Best Practices: Case Management and Keys to a Successful Implementation

Transcription

1 Best Practices: Case Management and Keys to a Successful Implementation Teresa Gonzalvo, RN, BSN, MPA, CPHQ, ACM Vice President, Care Coordination Sentara Healthcare Sherry Norquist, RN, BSN, ACM Manager, Care Coordination Sentara Leigh Hospital August 14, Sentara Healthcare 125-years of service, not-for-profit organization 11 hospitals; 2,572 beds; 3,825 physicians on staff 13 long term care/assisted living centers LTACH 4 Medical Groups (650+ Providers) Optima-453,118 member health plan Virginia Sentara College of Health Sciences $4.9B total operating revenues North Carolina $5.4B total assets 25,000+ members of the team 2 Health Plan Primary/ Specialty Care Hospital Rehab Care Integrated Health System Emergency Care Home Health Care Long Term Care Ambulatory Care 3 Conference 1

2 Sentara CarePlex (Hampton) 224 beds Sentara Hampton Roads Hospitals (MCCM users) Sentara Leigh (Norfolk) 250 beds Sentara Williamsburg Regional Medical Center (Williamsburg) 145 beds Sentara Norfolk General (Norfolk) 525 beds Sentara Princess Anne (Virginia Beach) 160 beds Sentara Obici (Suffolk) 168 beds Sentara Heart Hospital (Norfolk) 112 Beds (Included in SNGH License) Sentara Virginia Beach General (Virginia Beach) 276 beds 4 Blue Ridge, Northern Virginia Hospitals Sentara Northern Virginia Medical Center (Woodbridge) 183 Beds Rockingham Memorial Hospital (Harrisonburg) 238 Beds Martha Jefferson Hospital (Charlottesville) 176 Beds Halifax Regional Medical Center (Halifax/South Boston area) 192 Beds 5 Our Objectives Describe the department structure and how it integrates with the patient care team Outline the key workflows automated by the care coordination department Outline keys to a successful implementation 6 Conference 2

3 The Sentara Care Coordination Model Access Care Coordinators Continuum of Care Providers Our patients Resource Management Center Multi-disciplinary Teams Sentara Hospitals VPMA s/physician Advisors Unit Based Care Coordination Team 7 Inpatient Redesign First Step in Improving Ability to Support Broader Efforts Multifaceted Case Management Approach at Sentara Healthcare Crafting a Comprehensive Case Management Strategy 1 Phase I Phase II Phase III 2012 THE ADVISORY BOARD COMPANY Resource Management: Centralized corporate office conducts utilization review, discharge planning Access Coordination: Case managers embedded at all points of patient access (e.g., ED, OB, etc.) to ensure appropriate level of care provided Medical Necessity Reviews: VPMA advisors, with support from external agency, reviews cases, interfaces with medical staff 1) Samplestaff included in rounds are physicians, nurses, physical therapists, nutritionists, etc. Care Coordination Dyad Model: Social worker and care coordinator paired to improve coordination of care; staffing ratios re-evaluated to ensure adequate support Revitalized Multidisciplinary Rounds: Representatives across different clinical disciplines collaborate to conduct joint rounds and create a patientcentered care plan 1 Enhanced Technology: Case management system evaluation underway Post Acute Partnerships: Case management leaders will collaborate with post-acute care providers to improve transitions, information exchange, unnecessary transfers Care Coordination Practice Council: New cross-continuum committee will integrate inpatient, ambulatory-based, and health plan case managers to improve communication and best practice sharing 8 Care Coordination journey consistent and standardization of our support services The Morrisey Concurrent Care Manager application is part of our solutions package Successful implementation is contingent upon detailed project planning, ongoing communication, staff education and practice Staff engagement with the design phase is necessary 9 Conference 3

4 Access Coordinators At the access points of the hospitals, RNs assess patients to determine medical necessity and provide transition planning The use of MCCM enables the RMC staff to seamlessly provide additional clinical information as needed or determine if a physician review is required 10 Case Summary Topics currently is use Comments all notes on case Concerns key internal communications Delays avoidable delay capture Saved Days shortened LOS Images stores a picture of faxes sent Payor Contacts documentation of communications with payors Encounter sections easy access to any Sentara encounter since go-live (2/13/13) Medical Nec. Reviews all UM reviews completed, including InterQual data Denial Reviews if denial received, can begin the appeal process documentation Physician Advisor to send cases to PA s for review User Defined for special things not covered elsewhere 11 Sentara s Resource Management Center Our Utilization Management Hub Sentara Independence (Virginia Beach) Resource Management Center (2 nd floor) 12 Conference 4

5 Resource Management Center- Our UM Hub for 7 hospitals Utilization Management Discharge Facilitation Compliance and Auditing RMC Resource Staffing Pool 13 Resource Management Center- Living the Vision 14 Resource Management Center The Access Care Coordination and Resource Management functions were the first ones to Go Live Teams of Care Coordinators and Associate Care Coordinators, assigned by hospital Administrative support vital to the team Responsible for medical necessity, admission, continued stay and post discharge reviews Referrals to internal and external physician advisors Third Party Payor contacts and follow up 15 Conference 5

6 Sample RMC Work list New Concern PA response Why case is on work list 16 Payor Contacts 17 Sending a Concern Add New Concern 18 Conference 6

