An innovative leader in intelligent technology and consulting services for the Health and Ageing sector

Intelligent solutions for Health and Ageing Page 1

What is eCase?

eCase is an enterprise systemproviding solutions for residential agecare, community care and independentliving. The enterprise suite can be run in a cloud infrastructure or as an in-house application. eCase does not require any third party communication tools or a VPN connection for smooth, high performance operation. All that is required is a browser (e.g. Safari*, Internet Explorer®, ChromeTM, Firefox®).

Residential, ILU and Community

Quality ManagementRegisters & Assessments

Progress notes & Charting Care Plan & Work�ow

Surveys & Bench-marking

ACFI Management & Optimisation Dashboards & BI

Competencies & e-Learning

Certi�ed Medicare B2B Integration

Medication Management

Community Care

Apps for iPad and Android Tablets

“...The software is incredible ...it’s the next generation for aged care management "

Technology for Nurses, Carers & Executives

®

Page 1 Intelligent solutions for Health and Ageing Page 2*Safari is trademark of Apple Inc., registered in the U.S. and other countries.Internet Explorer is registered trademark of Microsoft Corporation in the United States and/or other countries.Google Chrome™ browser is a trademark of Google Inc. Use of this trademark is subject to Google Permissions.Firefox is a registered trademark of the Mozilla Foundation.

eCase has established integrations with all popular core financial systems.

eCase has a Single Client Record Architecture™

which enables a provider to have clients/residents traverse the pillars of aged care (Community, ILU,

Residential) seamlessly with all the client’s records following his or her care journey.

ACFI Management & Optimisation

Today, between 70 and 80 percent of facility revenue is attributable to subsidy funding. For providers this can amount to millions, if not tens of millions of dollars.

Manage “your” revenue position; eCase 4.0 uses dash-boards with drill-down features that empower CEO’s, CFO’s, Financial Analysts,DON’s, FM’s and Business Managers with all the reactive and proactive fundamentals for managing the revenue stream.

Optimise your revenue consistent with entitlements whilst driving better care outcomes. Use eCase 4.0 for staff training. Help staff come to terms with the Aged Care Funding Instrument. eCase 4.0 supports the concepts of multiple appraisals and quality checking which allows the user to “model” the outcome before submission.

Review, optimise and train, all at the same time. Use eCase to validate and Audit every appraisal. Use eCase to validate appraisals in anticipation of audits.

®

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Dashboards & Reporting Registers & Assessments

eCase 4.0 dashboards provide high level information that can be drilled into for detail as required. All reports

are clear and well defined. Any report can be sent to PDF, Excel® or configured for push-email output.

An intuitive system designed to capture, collate, report and analyse all clinical indicators, just the way it’s done at the facility. Also provides bench

marking capabilities.

eCase supports the ACFI paradigm (shift) exceptionally well. All components of eCase interact harmoniously to provide users with high integrity outcomes and evidence.

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Charting

eCase 4.0 provides simple to use charting that automatically caters for relevant scores and summation (ACFI), thus minimising scope for error.

Work flows

eCase 4.0 has a workflow to-do list that facilitates control and provides instantaneous management information for the supervision of the care process (cradle to grave). Further, this includes management sign-off functionality and “process gates” that prevent process error.

Progress Notes

An “email like” interface that is both simple to use and intelligent. The

progress note system caters for exception reporting and other events

within the day to day data capture that is progress note collection.

Care Plan

A care plan cannot commence without a corresponding assessment. This in

combination with the workflow functionality closes the loop on diagnosis driven care.

Quality Management

The quality module within eCase 4.0 is completely configurable to specific

organisational requirements. The basis for quality management ensures accreditation compliance with the four

standards and 44 outcomes.

Medication ManagementeCase offers a comprehensive integrated Medication Management suite. The system manages all the administration functions of Medication Management and because it is fully integrated, all Medication Management data is immediately available within the Business Intelligence module. eCase uses the MIMS database to provide users with comprehensive drug information including photos and interactions.

