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Timing is everything – How the Right Data flow can bring your care management up to speed

Timing is everything – How the Right Data flow can bring your care management up to speed. Mark r Dambro, MD CMO, CenseoHEalth, LLC. April 12, 2012. Introduction. Surmounting challenges such as:. Poor selection of member populations Poor communication patterns

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Timing is everything – How the Right Data flow can bring your care management up to speed

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  1. Timing is everything – How the Right Data flow can bring your care management up to speed Mark r Dambro, MD CMO, CenseoHEalth, LLC April 12, 2012

  2. Introduction Surmounting challenges such as: • Poor selection of member populations • Poor communication patterns • Lack of systematic follow up on gaps in care • Failure to recognize the value of utilization change • Over-exposure to RADV risk • Poorly timed feedback

  3. Poor selection of member populations

  4. Team communication

  5. Improving network compliance Or how to get the PCPs on board • Adult learners need multiple exposures to new information • Tailor learning methods; lectures, handouts, webinars, one-on-one • Meaningful incentives • Capitalize on physicians innate competitiveness; compare their gap closure rates with peers, for example • Remember, compliance may be more related to operational issues than physician issues

  6. Improving member compliance Or how to get the members to accept the in-home evaluation • Adult learners need multiple exposures to new information; things will improve after year one • Comfort with the messenger is key • Tailor learning methods; lectures, handouts, webinars, one-on-one • Meaningful incentives

  7. Lack of systematic follow up on gaps in care • Gap closure is a CMS imperative to risk adjustment associated premium change • Failure to address gaps in care results in poor healthcare, continuing risk in HEDIS review, poor Star ratings and possible CMS negative review

  8. Failure to appreciate changes in utilization • Home visit by physicians introduces a new model • Expect change • Behavioral • Health • Decrease in E&M utilization • Lack of need for ER and hospital stay follow up • Improved chronic disease management • More timely interventions to prevent unexpected exacerbations

  9. The new ROI calculation ROI = (RA + Utilization savings) / Data cost • Traditional ROI uses risk adjustment (RA) and cost of obtaining that data • Now we must factor in the very real lack of expenditures in decreased utilization as an addition to ROI • Case management is not just about improving health care and quality; it’s also about decreasing utilization

  10. Over exposure to RADV risk • Claims-based submissions represent the greatest RADV risk • Controlled, face-to-face encounters provide strong support for submitted HCC codes

  11. Move audits to year of service • Immediate feedback is best • Audits months to years post the event are punitive, not educational • Audits in the year of service allow for chart correction and will positively affect member heath care

  12. Summary • Selection of member populations • Communication patterns • Systematic follow up on gaps in care • Recognize the value of utilization change • Study and decrease RADV risk • Timely feedback

  13. News, updates, and thought leadership at Censeohealth.com/blog Mark R Dambro, MD 972.715.3820 Chief Medical Officer mdambro@censeohealth.com

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