1 ch mack, inc. medcompass™ overview for developmental disabilities provider association (ddpa)

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CH Mack, Inc. MedCompass™ Overview

for

Developmental Disabilities Provider Association (DDPA)

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Company Overview

65 Clients, 8500+ users

14+ yrs serving Health & Human Services− State & Local Govt. (SLG) Agencies

8+ yrs serving Health Plans

Serving all points on the Continuum of Care Managed Care Organizations (MCOs, HMOs, etc.)

State & Local Govt. (SLG) HHS organizations

LTC, HCBS

75% use in support of government-sponsored healthcare programs

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Customer Experience

CA

NV

OR

WA

ID

MT

WY

UT CO

AZ NM

TX

AK

HI

CH Mack Users

ND

SD

NE

KS

OK

MN

IA

MO

AR

LA

WI

IL IN OH

KY

TN

MS ALGA

FL

SC

NC

VAWV

PA

NY

ME

VT

NHMIMA

CTRI

NJDE

MD

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Representative Clients

Arkansas Department of Human Services

Xerox Government Healthcare Solutions

BlueCross BlueShield of Tennessee

Kaiser Permanente

NevadaCare, The i/mx Companies

California Dept of Aging (Multipurpose Senior Services Program)

Many other leading Health & Human Services organizations

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Real-time Collaboration

Collaboration Among Care Team Members

Case Manager

Hospital

Physician

HHS Organizations,Health Plans

Home & Community Based Services

(HCBS)

Member Care Data

Member

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Integrating the Continuum of Care

Care Coordination

Specialist – PCP- Behavioral Health Specialist – Social Worker - Caregiver

Tertiary Care Center

ICU/CCU

Acute Care Hospitalization

Community Hospital

Outpatient Hospital

Discharge Planning

Skilled Nursing Facility

Intensive Care Management

Home Health Skilled Nursing

Home Infusion Enteral Feedings

Durable Medical Equipment

PT/OT/Speech

Ambulance Transportation

Public Transportation Fuel/Auto Repair

Disease Management

Health Coaching

Wellness Program

Personal Care Aid Home Maker

Consumer Directed Care

Supported Self Care

Advanced Directives

Hospice

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Member Centric Health Management

UM/UR Case Management Disease Management Outcomes Core Measures Productivity Many more

Health Management

UM/UR

DiseaseManagement

Referrals

CaseManagement

Pro-ActiveCare Planning

Health Assessments

HIPAA Electronic Record

Performance Reporting

Member

Clinical systems Claims systems Industry Std Criteria Clinical Data Repositories

Reporting Seamless Integration

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Business Function Overview

Assessment & referral management

Care planning

Task management

Documentation & letter generation

Mobile support

Third party integration

Care team coordination

Case Management

Member identification

Collaborative Care

Care planning

Ongoing monitoring

Documentation & letter generation

Third party integration

Disease Management

Referral management

Pre-authorization / Pre-certification

Auto approvals

Letter generation

Medical review process

Appeals & grievances

Embedded criteria

Utilization Management

Opportunity identification

Gap in care alerts

Stratification of members at risk

Utilization management

Health coaching support

Population Health

Health Risk Assessment (HRA) integration

Educational mailing generation

Monitoring of preventive metrics

Scheduled wellness activities

Mobile support

Wellness Management

System consolidated information

Integration of data from multiple sources

Ad hoc and standard reports

Data export capabilities

Industry leading BI platform, Microsoft SQL Server Reporting Services (SSRS)

Analytics & Reporting

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CMSA Standards of Practice

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The Continuum of Healthcare

* CMSA Standards of Practice for Case Management – 2010, p. 5

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Health Care Reform

From 2010-2019*:

Spend $938 billion on expanding insurance coverage, including $464 billion in subsidies to help uninsured people buy coverage.

Expand Medicaid coverage to 16 million additional people.

Reduce the number of uninsured by 32 million people.

