INPATIENT AND OUTPATIENT CARE MANAGEMENT 

SITUATION

HCIT Consulting worked with one of the nation’s leading independent medical groups. Founded in California in 1992 with a focus on becoming a role model for integrated and coordinated care, the medical group had grown to include high-quality medical groups in Colorado, Florida, Nevada, New Mexico and California that managed over 1.5 million patient lives.

The legacy software utilized for managing high risk patients in various inpatient settings, outpatient settings and became out of compliance for tracking and reporting for disease management per health plan regulations. As a result, the client was at risk to multi-million dollar fines and was experiencing operational issues with patient management and staff productivity.  The client purchased new software to be implemented across all five markets, totaling 13 regions. In addition, Leadership suspected that the case management processes were over engineered and had significant opportunity for local and national standardization, including national roll up reporting of performance and patient outcomes.  

ENGAGEMENT

HCIT Consulting became engaged by an IT executive within the Continuum of Care Division at the national level of the health system.  HCIT’s deliverables were to provide pre-implementation process and IT assessments regarding workflow, inpatient and outpatient process clinical review, report review, as well as an IT gap analysis for the legacy and EMR products. The engagement consisted of assessment of care planning and disease management processes, workflows throughout the care continuum, and providing multiple levels of recommendations based on budget, resources, and time. The engagement with the Medical Group consisted of process and workflow assessments in five markets as well as the implementation of new Case Management Processes in conjunction with the new CM system to two of those markets.

PROJECT OBJECTIVES:

Assessment, Implementation and Optimization of Care Management inpatient, outpatient and disease management care planning processes to maximize:

  • National and local standardization of content, documentation, program management, and patient care continuity
  • Optimize software configuration to utilize best practice functionality and eliminate over processing and streamline patient care planning
  • Streamline workflow with standardization and implementation of care management best practices
  • Leadership visibility into operational productivity and reports
  • National roll up reporting of outcomes, including LOS, compliance measures, and health plan requirements

DELIVERABLES COMPLETED

  • Performed Care Management Process Assessments for 11 Case Management Departments in 13 Regions producing over 60 current state workflows.
  • Evaluated multiple levels of leadership to identify strengths and weaknesses.
  • Reviewed data elements, data capture, reports and recognized area of opportunity based on best practice and optimization of process and data entry to maximize health plan reporting and compliance needs.
  • Developed a project plan to roll out recommendations during the software implementation. This included IT project management, interface management, QA, operations project management, and cut over plan and sustainability.
  • Implementation of inbound and outbound interfaces from multiple sources into the case management solution and outbound to the EMR
  • Evaluated, Configured and Educated various levels of leadership on operational reports.
  • Completed training with vendor support to over 850 case managers, social workers and care coordinators at system go live (6 weeks in total)
  • Completed Assessment and recommendations for Emergency Department CM best practices, Readmission Management and Avoidable Day capture

OUTCOMES:

National Workflow Design

  • Best practice accounting for Health plan requirements
  • Standard design and nomenclature
  • National Steering Committee guidance
  • 109 separate programs and subprograms optimized and reduced to 32 for National use.

Content and Process Standardization

  • Streamlined and standardized workflow for staff in the outpatient setting and to inpatient hospitals and skilled nursing facilities including out of area, out of network and ACO patients.
  • Data Dictionaries for reporting and transition to discrete reporting data elements
  • New reporting at the patient level vs. program level
  • National Avoidable Day and Readmission Tracking
  • 174 total legacy system documentation types were reduced & standardized to 73, including MCG Evidenced Based Care Plans
  • 45+ outpatient processes standardized to 10.
  • 25+ inpatient processes at over 125 inpatient facilities standardized to 5
  • Implementation and training of new processes, workflow and IT system to over 850 Case Managers and Care Coordinators

Scalability, Staff Onboarding, and Acquisitions

  • Consolidated tool sets currently utilized
  • Paper and Manual Processes transitioned to new Case Management System
  • Updated 124 job aids, standard operating procedures, and tip sheets while retiring 155 that were no longer needed with department standardization, automation, and optimization
  • System clean up to over 35,000 outstanding actions and migrated over 11,000 goals, tasks and care actions to new system
  • Seamless TouchWorks Integration with Care Plan Sharing and Tasking

National Enterprise Reporting Completed

  • Enterprise data warehouse reporting
  • Enterprise CM application reporting
  • Enabled historical reporting
  • Pre-Implementation mapping and reverse mapping of over 625 individual fields from legacy system to new system, the ambulatory EMR, and national data warehouse
  • Reviewed 284 reports and reduced to 119 reports that were rebuilt to be run at the national and local levels to meet KPIs and compliance requirements