clinical transformation: fee-for-service solutions · clinical transformation: fee-for-service...

Clinical Transformation: Fee-For-Service Solutions

Dr. Kent Locklear, Jessica Scruton, and Alexis Edwards

© 2020 Lightbeam Health Solutions | All rights reserved. | Confidential. Please do not copy or forward.

Confidential Information

This communication contains confidential information governed by the written confidentiality provisions contained in our license agreement and/or

NDA. It is intended only for the individuals or the entity to which it was originally sent. Please do not copy or forward.

Copyright © 2020 Lightbeam Health Solutions, Inc. All rights reserved.

Website: www.lightbeamhealth.com

http://www.lightbeamhealth.com/


Housekeeping

• Slides and webinar recording will be distributed

• The webinar will be available in the Lightbeam Learning Portal• https://learning.lightbeamhealth.com/

• Q&A at the end

https://learning.lightbeamhealth.com/


Agenda

• Pain-Points

• Clinical Transformation Advisory Support

• Extended Staffing Solution

• Full-Service Solution

• Summary

• Q&A


Kent Locklear, MD, MBA

Lightbeam’s Chief Medical Officer

• MD and MBA from the University of Virginia

• Double-boarded in family medicine and clinical informatics

• Over three decades of experience in physician leadership and operational healthcare change

• Extensive medical practice and management experience with both federal systems and private practices

• Medical Director of a safety net organization in Southeast North Carolina


Pain-Points Providers are Facing

• Dramatic decrease in office visits

• Financial burden - laying off or furloughing staff

• Care managers shifting roles

• Challenges in maintaining attribution


3 Solutions with Lightbeam

• Clinical Transformation Advisory Support: Implementation of In-House Care Management• Provide all required pieces to support an in-house CM program from patient identification to

reporting on outcomes post-program

• Build, train/cross-train additional staff and track progress

• Extended Staffing Solution: LCS Supplements What Your CM Staff are Doing • Supports a portion of your activities

• Serves as a bridge; Can be short-term or long-term (act as support during this time or provide a long-term solution to staffing strains post-COVID)

• Full-Service Solution: LCS Performs All AWVs and CCM for the Beneficiaries • Execute all care management activities using our in-house staffing


AlexisEdwards,BSN, RNAdvisor, ClinicalTransformation

Jessica Scruton, BSN, RN, CCMDirector, Clinical Transformation

Clinical Transformation Team

[email protected] [email protected]


3 Solutions with Lightbeam


Clinical Transformation can assist you with launching your CCM program or you can outsource the full range

of CCM activity.

We understand that staffing needs change continually and we are also here to provide continuity of care if

your staffing needs fluctuate.

Clinical Transformation Advisory Support

Extended Staffing Solution Full-Service Solutions


What is Clinical Transformation?

Wing of Advisory Services

Subject Matter Experts in Care Management

Provides Deployment Strategy and Scalable Solutions

Oversight of Lightbeam Client Services


Clinical Transformation Advisory Support: Implementation of In-House Care Management


Clinical Transformation Programs

Population – Care Management

• CHF >3 Risk

• ER Frequent Fliers - nonemergent

• Behavioral Health + 1 chronic cond

• COPD

• Rising Risk/Cost

• Drug Seekers

• Transition of Care Management

• Real time ADT alerts

Program Management / FFS

• MSSP ACO

• ESRD Classification• Retaining low cost beneficiaries

• HCC Coding

• Annual Wellness Visits

• Fee For Service Revenue• Improved Quality Scores• Retain Attribution

• CCM

• RPM

• High Spend out of network

• Proactive Patient outreach

• Preventive/Chronic Condition Follow up

Quality Improvement

• Optimize Quality Scores

• Huddle Forms• Face Sheets

• Vaccination Programs• Flu• Pneumococcal

• Machine Learning - AI• Identifying undiagnosed Diabetics• CHF, COPD, ER Utilizers

• Proactive Patient outreach

• Preventive/Chronic Condition Follow up


CCM: CMS Solution to Manage Chronic Diseases


What We Provide For You

• Each program package will include recommendations around:• Cohort criteria

• Assessments specific to the program

• Condition assessments

• Care plans

• Lightbeam workflows

• Staff training

• Reporting for productivity and program outcomes


Keeping Patients Engaged: Drive Revenue While Managing Patient Needs Remotely

Any non-face-to-face care management and coordination service provided on behalf of an enrolled beneficiary by a clinical staff member or provider counts. Here are a few of the activities that count towards CCM time:

✓ Phone calls, emails, and messaging with the patient and their caregiver and family members

✓ Lab, report, and image review and processing

✓ Care plan creation, revision, and review

✓ Chart documentation

✓ Medication reconciliation, overseeing patient self-management of medication

✓ Medication refills

✓ Referring to and consulting with other providers and time spent closing the referral loop

✓ Communicating with home and community-based providers

✓ Remote monitoring of physiological data

✓ Post-discharge follow-up


CCM Workflow


Contract*❑ Select All❑ Medicare Shared Savings

Program❑ BCBS❑ Aetna❑ Cigna❑ Wellmed❑ No Contract*RequiredThe values are determined by the data in your system. These are examples.

❑ Patient Eligible for Chronic Care Management

GenderMaleFemaleThe values are determined by the data in your system.

EthnicityNot Hispanic or LatinoUnknown/Not ReportedDeclined to specifyHispanic or LatinoThe values are determined by the data in your system.

Ageo This Yearo Current Range

Risk ScoresRisk Score – Johns Hopkins ACG predictive model scoreATI – Ability to ImpactAdditional configurable Risk Scores – HCC shown above as an example

More AttributesAdditional filters available based on Patient Attribute flat file.

