This includes identifying high-risk individuals through risk stratifi cation and provider intervention through case, care and disease management. It also requires comprehensive medication reconciliation and drug monitoring capabilities for improved patient safety and utilization management.
Anil Kottoor is the CEO and president of MedHOK. For more on MedHOK: www. rsleads.com/207ht-203
Enter the cloud Taking a traditional approach to building a technical infrastructure capable of addressing the complex data re- quirements of today’s care and reimbursement models is not for the fainthearted. Cost barriers are prohibitively high for many healthcare organizations whose resources are already stretched thin to comply with multiple emerging mandates, such as ICD-10 and meaningful use. Other challenges also come into play, including interoperability with existing legacy systems and data ownership and other governance issues. The aggressive timeframes to meet initial reporting deadlines are also problematic. Finally, establishing the con- nections with CMS, commercial health plans and pharmacy benefi ts managers to gain access to claims data poses multiple challenges for physician groups, hospitals and other provider organizations that are typically unfamiliar with the processes and procedures for doing so.
This is where an integrated care-management, quality and compliance software platform holds the most promise. It can facilitate the connections necessary to securely link physicians, case managers, home health providers and others involved in patient care to meaningful, actionable data while enabling integration of workfl ow processes and improving interoperability by utilizing open standards. Because they are on the cloud, these integrated platforms provide a high level of fl exibility, so initiatives can custom- confi gure everything, from user access to business intelligence tools, to meet unique organizational and patient population needs. For example, they enable an ACO or Medicare Advan- tage plan to deploy tools that target those metrics that have the greatest impact on quality scores based on populations served. These tools should include: • Predictive modeling and stratifi cation tools to identify high- risk or multiple comorbid cases in need of intervention; • Tools to identify HEDIS, Star and other care gaps and trigger appropriate care/case, disease and quality interventions;
• Comprehensive case and disease-management modules, where assessments can be conducted, care plans cre- ated and tasks and clinical/social interventions fulfi lled and monitored; • Tools to generate profi les based on clinical, quality and fi nancial data for member, provider and local popula- tions; and
• Risk-score calculators to more-accurately predict future care costs and pharmaceutical utilization.
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Integrated care-management, quality and compliance platforms that leverage the cloud lower the barriers to innova- tion and modernization of health IT systems by minimizing costs, increasing scalability and improving accessibility and security. They eliminate interoperability issues by facilitating real-time information sharing without requiring organizations to replace existing legacy systems. This keeps initial capital requirements and total cost of ownership low, resulting in a rapid return on investment. Importantly, this fl exibility also allows for rapid deploy- ment – weeks versus the months or sometimes years required for site-based implementations – and quick response to regulatory and market changes.
Metrics in the cloud Performance monitoring is a major component of success- ful participation in today’s care and reimbursement models. Without the ability to quickly, easily and cost-effectively share complex information within the organization and across the patient’s care continuum, it will be impossible to track quality measures and infl uence clinical outcomes – both of which are critical to achieving benchmarks. An integrated care-management, quality and compli- ance platform provides a solid foundation to accomplish these objectives. It ensures physicians, hospitals and other providers have access to the information they need to better manage patient populations and enables the entity to demonstrate the quality and outcomes that dictate shared savings.