Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Technology Connects Case Managers to Better Processes, Improved Outcomes<br />Chris Boue, President & CEO<br />CH Mack<br />
Objectives<br />Evaluate current healthcare environment and demands on case managers.<br />Analyze how technology advances...
Technology in Today’s Healthcare Organizations<br />Technology advances in the past few decades have revolutionized the wa...
Looking Forward, Looking Back<br />Incentives<br />Performance<br />Outcomes<br />
Technology’s role in Care Management<br />
U.S. Healthcare Performance and Future Challenges<br />
Healthcare     	Economics<br />
New Incentives and Processes:<br /> Pay for Performance….<br />A work in progress<br />
Pay for Performance….<br />A grading challenge<br />
Pay for Performance….<br />It’s about improvement<br />
Business<br />Cost management<br />Demand management<br />Value management<br />
Government<br />CMS (Medicare and Medicaid)<br />Special Needs Plans (SNPs)<br />Medicare Part D<br />
Long Term Care - Service Delivery<br />
Case Management<br />Patients<br />Providers<br />Accreditation<br />
The view of care management has been revolutionized<br />
In many ways…..<br />
Home and Community Based Services (HCBS) <br />Care Coordination<br />Specialist - PCP - Behavioral Health Specialist - So...
Case Management<br />Consumer-centered market<br />Creating value<br />Integration<br />
Consumer-centered market<br />
Consumer-centered market<br />
Stakeholder communication via portals<br />Integrating data from multiple sources<br />	Eligibility, Medical/PBM claims, C...
Software application: portals<br />Data <br />Sources<br />Data<br />Exchange<br />Application <br />Marketplace<br />End ...
Databases
Text
Web
Email
Phone</li></ul>Portal<br />App<br /><ul><li>Mobile
US Mail
Fax
Live Voice</li></li></ul><li>Portal Example- Providers<br />
Integrated Portal - Providers<br />
Portal Example- Patients (wellness)<br />Four main features:<br />Interactive online software: fitness tracker, workout ge...
Portal Example- Patients (wellness)<br />
Software Applications<br />Utilization Management<br />Case Management<br />Claims<br />
 Role Based Design<br />
Utilization Management<br />Workflow<br />Auto-adjudication<br />Integration	<br />
Workflows<br />With workflows, the right job goes to the right people, at the right time<br />Workflows helps the user to:...
Workflow: System Example<br />
Workflow: Forms Management<br />
Workflow: Document Management<br />
The technology battlefield:<br />Siloed data<br />Integration<br />
Integration<br />
Integrated Case Management: Connected Care <br />Integrated Care Management<br />Functions<br />P<br />R<br />E<br />D<br ...
Case Study: 800 users<br /> <br />Automating key business process and workflows provides consistent delivery and contract ...
Case Study: 800 users<br /> <br />Key Drivers:<br />		• Centralizing information<br />		• Improving member and provider sa...
Case Study: Impact<br />
Upcoming SlideShare
Loading in …5
×

