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Connecting the dots of coordinated, accountable patient care

By Dr. Joe Bormel, M.D., MPH, chief medical officer and vice president, clinical product management, QuadraMed

As the echo of New Year’s celebrations fades, the healthcare industry returns to the challenges of meeting Stage 1 of ARRA’s meaningful-use requirements, preparing for the ICD-10 transition, innovations in care coordination, mobile-device advancements and the advent of computer-assisted coding technology, as well as healthcare reform legislation and technology integration. Close behind are Stages 2 and 3 of meaningful use, as well as federal and state funding uncertainties. This unprecedented confl uence of healthcare mandates and opportunities has driven organizations to launch signifi cant investments in planning, education, training and testing … or has it?

rements In 2011, we will finally see mainstream healthcare

organizations move beyond their economic and risk-driven inertia. As a fi rst step, providers will need to recognize that achieving meaningful use means transcending discrete claims data by embracing a problem-aware platform. Specifi cally, organizations that leverage an electronic health

CRM to gain traction

By Jim Schleck, executive director, REACH3

In the coming year, expect hospitals and health systems to increasingly look to customer relationship-management (CRM) technology to communicate, market and strengthen ties with consumers and physicians. Currently, only a small percentage of the

country’s approximately 5,000 hospitals use CRM to reach their key revenue-generating constituencies. Until now, most organizations have relied on conventional print, television and radio marketing campaigns to drive existing and potential prospects to utilize medical services. Although the approach casts a wide net, it delivers minimal bang for the buck because the promoted services are irrelevant to the majority of the targeted audience. Physician outreach is infused with the same marketing ineffectiveness. To achieve physician alignment, hospitals create strategies using paper-based data that usually are inaccurate and outdated. When information is electronically available, it is housed in disparate systems,

CRM to

record’s integration of inpatient and ambulatory data can evaluate patients’ needs within the context of a problem or set of problems. Not just any and all problems, but initially problems associated with quality measures. This natural evolution to coordinated care aligns with meaningful-use criteria, which require an up- to-date problem list, quality measures and interoperability with coded patient summaries. Additionally, the problem-aware platform facilitates the ICD-10 transition and related

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clinical documentation improvement goals, which will change the way health systems manage coding processes by the documented transition date of Oct. 1, 2013. How is this different than previous years? The greater

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specifi city of SNOMED, ICD-10 and other codes enables identifi cation of detailed diagnoses and discrete therapies when updating problem lists. As a result, organizations will reduce manual, redundant processes; optimize operational performance; and improve care through a comprehensive patient view delivered by the contextual problem-aware platform.

The industry’s heightened standards and implementation of data specifi city, integration and interoperability – within and beyond up-to-date problem lists – will empower healthcare organizations to connect the dots of coordinated and, ultimately, accountable care. Now that’s a New Year’s resolution to keep!

making it diffi cult and time consuming for marketers and physician liaisons to aggregate and analyze it. Usually, marketing employees must ask and wait several weeks for the IT department to produce a report. The results: lost opportunities galore. With revenue growth rate and payer reimbursement declining while the population grows older and millions of uninsured Americans are being extended health coverage, providers will soon recognize the need to fi nd a better

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way to forge closer relationships with consumers and physicians.

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By consolidating their patient and physician information with data from external sources in a centralized CRM database, hospitals will be able to identify trends, patterns and problems easily and early. They will know whether Mr. Smith requires a medical service or Dr. Jones has dropped in referrals, enabling them to generate timely communications tailored to the specifi c needs and wants of every person in the database. The compelling agility, value and effi cacy CRM offers is why the technology will emerge and become a must-have-tool for hospitals in 2011 and beyond.


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