Transcription
8/14/13Best Practices:Case Management and Keys to aSuccessful ImplementationTeresa Gonzalvo, RN, BSN, MPA, CPHQ, ACMVice President, Care CoordinationSentara HealthcareSherry Norquist, RN, BSN, ACMManager, Care CoordinationSentara Leigh HospitalAugust 14, 20131Sentara Healthcare 125-years of service, not-for-profit organization11 hospitals; 2,572 beds; 3,825 physicians on staff13 long term care/assisted living centersLTACH4 Medical Groups (650 Providers)VirginiaOptima-453,118 member health planSentara College of Health SciencesNorth Carolina 4.9B total operating revenues 5.4B total assets25,000 members of the team22013 Morrisey Technology & EducationalConference1
gratedHealthSystemRehab erm Care3Sentara CarePlex (Hampton)224 bedsSentara Williamsburg RegionalMedical Center (Williamsburg)145 bedsSentara Obici (Suffolk)168 bedsSentara HamptonRoads Hospitals(MCCM users)Sentara Norfolk General (Norfolk)525 bedsSentara Heart Hospital (Norfolk)112 Beds(Included in SNGH License)Sentara Leigh (Norfolk)250 bedsSentara Princess Anne(Virginia Beach)160 bedsSentara VirginiaBeach General (Virginia Beach)276 beds42013 Morrisey Technology & EducationalConference2
8/14/13Blue Ridge, Northern Virginia HospitalsSentara Northern VirginiaMedical Center (Woodbridge)183 BedsMartha Jefferson Hospital(Charlottesville)176 BedsRockingham Memorial Hospital(Harrisonburg)238 BedsHalifax Regional Medical Center(Halifax/South Boston area)192 Beds5Our Objectives Describe the department structure andhow it integrates with the patient careteam Outline the key workflows automated bythe care coordination department Outline keys to a successfulimplementation62013 Morrisey Technology & EducationalConference3
8/14/13The Sentara Care Coordination ModelAccess CareCoordinatorsResourceManagementCenterContinuum ofCare ProvidersOur patientsSentara AdvisorsUnit BasedCare CoordinationTeam7Inpatient Redesign First Step in Improving Ability to Support Broader EffortsMultifaceted Case Management Approach at Sentara Healthcare1Crafting a Comprehensive Case Management StrategyPhase IIPhase IResource Management:Centralized corporate officeconducts utilization review,discharge planningAccess Coordination:Case managers embedded at allpoints of patient access (e.g., ED,OB, etc.) to ensure appropriatelevel of care provided 2012 THE ADVISORY BOARD COMPANYMedical Necessity Reviews:VPMA advisors, with supportfrom external agency, reviewscases, interfaces with medical staffCare Coordination DyadModel: Social worker and carecoordinator paired to improvecoordination of care; staffingratios re-evaluated to ensureadequate supportRevitalized MultidisciplinaryRounds: Representatives acrossdifferent clinical disciplinescollaborate to conduct jointrounds and create a patientcenteredcare plan1Phase IIIEnhanced Technology:Case management systemevaluation underwayPost Acute Partnerships: Casemanagement leaders will collaboratewith post-acute care providers toimprove transitions, informationexchange, unnecessary transfersCare Coordination PracticeCouncil: New cross-continuumcommittee will integrate inpatient,ambulatory-based, and health plancase managers to improvecommunication and best practicesharing81) Sample staff included in rounds are physicians, nurses, physical therapists, nutritionists, etc.2013 Morrisey Technology & EducationalConference4
8/14/13Care Coordination journey – consistent andstandardization of our support services The Morrisey ConcurrentCare Manager applicationis part of our solutionspackage Successful implementationis contingent upondetailed project planning,ongoing communication,staff education andpractice Staff engagement with thedesign phase is necessary9Access Coordinators At the access points of the hospitals, RNsassess patients to determine medical necessityand provide transition planning The use of MCCM enables the RMC staff toseamlessly provide additional clinicalinformation as needed or determine if aphysician review is required102013 Morrisey Technology & EducationalConference5