Software Tools that Empower Healthcare

438 views

Published on

Published in: Business
  • Be the first to comment

Software Tools that Empower Healthcare

  1. 1. Technology Connects Case Managers to Better Processes, Improved Outcomes<br />Chris Boue, President & CEO<br />CH Mack<br />
  2. 2. Objectives<br />Evaluate current healthcare environment and demands on case managers.<br />Analyze how technology advances can streamline productivity, while cutting administrative costs and improving quality of care in a managed care environment.<br />“This is so cool…I’m flying this thing with my Palm Pilot.”<br /><ul><li>Evaluate your own organization and consider how technology can improve quality of care for your members</li></li></ul><li>Content to Cover<br />Identify healthcare IT landscape from different points of view: employer, government, and private payer perspectives.<br />Explain how technology and tools, specifically workflows and dashboards, can enhance productivity.<br />Discuss a specific case study, detailing how collaboration technology helped a managed-care provider eliminate paper-based systems and improve productivity and customer service.<br />
  3. 3. Technology in Today’s Healthcare Organizations<br />Technology advances in the past few decades have revolutionized the way health care organizations:<br />Relate to their customers,<br />Conduct business operations, and <br />Organize themselves<br />
  4. 4. Looking Forward, Looking Back<br />Incentives<br />Performance<br />Outcomes<br />
  5. 5. Technology’s role in Care Management<br />
  6. 6. U.S. Healthcare Performance and Future Challenges<br />
  7. 7. Healthcare Economics<br />
  8. 8. New Incentives and Processes:<br /> Pay for Performance….<br />A work in progress<br />
  9. 9. Pay for Performance….<br />A grading challenge<br />
  10. 10. Pay for Performance….<br />It’s about improvement<br />
  11. 11. Business<br />Cost management<br />Demand management<br />Value management<br />
  12. 12. Government<br />CMS (Medicare and Medicaid)<br />Special Needs Plans (SNPs)<br />Medicare Part D<br />
  13. 13. Long Term Care - Service Delivery<br />
  14. 14. Case Management<br />Patients<br />Providers<br />Accreditation<br />
  15. 15. The view of care management has been revolutionized<br />
  16. 16. In many ways…..<br />
  17. 17. Home and Community Based Services (HCBS) <br />Care Coordination<br />Specialist - PCP - Behavioral Health Specialist - Social Worker<br />
  18. 18. Case Management<br />Consumer-centered market<br />Creating value<br />Integration<br />
  19. 19. Consumer-centered market<br />
  20. 20. Consumer-centered market<br />
  21. 21. Stakeholder communication via portals<br />Integrating data from multiple sources<br /> Eligibility, Medical/PBM claims, Care management,<br /> Profile/PHR , FSA<br />Self Service Tools <br /> Web Portals, IVR/FAX Services<br />Delivering multiple applications<br /> Enrollment, Disease Management, Wellness, Decision<br /> Support, Predictive Modeling<br />Implementing data enabled communication services<br /> Sending email, text, automated phone calls, live voice<br /> notifications based upon user profile<br /> Turning paper based solutions into paperless<br />Supporting Member and Provider Communication and Engagement Strategies<br />
  22. 22. Software application: portals<br />Data <br />Sources<br />Data<br />Exchange<br />Application <br />Marketplace<br />End <br />Users<br />Delivery<br />Network<br />Portal<br />App<br />Portal<br />App<br />Portal<br />App<br /><ul><li>Care Management
  23. 23. Databases
  24. 24. Text
  25. 25. Web
  26. 26. Email
  27. 27. Phone</li></ul>Portal<br />App<br /><ul><li>Mobile
  28. 28. US Mail
  29. 29. Fax
  30. 30. Live Voice</li></li></ul><li>Portal Example- Providers<br />
  31. 31. Integrated Portal - Providers<br />
  32. 32. Portal Example- Patients (wellness)<br />Four main features:<br />Interactive online software: fitness tracker, workout generator, calorie counter, meal plans and more.<br />Website content that is regularly updated by in-house experts.<br />Advanced social networking community features including: personal homepages, teams, and more.<br />Regular email newsletters.<br />
  33. 33. Portal Example- Patients (wellness)<br />
  34. 34. Software Applications<br />Utilization Management<br />Case Management<br />Claims<br />
  35. 35. Role Based Design<br />
  36. 36. Utilization Management<br />Workflow<br />Auto-adjudication<br />Integration <br />
  37. 37. Workflows<br />With workflows, the right job goes to the right people, at the right time<br />Workflows helps the user to:<br />Reduce the number of pended claims<br />Maximize team efficiency<br />Process more work<br />Exceed service commitments<br />Monitor and adjust work tasks in real time<br />Proactively identify backlogs or bottlenecks<br />
