- 700 bed hospital and health system
- 19 primary care locations
- 70 primary care providers
- Achieve PCMH Recognition and setup case management
- Expanded to: project management, reports and analytics, Pharm-D and strategic advisory services.
- All primary care locations received PCMH Recognition
- Large reimbursement increase
- Stronger negotiating power within hospital and community
- Built foundation for an ACO
- Quality focused outlook on health care delivery
- Visible improvement in their QRUR report after 12 months
Healthier through Data
This health system’s practices noticeably improved quality measures, saw visible improvement in their QRUR report, and boosted their reimbursement rates while achieving PCMH Recognition within just ONE year.
Managing patient population’s health and gaining PCMH Recognition has never been more achievable. Let’s focus on a health system with approximately 20 primary care locations, including family medicine, internal medicine and pediatrics. This client needed Recognition fast, but they were unaware of other opportunities for financial, quality and patient gain until Clarify started working with them.
This health system client contacted Clarify requesting assistance in gaining NCQA Patient Centered Medical Home (PCMH) Recognition for all three of their primary care divisions - in total approximately 20 locations. After a few meetings, agreements were signed, and this organization became a Clarify client.
Leadership at the health system indicated a strict and aggressive internal deadline on this project, so Clarify needed to work quickly and efficiently. Clear, frequent updates and communication on timelines and deadlines was a critical factor for the success of the project.
PCMH Recognition Process
The client was a multi-site application with NCQA, so the corporate portions of the PCMH application and submission were completed first. Clarify then began working with the different locations and they were prioritized by size and readiness. Timelines were established for items, tasks, and deliverables to be completed which streamlined the PCMH Recognition process. Clarify worked closely with their internal assets and people to get this all done. PCMH Recognition was achieved in all locations. The project quickly expanded to include consulting in project management, reports and analytics, case management and strategic advisory services. Gap analyses were performed throughout the project to determine areas in need of improvement.
Population Management and EHR Optimization
What started as a simple request to get PCMH Recognition soon evolved to include Population Health Management. Population Health Management, “involves the design, delivery, coordination, and payment of high-quality health care services to manage the populations we identify while using the best resources available.” (Institute for Healthcare Improvement, 2014). This organization was aware of the benefits that population health management held, both to the patients as well as the organization. Clarify’s focus shifted to patient engagement. A case management department was started, case managers were hired, and a Pharm-D and RN Nurse Leader was later added to the team. These activities allowed Patient Outreach processes to be implemented. The Patient Outreach processes enabled providers and the care team to keep in more frequent contact with their patients ensuring that appointments were kept and treatments were followed. Clarify’s research has shown that by keeping in contact with patients, health is improved and spending is ultimately reduced.
"We were missing a lot of stuff"
- our Client
The health system already had a top notch EHR system-they just needed to use it wisely and get information and reports into the hands of people making decisions. What data and reports, how frequently and who needs the data is mission critical. Clarify helped the client make decisions to create for providers to document, report, and analyze patient data. The use of data is critical to Population Health Management (and plenty of other things, by the way. It enables providers to find trends in a patient population, which can determine the most effective and efficient treatments for the population in question. The use of the now available data and the shift towards practicing Population Health Management has allowed this health system to greatly improve their patients’ health outcomes.
Strategic Advisory Services
COMMunication is key
There wasn’t enough effective and coordinated communication between the different entities of this primary care health system, and this needed to change. Different groups were requesting similar reports to be run from corporate, and it was in their best interest to combine efforts and unify and streamline their requests. Clarify assisted in their assembling a PCMH “task force” comprised of leaders from each entity to make these unified requests as one group. This task force was necessary because of this particular client’s size, and it turned out to be truly beneficial in their progress and opening communication lines for future progress in which was in their mutual best interest.
“We were able to configure our PCMH and case management programs in a way that worked for us and our budget, but was more cost effective than other complex models. Clarify helped us do that.”
- our Client
After working with Clarify, the health system has experienced quality improvement in both process and outcome measures, and their reimbursements have been positively impacted. In just one year from their project start date, the health system witnessed the effect that PCMH can have on an organization.
Their Medicare quality metrics improved: their position on the CMS QDR Scatter Plot Grid, a series of quality metrics tied reimbursement rates, has gone from the bottom left quadrant to the top right - a drastic rate increase in just ONE year! The client said it was a visually noticeable difference.
PCMH related activities like routine Diabetic Foot Exams, monitoring A1C and increasing medication reconciliation have also resulted in noticeably improved patient health. Clarify helped this health system add some processes, verification, checks and enhance the focus on quality. Before the transformation, there was the mentality of assumption that the care being delivered was good.
“Our partnership with Clarify and the hard work we've done has changed the way we do business.”
- our Client
PCMH Recognition has given the health system the ability to negotiate contracts with both government agencies and manufacturers. They have since secured a government contract with the city where they’re located. Also, the health system now has more internal control and ability to document and execute additional PCMH related initiatives such as TCM, CCM and Care Coordination. This project has paved the way for them to transition to volume to value reimbursement, starting the path for this health system client to become an ACO. Overall, Clarify’s work opened the door for higher reimbursements and greater patient health outcomes for this health system.