8/14/13CaseSummary Topics currently is use––––––Comments – all notes on caseConcerns – key internal communicationsDelays – avoidable delay captureSaved Days – shortened LOSImages – stores a picture of faxes sentPayor Contacts – documentation ofcommunications with payors– Encounter sections – easy access to any Sentaraencounter since go-live (2/13/13)– Medical Nec. Reviews – all UM reviewscompleted, including InterQual data– Denial Reviews – if denial received, can begin theappeal process documentation– Physician Advisor – to send cases to PA’s forreview– User Defined for special things not coveredelsewhere11Sentara’s Resource Management CenterOur Utilization Management HubSentara Independence(Virginia Beach)Resource Management Center (2nd floor)122013 Morrisey Technology & EducationalConference6
8/14/13Resource Management CenterOur UM Hub for 7 nComplianceandAuditingResourceStaffing PoolRMC13Resource Management CenterLiving the Vision142013 Morrisey Technology & EducationalConference7
8/14/13Resource Management Center The Access Care Coordination and ResourceManagement functions were the first ones to GoLive Teams of Care Coordinators and Associate CareCoordinators, 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 physicianadvisors Third Party Payor contacts and follow up15Sample RMC Work listNew ConcernPA responseWhy case ison work list162013 Morrisey Technology & EducationalConference8
8/14/13Payor Contacts17Sending a ConcernAdd NewConcern182013 Morrisey Technology & EducationalConference9
8/14/13Discharge 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 header19Resource 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 effectivenotification to our patients. Increased compliance with CMS andother regulatory guidelines due to standardization of workflowsand reports202013 Morrisey Technology & EducationalConference10
8/14/13The hospitals and the RMC are allon the same page Having the tools to help uscommunicate enables us toincrease our efficiency The team is able to see notesfrom their teammates, and theVPMA or PhysicianAdvisors, in real timeSentara Leigh’s Nurse ExecutiveGenemarie, Care Coordinators andSocial WorkersVPMA Dr. Scott Miller’s gift ofTHANKS!21VPMAs and Physician Advisors The MCCM applicationallows the RMC andhospital based staff torefer cases easily tocontracted physicianadvisors or internally toa VPMA All of the many complexfunctions that happenwithin the hospitalizedpatient’s case are easilyviewed by all membersof the CareCoordination team222013 Morrisey Technology & EducationalConference11
8/14/13Physician Advisor Work list Resource Coordinator creates PAreferralAuto-populates to work list forPAUsed for VPMA, PA, and E.H.R.PA respondsStethoscope alert appears forresource coordinator once PAresponds23Unit Based Care Coordination Team Unit Based Care Coordinators,Social Workers and AssociateCare Coordinators spend theirtime with patients and theirfamilies These staff members use theirclinical expertise to providetransitional planning andpatient support, plan for theday, plan for the stay, as well asguiding the multidisciplinaryteam to remain on target forLength of Stay goals242013 Morrisey Technology & EducationalConference12
8/14/13Multidisciplinary Teams Multidisciplinaryteams discuss patientcare issues and plansfor the day Rounds and huddlesare conducted on aregular basis. Patientwork lists are utilizedfor discussionpurposes25Other functions-Readmission Review Patients populate to the readmission work list at the timeregistration occurs based on:– Having been in Observation or Inpatient in the last 30 days atany Sentara Hampton Roads Hospital– Currently admitted as an inpatient or observation at any SentaraHampton Roads Hospital262013 Morrisey Technology & EducationalConference13
8/14/13Avoidable DelaysDelay TypedrivesDelay ReasonsUsing ACMACompare ADDelay typesAnd reasons27Keys to Successful Implementation Live the Care Coordination VISION Ongoing communication with system,hospital leadership and staff Established a core team - cross section ofleadership, IT, staff and end users for CareCoordination Co-chairs: Education Manager and IT Director Assigned a Project Coordinator Developed a well defined Project Plan, withstructured updates given at the Leadershipmeetings282013 Morrisey Technology & EducationalConference14
