HR 3590's Unique Implication for Health Care Coordination
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US Health Reform Quality through Care Coordination
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HR 3590's Unique Implication for Health Care Coordination
- 1. HR BILLHR BILL 35903590 A UNIQUE Implication for Health CareA UNIQUE Implication for Health Care 06/20/13 Casey Dills O'Donnell 1
- 2. 06/20/13 Casey Dills O'Donnell 2 BACK TO THE FUTURE Protects use of individual health records (Healthcare Insurance Portability and Accountability:Aug 1996) Ensures storage and use of electronic records (Electronic Freedom of Information Act: Oct 1996) Makes it easier to retrieve secure information online (Electronic Freedom of Information Act) Electronically attributes; associates; or links individual records (ARRA: Feb 2009) Enables users to select, sort, and retrieve minimum data (Meaningful Use:July 2010) Enables users to electronically record, modify and retrieve patient data over multiple encounters. (EHR Technology Final Rule: July 2010)
- 3. Health Care Quality Improvement: Quality Measure Prioritization Health Outcomes Multiple Chronic Conditions Coordination/Continuum of Care Efficiency Meaningful Use Clinical Decision Support & related technologies Patient Centered Care effectiveness; safety; appropriateness; Value Based Healthcare Patient Experience and satisfaction
- 4. 06/20/13 Casey Dills O'Donnell 4 New Goal of Health Reform Leverage Data Collection Analyze data in a way that informs policy Deliver patient centered care Support progress that utilizes evidence-based strategies and promotes best practices Refocus health care system on improving health, intervention, and coordination Select measures and processes that have the greatest impact on population health AHRQ 2010
- 5. 06/20/13 Casey Dills O'Donnell 5 Ensuring the Quality of Care: Section 2717 National Strategy for Quality Improvement Improve Measure of Health Outcomes Develop Quality Measures Develop Reporting Requirement Identify areas for Improvement Potential Emphasize efficiency Improve research (service research) Comparative Clinical Effectiveness
- 6. 06/20/13 Casey Dills O'Donnell 6 Improve Health Outcomes: Section 2717 New Emphasis in Care Management Implementation Activities Quality Reporting Effective Case Management & Care Coordination Chronic Disease Management Comprehensive Discharge Planning (Avoidable Readmissions) Patient Safety Best Practice and Evidence Based Medicine (Reduce Medical Error) Health and Wellness activities (preventative care)
- 7. Reporting Requirements Wellness and Health promotion activities `(1) Smoking cessation. `(2) Weight management. `(3) Stress management. `(4) Physical fitness. `(5) Nutrition. `(6) Heart disease prevention. `(7) Healthy lifestyle support. `(8) Diabetes prevention
- 8. Aligning Quality with Measurement Logical Relationship Behavior of Health Service Delivery & Application of Technology
- 9. 06/20/13 Casey Dills O'Donnell 9 Process Measures linked to outcomes Target Outcomes (example for readmissions) Reduction in adverse drug events Reduction in patient medical errors Reduction in unnecessary encounter Reeducation in redundant tests and procedures Achievement of patient goals Improved patient understanding Targeted Processes Timely transfer of information across settings and providers Effective care coordination across settings and providers Timely delivery of care Improved patient understanding Improved patient awareness and emergency back up Improved patient engagement
- 10. 06/20/13 Casey Dills O'Donnell 10 Goal Mapping Systematic approach Define the process your trying to improve What is the problem or question I am going to solve or answer Why is this Issue or Topic Important Define how you will know when it is accomplished Intended Outcome Desired Results Determine how this change will impact other service areas and resources Use goal mapping to understand and communicate the improvement goals throughout the process. What ‘benchmark’ are there to evaluate progress or success and, How am I going to use it to tell about my findings and solutions
- 11. Guide to Effective Case Management Strengthen your case management Program Strive for quality in your case management Pursue quality from the design of your care coordination activities
- 12. Care Planning and Monitoring Care Planning Individualized Identifies frequency/need Required for Authorization of Services Monitoring Monitor the care and progress of the client Review effectiveness of services New Service(s) Change in service(s) Termination of Service(s) 06/20/13 Casey Dills O'Donnell 12
