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  1. 2. Medrok Intelligent Medical Software Solutions
  2. 3. How Information was shared before computer technology
  3. 4. Thinking Outside the Box Thinking Outside the Box
  4. 5. Using Technology to Meet Industry Challenges Consolidation Dissemination Evaluation Assessment
  5. 6. Current Industry Strategies <ul><li>Utilizing increasing numbers of on-site case managers to procure inpatient information </li></ul><ul><li>Increasing numbers of physicians/hospitalists to review inpatient cases </li></ul><ul><li>Attempting to strengthen provider relations by taking responsibility for retrieving clinical information without providing them with tools for independent management (working from the outside “in” instead of the inside “out”. </li></ul><ul><li>Constructing software programs for manual entry (using technology to improve manual activities without fully utilizing the potential of technology to reduce the unnecessary replication of manual services) </li></ul><ul><li>Focusing on regulatory time-frames without resolving communication systems </li></ul>
  6. 7. Visual of Current System Clinical Information Hospital Case Managers Paper Chart: Nursing, MD Notes Hospital Physicians Blue Cross Telephonic Case Managers Blue Cross On-site Case Managers Blue Cross Computer System Blue Cross Physician Computerized Information Intake Center ARU, Acute Long Term Sub-Acute, Skilled Nursing Facility Home Health Services Discharge Facility CM This is the reason for regulatory time-frames due to the sluggish communication system currently in use Pharmacies
  7. 8. Visual of Medrok System Clinical Information from bedside nurse shift report Medrok System Hospital CM only for questionable cases Hospital UR Office Receives Daily Authorization Status Hospital Physicians Blue Cross Physicians Blue Cross CM only for questionable cases Discharge Facilities Home Health Blue Cross Pharmacy This system is “real-time” virtually making regulatory time-frames obsolete
  8. 9. <ul><li>Provides admission/discharge information, benefits (with smart card) & LOC throughout inpatient stay </li></ul><ul><li>Consolidates current, daily clinical state & treatments of patient with the nursing shift report while decreasing insurer and hospital case management costs </li></ul><ul><li>Disseminates organized, thorough clinical information to physicians and ancillary services improving quality of care </li></ul><ul><li>Identifies abnormal clinical states, lab values and culture results </li></ul><ul><li>Auto-authorizes clear-cut clinical criteria for medical necessity and auto-sends review cases with current clinical state to MD Reviewers </li></ul><ul><li>Allows hospital real-time status of medical necessity & streamlines hospital case management workload </li></ul><ul><li>Auto-sends 14 day reviews, < 30 day re-admissions and referrals for case management program for quality control </li></ul><ul><li>Provides communication of auth/denial process in real-time exceeding regulatory time frames </li></ul><ul><li>Provides direct, convenient communications between hospital MD’s and Insurance Physician Reviewers </li></ul><ul><li>Identifies discharge level and provides auto-matching, patient/family education and virtual visit videos for cost-effective discharges </li></ul><ul><li>Auto-authorizes ARU, Acute Long Term, SNF, Home Health, Pharmacy (Drugs) admission and medical necessity </li></ul>Medrok System
  9. 10. Current Mindset of Providers towards Insurers <ul><li>Unaware/uneducated regarding what clinical information justifies stay </li></ul><ul><li>Perception that insurer’s are trying to avoid reimbursements even if medically necessary </li></ul><ul><li>Uneducated regarding discharge criteria </li></ul><ul><li>Frustrated regarding multiple plans e.g. who is responsible for reviewing/authorizing stay </li></ul><ul><li>Frustrated with poor communication systems which they view as just another means for insurer to avoid payments </li></ul><ul><li>View on-site case managers as another ploy for insurer to deny cases </li></ul><ul><li>Communicate their frustrations/resentments to patients/families when denials occur which causes members to become angry towards insurer (unaware of the reason for denial such as the hospital being unable to provide adequate information to justify stay) </li></ul>
  10. 11. Current Mindset of Members Towards Insurers <ul><li>Feel uneasy & unsure of whether hospitalization </li></ul><ul><li>costs will be reimbursed by insurer or what their </li></ul><ul><li>benefits truly cover </li></ul><ul><li>The only time the insurer interacts with hospitalized </li></ul><ul><li>patients & families is when a case is denied </li></ul><ul><li>Feel like insurer is pushing them out when sent to </li></ul><ul><li>discharge facilities and do not understand why they </li></ul><ul><li>can’t for example go to an ARU instead of a SNF </li></ul><ul><li>Feel a loss of control regarding choosing discharge </li></ul><ul><li>facilities </li></ul>
