COLLABORATIVE CARE MANAGEMENT. throughout the continuum

Transcription

1 COLLABORATIVE CARE MANAGEMENT throughout the continuum

2 OPTIONAL modules Morrisey helps hospitals and other healthcare providers achieve measurable clinical, process and financial outcomes. Our products support reviews throughout the continuum of care, from pre-admission assessments to transitional care planning and community-based population health management. Our comprehensive care management software and optional modules, and Transitions of Care (TOC) solutions automate case management processes, streamline work flows and support collaboration among multidisciplinary teams. These solutions exchange information with one another and integrate with existing hospital systems. Care/Utilization Management The Care/Utilization Management module helps hospital case managers optimize care processes to ensure quality outcomes and patient satisfaction. The software supports criteria-based reviews for medical necessity, standardized documentation and detailed communication with payors, physician advisors, post-acute care providers and others. MCCM integrates McKesson s browser-based CareEnhance Review Manager and the Milliman CareWebQI application. The system also enables users to define and load their own criteria for case reviews. Enter unlimited notes and use pre-defined comment templates to simplify and standardize documentation. MCCM integrates this information with detailed clinical documentation, lab results and medication orders to generate clinical information packets. These packets provide the details needed to communicate effectively with healthcare stakeholders. Real-time HL7 messages for updates to patient records Customizable rules for automatic identification of pre-admission, observation, admission, readmission and continued-stay reviews A link to continuum of care assessments, interventions and documentation to ensure continuity of care Automated referrals to internal and external physician advisors Standardized documentation and clinical information packets for use in payor contacts Automated identification and documentation of coverage notices, including important messages Variance tracking, including readmission assessments, and avoidable days and delays Morrisey Concurrent Care Manager (MCCM ) MCCM supports acute and community case management; discharge planning; documentation reviews; audits, denials and appeals management; quality/peer review; online risk incident reporting and tracking; liability claims management; and infection control. This fully integrated suite of applications is the only Web-based system to include an executive dashboard for point-and-click trend analysis. A longitudinal, patient-focused relational database Convenient online access Apple ipad and tablet support for remote access A rules engine that identifies and schedules patients for reviews automatically Configurable work lists Standard and ad hoc reporting options Point-and-click graphical reporting for department managers and executives Denials, Audits and Appeals The Denials, Audits and Appeals module integrates with the Care/Utilization Management module. MCCM records the financial effect of audits and denials and the outcomes based on the appeals process, allowing analysis of losses and recoveries by payor. Online audit tracking from insurers initial records requests to resolution Online denial tracking from insurers initial verbal denials to resolution Medical records tracking of requested and sent documents DRG validation, including initial and revised coding details Reporting that includes audit and denial types, and reasons and outcomes for revenue analysis Contact logs for recording and tracking interactions with payors and auditors Automated, organization-specific work lists 2 3

