- 49. DashboardsThe new face of BI (Business Intelligence)Business-driven and focused
- 50. Evaluating Your Own OrganizationBusiness requirementsDelivery of consistency across the Continuum of CareCost metricsTechnology solutions
- 51. Thanks for EngagingChris Boue, President & CEOCH MackE-mail: cboue@chmack.comLinkedIn: www.linkedin.com/in/chrisboueTechnology Connects Case Managers to Better Processes, Improved OutcomesChris Boue, President & CEOCH MackChris Boue, President & CEOCH Mack
- 52. ReferencesBurns, L., Brunker, C. P., Dorr, D. A., McConnell, K. J., & Wilcox, A. (2007). Productivity Enhancement for Primary Care Providers Using Multicondition Care Management. The American Journal of Managed Care, 13, 22-28. Chao, S. H. (2006). Introduction: Shifting the Focus From Cost to Value. Journal of Managed Care Pharmacy, 12(6). Supplement. Cornell, S. A. (2007). Clinical case study: Achieving long-term control of insulin resistance. Journal of Managed Care Pharmacy, 13(2). S11-S15.Cross, M. A. (2007). Follow the leaders: Top pay-for-performance programs point to increased focus on hospital incentives, efficiency measures, coordination, and standardization. Managed Care Magazine. MediMedia. Dunn, J. D. (2007). Pharmacy management approach: How do we align all the incentives? Journal of Managed Care Pharmacy, 13(2). S16-S19. Edgar, B. S. (2006). Shifting the Focus from Cost to Value: A Government Perspective. Journal of Managed Care Pharmacy, 12(6). Supplement. Enterprise Content Management (2009). Collaboration technology helps managed-care provider eliminate paper piles. Accessed on April 14, 2009 at http://www.ecmconnection.com/download.mvc/Collaboration-Technology-Managed-Care-Provide-0001 O’Kane, M. E. (2007). Performance-based measures: The results are in. Journal of Managed Care Pharmacy, 13(2). S3-S7. Shurney, D. W. (2006). Shifting The Focus From Cost To Value: A Private Payer Perspective. Journal of Managed Care Pharmacy, 12(6). Supplement. Smith, A. L. (2007). Merging P4P and disease management: How do you know it is working? Journal of Managed Care Pharmacy, 13(2). S7-S10.