* Source: The Congressional Budget OfficeMarch 23, 2010

Affordable Care Act

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Government Health Care Programs

Deep History in Medicaid Managed Care Programs:

Arkansas DHS – All Medicaid Divisions− DAAS, DDS, DMS, DBHS, DCO

Florida− Neighborly Care Network, American ElderCare

Arizona− Medicaid LTC

California− MSSP Program – 20 Organizations

New York− Suffolk, Erie, Westchester County DSS’s

WellCare Health Plans− 1,349,000 Medicaid Members− 246,000 Medicare Advantage Members

Tennessee – TennCare CHOICES Program

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Representative Clients

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Representative Clients

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Representative Clients

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Xerox Government Healthcare Solutions

After a rigorous 12+ month vendor evaluation process, in May CH Mack was notified that Xerox Government Healthcare Solutions (http://www.acs-inc.com/healthcare.aspx) selected MedCompass™ as the new Health Management platform to serve all Xerox State & Local Government HHS customers going forward. 

Xerox Govt. Healthcare Solutions

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Xerox Govt. Healthcare Solutions

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interRAI – Strategic Partner

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Scope of Automation

MedCompass™ automates the complete interRAI instrument system: Data Collection Form (Assessment) Triggers (Algorithms) Clinical Assmt. Protocols (CAPs) Status and outcome measures

(Scales)Assessment

Minimum Data Set

Minimum Data Set

OutcomeMeasurement

Scales

QualityIndicators

Case Mix(RUG-III, RUG-IV)

Clinical Assmt. Protocols

interRAI Instrument Model

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Key Components of interRAI Instrument that are automated in MedCompass™:

Data Collection Forms – interRAI assessments Clinical Assessment Protocols – “CAPs”

• ID – Collaborative Action Plans

Status and Outcomes Measures – “Scales” Algorithms developed by interRAI Outputs – Via MedCompass Reporting Engine

• Microsoft SQL Server Reporting Services (SSRS)

• Tableau – Data Visualization / BI Technology

Key Components in MedCompass™

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interRAI HC in MedCompass™

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CAPs

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CAPs in MedCompass™

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Scales

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Scales in MedCompass™

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Gartner Industry Validation

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Gartner Industry Validation

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HHS Strategic Plan

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HHS Strategic Plan

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“At the heart of HHS’s strategy to transform and modernize the healthcare system is the use of data to improve healthcare quality, reduce unnecessary healthcare costs, decrease paperwork, expand access to affordable care, improve population health, …”

HHS Strategic Plan

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CMS Innovation Center

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Accountable Care Organizations

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What are Accountable Care Organizations?

The Term Accountable Care Organization (ACO) describes the development of partnerships between hospitals and physicians to coordinate and deliver efficient care. The ACO concept envisions multiple providers assuming joint accountability for improving health care quality and slowing the growth of health care costs. The concept was included in national health care reform legislation as one of several demonstration programs to be administered by Medicare (Patient Protection and Affordable Care Act, 2010).

The success of the ACO model in fostering clinical excellence and continual improvement while effectively managing costs hinges on its ability to incentivize hospitals, physicians, post-acute care facilities, and other providers involved to form linkages that facilitate coordination of care delivery throughout different settings and collection and analysis of data on costs and outcomes.

Accountable Care Organizations

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Patient Centered Medical Home

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What is Patient Centered Medical Home?

In a set of standards that describe clear and specific criteria, NCQA’s Patient Centered Medical Home (PCMH) program gives practices information about organizing care around patients, working in teams and coordinating and tracking care over time.

The Patient Centered Medical Home is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.

Patient Centered Medical Home

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Patient Centered Medical Home

From H.R. 3590 Patient Protection and Affordable Care Act

Title II Subtitle I

Sec. 2703. State option to provide health homes for enrollees with chronic conditions. Provide States the option of enrolling Medicaid beneficiaries with chronic conditions into a health home. Health homes would be composed of a team of health professionals and would provide a comprehensive set of medical services, including care coordination.

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Product Evolution

The convergence between advanced Microsoft technologies, industry best practices, and proven Health Management functionality.