3 Discharge Planning The Discharge Planning module integrates with the Care/Utilization Management module. The software helps case managers assess patient and family needs and develop effective discharge plans. Enter discharge planning assessments, document patient and family needs and interventions, refer patients to social workers and other hospital support staff, and schedule follow-up reviews. Users can also track expected and actual discharge dates and dispositions in the system. Discharge planning assessment and referral tools Instant access to critical information for accurate discharge planning Online documentation of patient and family needs and interventions Online referrals and scheduling with social workers and other hospital support services Easy scheduling of follow-up reviews Documentation of transportation and required post-discharge service types and providers Documentation of patient choice to meet regulatory requirements Transitions of Care Solutions Morrisey s integrated Transitions of Care (TOC) solutions facilitate online care coordination and communication to close potential gaps in care and ensure safe, effective hand-offs. Case managers and post-acute care providers collaborate and share confidential information using a secure Morrisey-hosted website. Active and ongoing communication promotes adherence to treatment plans and reduces the potential for medical errors and unnecessary readmissions. The TOC package includes the MCCM Provider Networking module, the Morrisey Care Communications Networking (MCCN ) website and the Survey Management module. Care communications networking from a Morrisey-hosted website that includes a national provider database A Web portal for post-acute care providers Survey capabilities to track compliance with care plans and patient outcomes Integration with MCCM s acute and community care management modules Documentation Review The Documentation Review module helps hospitals achieve their full reimbursement potential by enabling them to track and manage patient records for accuracy and completeness. The software uses automated rules to identify patients for documentation reviews. It supports automated queries to care providers who request clarifications to documentation and enables reviewers to escalate cases to internal and external physician advisors. Automated rules to identify populations that need documentation review Standardized physician queries when issues need clarification Configurable work lists Integration of concurrent coding, including working DRGs, procedures and diagnoses Report generation for reviewer productivity, physician query response rates and financial savings Case-specific reports for health information management to ensure accurate coding and billing Provider Networking The Provider Networking module helps hospitals identify and schedule post-acute care providers that meet specific patient needs, helping to prevent gaps in care and improving patient and provider satisfaction. Improving patient care transitions also helps hospitals reduce length of stay and unnecessary readmissions. The module enables discharge planners to communicate electronically with a national network of providers to coordinate follow-up care. Case managers have instant access to providers availability, the insurance they accept, the equipment and services they provide, and other care coordination information. Access to Morrisey s national database of post-acute care providers Extensive search capabilities Required state and federal forms that users can complete, route and sign electronically Ability for hospitals to report referral volumes and reasons providers declined referrals The module includes an extensive library of intelligent forms that post-acute providers require for ongoing medical management. The forms integrate information from the MCCM database, eliminating duplicate data entry. Case managers can route forms to clinical staff members, who can then review and sign them. The software stores electronic copies of the forms as part of the patient s file for use in clinical information packets. 4 5

4 Survey Management The Survey Management module helps healthcare stakeholders comply with transitions of care plans by automating surveys and related activities from pre-admission assessment through post-discharge follow-up. Morrisey is the only care management vendor to offer user-defined surveys to ensure compliance with care plans and to track satisfaction and other outcomes. The module makes it seamless to create and schedule surveys for primary care physicians, specialists, patients and families, and post-acute care providers online. Users can include response dates and get work-list alerts when respondents complete surveys, as well as when their responses are overdue. Reporting and trend analysis allows hospitals to identify problems quickly and take corrective actions, including targeted process improvements. MCCN Website Post-Acute Care Provider Portal The MCCN website contains a portal for post-acute care providers, including skilled nursing facilities, rehabilitation centers, home healthcare companies, durable medical equipment providers and other post-acute care providers. These providers use the portal to manage patient referrals, communications and follow-up surveys from hospital case managers. Intake coordinators review and approve or deny service requests. When they deny requests, they must document the reasons. For approved requests, hospital case managers can send required clinical documentation and forms to the post-acute care providers through the portal. To encourage providers online participation, Morrisey does not charge providers to access the Post-Acute Care Provider Portal. Secure portal connects hospital case managers and post-acute care providers Free MCCN website access for post-acute care providers Integration with the MCCM system Online survey creation, administration and management Work-list alerts for completed surveys, critical deadlines and overdue responses Survey delivery online through or secure portals Trend analysis to identify areas for process improvements Continuum of Care The Continuum of Care module allows hospitals to manage high-risk patients beyond the acute-care setting. Users can define programs, functional assessments and quality studies for population management and track and report associated patient functional status, satisfaction and other outcomes. A rules engine to identify at-risk patients when they re admitted and discharged Work lists of patients who require care assessments and related follow-up activities A link to inpatient case management documentation to ensure continuity of care Integrated scheduling of required follow-up activities and assessments Ability to document problem lists and goals to generate effective care plans 6 7

