chronic care management program and tools · 2017-02-13 · •chronic care management (ccm)...
TRANSCRIPT
© HTS3 2015 | Page 1
Expand your Reach
Chronic Care Management Program
and Tools
© HTS3 2015 | Page 2
• Turnaround
Strategy
• Financial
•Operations
•Corporate
Compliance
• Board
Development
•Regulatory Compliance and Accreditation Preparation
• Lean Process Improvement
•CHNA
•Gaffey Revenue Cycle Management
•CrossTX Population Health Platform
•Optimum Productivity
• Execuitve Recruiting
• Interim Executive Placements
•Mid-level and Specialty Placements
Formerly known as Brim
Healthcare we have a
45 year track record of
delivering superior
clinical & operating
results for our clients.
We believe that the combination of People, Process & Technology transforms healthcare & provides the required
results
Our Company
Our Executive Team
has experience in
managing hospitals
from multi-billion $
healthcare systems to
community hospitals
Our Team Our Mission
Management Placement Consulting Technology
Who We Are
Building Leaders – Transforming Hospitals – Improving Care
CrossTx is a premium cloud based Care
Management Platform focused on driving world
class patient care through innovative
technology www.CrossTx.com
© HTS3 2015 | Page 4
Faith M Jones, MSN, RN, NEA-BC
Director of Care Coordination and Lean Consulting Faith Jones began her healthcare career in the US Navy over 30 years ago.
She has worked in a variety of roles in clinical practice, education,
management, administration, consulting, and healthcare compliance. Her
knowledge and experience spans various settings including ambulance,
clinics, hospitals, home care, and long term care. In her leadership roles she
has been responsible for operational leadership for all clinical functions
including multiple nursing specialties, pharmacy, laboratory, imaging, nutrition,
therapies, as well as administrative functions related to quality management,
case management, medical staff credentialing, staff education, and
corporate compliance.
David Householter, BSCS CrossTx, Web Developer David Householter is a graduate from Montana State University with a
Bachelor of Science in Computer Science while exploring the
surroundings of Bozeman, MT. Through his experiences over the last
several years David has had a focus on user experience web
development. He seeks to solve challenging issues by building an
interface that allows for simple interactions. In addition to his work with
CrossTx, David teaches web development, most recently teaching a
Web Development Seminar (CSCI 494) for Montana State University.
Outside of the office: David enjoys spending time in the mountains of
Big Sky country while riding his bike and sliding down mountains on
skis.
© HTS3 2015 | Page 6
3-Part Series • Welcome
• 3 part series on Care Coordination in Primary Care – Overview of Population Health in Primary
Care: A Look at Financial Impacts • July 26, 2016 Recording Available at:
http://www.healthtechs3.com/category/past-webinars/
– Chronic Care Management Program and Tools – Today
– Advance Care Planning Process and Reimbursement Opportunities – September 20, 2016
© HTS3 2015 | Page 7
“Our goal is to recognize the trend
toward practice transformation and
overall improved quality of care, while
preventing unwanted and
unnecessary care”
CMS CFR 11-12-2014
© HTS3 2015 | Page 8
“We acknowledged that the care coordination included in services such as office visits does not always describe adequately the non-face-to-face care management work involved in primary care and may not reflect all the services and resources required to furnish comprehensive, coordinated care management for certain categories of beneficiaries”
CMS CFR 7-15-2015
Changing Model
© HTS3 2015 | Page 9
• Chronic Care Management (CCM)
– Effective January 1, 2015 (2016 for RHCs and FQHCs
• CPT code 99490
– Proposed Rules for January 1, 2017
• Intent remains the same but “less
administrative burden”
• Additional CPT codes for Complex CCM
– 99487 and 99489
New Payment Codes
© HTS3 2015 | Page 10
CCM Billing Pre-Requisites
Practice Eligibility
• Qualified EMR
• After hours access
• Care Plan Access
Patient Eligibility
• Medicare Patient
• Two or more chronic conditions expected to last at least 12
months or until the death of
the patient
• At significant risk of death,
acute exacerbation,
decomposition, or functional
decline without management
© HTS3 2015 | Page 11
• Patient Consent
• Documentation of at least 20 minutes
per calendar month spent coordinating
care
• Patient Centered Care Plan
– Include outside healthcare providers (as
appropriate)
– Include community resources (as
appropriate)
CCM Criteria to Bill
© HTS3 2015 | Page 12
Charging vs. Tracking
Billable Visit Time Tracking
• No Double Dipping
• Track all time for non-billable services
• Do Not track time if billing for
the visit
• No Double Dipping
• Continue to bill for eligible services
• If service is billable do not track
time
© HTS3 2015 | Page 13
The Provider Question
What do I have to do?