7 Discharge Facilitation Process Q. How do we know when we have a DCF Concern? A. You will monitor the Discharge Facilitators work list all day You will click on the patient name to open the concern Patient data for locating patient in Epic will be in the header 19 Resource Management Center With the use of technology, and the right skill mix, this one-of-akind Care Coordination hub manages hundreds of accounts daily, for 7 out of 11 hospitals This high-tech communication promotes timely and effective notification to our patients. Increased compliance with CMS and other regulatory guidelines due to standardization of workflows and reports 20 The hospitals and the RMC are all on the same page Having the tools to help us communicate enables us to increase our efficiency The team is able to see notes from their teammates, and the VPMA or Physician Advisors, in real time Sentara Leigh s Nurse Executive Genemarie, Care Coordinators and Social Workers VPMA Dr. Scott Miller s gift of THANKS! 21 Conference 7

8 VPMAs and Physician Advisors The MCCM application allows the RMC and hospital based staff to refer cases easily to contracted physician advisors or internally to a VPMA All of the many complex functions that happen within the hospitalized patient s case are easily viewed by all members of the Care Coordination team 22 Physician Advisor Work list Resource Coordinator creates PA referral Auto-populates to work list for PA Used for VPMA, PA, and E.H.R. PA responds Stethoscope alert appears for resource coordinator once PA responds 23 Unit Based Care Coordination Team Unit Based Care Coordinators, Social Workers and Associate Care Coordinators spend their time with patients and their families These staff members use their clinical expertise to provide transitional planning and patient support, plan for the day, plan for the stay, as well as guiding the multidisciplinary team to remain on target for Length of Stay goals 24 Conference 8

9 Multidisciplinary Teams Multidisciplinary teams discuss patient care issues and plans for the day Rounds and huddles are conducted on a regular basis. Patient work lists are utilized for discussion purposes 25 Other functions-readmission Review Patients populate to the readmission work list at the time registration occurs based on: Having been in Observation or Inpatient in the last 30 days at any Sentara Hampton Roads Hospital Currently admitted as an inpatient or observation at any Sentara Hampton Roads Hospital 26 Avoidable Delays Delay Type drives Delay Reasons Using ACMA Compare AD Delay types And reasons 27 Conference 9

10 Keys to Successful Implementation Live the Care Coordination VISION Ongoing communication with system, hospital leadership and staff Established a core team - cross section of leadership, IT, staff and end users for Care Coordination Co-chairs: Education Manager and IT Director Assigned a Project Coordinator Developed a well defined Project Plan, with structured updates given at the Leadership meetings 28 Keys to Successful Implementation Outlined a Training Plan, with time to play in the Test environment. This is to include after hours and weekend classes Developed and updated all training materials as workflows are re-designed Implemented a pre Go Live checklist All hands on deck - from executive leadership, directors and managers 29 Keys to Successful Implementation Created a central Command Center for Go Live dates with a predefined timeframe. Three phone lines were available for staff and a dedicated line for physicians and VPMAs Established Black Out days (No vacations) prior to and after Go Live dates Developed Frequently Asked Question and Answer sheet and sent out to all staff Identified a consistent process for issues and its resolution 30 Conference 10

11 MCCM Command Center Sentara Independence (RMC) 31 Increased Staff Satisfaction Takes the complexity of our work, combines it to one central program, simplifies and makes work manageable Everyone likes to be able to start on their work load right away instead of having to wait on an assignment Saves time, better organization, all documentation can be found in one place, chronological order and time frame Insurance changes are easily identified -Darlene Brink, RN, Manager -Joanne West, RN, Team Leader Resource Management Center and staff 32 Increased Staff Satisfaction Provides accountability, shows when case was worked on, provides an accurate time frame Faxing to Commercial payers much better as you receive immediate notification that the fax was sent or that it did not go thru Gratification-to see the list shrink as you work it, feels like you are accomplishing something MCCM allows you to manage your workload better and improves time management -Kim Tortora, RN Resource Care Coordinator -Diane Pearson, LPN and -Kathy Plank, LPN Associate Care Coordinators, RMC 33 Conference 11

12 Increased Staff Satisfaction Having the admit/discharge date and time, I can easily identify triage patients who are only in L&D a few hours and mass delete them or know that a status change will need to be sent if they are inpatient. I complete preliminary reviews on obstetric patients and set the NRD for when the patient should go home. This way I can easily see if a baby stays longer than the Mom and needs an auth or if a Mom takes more than 2 days to deliver and may need an auth. -Patsy Duguay, RN Resource Care Coordinator, RMC 34 Lessons Learned Allow more time for staff to practice in the Test Environment Frequent and multimedia communication to key stakeholders and end users Define and run reports sooner than later Clarify expectations and timelines from both Morrisey and Sentara teams Ongoing assessment and evaluation via leadership, staff surveys (i.e. Zoomerang) 35 What the Future Holds Managing Transitions Across the Continuum of Care As we strive to bridge the gap and ensure seamless transitions, we are seeking to engage our home care and skilled nursing facility providers in this endeavor Ongoing close collaboration with our community partners through the Long Term Care Council Care Coordination Long Term Council Launched with the Hampton Roads community post- acute providers Dr. Gene Burke, VP of Clinical Effectiveness, discussing the Readmission initiatives with the Long Term Care Council 36 Conference 12

13 With the help of technology and reports, we will be eliminating unnecessary variation, standardizing best practices, across the care continuum Consistent patient care coordination and safe transitions across all levels of care is our vision Summary 37 Care Coordination Movers and Shakers-we improve health every day! 38 QUESTIONS? 39 Conference 13

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