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Community Care on eCase

Appointment book

Single Client Record™

Rostering & Assessment

Care Plans

Route Optimisation

Medicare B2B Integration

Support for Allied Health & Dr’s Disability Services

Work�ow & Noti�cations Progress Notes

Health Metrics the class leader in Residential Care software has now entered the Community Care segment of Aged Care with the launch of its Community Care application suite. The new suite seamlessly integrates with its popular eCase system.

The eCase Single Client Record system means that all client details (including clinical care records) move with the client, irrespective of their status, location or services. Whether they’re in their home (Community), in an ILU or in Residential Care, the eCase platform caters for all the permutations. Health Metrics calls this their “Single Client Record Architecture™”. The eCase Community Care modules have been specifically built for Community Care. Amongst many other things, the software includes rostering for the field support workers. The rostering system is modern and sophisticated. It includes route optimisation and intelligent capacity planning measures. eCase is a cut above the rest in the way it manages the balance between a client’s needs (demand) and the available staffing options (supply).

Key Benefits

Access: Any Device, Anytime, Anywhere

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Having an architecture that already supports a cloud computing model, eCase 4.0 “future proofs” the client’s investment.

eCase 4.0 Has been built (ground-up) for “the cloud” . In the coming years, more and more Small to Medium Enterprises will move toward cloud based applicationsand infrastructure.

Cloud future

eCase is already positioned as a cloudbased architecture.Health Metrics currently offers eCase to clients on a cloud architecture basis. Health Metrics already has cloud based clients using the product over the cloud.

Cloud ready

With no upfront fees and no additional I.T. infrastructure, Health Metrics delivers to you state of art software through our seamless cloud technology. The cloud feature gives you better access to critical business data and makes it affordable to use an intelligent clinical system for whatever size your organisation is.

Cloud deployment

Cloud Computing Model

Inside the Data Centre

External HosteCase User

www

Secure Connections

Firewall

Firewall

eCaseBuilt for the Cloud

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Access:Any Device, Anytime, Anywhere

eCase 4.0 has a modern and consistent browser-based user interface where the resident is central to all functionality.

eCase 4.0 takes great care in ensuring a realistic balance between the need for critical information and the burden of collecting it.

eCase 4.0 minimises keystrokes. In most instances, information is found within two mouse clicks. All drill down (detail) data is delivered via a single click on asimple link.

The interface is intuitive and “web-familiar”, making for shorter learning curves and faster deployments. A friendly interface combines with fast response timesto create a positive user experience. This equates to alow deployment cost and a low total cost of ownership (retraining).

Simple, Intuitive User Interface On Browser, on Tablets

Health Metrics also has iPad and Android “Apps” for their Clinical Care system (eCase).

The new applications are native compatible with iPad, Android and Windows 8 devices.

The thin client, browser environment will continue to be a core part of the system.

These new additions will enhance the user experience and give customers greater choice when deciding on how to access the system on

any device, anytime and anywhere.

Further, these applications will provide additional “power out” features that will allow users to store

data locally and re-synch with the server at a later point.

No.

Of R

esid

ents

ACFI Subsidy

E

B

F

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Like Frogs in Hot Water- Thought Leadership on the ACFI Reforms

1. BackgroundThe Aged Care Funding Instrument (ACFI) was born March 2008. From the time of its birth the ACFI framework has been muddied by issues and concerns. Most of which have been misinformed or misguided. Acknowledging the industry potential for ACFI at the time, Health Metrics voiced the opinion that the change to ACFI was a great step forward for the industry. Further, that the industry should embrace the opportunity that the new

instrument provided. That is, that is promised to closely correlate need for care to the cost of the delivery. Which in review, one would have to say that the instrument did very well.

Whilst moving from the old to the new (RCS to ACFI) was an opportunity, it was also a paradigm shift. Its introduction dragged along a considerable “retooling” cost with it. The total cost

included but was not limited to*:

• Software changes• Re-alignment of

systems and process• Staff training• Productivity loss

* Prior contributionsfrom Dr Michael Newton PhD (Health Metrics).

Industry wide, these costs would have been significant and it remains something the government has chosen to ignore.

