Implement a Gap Analysis (Value Measures) Framework to Improve Quality of Care
Our gap analysis methodolgy is used in assessing the differences in clinical and non-clinical functions’ performance among healthcare information systems to determine whether business requirements are being met and, if not, what steps should be taken to ensure they are met successfully. Through our analysis of clients’ needs, resources and gap; our consultants can figure out “where our clients are” (the current state) and “where our clients want to be” (the future/target state) and presenting alternative solutions to be implemented. Besides, the gap analysis gives decision makers a comprehensive overview of the entire workflow or a particular function or an area, such as patient accounting, information technology or operations. This allows all healthcare stakeholders (i.e. directors and executives, …) to determine whether the department or organization has the resources to meet their mission, goals and objectives.
Our Readiness Assessment Process:
Care Coordination involves two different but related aspects of patient care. One provides information to the clinician who must be able to access from and provide relevant clinical data to multiple sources in order to determine and provide for appropriate next steps in diagnosis or treatment.
The other is to assure that patients are in the appropriate setting as they transition among multiple levels of care. Both are important for providing high quality care as well as mitigating excess, both must incorporate patient needs and preferences, and both are highly dependent on the ability to quickly and easily send and query health information on a given patient to and from multiple electronic sources.
Also referred to as population management in some settings, cohort management starts with an assessment of the entire risk based population, in order to identify the specific cohorts on which the organization chooses to focus: high risk patients, those with specific chronic disease, and those in need of appropriate screenings and primary prevention interventions.
Specific aspects of patient engagement are particularly important, especially for those patients who must manage their own health and care outside of a clinical setting. As the health of each patient in cohort improves, so does that of the whole cohort, ultimately leading to improved health of the entire population of the organization.
Critical step in population segmentation for the accountable care organization since each sub-population will be managed differently with different anticipated outcomes
Ability of the clinician to monitor, track, and trend events and results per the individualized care plan with respect to a patient’s specified milestones, goals, and outcomes
Specific features of the organization’s knowledge management program that prompt providers, patients and designated caregivers, and specified health plan personnel that specific Evidence Based Medicine (EBM) interventions should be considered
Includes those aspects of Patient Relationship Management that are specific for the sub-populations (cohorts) on which the organization has chosen to focus
Both internal and external to accountable organization as needed, including designated health plan clinicians as appropriate
A single source of information about anticipated care in specific circumstances by each team participant (including
Systematic approach in assuring that the most appropriate intervention is offered, explained, and ordered at the
Right time; Includes care in addition to that of standard Evidence Based Medicine alerts and reminders
Assurance that all results (and all appointments or orders not acted on by patient) are tracked, acted upon, and communicated appropriately to designated parties in a timely manner
As the delivery system evolves from doing things “to” the patient, to doing things “for” the patient, to doing things “with” the patient and designated caregiver as partner, the expectations of patients and caregivers and their cultural attitudes about accountability for their own health will also evolve.
This will require a major change in how communication occurs between patients, their caregivers and providers, and even a more significant change in how patients and caregivers can use technology to better care for themselves on multiple levels — to stay well, manage a chronic condition, or assume informed control of major life changing decisions and events. Sound health literacy principles, access by the visually and hearing impaired, cultural competence, and linguistically appropriate communications are all fundamental attributes to HIT support for patient and caregiver relationship management.
Online and mobile access to maps, directions, provider directories, available services, 24/7 contact information, quality reports, cost information, results of satisfaction surveys, opportunities to provide feedback
Assure that care system is easy to navigate and all patient billing is accurate, timely, and understandable
Should be targeted, Pertinent, and customizable to the individual patient, status, condition(s), and circumstances. Information should be delivered in format that fits patient and caregiver’s learning style (audio, visual, graphic, etc.); Should include information about general health concerns, patient specific health concerns, full disclosure about options and outcomes of various modes of treatment, advanced care planning, and about different care processes (e.g., self-management, group visits, coordinated care, cohort management, use of HIT, and patient focused health technologies)
Ability to securely communicate electronically and bi-directionally about care, concerns, expectations, and status
Patients have the tools to actively monitor and care for themselves and have the ability to contribute to information in the EHR about the care they provide for themselves
Reflects need to track, understand, and respond appropriately to patients
Who do not keep appointments, fill prescriptions, and follow up with diagnostic testing or referral, Or follow their care plans.
