Secretary Alex Azar, Health and Human Services, spoke on March 5th, 2018, at the Federation of American Hospitals. His presentation reaffirmed CMS’ commitment to value-based transformation. He said, “there is no turning back to an unsustainable system that pays for procedures rather than value”. Additionally, he said, “value must be rewarded handsomely”. With the repeal of SGR (sustained growth rate), provider reimbursement will not see an increase beginning 2019. Therefore, the assessment of value (quality, stewardship of resources, appropriate utilizations) will determine if and when providers will see additional reimbursement.
St. Vincent’s Health Partners (SVHP), Inc., the first nationally-recognized clinically-integrated network by URAC, has developed a network and operational infrastructure to manage patients through more than 140 care transitions. SVHP is participating in most models of reimbursement including Medicare Shared Savings, commercial and governmental payment models, and direct-to-employer contracting.
SVHP has partnered with PatientPing, a software company that allows care coordinators and the medical management team to better serve attributed patients and covered lives as they transition between healthcare settings. Our team receives a “ping” each time a patient is seen in the emergency department, admitted to the hospital, or uses skilled nursing facilities and home health agencies. The “ping” provides enough information to allow coordinators to ensure that the patient care plan is utilized and maintained, and that each member of our network has access to appropriate patient-level information timely to maximize the therapy plan at each step of patient service.
Each new model of reimbursement requires effective patient engagement both directly and indirectly. When our team knows that patients have been admitted and discharged from an ED, inpatient, or skilled nursing facility, we can help each network provider offer coordinated and timely interventions effectively, and allow the whole system to meet operational, quality, and utilization objectives. Knowing when a patient expectedly and unexpectedly requires urgent, emergent, and continuous care, provides opportunities to use most current support tools and assures that clinical guidelines and aggregated data enhance care. For example, when a Bundle Payments for Care Improvement(BPCI) patient is transferred to a skilled nursing facility after hospitalization, our care coordinators make sure that the patient is followed-up timely with their primary care provider and many times prevent readmissions.
Another transformational software is SymphonyRM. It is software that allows the translational care coordination record to enhance the medical record between transitions of care and track the therapeutic plan while discretely recording efficacy of our care coordination processes. The software has allowed us to move away from registries to focus on patient-level healthcare success. The Quadruple Aim includes provider and patient satisfaction. SymphonyRM also allows us to improve physician outreach, provide additional tools to facilitate more effective clinically-integrated network, more adeptly keep aware of government and payer economic credentialing, and meet utilization and quality goals. Ultimately, the patient and provider can leverage effectiveness and advantages of a clinically-integrated network.
SVHP, PatientPing, and SymphonyRM have evolved together to allow care coordination documentation to become the translational patient record between patient care sites. Working with these two companies has grown from a vendor relationship to a partnership that has allowed SVHP to begin to discretely capture care coordination outcomes and show how SVHP is maximizing the Quadruple Aim. SVHP members collaborate every single day to face and solve unique challenges that have galvanized our network, transcended the limitations of the EMR, and positioned us to work in a subtle way with Secretary Azar and realize momentum to move towards value care with less dependency on volume.