Health Metrics has been modelling ACFI since late 2007. In its white paper of the time, Health Metrics discussed the benefits of ACFI and why providers should embrace the change. At the time, it seemed that the disruptive nature of the change was clouding the benefits. To recap, some of the benefits were/are:

•Diagnosis driven care is anexcellent model for betterhealth care outcomes. ACFIis a diagnosis driven caremodel.

•The ACFI model provides adirect correlation betweenthe care needs and thecorresponding execution ofrelevant care activities.

•Under the previousinstrument (RCS), pain andother comorbidities wereunaddressed in any officialsense. The implication beingthat care was always beingprovided and the associatedcosts were being “absorbed”.

•ACFI provided awin-win-win-win scenario.Residents-Families-Staff-Providers. The right fundingfor the right activities.

An irony: “…The Review ofthe Aged Care Funding Instrument (ACFI), published in May 2011, found that some specialist aged care providers are facing additional pressures in transitioning to the ACFI…”

2. ACFI MalignedAt the tender age of four and a half, its reputation is being tarnished. Brought into disrepute some might say. The disrepute centres around the “over claiming” argument.

“…concerns about provider claiming behaviour…” This argument is a furphy and ignores the positive care outcome aspect of the instrument. It’s overly focussed upon a necessary budgetary blowout ($1.6b). That is, it’s costing more, because the industry is doing more and thus achieving better care outcomes. Needless to say, governments of any persuasion should not throw out the baby with the bath water.

3. OptimisationFor most businesses (Residential Aged Care) the care subsidy can amount to as much as 80% of total revenues. Recent reforms mean that certain refinements to the optimisation paradigm

must be taken into the account for providers to stay ahead of the curve.

The eCase optimiser by Health Metrics provides a mechanism by which a provider can ensure congruence and optimisation per claim.

The histogram below illustrates the effect of moving one resident up one notch in the ACFI subsidy scale. The area B, representing the resident at the old subsidy level, moves to the area E at the next level. The ACFI revenue from the resident at the old level is represented by the area A+B, and at the new level by C+D+E. A is congruent to C and B to D, so E represents the new revenue due to the change.

No.

Of R

esid

ents

ACFI Subsidy

A

E

B

C D

Diagram A

Diagram B

Steven Strange, CEO of Health Metrics Pty Ltd

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In practice though, the interdependence of the ACFI criteria means that many points on the subsidy scale will almost never be occupied, assuming that claims are optimal, and picking up these inconsistencies is a major part of the job of the eCase optimizer. Thus by running the optimizer whenever a change occurs, the effect of the noticed change is transformed to the second diagram above. Additional revenue is now E+F, and the optimizer has gained an additional F in incremental revenue.

This illustrates the ongoing value of the optimizer to individual changes; at introduction this effect be multiplied by a substantial proportion of the population database.

4. A Typical Care-SubsidyJourneyHealth Metrics has modelled the “typical” residential care journey as follows:

In diagram C, the blue curve represents the subsidy and the red curve represents the cost of care. Reducing the subsidy values during the shallow subsidy growth period despite the corresponding physical and cognitive decline has the potential for critical financial and thus operational impact.

It is Health Metrics’ view that the cash impact of the subsidy adjustment will most likely take between seven and ten quarters to achieve its highest probability of peak effect.

Thus, the financial pain is predicted to have the greatest impact approximately two years after its implementation (ie. post July 1, 2012).

Providers need to model their own predictive cash impact scenarios in order to specifically understand when the worst of the cash impact will hit. Specifically, the subsidy based predictivecash model must focus upon the resident replacement process. Factors include but are not limited to:

•Current and futureattrition rates•Average frailty uponadmission •Age distribution.

respond quickly to market adjustments?

4)With respect to (1), ensurethat the electronic system supports a sophisticated optimisation system. Ensure your electronic optimisation system comes from a reputable vendor. A vendor with runs on the board in terms of subsidy optimisation.

5)Procure a system by whichyou can model various “what-if” scenarios against your resident population.