- 13. Quality Case Management Objective and Nonjudgmental Use only standard medical abbreviations Nature of Contact Detailed description of Contact Brief (if possible) Event focused Relevant Information Actions Taken/Follow Up 06/20/13 Casey Dills O'Donnell 13
- 14. Quality Coordination Process are Standard Care is Individualized Case Manager Roles Coordinate needed services. Communicate with service providers regarding service delivery, and concerns. Review and revise services, as necessary 06/20/13 Casey Dills O'Donnell 14
- 15. Case Management Reporting Medical Record (EHR) Requirements Central Location to document and track case management activity Accessible to multiple users Entry for care planning and monitoring activites Available for Review Supervisors Colleagues State/Federal Auditors Clients Legal Reviews 06/20/13 Casey Dills O'Donnell 15
- 16. 06/20/13 Casey Dills O'Donnell 16 Care Management Systems Effectiveness Systems that support clinical decision activity Clinical guidelines; protocols; procedures Standards orders; Triage (critical); clinical pathways Disease Case management Ancillary service management Utilization Review Outcomes and accountability (data) Benchmark Identification (data) Efficiencies System supports Information sharing Facilitates cross site information transfer Report extraction
- 17. 06/20/13 Casey Dills O'Donnell 17 THE CHALLENGE Health Reform 3590 strives to enhance quality improvement, and stresses the importance on care management coordination. The single most challenging opportunity in the quest for improvement in health care, is the harness of integrated coordinated care.
- 18. 06/20/13 Casey Dills O'Donnell 18 THE DILLEMA Today most providers lack the information systems necessary to coordinate patient care. Care Management systems that can improve the integration of care in real time leverage the market toward intelligent evidence based support Systems are fragmented Improvement efforts are silo/singular Technologies are disjointed Communications staggered or non existent Resources strained
- 19. 06/20/13 Casey Dills O'Donnell 19 THE REMEDIATION Identity common goal utilizing the resources and technologies already available. Use an Evidenced-Based design to successfully implement improvement Apply evidenced-based strategies to achieve successful implementation activities.
- 20. 06/20/13 Casey Dills O'Donnell 20 Coordinated Care with a Meaningful Use “The final meaningful use regulations may be the first domino to bring about monumental change and transformation to the U.S. healthcare system”. (Demers, Eric) Meaningful use is the top priority 84%, among healthcare executives when considering how the reform bill will impact their organizations (Health Populi)
- 21. 06/20/13 Casey Dills O'Donnell 21 Integrating care management activities Strategies Multidisciplinary TEAM case management CARE COORDINATION Aim to improve the continuum of care through discharge planning and transitional care modeling. Employ a coordinated interdisciplinary approach Coordinate with medical homes and/or accountable care organizations Apply integrated computer technologies Clinical decision support
- 22. 06/20/13 Casey Dills O'Donnell 22 Implementation Activity Workflow is KEY to effective care management. Care Management tools that supports interdisciplinary communication. Community resources Patient Education Clinical Decision Support tools that assist at the point of care. Data Driven Quality Assessment (SIS/Functional) Quality Assurance and Improvement
- 23. 06/20/13 Casey Dills O'Donnell 23 Workflow Development Sample Questions: How do you sort tasks, can you sort by priority? Can you hyperlink between tasks? Can you print health education documents? Can assessment trigger clinical alerts Do triggers take the user to the necessary task? Can completion of an assessment trigger care coordinated document? Can your documents be electronically transmitted to other care providers?
- 24. 06/20/13 Casey Dills O'Donnell 24 Enact Implementation Activities using an Evidence-Based design Implementation activities are effective when applied to structured quality improvements. Implementation is successful when outcomes are used to benchmark or compared. Regular feedback is critical to implementation success. Assistive support (CDS), alerts and other real time technologies aid successful implementation. Organizational setting must be support the strategy.
