#ACO

Improving Population Health using Epic’s Healthy Planet

Population Health Management isn’t a concept that is new to the healthcare industry however, efficiently managing high-cost and high-risk patients is becoming a necessity with payment models focusing on reducing cost and improving outcomes. With this, many organizations are instituting an increased focus towards population health management, participating as Accountable Care Organizations (ACOs) in order to more effectively identify, understand, engage, and track patient populations. An ACO delivering high-quality and low cost care will share in the savings that is achieved for the Medicare program.

Many EHR vendors, including Epic, are looking to provide tools to assist organizations in moving toward better and more coordinated care for individuals, greater health and disease prevention, and less healthcare expenditure.  Healthy Planet is Epic’s solution for helping organizations achieve these goals.  It allows clinicians to identify and address gaps in care with patient populations using tools within Epic – EpicCare Ambulatory, MyChart and Cogito – to take action on population health analytics, integrate care management and coordination, and engage the patient in their care.

Many of our clients are part of an Accountable Care Organization (ACO) establishing integrated care teams made up of physicians, nurses and social workers that utilize the tools provided by Healthy Planet such as navigators, dashboards and bulk ordering and communication functions as well as MyChart to help manage the needs of their high-risk patients. Healthy Planet’s ACO functionality has been used to define ACO patient populations, complete patient questionnaires for risk stratification, track patient outreach, provide care management which includes documentation of medication compliance, care plans and goals, as well as interaction through MyChart. Organizations have also begun to create team Longitudinal Plans of Care allowing other clinicians throughout their organization as well as other Epic organizations to see their care efforts in one concise place.

As a result, organizations have already begun to see the benefits of their Population Health Management efforts meeting the goals of:

  • Accurately and efficiently capture data for preventive care and disease management services
  • Monitor the performance of providers on closing care gaps for these services
  • Implement chronic care management workflows for care managers
  • Apply risk stratification models to your patient populations
  • Increase efficiency through bulk ordering and communication
  • Engage patients through MyChart
  • Improve transitions of care and patient engagement with a longitudinal plan of care

 

Through their care management teams, they have been able to better understand patient needs in areas ranging from transportation to doctor’s appointments and picking up medications to education regarding their clinical care. Reporting shows decreases in Emergency Room visits as a specific example and clients continue to gather data that demonstrates how critical care management is to overall population health.   The successful implementation of tools such as Healthy Planet provide both short term and long term benefits that result in a more educated ACO and an overall improvement in the healthcare experience and general well-being of individual patients.

Progressive Approaches to Revenue Cycle Optimization

Sharing best practices, lessons learned and innovative solutions to improve the effectiveness and efficiency of a revenue cycle operation is central to any consulting firm’s success. As part our approach to introducing our firm’s capabilities and experience, I wanted to share examples of how we have helped hospitals, integrated delivery networks, academic medical centers and group practices solve challenges faced by the multitude of regulatory changes, ICD-10, shifting reimbursement models and healthcare reform. Additionally, these solutions have included leveraging leading edge IT vendors to enhance the patient experience while improving revenue cycle performance. Progressive healthcare organizations are taking a strategic view at addressing these seemingly endless pressures by transforming overall patient access and revenue cycle operations as opposed to tackling each pressure as an individual project.

Examples of how progressive healthcare organizations have transformed patient access and revenue cycle operations include:

Evaluating Benefits of A Core Vendor to Support Patient Access, EHR and Revenue Cycle Requirements: A core vendor to meet enterprise-wide registration, scheduling, EHR and billing requirements can provide a variety of benefits including reduced annual operating expenses, clinical work flow efficiencies, improved physician productivity and satisfaction, reductions in lost charges, improved coding and compliance, and enhanced patient satisfaction. However, vendors differ in their features and functionality, as well as their Total Cost of Ownership. Meaningful Use financial incentives have directed attention and resources towards Electronic Health Records, however future state requirements provide an optimal opportunity to evaluate the benefits and trade-offs of vendor capabilities to address an organization’s future state revenue cycle requirements.

Leveraging ICD-10 Conversion to Improve Coding and Clinical Documentation: Converting to ICD-10 will require upgrades to clinical and revenue cycle systems, as well as a significant investment in training physicians, administrative and billing staff. While most organizations have completed or are in the process of completing an ICD-10 impact assessment, ICD-10 planning should include a holistic view of improving charge capture, documentation and billing workflows. As with new revenue cycle system implementations, this conversion provides a unique opportunity for re-designing processes, policies and procedures and your use of technology to drive revenue cycle efficiencies.

Centralizing & Standardizing Patient Access: Establishing a centralized patient access unit to support registration and scheduling for hospital and professional services. Centralized patient access has been an effective vehicle for improving data capture to reduce denials, and also for improving the patient experience by reducing the number of phone calls to schedule services. Frequently, this type of implementation involves consolidating and standardizing Visit Types to improve physician productivity and enterprise-wide reporting.

Single Consolidated Patient Statement: Accountable Care Organizations will tightly align professional and hospital billing operations and require revenue cycle systems to support bundled payments. When addressing these requirements, several of our clients have leveraged this opportunity to implement a single consolidated patient statement covering both hospital and professional services. In addition to significant cost efficiencies, this has a major impact on patient satisfaction which has proven to accelerate patient payments.

Business Intelligence & Population Management: The use of metrics and benchmarking is not new, however advances in healthcare business and clinical intelligence tools provides the ability to leverage actionable information to improve financial and clinical performance. These tools help maximize reimbursement and allow healthcare organizations to effectively and proactively manage patient populations, while complying with payer and regulatory requirements.