  38. 38. Workflow: System Example<br />
  39. 39. Workflow: Forms Management<br />
  40. 40. Workflow: Document Management<br />
  41. 41. The technology battlefield:<br />Siloed data<br />Integration<br />
  42. 42. Integration<br />
  43. 43. Integrated Case Management: Connected Care <br />Integrated Care Management<br />Functions<br />P<br />R<br />E<br />D<br />I<br />C<br />T<br />I<br />V<br />E<br />M<br />O<br />D<br />E<br />L<br />M<br />E<br />M<br />B<br />E<br />R<br />P<br />R<br />O<br />F<br />I<br />L<br />I<br />N<br />G<br />I<br />M<br />P<br />R<br />O<br />V<br />E<br />D<br />O<br />U<br />T<br />C<br />O<br />M<br />E<br />S<br />Claims<br />Data<br />Case<br />Mgt.<br />Chronic <br />Conditions<br />RX Data<br />Service<br />Mgt.<br />Referral<br />Mgt.<br />Clinical<br />Data<br />Reports<br />Operational<br />Insight<br />Q Continuum<br />Data<br />Other<br />Data<br />
  44. 44. Case Study: 800 users<br /> <br />Automating key business process and workflows provides consistent delivery and contract compliance for a Fortune 500 managed care organization.<br /> <br /> A Fortune 500 company focusing on Medicaid and Medicare that offers a variety of health plans for families, children, the aged, blind, and disabled, as well as prescription drug plans. The company served more than 2.5 million members nationwide as of December 31, 2008.<br /> <br /> The priority for this company was to automate processes, eliminate redundant data entry, improve productivity and accuracy, while reducing support costs and increasing efficiencies. The Company wished to “retire” multiple, dispersed legacy systems in place and focus on:<br />
  45. 45. Case Study: 800 users<br /> <br />Key Drivers:<br /> • Centralizing information<br /> • Improving member and provider satisfaction<br /> • Enhancing the interactivity of medical management<br /> • Improving the accuracy of information and authorizations<br /> • Supporting new programs and markets, as the Company grows<br />
  46. 46. Case Study: Impact<br />
  47. 47. Productivity Example<br />Motivation<br />Inspiration<br />Communication<br />
  48. 48. Enhancing Productivity: How<br />Workflows<br />Dashboards<br />Technology<br />
  49. 49. Dashboards<br />The new face of BI (Business Intelligence)<br />Business-driven and focused<br />
  50. 50. Evaluating Your Own Organization<br />Business requirements<br />Delivery of consistency across the Continuum of Care<br />Cost metrics<br />Technology solutions<br />
  51. 51. Thanks for Engaging<br />Chris Boue, President & CEO<br />CH Mack<br />E-mail: cboue@chmack.com<br />LinkedIn: www.linkedin.com/in/chrisboue<br />Technology Connects Case Managers to Better Processes, Improved Outcomes<br />Chris Boue, President & CEO<br />CH Mack<br />Chris Boue, President & CEO<br />CH Mack<br />
  52. 52. References<br />Burns, L., Brunker, C. P., Dorr, D. A., McConnell, K. J., & Wilcox, A. (2007). Productivity Enhancement for Primary Care Providers Using Multicondition Care Management. The American Journal of Managed Care, 13, 22-28.<br /> <br />Chao, S. H. (2006). Introduction: Shifting the Focus From Cost to Value. Journal of Managed Care Pharmacy, 12(6). Supplement.<br /> <br />Cornell, S. A. (2007). Clinical case study: Achieving long-term control of insulin resistance. Journal of Managed Care Pharmacy, 13(2). S11-S15.<br />Cross, M. A. (2007). Follow the leaders: Top pay-for-performance programs point to increased focus on hospital incentives, efficiency measures, coordination, and standardization. Managed Care Magazine. MediMedia. <br />Dunn, J. D. (2007). Pharmacy management approach: How do we align all the incentives? Journal of Managed Care Pharmacy, 13(2). S16-S19.<br /> <br />Edgar, B. S. (2006). Shifting the Focus from Cost to Value: A Government Perspective. Journal of Managed Care Pharmacy, 12(6). Supplement.<br /> <br />Enterprise Content Management (2009). Collaboration technology helps managed-care provider eliminate paper piles. Accessed on April 14, 2009 at http://www.ecmconnection.com/download.mvc/Collaboration-Technology-Managed-Care-Provide-0001<br /> <br />O’Kane, M. E. (2007). Performance-based measures: The results are in. Journal of Managed Care Pharmacy, 13(2). S3-S7.<br /> <br />Shurney, D. W. (2006). Shifting The Focus From Cost To Value: A Private Payer Perspective. Journal of Managed Care Pharmacy, 12(6). Supplement.<br /> <br />Smith, A. L. (2007). Merging P4P and disease management: How do you know it is working? Journal of Managed Care Pharmacy, 13(2). S7-S10.<br />

×