Medicaid Programs are in

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1 Winter 2013 CEO perspective Creating Communities It Takes a Village Rob Pock, Founder & CEO, TCS Healthcare Technologies few months ago, TCS hosted a user summit with A many of our clients. I closed down our office and invited my entire staff to attend the two-day event. What happens when you mix TCS clients with our staff and a couple of guest speakers? Keep on reading. TCS has been blessed with many loyal clients and staff over the years. That s part of the recipe behind TCS formula for success. Our ability to have the highest customer satisfaction ratings in the care management software field is directly tied to making sure we hear from our customers and staff on how we can improve our applications. I was not disappointed with our client summit this year. A number of interactive sessions were held where staff and clients interacted, exchanged ideas and got inspired. In addition to the compliments, there also was pragmatic discussion about how to continue tweaking and improving ACUITY Advance Care, our flagship application. I knew we hit the mark when Julie O Brien, chief operating officer for Alicare Medical Management, noted, Hands down, this simply is the best conference I have attended. Similar responses were voiced by members of the TCS staff, most of whom do not have opportunities to meet our clients face-to-face during the rest of the year, so this event was very rewarding for them. TCS is a remarkable company, with amazing clients and a wonderful team. If someone asked me what the secret formula for success has been over the past 30 years, I would say fostering a dynamic community with a shared mission of improving clinical outcomes through the continuum of care. n Clinical Insights Leveraging Care Management Software for Medicaid Pat Stricker, RN, MEd Senior Vice President TCS Healthcare Technologies Medicaid Programs are in the spotlight as the United States moves forward with a myriad of health care reform initiatives. As a result, health plans and providers will need to utilize care management software and related health information technology (IT) systems to support the care coordination needs of underinsured and uninsured Americans. With millions of individuals already receiving insurance coverage through Medicaid or the Children s Health Insurance Program (CHIP), and 10 million-plus expected to join in the next few years, Medicaid is set to become an even bigger part of the case management industry, and in a broader sense, the health care delivery system. See Clinical Insights, page 3 Up Close and Personal: Debb Keller, Director of Client Services... 2 TCS Celebrates 30 Years Client Summit... 4 AAW Version 7.00 Sneak Peek page 1

2 Up Close and Personal Debb Keller, Director of Client Services TCS is pleased to welcome Debb Keller, RN, BSN, as director of client services. A registered nurse with extensive Medicare, Medicaid, managed care, EMR implementation and analytics experience, Keller s responsibilities include managing the client-facing entity that supports clinical and technical implementation, training, managing accounts, and ongoing client support. She also will be working with the TCS development staff to create new products and enhancements to existing products. TCS Healthcare Technologies Celebrates 30th Anniversary Since 1983, TCS Healthcare Technologies has been developing, selling, implementing and supporting clinical software solutions that are reliable, costeffective, and promote the best clinical practices. Comprehensive care management is our core competency. The TCS team of nurses and technicians creates a user-friendly experience for clients, taking pride in outstanding customer service. Our design team is focused on continuous software upgrades to keep customers updated on the ever-changing care management world. n I met the TCS team while attending a conference in Orlando, FL, when I was a medical management director for a health plan and saw immediately that the Acuity software solution was what I needed to move my clinical program forward, says Keller. I implemented Acuity and found it to be everything I had hoped it would be. Now, years later, I m excited to be part of the TCS family and have the opportunity to work with these talented people while collaborating with new and existing clients. Keller has extensive experience in the case management arena, previously serving as director of clinical services for a health plan with over 150,000 members, directing utilization management, prior authorization, case management and concurrent review. Other notable professional milestones include managing utilization management within a Fortune 500 health plan to implement the first fully integrated medical and behavioral health program in Tennessee s history. She has participated in the writing of five successful state RFPs for Medicaid contracts, both as a contractor and as a private consultant. Keller also participated in the writing of successful correctional medicine contracts while serving as the vice president of managed care at Correct Care Solutions, while focusing on off-site utilization and cost management of inmate care, including concurrent review, prior authorization, retrospective review and claims analysis. Keller received her nursing degree from Middle Tennessee State University and served as a nurse in the Army Reserves for eight years. I am so glad to have Debb join our team, says Pat Stricker, RN, MEd, TCS senior vice president. Her professionalism, attention to detail, industry knowledge and experience make her an immediate asset to TCS. I look forward to working with her and enjoying the benefits her talents and expertise will bring to both clients and the company as a whole. Keep an eye out for Debb s Clinical Corner, debuting on the TCS website in early 2014, to learn more about Debb, her perspectives on medical management and insights into the TCS suite of products. n page 2