6)Engage agile vendors thatcan supply pro-active and re-active functionality. Don’t wait years for the changes your environment needs.

7)Evangelise congruence;Continue to train, mentor, and supervise appraisal development on the basis of congruent documentation. Have the evidence! Employ electronic systems that allow the provider to scale the ACFI auditing operation. Have functionality that supports desk top audits from headquarters.

8)Understand the correlationbetween high cost and low subsidy value activities.

9)Consider implementingforms of resident “profiling”.

10)Maintain, track, strategizeand manage the basic Subsidy vs. Care Cost as a

metaphor will apply to you.

From the metaphor, the providers are the frogs and the water is the subsidy reduction. The stealth-like element of the current reform is its lagging impact on a business’ cash flow.

Health Metrics modelling points to an extrapolated industry impact of between $250m and $300m (approximately 3.4%) for year one. This is congruent with other industry estimates

The one off reduction of any inflationary adjustment could cost approximately 3%. EBA arrangements this year could add cost to the tune of 3%+.

Combine the 3%+3%+3% and providers could be facing a 9%+ shortfall.

The current ACFI reforms may equate to the difference between a profit and a loss for some or the difference between solvency and insolvency for others.

154 Weeks

$Sub

sidy

Vs.

$C

ost

Time

ADL: L-> M Spike

HHH or HMH

National Average

Expectation

Shallow $ growth despite Physical

& Cognitive decline

5. Crafting a SubsidyArchitectureNotwithstanding further government inspired “adjustments”, the following is a recipe for crafting and managing your subsidy architecture:

1)Always operate withinthe rules as compliance is utmost.

2)Electronic systems;There has never been a more important time to run an electronic ACFI management system.

3)Ask yourself, does mypaper based or electronic ACFI Management system do these things?a.Model Appraisalsb.Intelligently highlight

possible uplift opportunitiesc.Enable future value(actuarial) modelling.

d.Benchmark data.e.Mine data across the

group.f.Protect claims acrossthe group.

g.Can my electronicsystems vendor

key performance indicator for your business.

11)Use predictive analysismodels to understand the most probable cash impact points of the subsidy adjustments.

12)Engage with vendorscapable of producing predictive analysis models.

13)Continue to maintain arevenue mining and revenue protection approach to subsidy management.

6. ConclusionThere’s an anecdote about frogs and boiling water and it goes like this; If you throw a frog into boiling water, it will jump straight out. However, if you put it in cold water and gradually boil it, it will remain there until it is slowly boiled alive.

Understanding your probability based cash impact model is critical. For the new era of funding, if addressing the short comings of the model isleft untouched, the

Intelligent solutions for Health and Ageing Page 22Page 21

The Australian Hospital and Healthcare Bulletin SPRING 2009

This is an ever changing, complex and highly competitive world. The Aged Care industry faces a number of challenges. Whether the organisation is “for profit” or

“not for profit”, the competitive environment is the same for all providers. Competition is rife for clinical staff, for managers, for CEOs, for bonds.

ACFI (Aged Care Funding Instrument) is not about competition. The new model challenges all stakeholders to think outside the square. To think laterally. For all business initiatives and challenges that confront the industry, the participants should EMBRACE, MANAGE and LEVERAGE.

Embrace ACFI – What else can one do?

Manage ACFI - Make sure that a cent isn’t lost. Protect the revenue.

Leverage ACFI - Optimise the entitlements within the rules.

A classical definition of what a paradigm would go something like this “⋯ a paradigm is a collection of assumptions, concepts, practices, and values. It’s the framework for a specific community to view their reality⋯” So it is when the framework changes that the term “a paradigm shift” emerges.

The introduction of the ACFI funding model in March 2008 to the Aged Care community was a major paradigm shift.

From the perspective of the approved provider, March 2008 also marked the beginning of an era of confusion, misinterpretation, fear, conspiracy theories and everything else one could think of. As a result, many in the industry were not prepared and have subsequently experienced poor results from the subsidy side of the ledger. A small number of organisations prepared for the new funding model but even these organisations have to a greater extent missed the core opportunities for having a “Subsidy Architecture” within their respective organisations. Early gains can be made “sustainable” via a structured subsidy architecture.