Embrace the concept of
Team Based Care
© HTS3 2015 | Page 14
Team Based Care
© HTS3 2015 | Page 15
Expand your Reach • Get the full value from your healthcare
team.
• Bridge the gap between healthcare professionals and the patient’s family and community.
• Invest in tools & processes to maximize the benefits of connectivity of formal and informal networks. – average clinic RN has been doing this already
behind the scenes.
© HTS3 2015 | Page 16
CrossTx is a premium cloud based Care
Management Platform focused on driving world
class patient care through innovative
technology www.CrossTx.com
© HTS3 2015 | Page 17
CrossTx Care Management Platform
Provider Connect
– Effective Care Management
– Chronic Condition Management
– Episode of Care (Referral) Management
– Reports and Analytics
Community Connect
– Invite community into a patient’s care
– Track Time spent coordinating with community
– Secure Messages to patent and family
– HIPAA Compliant
© HTS3 2015 | Page 18
Provider Connect
Care Management
Chronic Condition Management
– Manage all Medicare Requirements
– Bill for Medicare Reimbursement
– Medication reconciliation
Referral Management
– Closed Loop
– Electronic Data Standard Support
Reports and Analytics
* Health Affairs: An Insurer’s Care Transition Program Emphasizes Medication Reconciliation, Reduces Readmissions and Costs. July 2016
50% reduced relative risk of
readmission*
Save $2 for every $1 spent*
© HTS3 2015 | Page 19
Patient Eligibility
Track Patient Eligibility for Medicare
– 2+ Chronic Conditions
– Primary Care Provider
– Consent
– Care Plan
© HTS3 2015 | Page 20
Internal Note
Non-Face-to-Face
Encounters
– Staff Coordinating
– Patient Experience
Internal Notes add information to the patients chart.
© HTS3 2015 | Page 21
Perform an Intervention
Saving 2 Dollars for Every dollar spent for medication reconciliation*
* Health Affairs: An Insurer’s Care Transition Program Emphasizes Medication Reconciliation, Reduces Readmissions and Costs. July 2016
© HTS3 2015 | Page 22
Referral Management
Seamless Communication
Provider Networks
– Refer In-Network
– Drive Revenue
Closes the Loop
CCM Time Tracking
© HTS3 2015 | Page 23
Attach Patient Files
Consolidate Care Document (CCD) / HL7
© HTS3 2015 | Page 24
Referral Details
© HTS3 2015 | Page 25
Conclude Assignment
Closed Loop Referral Management
© HTS3 2015 | Page 26
Community Connect
• Invite community into a patient’s
care
• Track & Report any time spent
with Non Face-to-Face
Coordination
– among the entire care team, family
& community
• Engage the patient & family
• HIPAA Compliant
© HTS3 2015 | Page 27
Organization Access
Invite community into patient’s care
© HTS3 2015 | Page 28
Invite community into patient’s care
Personal Access
Is used for: - Family - Care Givers
© HTS3 2015 | Page 29
Invite by Email
Simple Sign Up
No Charge for Community
Invite community into patient’s care
© HTS3 2015 | Page 30
Track Time Coordinating Community
© HTS3 2015 | Page 31
• Message Community
– Control Visibility of the message
Track Time Coordinating Community
© HTS3 2015 | Page 32
Reports & Analytics
Chronic Condition
Reporting
– Requirements Met &
Time Tracking
– Adjusting
Requirements
Patient Activity Report
– Snapshot for
Providers
– Reference for
Patients
© HTS3 2015 | Page 33
CrossTx Care Management Platform
Provider Connect
– Effective Care Management
– Chronic Condition Management
– Episode of Care (Referral) Management
– Reports and Analytics
Community Connect
– Invite community into a patient’s care
– Track Time spent coordinating with community
– Engage the patent and family
– HIPAA Compliant
© HTS3 2015 | Page 34
Caring. Community. Connections.
© HTS3 2015 | Page 35
Upcoming Events
http://www.healthtechs3.com/webinars/
© HTS3 2015 | Page 36
THANK YOU!
Faith M Jones, MSN, RN, NEA-BC
HealthTechS3
David Householter, BSCS
CrossTx