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