Becker's Hospital Review

Becker's Hospital Review March 2016

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67 Executive Briefing Essential Elements of Care Redesign and Care Management I mproving care quality and patient outcomes continue to be prominent goals in our healthcare system. However, cost control is also an important goal, catalyzed in part by CMS' announcement that it intends to shift 50 percent of Medicare payments from fee-for-service to fee-for-value models by 2018. Heightened standards for quality and coordination of care are central to value-based payment models. Over time, hospitals' financial performance will increasingly depend on their ability to meet these standards. The introduction of tougher quality metrics and greater finan- cial risk puts care teams under greater pressure. To preserve the organic drive to improve care quality, many hospitals and health systems are launching care redesign initiatives to im- prove workflows and strengthen clinical decision-making. Additionally, more healthcare providers are realizing the importance of robust care management teams, as these multidisciplinary groups increase the care coordination across the continuum and serve as "first responders" when high-risk patients need intervention. Care managers help ensure the most complex patients — who are also the highest utilizers of healthcare services and the most expensive — are monitored and cared for in a proactive manner. Developing an effective care redesign process requires stan- dardization, cultural buy-in, solid leadership and a strong com- mitment to education of clinicians and non–clinical caregivers. Many organizations find they need help in redesigning care processes and developing their care management teams. xG Health Solutions, a national healthcare improvement company launched in 2013 by Danville, Pa.-based Geisinger Health Sys- tem, has developed a suite of tools and solutions to assist pro- viders in the process of care redesign and care management, A Proven Approach At their core, care redesign programs should ensure buy-in from key stakeholders — including physicians, nurses, care managers, pharmacists and ancillary personnel — to ensure adherence to best practices, reduce variation in care and drive accountability for outcomes, according to Meg Horgan, RN, MSN, senior vice president of partner resources at xG Health. Effective care redesign programs have five key components: 1. Document what constitutes appropriate care 2. Establish evidence-based or consensus-based best practices 3. Reliably deliver those best practices, primarily by embed- ding them in the everyday workflow in the EHR 4. Engage patients and families in the care process 5. Monitor compliance with agreed upon best practices Glenn D. Steele, Jr., MD, PhD, chairman of the board at xG Health, conceptualized ProvenCare in 2006 while serving as president and CEO of Geisinger Health System. ProvenCare is a multicomponent program that facilitates the delivery of reliable, evidence-based care for a population of patients. It re- designs workflow to incorporate best practices, often within the EHR to enable real-time decision support. The model has been shown to reduce mortality, complications, length of stay and readmissions, while as increasing efficiency and profitability. "Any organization that is looking for a process or methodology to improve the reliable delivery of best practices would benefit from ProvenCare," says Ms. Horgan. "If they lack standardiza- tion, have inconsistent quality or outcomes or don't leverage their EHR to support workflow — implementing ProvenCare could accelerate solving these problems." ProvenCare is a flexible template easily adapted to the individ- ual needs and preferences of a provider organization. Although xG Health provides recommended evidence-based best prac- tices, providers can modify them to enhance acceptance and integration from all members of the care team. One critically important component of the ProvenCare method- ology is regular monitoring of individual clinicians' compliance with the agreed-upon best practices. Care Management Care management is an integral component of and com- plement to effective care redesign. Working in tandem with physicians, care management personnel are leading a trans- formation in healthcare delivery, according to Sarika Aggarwal, MD, CMO and senior vice president of population health at xG Health. "Care managers support primary care physicians by focusing on highly complex or high-risk patients that would benefit from additional education, care coordination and man- agement of goals." As providers transition to value-based care, the need for all healthcare workers to operate at the "top of their license" to most efficiently manage patient care is greater than ever. Nurse Sponsored by:

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