For Health Metrics, March 2008 marked the beginning of a new era for “intelligent solutions” in health and ageing. An opportunity to show case a new style of technology.

Technology with short returns on investment. Technology that drives revenue. Technology that is easy to use with short learning curves for the health care professionals who are chartered with driving the solution at the floor level.

With subsidy income accounting for up to 80% of provider revenues and most other costs as managed as they can be, ACFI income should be of the highest concern to any approved provider.

ACFI is an opportunity. ACFI presents the approved provider with the chance to have a win-win-win situation. Win on compliance, win on subsidy dollars, win on care for the resident. As an instrument ACFI can deliver all these things as long as the provider doesn’t miss the forest for the trees.

Too many providers have focussed on the difficulty of the transition rather than the benefits of the new system. Yes, understand that there has been a large paradigm shift but don’t focus on it. Focus on the new instrument and what it is capable of delivering to the organisation. Without doubt the introduction of ACFI has been one of the better policy initiatives of the federal government. Either through good luck or good management, the government has produced a subsidy scheme that facilitates the prospect of providers getting themselves into a win-win-win position.

Although it seems complex, ACFI is an opportunity! Health Metrics uses sophisticated solutions to take seemingly complex ACFI issues and abstract them into user-friendly functionality. Health Metrics can supply any provider with all the tools it needs to manage, protect and optimise its subsidy revenues.

The ACFI Manager software product from Health Metrics has already delivered millions of additional dollars to providers (ask for the testimonials). ACFI Manager has already protected the providers with regards to compliance and most importantly, created better health outcomes for residents. After all, ACFI is diagnosis driven care. Health Metrics can also illustrate how various strategies will ensure a “subsidy architecture” is in place for the respective provider.

Talk to Health Metrics about how to both manage and leverage subsidy income via innovative and friendly solutions.

Where does your organisation sit? How do you compare with the rest of the industry? Health Metrics can assist with the answers to these questions.

ACFI Management Seizing the Opportunity

ACFI & Clinical TrainingBecoming an ACFI expert

Industry based clinical trainers are here to help

Benefit from industry experts Professional sevies and training on:

• Compliance matters• Pre accreditation audits• Preparation of appeals• Industry applications• ACFI validation appeals• Pre-validation audits• Quality assurance

Training contentincludes:

• ACFI basics• ACFI validation – protect your

entitlements• ACFI optimization• ACFI for care staff• ACFI for RN’s• ACFI for senior management

Participants in our ACFI training will take away a valuable understanding of the impact of current ACFI reforms. Further, participants will engage in the opportunity to take back to their organisation, various strategies for future-proofinng their funding.

Jan Fisher, Executive Director of Clinical Care,West Wimmera Health Service:"Health metrics has been instrumental in assisting our serviceto not only make substantial financial gains in ACFI but also in training our managers and staff in understanding ACFI and the associated documentation that is required to substantiate any claims and validations.The staff are a pleasure to work with and we wouldn't be where we are now without them."

Neil Stubbs, CEO, The Forrest Centre"The team at Health Metrics provided professional advice duringthe initial uplift phase and on a continuing basis.Their knowledge has been found to be second to none and continued to ensure high quality ACFI outcomes."

Take the mystery out of ACFI through new learning

About Health MetricsHealth Metrics provides technology and consulting services to the Health and Ageing sector. It is a well-established provider of accreditation and ACFI related services, specializing in ACFI uplift and other clinicalconsulting programs. It is well 'ahead of the curve' in terms of its ground breaking research & development as well as its scenario modelling. The �agship software system eCase supports all functions of Residential Aged Care, Community Care and ILUs to all sizes with cloud support as an option.

HealthMetrics.com.auFreecall 1800 810 081

enquiries@healthmetrics.com.au

MELBOURNESuite 33, 296 Bay RoadCheltenham VIC 3192

GOLD COASTUnit 36, 47-51 Broadbeach BlvdBroadbeach Qld 4218