ACO Toolkit. Face-To-Face Care Coordination Services & Comprehensive Cloud-Based IT Solutions e q h s. o r g

Transcription

1 ACO Toolkit Face-To-Face Care Coordination Services & Comprehensive Cloud-Based IT Solutions e q h s. o r g 2014 eqhealth Solutions, Inc. All rights reserved. All other trademarks designated herein are proprietary to eqhealth Solutions, its affiliates and/or licensors. DSL# (9/14)

2 Overview For over 25 years, we ve been improving healthcare quality and reducing costs through innovative IT and medical management services ACO Solutions Overview THE RIGHT TOOLS IN ONE PLACE eqcare Services Face-To-Face Care Coordination Services WORKING DIRECTLY WITH YOUR PATIENTS/PROVIDERS eqsuite Cloud-Based Technology Population Health Management Module (Care Coordination) HIGH-RISK PATIENT MANAGEMENT PLATFORM Business Intelligence Module ANALYZE DATA FOR ACTIONABLE INFORMATION Clinical Integration Framework Module INTEGRATING YOUR CLINICAL PROVIDERS eqhealth Value e q h s. o r g 11 Testimonials/Value WHAT THEY RE SAYING

3 THE RIGHT TOOLS IN ONE PLACE. eqcare Services Composed of two medical management service offerings: Care Coordination and Utilization Review/Utilization Management. eqcare Care Coordination key features/benefits: Provides high-touch, face-to-face services to identified members of a healthcare population Hired from the community they serve, our care coordinators work with the providers of care (physicians) and support members (patients) with medical and psychosocial behavior management Complex case management and disease management (URAC Certified) eqcare Utilization Review/Utilization Management helps health plans by providing a means to manage requests of medical services prior to execution of those services, based on medical necessity. eqsuite Cloud-Based Technology A scalable, cloud-based IT software platform targeted for network population management and individual member management that is composed of various modules (products). It has been designed to create a one stop integrated information system for patients, providers, payers and administrators or provide stand-alone options for specific needs. Delivering High-Touch, Face-To-Face Care To High-Risk Patients eqcare Care Coordination Services: Providing Face-To-Face Community-Based Nurses Understand drivers behind individual member Build relationships with physicians and providers to drive behavior change Local Community Provider Hospital Understand the community relationships and culture to engage the member and provider to drive behavior change Payor eqsuite Cloud-Based Technology: Fully Integrated or Stand-Alone Modules Front line driver for value and quality improvement programs, including provider channeling Clinical Integration Framework (CIF) Technology Module Develops a connected landscape across all healthcare stakeholders Improves operational efficiency and reduces total healthcare costs Improves quality and safety of care through care coordination Business Intelligence (BI) Technology Module Optimizes networks Simplifies reporting Real time analytics of costs, utilization, quality and predictive data Immediate identification of actionable trends with drill down capabilities Includes report generation of GPRO and HEDIS measures Data Gathering & Aggregation Real Time Analytics EMR HEDIS GPRO Quality eqhealth Clinical Framework Business Intelligence EMR State HIE Other HIE Medical Claims Care Coordination/Population Health Management (PM) Technology Module Identifies high cost members through analytics and predictive modeling Single platform to manage members and care plans Minimizes time on documentation - maximizes time spent with members Intuitive workflow engine, Smart HRA(s) and care plans Provider channeling Care Management Platform POPULATION MANAGEMENT Medical Management - Member Provider Rx Claims Lab 1 2

4 WORKING DIRECTLY WITH YOUR PATIENTS. eqcare Care Coordination services provides high-touch, face-to-face services to identified members of a healthcare population. Hired from the community they serve, our care coordinators work with the providers of care (physicians) and support members (patients) with medical and psychosocial behavior management. Key Features/Benefits: Embedded care coordinators provide face-to-face care to identified highrisk members Care coordinators are clinicians within the community and work closely with providers Complex case management Disease management (URAC Certified) Provide high-touch member (patient) support that includes: Single point of contact for all health care needs Provider engagement on member needs Creation and execution of individualized member care plans Help coordinate care across multiple providers Support and address psychosocial variables that impact health Identify community resources outside of health plan resources Support plan provider channeling to benefit both patients and plan Provide education on disease and self-management opportunities 3 ACCREDITED DISEASE MANAGEMENT FACE-TO-FACE. COMMUNITY-BASED. WHOLE PERSON FOCUSED. 4