Click to add a widget

Patient Eligibility


Streamlined Care Plan Creation via Assessments Streamlined Assessment & Care Planning Options


Codes Revenue Description

CCM 99490 $43 20 min / month

Complex CCM 99487 $94 60 min / month

Add-On 99489 $47Each additional 30 min

Add-On G2058 $38Each additional 20 minutes of clinical staff time directed by

a physician or other qualified health care professional, per calendar month

PCM G2064/G2065 $79/$40Each additional 20 minutes of clinical staff time directed by a

physician or other qualified health care professional, per calendar month

TCM 99495/99496 varies MD Visit 7-14 days Post DC

RPM 99453 $21 RPM Enrollment

RPM 99454 $64

Device & Data Transmission

RPM 99458$52 Interpretation and management

RPM 99458 $42Additional 20 mins (optional) - Can be billed additional 2 times

in a month totaling 60 mins

Billing Codes


Extended Staffing Solution: LCS Supplements What Your Care Management Staff are Doing


Why Lightbeam LCSProviding Differentiated Opportunity

Streamline clinical effectiveness through workflow management and technology enablers

01

02

03

04

Lightbeam Client Services (LCS) positions you to optimize your ability to deliver care and protect revenue growth.

Improve Patient Outcomes/SatisfactionIdentifying eligible patients for TCM, CCM, or AWV and enrolling in these services has a positive effect on outcomes

Achieve Top-Line Revenue GrowthAbility to optimize efficiency broadens patient reach and allows for revenue growth opportunity

Improve Quality MeasuresOptimizing workflows and patient scheduling allow you to close more care gaps at time of appointment

Improve Frontline Clinical Staff MoraleOutsourcing repetitive tasks to LCS allows your frontline staff to do what they love – deliver care


What LCS OffersDedicated Clinical Team Working Remotely To Manage Your Patients

Our Clinical Staff:

• Are located in the U.S.

• Hold compact or reciprocal licenses

• Do not practice medicine

• Adhere to a strict scope of practice

Registered Nurse (RN)• Day-to-day patient management including medication

reconciliation, care plan review, and identification of new symptoms

• Primary patient outreach

Healthcare Documentation Specialist• Enroll patients as necessary into CCM

• Gather appropriate documentation and transcribe documentation as necessary

• Support day-today patient management as necessary for RNs


• Outsource outreach to top 10% of high-risk patients if needed• LCS CCM • LCS RPM

Confidential. Please do not copy or forward.

Risk Stratify your CCM Population and Optimize your Staffing Resources• Focus internally on top 3% of highest-risk patients who

account for +40% of your overall spend• In-house CCM: Repurposing staff to manage Chronic Diseases remotely • LCS RPM 3%

7-10%

• Promote preventative health through AWVs and closing quality care gaps.

Internal

Outsource


Full-Service Solution: LCS Performs All AWVs and CCM for the Beneficiaries


Patient Stratification Identify CCM Eligibility Coordination with Hospitals & HIEs

Patient Outreach Patient OutreachPatient Contact within 48 Hours of

Discharge

Appointment Explanation Program Explanation and Enrollment Discharge and Medication Review

Medication Reconciliation Patient Initial AssessmentSchedule Face-to-Face Visit within 7-14

days

Health Risk Assessment Care Plan Drafting Patient Appointment Confirmation

Identify Preventable Services Care Plan Approval and Periodic Review Face-to-Face Visit with PCP

Schedule Face-to-Face Visit Record Collections Follow-up Call

Patient Appointment Confirmation Medication Reconciliations Provide Support for Barriers to Care

Perform Face-to-Face Visit Treatment Plan Coordination Support Patient 30-day Post D/C

Access to Care and Care Team Documentation of Services

Condition and Medication Education

Triage Services for Active Distress

Documentation of Time Spent

Annual Wellness Program Tasks

Chronic Care Management Tasks (Performed Monthly)

Transitional Care Management Tasks (Performed as Needed)

Remote Patient Monitoring (Continual)

Patient Stratification

Device Selection (based on DX)

and Deployment

Initial Set-Up and Patient

Education

Ongoing Remote Patient

Monitoring and Outreach Via

Dedicated Team of Clinicians

Physician/Care Team Notification:

Alerts and Exacerbations

Monthly Care Plans with Biometric

Data Trending

Documentation of Time Spent

What Lightbeam Client Services Can Perform For You


Chronic Care ManagementA Good CCM Program Can Help

Chronic Care Management programs, when administered correctly, combine three key elements to help patients manage their long-term health concerns.

Consistent “Between Visit” Care Proactive Preventative Measures Remote Care

Increases the ease of access to wellness resources.

Lowers the barriers of providing consistent engagement.

Helps patients identify and act on personalized preventative

care measures proactively.

Improves practice compliance with value-based care measures.

Increases patient focus on their health.

Increases provider visibility into health issues.


Next Steps for Us to Help

If you are interested in any of these, contact the clinical transformation team or reach out to your Account Manger or Advisor.

AlexisEdwards,BSN, RNAdvisor, ClinicalTransformation

Jessica Scruton, BSN, RN, CCMDirector, Clinical Transformation

[email protected] [email protected]


Questions?


Confidential Information

This communication contains confidential information governed by the written confidentiality provisions contained in our license agreement and/or

NDA. It is intended only for the individuals or the entity to which it was originally sent. Please do not copy or forward.

Copyright © 2020 Lightbeam Health Solutions, Inc. All rights reserved.

Website: www.lightbeamhealth.com

http://www.lightbeamhealth.com/

clinical transformation: fee-for-service solutions · clinical transformation: fee-for-service...

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