Interoperability is Happening Now Nick Knowlton and Tammy Ordoyne-Vial Brightree and Ochsner HME
Interoperability - Better Business, Better Outcomes Shifts in the Healthcare Ecosystem impact our HME Space Interoperability is being driven by Payment Reform and Government Mandates on you and your Referral Sources Technology and Adoption are creating timely opportunities for our industry to engage Engagement is not Optional
Key Takeaways Problems for HME Providers Solutions Based on Interoperability Continuous Pressure on Operating Margins Large Cost Savings Available Through Automation Referral Sources Treating HME as Commodity Differentiation for Your HME Practice Increased Paperwork Burden to Collect Reimbursement Increased Ability to Reduce Paper Chase and Improve Your Bottom Line
Introductions
Interoperability Definition definition: In healthcare, interoperability is the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged.
THE CONNECTED HME
What is our Current Reality?
The Post- Acute World is Challenging Hospital penalties Competition for referrals ADRs, RACs, ZPICs ACOs and HIEs Dx codes in ICD-10 Regulatory changes Number of Referrals Fee-for-Service Reimbursement rates Re-hospitalization rates
Interoperability Definition (Part 2) Simply put Interoperability is the right information moving to the right place at the right time so you can do your job to take care of the patient!
Interoperability in the HME Space: Our Path Forward
What is Driving the Need for Interoperability? Payment Reform Government Mandates Fee for Service replaced Meaningful Use Quality is new model MACRA Quality Requires Interoperability Intensify Focus on Interoperability
Government s New Direction [The new program will prioritize] interoperability by implementing federally recognized, national interoperability standards and focusing on real-world uses of technology, like ensuring continuity of care during referrals or finding ways for patients to engage in their own care. We will not tolerate business models that prevent or inhibit the data from flowing around the needs of the patient. Karen DeSalvo, MD and Andy Slavitt
What is the National Vision for Healthcare Delivery? ONC 10-year plan:
Lessons Learned Interoperability 1.0 Positive Outcomes Codified, Liquid Data Exists Maturity of Standards Mandated Support of Certain Standards Improving Culture of Interoperability Challenges Cost Scalability Patient Matching Workflow Interruptions Nothing Designed for Our Industry!
There are opportunities to connect today! The system is largely electronified in the physician practice and hospital space Current and emerging mandates require tools TODAY that we can leverage to move health information from the referral source to the HME and back We must engage and lead the charge to adapt these existing tools to our industry needs!
How do we Engage?
Example 1 - Electronic Referrals for HME 3 Components Necessary to Complete an Order (and Get Paid!) 1. Order to HME 3. Completed Forms Physician Practice, Hospital, etc. HME 2. Intelligent Forms Selection
Example 1 A Portfolio Approach Inpatient to Post-Acute Referral Management Solutions Allscripts Curaspan None
network enabled services 85,000+ Providers across the network 69M Patient Records 5B Annual Data Transactions 278,000 End-point Interfaces 2.8M Encounters Documented Per week 330+ quality programs tracked 3M+ Lives managed on Pop Health Platform
Example 1 Electronic Referral for HME Once the diagnosis is selected it will appear below the Diagnosis section. Selecting the DME tab adds the order to the diagnosis and begins the referral process.
LIVE! Direct Secure Messaging Ochsner Health System Largest Health System in LA HME group processes 3,000+ patients per month Key Benefits to Program Practice Efficiency Save 7 minutes per patient Physicians Stay in Native Workflow Data Accuracy and Personnel Management Gains
How Does this Work in Brightree?
Referral Management Work List
Patient Level Information
Patient Matching Logic
Intelligent Reconciliation
Insurance
Next Steps for ereferrals Additional Future Functionality Order Details and Supportive Questions Documentation Additional Future Vendors Cerner eclinicalworks Curaspan Allscripts (ECIN) Greenway And on down the list
Electronic Referrals for HME Our Vision is to Automate this Entire Process! 1. Order to HME 3. Completed Forms Physician Practice, Hospital, etc. HME 2. Intelligent Forms Selection
Example 2 Value Based Differentiation Demonstrate Positive Impact on Patient Outcomes Technology advancements now enable integrated therapy compliance and billing system workflows Proactively provide valuable information vs. constantly asking for referrals Update source on clinical progress with access to near real-time data Easily handle new PAR requirements for ongoing therapy management Your Software System Compliance monitoring systems Adherence Reports Delivered
Example 2 Differentiation Sleep Compliance
Our vision for how this should work HME/DME PROVIDER
Example 3 Tracking Down Notes and Diagnosis Codes Provider Groups must obtain diagnosis codes and physician notes to complete orders and to be reimbursed A large portion of orders do not come with appropriate diagnosis code or physician notes to justify reimbursement for equipment 70-80% of our O2 orders do not come with sufficient information to justify dispensing or documentation that will be required when we do seek reimbursement. Current practice of chasing this information can take 2-3 days to obtain it, and 15-20 minutes to scan it all in once they have it.
CommonWell Health Alliance Vision CommonWell is an independent, not-for-profit trade association open to all HIT suppliers and others devoted to the simple notion: That health data should be available to individuals and providers regardless of where care occurs and; That provider access to this data must be built into HIT at a reasonable cost for use by a broad range of health care providers and the people they serve
CommonWell Health Alliance Members 68%+ of acute EHR 37%+ of ambulatory EHR Leaders in post-acute care, imaging, patient portals, lab, retail pharmacy and more Founding Contributor General Source: KLAS and SK&A, a Cegedim Company Clinical Market Share 2015 2015 KLAS Enterprises, LLC. All rights reserved. www.klasresearch.com Physician Office Usage of EHR Software SK&A. February 2016. Initial Service Provider
Example 3 Chasing Down Notes and Dx Codes CommonWell is uniquely structured to find this information on behalf of providers. Data Access Siloed Nationwide Patient Matching Duplicative Scalable (if even present) Long- Term Care Lab Clinic Community PCP Hospital Community Hospital Lab IDN Rising Costs Costs Managed Multiple Interfaces One Connection Post-Acute Physician Office Specialist IDN Pharmacy
Automate HME Orders and Referrals Explain to Physicians Workflow Optimization Save Time Use built in connection No more faxing or calling to order DME equipment Operational Efficiency Save Money Less Documentation Burden on your practice Near Paperless Process Alignment with Your Evolving Business Needs Improve your DME ordering efficiency AND help you meet the goals of your evolving reimbursement landscape Therapy Compliance + Insight = Partnership
It s great working with partners who are able to extend data back to us so we are not losing visibility and are better equipped to track our patients care. Our referral sources treat us as true partners now. We have a shared goal of improving the patient s condition and minimizing the risk of that patient re-entering the hospital. True interoperability, as well as ease of use that our solutions bring providers and patients, is a huge win for our end users, partners and providers as well as the health care industry as a whole.
Thank you Nick Knowlton nknowlton@brightree.com Tammy Ordoyne-Vial taordoyne@ochsner.org