5 HIGH-RISK PATIENT MANAGEMENT PLATFORM. eqsuite Cloud-Based Technology: Population Health Management Module (Care Coordination) eqsuite Population Health Management (Care Coordination) module uses sophisticated software to identify high-risk, high cost patients and provides the platform to guide you through coordination of care for these members. Who are my high-risk population members? What can we do for these members? Answering these questions is critical to managing population health, improving quality and reducing costs. Through predictive modeling, we are able to identify patients whose health, functional ability and use of health services suggest they are good candidates for care coordination and provide the platform to guide you to care for those members. eqsuite Population Health Management module features: Comprehensive care coordination platform (patient, care coordinator, provider, client administrator portals, etc.) Predictive modeling - identify current and future high-risk members Evidence-based, individualized plan of care documentation Identifies gaps in care - both medical care and pharmacy gaps Wholistic, evidence-based assessment tools incorporating the Modified Morisky Scale, depression screening, motivation and activation assessment, literacy, psychosocial barriers and quality of life measurements Processing of data - claims/pharmacy/other feeds Prior-authorization/pre-certification Provider channeling IDENTIFY HIGH-RISK PATIENTS. MANAGE & IMPROVE QUALITY. REDUCE COST. 5 6

6 ANALYZE DATA FOR ACTIONABLE INFORMATION. eqsuite Cloud-Based Technology: Business Intelligence Module eqsuite Business Intelligence module gives you the ability to take an in-depth look at current population and network trends and drill down into the details of any desired metric REAL TIME. Without interpretation, your data is only a vast collection of facts. Business intelligence uses advanced healthcare analytics that turns data into actionable information. In today s evolving healthcare landscape, even a one week delay in reporting may impact decisions. eqsuite Business Intelligence gives you the ability to perform analysis on any number of metrics REAL TIME, such as: Member spending by diagnosis Member spending by facility location Facility spending breakdown Diagnosis code eqsuite Business Intelligence module features: Cost and quality reporting Identification of high cost drivers Reporting capabilities (GPRO) Ad-hoc analysis and reporting on any desired data metric/combination Predictive modeling Multi-dimensional trending data Drill down capability ANALYZE POPULATION TRENDS. REAL TIME DRILL DOWN. ACTIONABLE DATA. 7 8

7 INTEGRATING YOUR CLINICAL PROVIDERS. eqsuite Cloud-Based Technology: Clinical Integration Framework (CIF) Module The eqsuite Clinical Integration Framework (CIF) module provides secure integration between disparate entities through a standards-based modular framework. It accepts a wide variety of clinical data payloads and is available at an affordable cost. eqsuite CIF module: Interfaces to the majority of the EMR/ market Develops a connected landscape across all healthcare stakeholders Increases point of care operational efficiency Reduces total healthcare costs Helps providers improve diagnoses Improves quality and safety of care for members EMR EMR eqhealth Clinical Framework State HIE Other HIE The CIF module delivers core clinical functionality with the right balance of features to make the system simple and efficient; these include: Provider Portal Patient search Longitudinal clinical summary view across all documents View of individual documents Messaging between all stakeholders Provider alerts External Connectivity Supports connectivity to HIE standards-based networks and registries such as the National Health Information Network (NHIN) Security Domain registration, physician registration and patient registration Unique domain identities for each entity Master Patient Index Supports unique patient identifier for each domain and creates unique CIF global identifier for each patient eqsuite CIF INTERFACES TO THE MAJORITY OF THE EMR/ MARKET. 9 10

8 WHAT THEY RE SAYING. eqhealth is a critical element to the management and steadfastness of our self-insured health plan. They have provided effective, efficient and best in class service to our plan participants and administrators with an eye to the needs of the plan member, their families and the ultimate sustainability of our health plan. They are client oriented, patient-centric, and they have provided, and continue to provide, value-added service to plan participants and administrators. Their expertise in medical management and care coordination has not only saved our plan money, but has also provided an essential resource to plan participants and their families, enabling them to receive the type of quality care they need and deserve. Benefits Manager Louisiana State University I have found eqhealth Solutions to be invaluable to our company. Through the eqsuite cloud-based IT platform, we are able to identify high-risk employee populations and execute effective care coordination services. From analytics to care coordination, eqsuite allows us to effectively manage and optimize our client populations, resulting in increased population health quality while reducing costs to employer organizations we serve. I highly recommend eqhealth Solutions to anyone searching for population management healthcare IT solutions and care coordination services. Michael G. Molyneux, CEO Symbol Health Solutions, LLC Schedule Your No-Obligation Demo. Contact Us Today. eqcare Services Care Coordination Utilization Review/Utilization Management eqsuite Cloud-Based Technology Population Health Management Module Business Intelligence Module Clinical Integration Framework Module 90 Day Implementation Period WAIVED Implementation Costs 1 LOWEST PMPM Costs In The Industry Waived implementation costs for select services contract. 2 Based on eqhealth client and industry interactions at certain volume lives covered. 12