- 25. 06/20/13 Casey Dills O'Donnell 25 Enact Implementation Activities using an Evidence-Based design Research shows Quality improvement activities facilitate social influencing. Feedback and other comparative measures promote group and individual competition and facilities social influence through perceived intention. Assistive supports used in real time aid in knowledge translation, and presents influencing at the level of interpersonal cognitive processing. Organizational cultures are a construct to social influence; Whereby the organization’s social structure has the most ability to positively or negatively influence the desired implementation.
- 26. 06/20/13 Casey Dills O'Donnell 26 Enact Implementation Activities using an Evidence-Based design Research Shows implementation activities are not successful when: Implementation is passive. Measures (activity outcome) or guidelines are not accepted. Implementation activity lacks accountability and ownership. Implementation processes are unorganized or require competing organizational values.
- 27. 06/20/13 Casey Dills O'Donnell 27 ContinuousQualityImprovement Plan Do Check Act
- 28. Changing Environment Increased emphasis on clinical quality Patient safety Cost effectiveness Transparency Payment structures (Value Based Purchasing) 06/20/13 Casey Dills O'Donnell 28
- 29. 06/20/13 Casey Dills O'Donnell 29 Meeting the Challenge We Have Technologies (E.H.R) containing data that represents health service performance (diagnostic & demographic reporting) Dedicated professionals We need Operationalize a structure that provides a means to efficiently and effectively administer health services in a way that values the delivery of care.
Editor's Notes
- The HR Bill, regardless of your political views, has some very exciting components.
- We have to go back about 20 years to see our national progression towards reform legislation.
- New Health Reform prioritizes quality through scientific measures emphasizing health outcomes and service delivery.
- The New Goal of HR legislation uses a scientific approach to measure quality and improve population health and health care service delivery. In the early 90s when we first started about HR, discussions, not unlike today, were centered around access and cost. After years of discussion, In 1996, the health insurance reform act was signed, that ACT was geared primarily improve HC quality through elimination of fradu,abuse, kick backs and monetary civil penalties. Today, HR has a new GOAL – Quality- Yes the bill still talks about access, fraud waste and abuse, BUT .
- HR 3590 promises to ensure the quality of care through identification and prioritization of scientific measures of health outcomes. To accomplish this, the bill requires appointment of a national strategy for quality improvement. The AHRQ recently summarized these strategies
- Unlike previous health reform initiatives, this bill describes Implementation Activities as the vehicle to operationalize quality improvement. Quality Reporting- `(1) IN GENERAL- Not later than 2 years after the date of enactment of the Patient Protection and Affordable Care Act, the Secretary, in consultation with experts in health care quality and stakeholders, shall develop reporting requirements for use by a group health plan, and a health insurance issuer offering group or individual health insurance coverage, with respect to plan or coverage benefits and health care provider reimbursement structures that-- `(A) improve health outcomes through the implementation of activities such as quality reporting, effective case management, care coordination, chronic disease management, and medication and care compliance initiatives, including through the use of the medical homes model as defined for purposes of section 3602 of the Patient Protection and Affordable Care Act, for treatment or services under the plan or coverage; `(B) implement activities to prevent hospital readmissions through a comprehensive program for hospital discharge that includes patient-centered education and counseling, comprehensive discharge planning, and post discharge reinforcement by an appropriate health care professional; `(C) implement activities to improve patient safety and reduce medical errors through the appropriate use of best clinical practices, evidence based medicine, and health information technology under the plan or coverage; and `(D) implement wellness and health promotion activities. Quality Reporting- `(1) IN GENERAL- Not later than 2 years after the date of enactment of the Patient Protection and Affordable Care Act, the Secretary, in consultation with experts in health care quality and stakeholders, shall develop reporting requirements for use by a group health plan, and a health insurance issuer offering group or individual health insurance coverage, with respect to plan or coverage benefits and health care provider reimbursement structures that-- `(A) improve health outcomes through the implementation of activities such as quality reporting, effective case management, care coordination, chronic disease management, and medication and care compliance initiatives, including through the use of the medical homes model as defined for purposes of section 3602 of the Patient Protection and Affordable Care Act, for treatment or services under the plan or coverage; `(B) implement activities to prevent hospital readmissions through a comprehensive program for hospital discharge that includes patient-centered education and counseling, comprehensive discharge planning, and post discharge reinforcement by an appropriate health care professional; `(C) implement activities to improve patient safety and reduce medical errors through the appropriate use of best clinical practices, evidence based medicine, and health information technology under the plan or coverage; and `(D) implement wellness and health promotion activities. Whats more Section 2717 defines Implementation Activities as a means to improve health outcomes. And specifically addresses case management, care coordination, discharge planning, evidenced based protocol preventative care and all those elements typically associated with case management.
