MDFlow Case Management & Disease Management (CM/DM) System

Transcription

1 MDFlow Case Management & Disease Management (CM/DM) System The COMPLETE and CUSTOMIZED Case and Disease Management Solution for Healthcare Payers (HMOs, PPOs and MA Plans) Accountable Care Organizations (ACOs) Benefits Administrators/TPAs/MOSs/IPAs Patient Centered Medical Homes Self Funded Groups

2 What is CaseFlow? MDFlow CM/DM system is a patient centric, integrated and user friendly case and disease management software. It enables healthcare management organizations to implement a system that follows the industry standards and guidelines of the case and disease management, as well as meets the specific needs and requirements of each individual health organization. MDFlow CM/DM system provides the functionality and integration of information to manage the most complex healthcare issues. From candidate identification through assessment, stratification, care plan development and care coordination, the care team has access to complete clinical and general health information of their patients to effectively and efficiently deliver consistent and results driven care management.

3 Target Market KEY FEATURES OF MDFLOW CM/DM SYSTEM: Candidate Identification Assessments (HRA, Disease Specific Assessments and User Defined Assessments) Care Plan Development Care Coordination, Collaboration and Management Take Management Chronic Care Improvement Program (CCIP) Documentation and Correspondence Transition of Care and Post Hospital Discharge Care Compliance Tracking and Reporting Interface with EHR systems Interface with Claims, Pharmacy and Lab data

4 HEALTH RISK ASSESSMENTS: Health Risk Assessments with automated branching to disease specific assessments and resulting risk scoring summary. INTERDISCIPLINARY CARE TEAM: A group of health care related professionals, patient family /friends and social services professionals to provide collaborative health care service to patient. CLINICAL FEATURES: Built in clinical programs including health assessments, disease specific assessments, data driven care plans, risk scoring summary and disease education. LAB INTERFACES AND CLAIMS INTERFACE: Allowing case managers to access patient s lab results and medical services rendered on the patient. CARE PLANS: Based on the assessment, system generated care plan options assure consistent and effective results. Automated tasks and follow up schedules to monitor, evaluate, and modify the plan to insure each patient maximizes their potential.

5 MONITORING: System monitoring provides automated alerts to all care team members of critical events, deadlines, and required actions. CARE VIEW: A single view of all activities and interactions with a patient combined with access to an expansive EHR combined to provide the care team with a complete picture of the patients past, current and future needs. COMPLIANCE TRACKING: Tracking of user defined compliance guidelines with automated user and supervisory alerts to prevent non compliance issues. DOCUMENTATION & CORRESPONDENCE: Facilitate communication and coordination between patients and care team members with integrated contacts, notes, letters, and document programs. All notes are recorded with user ID and time stamp. REPORTING: Report generation for both internal (operational) and external (client) monitoring to ensure all candidates are evaluated and participants are managed on a timely basis.

6 PRODUCTIVITY AND ACTIVITY TRACKING: Every action taken by the care team is noted and available for view or detailed performance evaluation reporting. IMAGING AND DOCUMENT MANAGEMENT MODULE: This module converts all the paper documents to electronic records that are directly linking to the patient files and can easily be displayed, printed, or e mailed. It provides a consistent, corporate wide document workflow process. MDFlow CM/DM system is deployed as an internet based Application Service Provider ( ASP ) software. For more information or to schedule a system demo, please contact us at or us at [email protected].

7 MDFLOW CASE MANAGEMENT AND DISEASE MANAGEMENT (CM/DM) SYSTEM MDFlow CM/DM system is an integrated, comprehensive and user friendly medical management software that enables healthcare management organizations to implement a system that will meet their specific needs and requirements of the case and disease management. It is deployed as an internet based Application Service Provider ( ASP ) software. MDFlow CM/DM system provides the functionality and integration of information to manage the most complex healthcare issues. From identification through assessment, stratification and care plan development, the care team has access to complete clinical and general health information of their patients to effectively and efficiently deliver consistent and results driven care management. CANDIDATE IDENTIFICATION Identification: MDFlow system utilizes its Analytical Data Warehouse and Reporting System to analyze the medical claims, pharmacy claims, lab results and medication history as well as HCC information from CMS to identify the potential candidates for case and disease management. Stratification: Use our pre configured or client defined evaluation parameters and rules engine to determine levels of care and potential risk. Assignment: Automated assignment to the appropriate personnel for triage. CLINICAL CONTENT MDFlow system provides a wide range of health risk, disease specific assessments and template driven care plans to facilitate consistency in the identification and management of health issues. Health Assessments: MDFlow s health assessment tools aid the care team in collecting information regarding the patient s clinical and functional status, determining the patient s healthcare needs and developing proper plans of care for the patient. Disease Specific Assessments: MDFlow s disease specific assessments tool assist the care team in the collection of information regarding the patient s specific disease(s). The relevant information from the health assessment is carry over automatically and the additional questions specific to the particular disease will be presented to complete the assessment. Care Planning: MDFlow s integrated care plan tool automatically populates based on assessment results and offers the flexibility to use pre defined templates, create your own templates or use free text. Incorporating data from internal and external data sources, the tool reduces redundant data entry while expediting the care planning process. During the course of a plan of care, all the review