  11. 12. <ul><li>Provider Needs </li></ul><ul><li>Cost-effective management of PPO, HMO, Medicare and Medi-Cal patients </li></ul><ul><li>Timely reimbursements from insurers </li></ul><ul><li>Identification of benefits/plans </li></ul><ul><li>Tracking of level of care throughout stay </li></ul><ul><li>Real-time evaluation of medical necessity and ongoing discharge plan </li></ul><ul><li>Automated generation of Medicare and TAR’s </li></ul><ul><li>Improved communication between nurse, physician and ancillary services </li></ul><ul><li>Evaluation of critical clinical states and lab/culture values </li></ul><ul><li>Improved communication for hospital physicians when requested clinical information from insurer </li></ul><ul><li>Ability of physicians to access daily clinical information off-site such as offices </li></ul><ul><li>Efficient placement of acute long-term, ARU, subacute, skilled nursing, home health services </li></ul><ul><li>Insurer Needs </li></ul><ul><li>Cost-effective management of large volume of patients </li></ul><ul><li>Notification of admissions/discharges </li></ul><ul><li>Identification of benefits/plans </li></ul><ul><li>Tracking of level of care throughout stay </li></ul><ul><li>Accurate/thorough daily clinical information </li></ul><ul><li>Real-time evaluation/authorization of medical necessity and adherence to regulatory time frames </li></ul><ul><li>Improved access of clinical information for physician reviewers </li></ul><ul><li>Improved and timely information exchange with hospital physicians </li></ul><ul><li>Continuity of care between inpatient, skilled nursing facilities and home health services </li></ul><ul><li>Efficient, appropriate & cost-effective discharge placements and services </li></ul><ul><li>Improved customer satisfaction, increased membership and retention of current members </li></ul>
  12. 13. The beauty of this system is that it is based on changing the nursing shift report from a handwritten “cheat sheet” that ends up in the pockets of nurses into an electronic wealth of information that is shared with all healthcare members without disrupting or adding to the workload of nursing. This simple act cuts out the replication of services and affords the healthcare team and the insurer accurate, current, evaluated clinical states & treatments which greatly improves the quality and cost-effectiveness of healthcare delivery.
  13. 28. Discharge/Placement Module <ul><li>A delayed discharge can cost the hospital and the insurer thousands of dollars a patient a day </li></ul><ul><li>Delayed discharges can be due to inexperienced hospital discharge planners, lack of communication between hospital and discharge facilities/services </li></ul><ul><li>Resistance of patient or family due to poor education regarding discharge services and lack of participation or facilitation with choosing facility </li></ul><ul><li>Inexperience of hospital case managers in resolving difficult to place patient issues </li></ul>
  14. 29. What a Difference a Day Makes <ul><li>The average cost of an ICU stay is between $6000.00 to $12.000.00/ day </li></ul><ul><li>The average cost of a telemetry stay is between $4000.00 to $6000.00/ day </li></ul><ul><li>The average cost of a med-surg stay is between $1500.00 to 2000.00 / day </li></ul><ul><li>The average cost of an acute long term stay is between $2000.00 to $5000.00 / day </li></ul><ul><li>The average cost of a subacute stay is between $ 600.00 to $900.00 /day </li></ul><ul><li>The average cost of a skilled nursing stay is between $300.00 to $450.00/ day </li></ul><ul><li>The average cost of a home health visit is between $150.00 to $300.00/ visit </li></ul><ul><li>Moving the patient appropriately and efficiently along this continuum is the key to conserving healthcare funds. This requires clinical expertise and watchful medical management while preserving quality of care. Medrok’s system is based on daily, clinical evaluations while identifying issues that the healthcare team needs to address in a timely manner with the goal being a cost-effective inpatient stay and discharge . </li></ul>
  15. 31. Discharge & Placement Module <ul><li>All discharge facilities enter in daily bed availabilities regarding gender, isolation, insurance type into Medrok system </li></ul><ul><li>All clinical services of each facility entered into system on profiles </li></ul><ul><li>System identifies level of discharge by clinical criteria & makes suggestions for what criteria needs to be resolved to qualify for lower level of care </li></ul><ul><li>System problem-solves difficult to place patients </li></ul><ul><li>System provides patient and family discharge education, virtual visit videos of discharge facilities and the ability to enter in preferences in system </li></ul><ul><li>System matches patient to appropriate facility with current open bed </li></ul><ul><li>If no available bed at matched facilities offers default facilities with open beds </li></ul><ul><li>System auto-authorizes initial placement by insurer criteria </li></ul><ul><li>System offers discharge facility current clinical shift report </li></ul><ul><li>System allows discharge facility ability to communicate issues regarding resolvable reasons why patient is not appropriate for their facility </li></ul><ul><li>System can arrange ambulance transfers electronically </li></ul><ul><li>All communications are electronic </li></ul><ul><li>Discharge Module can inform MD of placement information </li></ul><ul><li>All discharge facilities, home health, pharmacy and DME continue auto-auth with Medrok system </li></ul>
  16. 32. Medrok <ul><li>The Future </li></ul><ul><li>of </li></ul><ul><li>Medical Management </li></ul>