Culture change is generally a slow and difficult process. While professional clinicians may be quick to learn and apply scientific information in their daily work, the process and workflow changes necessary to improve care and mitigate excess costs will be difficult to assimilate.
HIT systems must be easy to use and support the need for relevant information at the point of care. With improved technical advances in communication, information sharing, and in data presentation, a culture of independence and authority can evolve to one of collaboration and partnership — with other clinicians, with staff in the clinical unit, and with patients and caregivers themselves.
Reminders, prompts, and information feeds to both providers and patients about possibly needed care that are informative, timely, actionable, appropriately sensitive and specific, and incorporated seamlessly into workflow
While several of these may be proprietary, access through an EHR would be invaluable for both patients and clinicians
Plans that take into account patient preferences, as well as health plan provider networks and the organization’s preferred provider contracts, will make it easier for clinicians to construct the most effective care team for a given patient
Minimizes the time spent on administrative tasks throughout the day
While this continues to be a developing science, recognized elements that enhance the human
To computer interface are now being incorporated in health information technologies; Ease of data capture and clear presentation of relevant data continue to evolve
Programs that provide comprehensive clinical information on specific topics and provide tools to incorporate information in the clinical care process.
The financial systems required to manage fiduciary health under risk arrangements are far more complex than the simple practice management and billing systems in the Fee for Service environment.
Consider the complexities of revenue cycle management, actuarial analytics, business intelligence analytics, and different reimbursement strategies under multiple different risk arrangements where the margin accrued from shared savings may be less than the loss incurred through improved care management for subsets of providers within the organization’s structure. The following functions and HIT capabilities are basic for all organizations taking on any form of downside risk.
Assures consistent data for claims adjudication, payment distributions, and analytics for financial management
Pulled from multiple clinical, financial, and operational system sources and integrated within each
Of these and across all of these sources
Before any clinical Or financial management can be undertaken, the provider groups will need to understand both the demographics and illness burden of its patient population
Patient and provider understanding of assignment and changes to enrollment
Focusing on agreed upon clinical, financial, and operational measures and goals
Contractual agreement between provider and payer on risk sharing formulas allowing computation of additional revenue or loss
Payers have unique approaches to contracting risk; providers groups also have unique preferred approaches; Providers must understand the complexity of managing multiple types of contracts, and enter into those contracts with clear understanding of what they entail with the recognition that A single care model applies to all patients within the organization
Ability to identify and pay preferred providers of all types outside of the legal purview of the accountable organization; will require payer collaboration
The ability to collect, analyze, and share accurate and granular financial data for retrospective, predictive, and activity-based cost accounting and analyses, and apply to various revenue streams
That align with incentives and payer contracts; Could include FFS, salaried, bundled, bonuses, or capitated payments to providers both within and external to the accountable care entity
This applies to both contracts with payers and contracts with other providers that may be providing revenue to the organization as well as billing of patients
If an accountable care organization that includes hospital and other non-physician care
The current focus on reporting of quality measures and the technical specifications drive much of what is needed in HIT systems to report out quality measures. It is perhaps more critical that providers of all types have access to internal reports on their quality of care as well as reports on their resource consumption.
Reporting to various registries and patient safety organizations (PSOs) are also functions that will not only lead to improved public health efforts, but to better health for the patients partnering with their provider organization.
One of the main assets of any provider organization is the wealth of health-related data that can be a mess. As it seeks to identify, create, represent, distribute, and enable adoption of insight and new knowledge, it will need document management systems, powerful search engines, and book-marking engines.
Internally developed reminders, prompts, and information feeds to both providers and patients about possibly needed care
And will support customized care planning, the creation of patient and caregiver support networks, and the ability to anticipate patient needs and resource use
Insight and experience shared collaboratively through collating clinical information from multiple sources in addition to the organization’s electronic health record
Determine how various workflows and process improvement interventions contribute to better outcomes