Teresa Gonzalvo, RN, BSN, MPA, CPHQ, ACM Vice … · 8/14/13 2013 Morrisey Technology & Educational...
Transcript of Teresa Gonzalvo, RN, BSN, MPA, CPHQ, ACM Vice … · 8/14/13 2013 Morrisey Technology & Educational...
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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, ACMManager, Care Coordination
Sentara Leigh Hospital
August 14, 2013
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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
• Sentara College of Health Sciences
• $4.9B total operating revenues
• $5.4B total assets
• 25,000+ members of the team
Virginia
North Carolina
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Integrated Health System
Primary/ Specialty
Care
Hospital
Emergency Care
Ambulatory Care
Long Term Care
Home Health Care
Rehab Care
Health Plan
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Sentara Hampton Roads Hospitals(MCCM users)
Sentara Norfolk General (Norfolk)525 beds
Sentara CarePlex (Hampton) 224 beds
Sentara Virginia Beach General (Virginia Beach)
276 beds
Sentara Williamsburg Regional Medical Center (Williamsburg)
145 beds
Sentara Leigh (Norfolk)250 beds
Sentara Heart Hospital (Norfolk)112 Beds
(Included in SNGH License)
Sentara Obici (Suffolk)168 beds
Sentara Princess Anne (Virginia Beach)
160 beds
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Blue Ridge, Northern Virginia Hospitals
Rockingham Memorial Hospital (Harrisonburg)
238 Beds
Sentara Northern Virginia Medical Center (Woodbridge)
183 Beds
Martha Jefferson Hospital (Charlottesville)
176 Beds
Halifax Regional Medical Center(Halifax/South Boston area)
192 Beds
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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
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The Sentara Care Coordination Model
Our patients
Sentara Hospitals
Access Care Coordinators
Continuum of Care Providers
Multi-disciplinary Teams
Unit Based
Care Coordination
Team
VPMA’s/Physician Advisors
Resource Management
Center
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Crafting a Comprehensive Case Management Strategy
1) Samplestaff included in rounds are physicians, nurses, physical therapists, nutritionists, etc.
1Inpatient Redesign First Step in Improving Ability to Support Broader Efforts
Multifaceted Case Management Approach at Sentara Healthcare
Phase II
Revitalized Multidisciplinary Rounds: Representatives across different clinical disciplines collaborate to conduct joint rounds and create a patient-centeredcare plan1
Care Coordination Dyad Model: Social worker and care coordinator paired to improve coordination of care; staffing ratios re-evaluated to ensure adequate supportAccess Coordination:
Case managers embedded at all points of patient access (e.g., ED, OB, etc.) to ensure appropriate level of care provided
Resource Management: Centralized corporate office conducts utilization review, discharge planning
Medical Necessity Reviews: VPMA advisors, with support from external agency, reviews cases, interfaces with medical staff
Phase I Phase III
Post Acute Partnerships: Case management leaders will collaborate with post-acute care providers to improve transitions, information exchange, unnecessary transfers
Enhanced Technology: Case management system evaluation underway
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
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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
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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
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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
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Sentara’s Resource Management CenterOur Utilization Management Hub
Sentara Independence(Virginia Beach)
Resource Management Center (2nd floor)
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Resource Management Center-Our UM Hub for 7 hospitals
RMC
Compliance and
Auditing
Utilization
ManagementDischarge Facilitation
Resource Staffing Pool
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Resource Management Center-Living the Vision
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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
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Sample RMC Work list
Why case is on work list
New Concern
PA response
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Payor Contacts
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Sending a Concern
Add New Concern
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Discharge Facilitation ProcessQ. 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
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Resource Management Center• With the use of technology, and the right skill mix, this one-of-a-
kind 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
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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
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VPMA Dr. Scott Miller’s gift of THANKS!
Sentara Leigh’s Nurse Executive Genemarie, Care Coordinators and
Social Workers
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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
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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
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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
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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
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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
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Avoidable Delays
Delay Typedrives
Delay Reasons
Using ACMA Compare ADDelay typesAnd reasons
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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
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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
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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
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MCCM Command CenterSentara Independence (RMC)
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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
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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
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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)
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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
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Dr. Gene Burke, VP of Clinical Effectiveness, discussing the Readmission initiatives with the
Long Term Care Council
Care Coordination Long Term Council Launched with the Hampton Roads
community post- acute providers
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Summary• 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
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Care Coordination Movers and Shakers-we improve health every day!
QUESTIONS?
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