8/14/13Keys to Successful Implementation Outlined a Training Plan, with time toplay in the Test environment. This is toinclude after hours and weekend classes Developed and updated all trainingmaterials as workflows are re-designed Implemented a pre Go Live checklist All hands on deck - from executiveleadership, directors and managers29Keys to Successful Implementation Created a central Command Center for Go Livedates with a predefined timeframe. Three phonelines were available for staff and a dedicated linefor physicians and VPMAs Established Black Out days (No vacations) priorto and after Go Live dates Developed Frequently Asked Question and Answersheet and sent out to all staff Identified a consistent process for issues and itsresolution302013 Morrisey Technology & EducationalConference15
8/14/13MCCM Command CenterSentara Independence (RMC)31Increased Staff Satisfaction Takes the complexity of our work, combines itto one central program, simplifies and makeswork manageable Everyone likes to be able to start on their workload right away instead of having to wait on anassignment Saves time, better organization, alldocumentation can be found in one place,chronological order and time frame Insurance changes are easily identified-Darlene Brink, RN, Manager-Joanne West, RN, Team LeaderResource Management Center and staff2013 Morrisey Technology & EducationalConference3216
8/14/13Increased Staff Satisfaction Provides accountability, shows when case wasworked on, provides an accurate time frame Faxing to Commercial payers much better asyou receive immediate notification that the faxwas sent or that it did not go thru Gratification-to see the list shrink as you workit, feels like you are accomplishing something MCCM allows you to manage your workloadbetter and improves time management-Kim Tortora, RNResource Care Coordinator-Diane Pearson, LPN and -Kathy Plank, LPNAssociate Care Coordinators, RMC33Increased Staff Satisfaction Having the admit/discharge date and time, I caneasily identify triage patients who are only in L&Da few hours and mass delete them or know that astatus change will need to be sent if they areinpatient. I complete preliminary reviews on obstetricpatients and set the NRD for when the patientshould go home. This way I can easily see if a babystays longer than the Mom and needs an auth or ifa Mom takes more than 2 days to deliver and mayneed an auth.-Patsy Duguay, RNResource Care Coordinator, RMC342013 Morrisey Technology & EducationalConference17
8/14/13Lessons Learned Allow more time for staff to practice in the TestEnvironment Frequent and multimedia communication to keystakeholders and end users Define and run reports sooner than later Clarify expectations and timelines from both Morriseyand Sentara teams Ongoing assessment and evaluation via leadership, staffsurveys (i.e. Zoomerang)35What the Future Holds Managing TransitionsAcross the Continuum ofCare As we strive to bridge thegap and ensure seamlesstransitions, we are seekingto engage our home careand skilled nursing facilityproviders in this endeavor Ongoing close collaborationwith our communitypartners through the LongTerm Care CouncilCare Coordination Long Term CouncilLaunched with the Hampton Roadscommunity post- acute providersDr. Gene Burke, VP of Clinical Effectiveness,discussing the Readmission initiatives with theLong Term Care Council362013 Morrisey Technology & EducationalConference18
8/14/13Summary With the help oftechnology andreports, we will beeliminatingunnecessary variation,standardizing bestpractices, across thecare continuum Consistent patientcare coordination andsafe transitions acrossall levels of care is ourvision37Care CoordinationMovers and Shakers-we improve health every day!382013 Morrisey Technology & EducationalConference19
8/14/13QUESTIONS?39402013 Morrisey Technology & EducationalConference20
detailed project planning, ongoing communication, staff education and practice Staff engagement with the design phase is necessary 9 Access Coordinators At the access points of the hospitals, RNs assess patients to determine medical necessity and provide transition plan
