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Archive for the ‘Accountable Care’ Category

Mobile, Analytics, Cloud, Value-Based Care, Social Dominate News at HIMSS15

Tuesday, April 21st, 2015
HIMSS 2015

HIMSS 2015 featured The Internet of Things for Health™, the Intelligent Hospital, the Intelligent Medical Home (i-Home™) as well as mobile, cloud, social, analytics, population health and value based care.

Record attendance at HIMSS 2015 in Chicago – over 43,000 people.  Now that HIMSS15 is over, take a look at some of the trends that dominated the headlines, the social buzz and the chatter at after show cocktail parties.

Of course, there were the overarching themes of interoperability, and population health, but there were some key themes that received the most attention. Here are the five areas that stood out:

  1. Value based care and population health mergers and acquisitions
  2. mHealth – HIMSS 2015 mobile health survey and ROI issues as well as HIPAA Privacy and Security.
  3. Emerging technologies focused on referrals, eligibility and personal health engagement / patient engagement.
  4. SMAC – Social Mobile Analytics and Cloud, including ICD-10
  5. While there is work being done to break down the data and process silos in healthcare, much more work needs to be accomplished to realize the promise of these solutions.

The health care industry continues to rely on X12 EDI claims data because it is standardized.  Though clinical data is increasingly structured (‘discrete data’ per Meaningful Use of EHR regulations) it is not standardized as to specific content such as blood pressure (systole and diastole can be expressed as 120 / 80, “blood pressure in normal range” etc). Therefore, it can still be difficult at times to query and manage populations using clinical data.  It’s needed though if we are going to deliver on the promise of value based care and  population health.

Read the full story here in GovHealthIT.

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ICD-10 Impacts Case Management and Case Management Reporting

Thursday, January 30th, 2014

ICD-10 assessment and implementation planning activities create many possible areas to focus on so it is important to prioritize those that are most critical to patient care and reimbursement.

When thinking about ICD-10 program governance, one of the key areas for both traditional Fee for Service (FFS) medicine and the transition to episodic (short-term) and longitudinal data for comparative effectiveness medicine in the Affordable Care Act is the Case Management process and supporting software and reports.  The member or patient, provider, case management RN, and dedicated Medical Director,  and Case Reviewers all collaborate in this process.   Therefore, the transition to ICD-10 creates just one more reason to take a closer look at Case Management and Case Management reports.

In our over 30 years’ experience in software development, IT systems and healthcare IT, we have found that reporting is one of the most overlooked areas by developers of solutions like these, but one of the most critical for users of these systems.

Does your organization depend on reports for Case Management?  If so any ICD-9 related information in those reports will need to be updated for ICD-10 if they contain procedure codes or diagnosis codes in ICD-9 today.

Some of the impacted systems, and processes to consider include:

  • Referrals (Utilization Management, Condition Management, Self-referrals, Client requests, Provider requests, etc.)
  • Targeted high volume, high cost, high risk diseases
  • Analytics, including predictive modeling, ICD-10 financial risk analytics, and population health management analytics
  • Clinical decision support
  • Plan compliance reporting
  • Inpatient reporting (bed days, denials, readmissions)
  • Shared savings, bundle payments, capitation, PMPM
  • Cost reporting (fee for service, case based, benchmarked, per diem)
  • Medicare Advantage specific measures (HEDIS, 5-Star Ratings)
  • Home health care
  • Medical necessity
  • DME
  • and more

Related Posts and Resources

  1. Case Management Guide for Providers from CMS
  2. Case Management, RAC Audits, Revenue Cycle Management and ICD-10
  3. ICD-10 Consulting
  4. ICD-10 Financial Risk Management
  5. ICD-10 Assessment and Data Quality
  6. ICD-10 Remediation
  7. ICD-10 and Interoperability
  8. ICD-10 Best Practices

 

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