- Generally speaking, Health and Wellness activities are relatively easy to report with hard data, as long as that data is consistent. What can be challenging is how to bridge the gap between ‘quality reporting and quality improvement’. The best way to get from here to there is through implementation of comprehensive case management and care coordination.
- In choosing an implementation strategy, consideration must be given to how care for the condition is currently organized and to what factors may prevent compliance There's a logical relationship Focus on the behavioral aspects of clinicians is necessary to achieve meaningful change (Conroy and Shannon, 1995) Understanding previous failure in application of technologies, especially, care management programs suggests, a level of integration a system requires that can facilitate appropriate decision making, relative to the clinical decision process or disease process and not necessarily the REPORTNG OUTCOME .
- To demonstrate the interdependent relationship between a target outcome and a targeted process I will use a readmission example, (implementation activity #2) Consider the inter-dependent relationship between targeted process and targeted outcomes. As this example demonstrates a timely transfer of information across settings if aligned well with a quality goal has potential to reduce adverse drug events.
- Using a systematic approach you can apply (Medication alerts) Using a mapping technique, Change could impact other areas of care coordination and medication reconciliation (re-admissions)
- Care Planning and Care Monitoring is the central function of the Case Manager This is the likely point of target measure to address CM effectiveness. (Implementation Activity #1) Strengthen your case management program and strengthen your Implementation Efforts
- How do you strive toward quality case management? . Effective case management systems/programs should be designed to guide case management documentation. Documentation is the key to effective quality driven case management, Case management documentation is so fundemental in fact, that free text documentation was addressed during publication of the EHR. Final Rule, CM documentation should always be Where necessary Describe the and provide Case management documentation should always include NEXT steps This is how you get to the core of case management quality
- Effective case management depends on the efficiency care coordination. Implementation activities will likely target efficiencies (design and productivity and application of technologies) as a target measure for care coordination reporting.
- To optimize case management reporting, Central location to track CM activities. Must be accessible for purposes of tracking entry related to care planning and monitoring Finally it should be organized logically for the review of multiple entities, This organization style (provides the additional benefit for data extraction based on need)
- In addition to standard reporting, to get the most of your system Should guide Coordination activities Information sharing, Theres different ways that can be done. Printing, emailing, faxing and mailing, interfacing, system network styles or designs.
- There is a significant amount of literature on the relative costs and casualty of interoperable gaps in care management.
- To overcome these dillemas
- So know that you know everything about HR BILL, Case Management, and coordination. How to implement a successful implementation activity?
- agree That MU is the most beneficial regulation and incentive to sweep HC to date.
- Guidance for implementing a fully integrated case management program capable to address, not just case management, but CD, RE-admissions, and prevention.
- Getting Started “ In choosing an implementation strategy, consideration must be given to how care for the condition is currently organized and to what factors may prevent compliance. Focus on the behavioral aspects of clinicians is necessary to achieve meaningful change (Conroy and Shannon, 1995)
- Develop a work plan that follows a an evidenced based design. Implementation Research approved by the Cochrane Collaboration for its scientific methodology and scope of work; suggests that
- Plan for implementation Activity (define objectives and activity plan) Do it (develop your action plan and implement) Check it (evaluation) Act on your results Provide feedback.
- Strengthening your case management program