.NET Framework,

Silverlight

Healthcare Management

Best Practices

CH Mack Medical Mgt

Solutions (QCS)

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MedCompass™

Best-in-Class Functionality + Technology

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User Friendliness

MedCompass is built using the latest Microsoft technologies, to include Silverlight – delivering the next generation of .NET based media experiences and rich interactive applications for the Web.  User experience engineering (UXE) has been core to CH Mack’s development of MedCompass, understanding the importance of low learning curves and high adoption rates to deliver high ROI in large-scale Care Management technology initiatives.

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User Friendliness

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User Friendliness

Silverlight is a powerful development tool that lets .NET developers rapidly develop and deploy applications for the Web, and mobile devices.

Using Silverlight, developers can create applications with richness and interactivity out of reach of traditional web technologies while retaining the simple deployment and update model of web applications.

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Efficiency – Workflow Automation

Patient-Centered Workflow

MedCompass, by enabling comprehensive workflow(s) across caregivers, optimizes the efficient use of resources to achieve specific patient and organizational goals.

MedCompass’ Workflow Management tools increase efficiency and effectiveness through the maximal integration and use of relevant, timely information.

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Efficiency – Workflow Automation

MedCompass’ patient-centered workflow automates:

• Identifying a target process (e.g., case management program).

• Defining both clinical and administrative tasks to be performed by a work group.

• Breaking down tasks into more specific actions that can be performed by different individuals but which, when completed together, accomplish the original tasks.

• Deciding on the skill set required to perform each task or action (e.g., skills of a physician, nurse, case manager, patient, caregiver, etc.).

• Understanding the sequence in which the tasks are to be performed.

• Recognizing and applying conditional rules and logic branching, so that only necessary and indicated tasks are performed.

• Planning the sequence of tasks, assigning the tasks to individuals, and then documenting the process so that others can understand and follow it.

• Creating the forms, documents, and instructions needed by individuals at each step to perform the tasks (e.g., care plans, service plans, etc.).

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Workflow Automation

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MedCompass includes easy to use System Configuration functions, in the Admin Console, that allow authorized users to configure and maintain dozens of system features and functions. Examples include:

● Lookup Table Configuration ● Program Configuration

● General System Configuration Items ● Print Configuration

● User Management ● ISP Configuration

● Assessment Management ● Rules Setup

● Automated Task Configuration ● Time Tracking Configuration

● Service Auth Configuration ● Case Note Configuration

● Contact Management Configuration ● And many other Configuration functions

● Metrics Configuration

● Document Template Administration

● Fax Management

● PGIM Administration

System Configuration Functions

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System Configuration Functions

System Admin Console

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Comprehensive Assessment Builder

CH Mack customers are able to control their own assessments, surveys, etc. using our industry leading assessment configuration tool. This functionality allows clients to build their own assessments and associated rules into the application without CH Mack professional services assistance.

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Comprehensive Assessment Builder

System Admin Console

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MedCompass™ and MITA

MITA 2.0 Principles MITA 3.0 Principles

Open Architecture Service Autonomy

Standards Standardized Contracts

Modularity Loose Coupling

Reusable Components Reuse

Collaboration Abstraction

Data Sharing Discoverability

MedCompass™ MedCompass™

Security - SSO Statelessness

Medicaid Information Technology Architecture

CMS Initiative – A national framework to support improved systems development and health care management for the Medicaid enterprise.

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MedCompass™ and MITA

MITA Technical Requirements MedCompass™

Use open data and technical standards that meet MITA requirements

Use Commercial Off-the-Shelf products as far as possible

Solution must be built using component based model

Should meet accessibility standards – support thin client web browsers, Adobe for document sharing

MedCompass™ Alignment with MITA Technical Requirements

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MedCompass™ and MITA

MITA Technical Requirements MedCompass™

Must use industry standard data communication mechanism such as HL7, X12 (EDI), XML and LOINC

Preferred that there is a workflow service spanning the entire application

Must use a Rules Engine that is easy to maintain and change

Must meet security and privacy needs of MITA

MedCompass™ Alignment with MITA Technical Requirements

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Contact Information

For additional information contact:

Greg Silence513-936-6000 x602

gsilence@chmack.com