5 Morrisey Enterprise Solutions MCCM and TOC can stand alone or work in cooperation with Morrisey s other enterprise solutions and modules, including MSO for the Web (MSOW ) and Morrisey Practitioner Performance Reporting (MPPR ). MCCM, MSOW, TOC and MPPR provide integrated clinical and administrative data that supports effective, efficient operations and reporting. Integration with Hospital Clinical and Financial Systems Discharge Planning Export The Discharge Planning Export module enables customers to export discharge planning documentation automatically for use in their electronic medical records systems. Hospitals can transmit complete discharge planning reports to patients electronic medical records or they can identify specific MCCM data elements to send to patients discharge planning flow sheets. Morrisey s development team works with customers to confirm integration requirements and develop the required export solution. Concurrent updates to inform clinical care teams about patients discharge plans Elimination of duplicate data entry in electronic medical records Integrated reporting and trend analysis available from MCCM Financial System Export Case managers use MCCM to document payor contacts, including initial and ongoing certifications, authorization numbers and days of stay approvals. This information is critical to accurate billing after patients are discharged. Hospitals can transmit complete payor authorizations and denials from MCCM to their billing systems. Morrisey s development team works with customers to confirm integration requirements and develop the required export solutions. Robust Reporting MCCM features point-and-click graphical reporting for executives, physicians and nurse managers. In addition, MCCM integrates SAP Crystal Reports and SAP BusinessObjects Web Intelligence for standard and ad hoc reporting. The Morrisey Difference Comprehensive care management. Morrisey is the only company that offers a full spectrum of Web-based care management applications from pre-admission review through community-based care management, including management of patient care transitions. Unique development process. We collaborate with customers on product requirements before we begin development. Customers work with us to shape, refine and test applications to ensure they meet market needs. We also work with customers to implement their suggestions for enhancements so that we remain agile, innovative and responsive to fast-changing business challenges. Flexible installation options. Install MCCM in a client-hosted environment or on Morrisey s private cloud, Software as a Service+ (SaaS+). SaaS+ eliminates the need to buy, implement and maintain hardware and system software. You get the same functionality with both options, including secure access to your data for reporting. Annual customer conference. Morrisey brings together healthcare leaders, industry experts and customers to share best practices and strategies for overcoming business challenges, improving profitability and efficiency, and meeting regulations. Customers also learn how to optimize Morrisey s software solutions. Concurrent updates that keep the business office apprised of payor authorizations and denials Elimination of duplicate data entry in the billing system Improved accuracy of billing, reducing denials 8 9

6 The Care Management Life Cycle INPATIENT CARE AND UTILIZATION MANAGEMENT Complete Medical Necessity Reviews Improve Clinical Documentation Refer to Physician Advisors Communicate with Payors Track Delays, Other Variances DISCHARGE PLANNING Assess Patient Risk Identify Patient, Family Needs Generate Discharge Plans Coordinate Services, Placements Document Patient Choice HOSPITAL USERS Inpatient Case Managers Community Case Managers Discharge Planners Social Workers COMPUTER/TABLET COMPUTER POST-ACUTE CARE PROVIDER PORTAL Intake Coordinators Provider Administrators DECISION SUPPORT ANALYSIS Review Trends Identify High-Cost Variances Improve Processes Track Improvements AUDITS, DENIALS AND APPEALS MANAGEMENT MORRISEY S CARE AND TOC MANAGEMENT SOLUTIONS CONTINUUM OF CARE MANAGEMENT Identify High-Risk Patients TRANSITIONS OF CARE Search for Providers Communicate via Portal Complete Required Forms Send Clinical Packets Schedule Follow-Up Surveys MCCM APPLICATION SERVER FIREWALL MORRISEY CARE COMMUNICATIONS NETWORKING WEBSITE MORRISEY NATIONAL PROVIDER DATABASE Import Audit Requests Perform Assessments Document Denial Types, Reasons Document Problems, Goals Track Appeals Record Financial Outcomes Record Actions, Interventions Coordinate Care with Providers ADT HIM Coding Lab Results Pharmacy Orders Clinical Documentation Microbiology Cost Accounting DATA FEEDS DATA EXPORTS Discharge Plans Payor Authorizations Electronic Medical Record Business Office MCCM LONGITUDINAL PATIENT DATABASE 10 11

7 About Morrisey Associates Morrisey Associates is a world-class healthcare solutions provider that offers enterprise-level applications for practitioner credentialing and privileging, care management and practitioner performance reporting. Morrisey also offers industry-leading consulting services and flexible licensing options. 222 S. Riverside Plaza Suite 1850 Chicago, IL P: F: /15