Smarter UM: Driving Results with a Smarter Approach

Panel discussion moderated by Mike McKitterick, RN, Executive Vice President, Clinical Services, Altruista Health

Panelists:
• Christine Seals, MD, Medical Director, GOBHI
• Eric Tryon, Senior Vice President, Product Management &
Strategic Initiatives, Altruista Health
• Holly Urban, MD, MBA, Director of Product Management, MCG

Transcript

1. SMARTER UM: DRIVING RESULTS WITH A SMARTER APPROACH SEPTEMBER 27-28, 2017 : CUSTOMER ADVISORY BOARD SUMMIT
2. 2 MEET THE PANELISTS • Christine Seals, MD, Medical Director, GOBHI • Eric Tryon, Senior Vice President, Product Management & Strategic Initiatives, Altruista Health • Holly Urban, MD MBA, Director of Product Management, MCG
3. 3 GOBHI
4. 4 TABLE
5. 5 OUTPATIENT MH PENETRATION RATE REPORT
6. 6 SECTION SLIDE
7. MCG CITE
8. ©2017 All rights reserved HERITAGE IN TRANSPARENCY Management of risk and resources to improve quality Established in 1990 As part of Milliman actuarial consulting firm. Founded by physicians and actuaries to understand risk and how to better manage it, to help align clinical care with medical necessity. Joined Hearst in 2012 A leading provider of care guidance solutions with practice-proven content, innovative technology, and a deep understanding of healthcare workflow.
9. 9 THE CARE GUIDELINES Post- Acute Care Acute Care Assessments, care plans, and patient handouts that provide care-coordination guidance to help you move patients toward health. More than 400 condition-specific guidelines to address admissions with evidence-based care pathway and LOS data Covers problem-oriented and complex patient situations not addressed by Inpatient and Surgical Care, LTACH, Inpatient Palliative care, Medical Oncology Supports outpatient authorization and referral management (diagnostics, genetic testing, DME, high cost injectables, procedures, imaging, PT/OT/Speech therapies, Chiropractic) Supports chronic condition case management with assessments, patient-facing care plans and patient handouts in English and Spanish Focuses on optimal care within Inpatient Rehab and Sub-Acute/Skilled Nursing Facilities Focuses on the need for skilled care in the home, includes Private Duty Nursing Provides optimal care criteria for mental health and substance use populations across all levels of care, includes ABA and Opioid Management Explains in simple language what patients need to know about self-management, conditions, and treatments (499 handouts) Covers more than 60 common complicating active conditions most frequently seen in acute setting, includes MBLOS data
10. 10 KEEPING CURRENT WITH THE STANDARD OF EXCELLENCE Every year, MCG adds to your solution 21st Edition of guidelines 9.0 version of software solutions 140,997 unique articles 39,157 Unique citations Guidelines now include 7,658 unique citations added since previous edition 4,660 Distinct guidelines Covering more than Q1 2017 Ongoing updates to guidelines • Incorporate new evidence and analytics Added features to enhance collaboration and documentation Included in base licensing fee Guidelines and features added • Examples from 21st ed. release: • Over 160 new care guidelines • New Clinical Opiate Withdrawal Scale (COWS) calculator • Upgraded adult and pediatric GFR calculators • New patient handouts: Almost 60 in Chronic Care; 40 in Transitions of Care • New, streamlined analytics dashboard
11. 11 CITE CAREWEBQI: CLINICAL WORKFLOW SOFTWARE Web-based tools combine MCG content and clinical intelligence in easy-to-use solution MCG Content Annually updated content provides clinical decision support via evidence-based pathways. Includes quality indications, benchmark data and length of stay criteria. Clinical Intelligence Clinically tested best practices to assess patient admission, treatment plans, goal length of stay, recovery and discharge; all with focus on highest quality and most cost effective care. Indications for Admission Episode Summary Optimal Recovery Course Ability to Run Reports Manage efficacy and productivity of reviewers Increase your operational efficiency
12. 12 CITE AUTOAUTH Rules-based engine driven by evidence-based indications • Ability to integrate with existing provider portals • Supplement with your own business and medical policy rules • Authorize a procedure or admission automatically or, in more complex cases, send it for manual review
13. AUTHORIZATION INTAKE & RULE-BASED AUTOMATION
14. 14 AUTHORIZATION INTAKE & RULE-BASED AUTOMATION Supporting Automation – Improving Provider Experience / Turn-around, Streamlining Intake Payer Provider Portal GuidingCare Population Health Authorization Rules / Automation GuidingCare Utilization Management Single SignOn (Option B) Integration (Option A) Integration (Option B) Auth Entry Auth Entry Real-time Rules Integration (Provider and GuidingCare Originated) 1 2 3 4 5 6
15. QUESTIONS?