8 notes and modification to the intervention and goal are recorded. Each plan of care can be used to derive the service authorization and calculate the estimated cost. Patient Medication and Lab Results Management: MDFlow integrated erx and elab module can automatically retrieve patients medication history and lab results from Lab Corp and Quest Lab. This module will also perform the medication review and check the drug drug and drug allergy interactions. Educational Sessions: MDFlow system provides educational sessions that can be tailored to each patient for the following conditions: asthma, diabetes, HIV/AIDS, COPD, CHF, CAD, maternity and hypertension. Adherence Guidelines and other clinical quality measurements: MDFlow system incorporates CMSA s case management adherence guidelines, HEDIS and Star Ratings measurement guidelines. This provides the care team with patient assessments and adherence improvement tools to promote patient medication adherence and health behavioral change, as well as prevention cares. CARE COORDINATION Coordinate care for patients with their health conditions MDFlow seamless integrates the utilization review; case management and disease management functions that allow the case team to readily access utilization information, claims and any other system related activity for a particular patient. Interdisciplinary Care Team (ICT), MDFlow system creates an ICT for each patient under the care. The member of ICT includes patient s PCP, other doctors of the patient, patient s family, care givers and etc. The care team has the ability in the MDFlow system to coordinate care for patients with complex cases by: Tracking of prescribed prescriptions lab results Assisting patients with their drug regimens Tracking of patient s health maintenance/preventive procedures that are based on patient health condition, age and gender. Follow ups with providers Arranging educational sessions Accessing utilization information and any other medical management activity Compliance Tracking and Prevent non compliance issues, MDFlow system tracks all activities using system defined or customized compliance guidelines and provides alerts to ensure timely completion of all required activities. DOCUMENTATION, CORRESPONDENCE AND REPORTING Improve continuity, tracking & retrieval of documentation MDFlow system provides extensive tracking and retrieval of all internal/external documentation and correspondence. User defined letter templates; note categories, contact reasons/outcomes and document types provide ease of use and continuity in the documentation process.

9 Letters: Create letter templates unique to your requirements. Standard or customized letters & educational materials regarding disease management can be produced directly from the application so that timely notification can be rendered. Notes: Use multiple note entry windows located throughout the system and review all notes in a single screen. Faxes: Send faxes directly from the system. Contacts: Track all contacts (telephone, , visit, fax etc.) throughout the care continuum. Activity reports can be produced to show a complete record of contacts for a patient. Documents: Create a paperless office environment by uploading patient documents ( s, clinical information, etc.) to patient activities. Interface with HER system to receive medical documents via CCD and CCR. Print Outs: Print health risk assessments, care plans, reviews, notes, etc. for internal and external distribution. Reporting: MDFlow reporting module features a wide range of reports to assist the care team and management to better manage their patient care. The client also can ask for customized reports. POST HOSPITAL DISCHARGE CARE The post hospital discharge care is an important part of the care transition and continuity of care. A well managed post discharge care can dramatically reduce avoidable re admissions. After Patients are discharged from the hospital, their care is often returned to their regular community doctor. It is also very important to make sure that the patient is following the discharge instructions that include medications, follow up care/doctor visits, disposition and other instructions for patient self care. During the course of the inpatient care to the hospital discharge, patient information from the daily hospital census or direct from the hospital are automatically transferred to the MDFlow system. MDFlow keeps tracking the progress of the inpatient care and records all the correspondences such as inpatient calls, treatments and tests the patient receives. On a daily basis the DRGs are calculated and determine if early transfer rule applies. When the patient is discharged from the hospital, a post discharge care record is created for the post discharge care team to assist them to coordinate the care, such as Access all the patient health information. Conduct the post discharge care assessment. Follow up patient s care with the community doctor including setting up PCP s appointment and arranging the transportations. Assisting patients with their medication regimens.

10 Keep tracking all the follow up events and communications, as well as streamline the coordination among stakeholders, such as patient, doctors, post discharge care team, family members, care givers and etc. Based on the condition of the patient, enroll the patient to proper case and/or disease management program. Create the plan of the care. Let us show you how we can transform your healthcare organization. For more information or to schedule a system demo, please contact us at or us at [email protected]. Contact Us MDFlow Systems 717 Ponce De Leon Boulevard, Suite 301 Coral Gables, Florida P F E [email protected]