3 Clinical Insights from page 1 Right now, the main driver of Medicaid growth is the Affordable Care Act (ACA). This has led statebased Medicaid programs to implement managed care systems and other integrated care techniques to not only improve outcomes for patients, but reduce costs within increasingly burdened budgets. Medicaid Expansion To understand case management s unique impact on Medicaid, it s important to examine who will be receiving new benefits as a result of the ACA. Because Medicaid and CHIP eligibility was skewed heavily toward covering children before the ACA, many newly eligible recipients will be adults, largely without dependent children. They will also be lowincome people 138% of the federal poverty line is less than $27,000 for a family of three who, in many cases, have not had health insurance before, but do not have significant health issues. Understanding this new population is key to grasping the key challenges and incredible opportunities case managers will face beginning next year. Integrating Case Management Because 5% of Medicaid patients account for more than 50% of health care costs, care management is central to improving clinical and financial outcomes. Care coordination is changing and care managers are essential to integrating and supporting these new populations through the continuum of care. For example, state Medicaid programs are placing a greater emphasis on treating targeted, complex populations with co-morbidities rather than focusing simply on specific disease states. Parity laws are also helping to more fully integrate behavioral health and addiction programs with primary care. A broader array of integrated health care services is being offered, using multi-disciplinary teams to address an individual s total health care needs. Care managers are a key component to providing these integrated services across the continuum of care. IT Support Without a doubt, care management IT systems must assume a central role to support Medicaid program sponsors, providers, individual beneficiaries and their families. As a result, the reliance on IT applications to support patient care will expand. Care managers must have access to IT systems that can provide key functions in support of Medicaid enrollees including: implementing risk-assessments that help create customized care treatment plans; promoting automated workflows and documentation; stratifying opportunities to identify and manage targeted populations; and tracking/reporting financial and clinical outcomes among other capabilities. It will be nearly impossible to provide the reporting these programs require without the use of IT systems. Final Thoughts Medicaid programs across the country are changing rapidly to meet the demands of these new eligible populations, as well as the overall increase in both the size and requirements of the Medicaid system. IT innovation has become a necessity as Medicaid costs consume more and more of a state s budget. Medicaid directors see care coordination and population management as effective ways to better serve both patients and taxpayers by reducing costs, while improving clinical outcomes. Health IT systems are an essential part of this strategy. n Originally published in CMSA s Member enewsletter (November 2013) Follow TCS Healthcare Technologies on LinkedIn to find out the latest company news, participate in discussions and hear about product updates. page 3

4 Special Feature: 2013 Client Summit Special Feature 2013 Client Summit Garry Carneal, JD, MA, Keynote Speaker Annual TCS Event a Hit with Clients, Staff In October, TCS hosted a two-day conference at Lake Tahoe, CA, as a way to connect TCS clients with the TCS team. The program featured a series of presentations and workshops on how to take advantage of and optimize TCS care management software applications. Several nationally known speakers provided updates on current industry and regulatory trends affecting case management, and TCS development staff previewed the latest and upcoming developments with software upgrades. One conference highlight was a sneak peek at ACUITY AnyWare, Version 7.00, due to launch early in Interactive sessions also facilitated discussions about what TCS is doing right and how its applications can become even better. See 2013 Client Summit, page 5 page 4

5 Special Feature: 2013 Client Summit Client feedback on the retreat was extremely positive: n Participation in the TCS client conference creates a sense of family as we learn about TCS suite of products and solutions. n My plan has been under utilizing ACUITY. This conference was indispensable in showing me all of the dynamic software features TCS has to offer. n The ability for us to change and customize the ACUITY application based on our own unique workflows is very impressive. n It was a great meeting by the TCS staff. I appreciate TCS high-touch customer support since my organization has been using ACUITY. See 2013 Client Summit, page 6 page 5

6 Special Feature: 2013 Client Summit n I am very excited about the analytic power behind AcuExchange. By participating in this conference, I feel energized and the excitement is back. TCS and its software applications have so much potential. n I love the fact that TCS actually listens to my needs and builds out real solutions. Stay tuned regarding the next TCS client summit. Events like these are so important to ensure TCS continues to meet the changing needs of its clients and educate them on topics that impact their business. We extend a special thanks to all of the clients who attended. n ACUITY AnyWare Version 7.00 Coming Soon TCS has rebuilt ACUITY AnyWare s (AAW) interface from the ground up, featuring a dashboard of activities, that allows for easier navigation, improved search functionality and workflow efficiency. The tracking and support of patient case management has never been more user-friendly, with less time needed to become proficient in using the application, and in return improve and report clinical outcomes. AAW Version 7.00 is feature-packed and easy to use. The TCS team will host a webinar focusing on AAW version 7.00 on January 15, 2014, from noon 1 p.m. EST. This informative session will address key features and updates to the ACUITY AnyWare product suite. Visit to register. n TCS Contact Jason Scruby Business Development Executive TCS Healthcare Technologies Blocker Drive, Suite 200 Auburn, CA (530) ext. 211 jscruby@tcshealthcare.com Website Subscribe To subscribe to this newsletter, newsletter@tcshealthcare.com. Newsletter published quarterly. Editing and Production by: Schooner Healthcare Services, Communications Department Please send comments or questions to Garry Carneal at gcarneal@tcshealthcare.com. page 6