Pioneer #ACO Repurposes Care Management for Accountable Care

As a top performer in Year 1 of the CMS Pioneer ACO program, the 2500-physician Monarch HealthCare is paving the way to accountable care with a foundation of patient- and provider-centered strategies that support Triple Aim goals.

Those goals – to improve quality, improve health outcomes and reduce cost, are detailed in Tactics from a Top-Performing Pioneer ACO: Engaging Patients and Providers in Accountable Care.

Colin LeClair, executive director of ACO for Monarch HealthCare, recounts how Monarch recast its Medicare Advantage (MA) care management program to target about 1,200 high-risk patients who have a similar constellation of issues.

“Monarch repurposed our Medicare Advantage (MA) care management program for the ACO,” LeClair said.

Monarch’s ACO care management team was designed to anticipate and prevent acute events and then to facilitate transitions of care for patients post-discharge, he said.

This interdisciplinary team is “comprised of a primary care physician who quarterbacks the team, and a care navigator, also known as a care coordinator, who performs most of the patient onboarding into the care management program and performs an initial triage of the patient’s needs,” LeClair explained.

The care manager is often a non-complex patient’s primary point of contact. The complex care manager is responsible for most of the complex cases, he said.

Then as needed, “we also deploy a behavioral health clinician, a community services coordinator, a clinic dietician and a palliative care nurse. The other resources may include a pharmacist or Pharm D to perform post-discharge medication reconciliation.”

Then, LeClair continued, “we have a team of medical directors, employed and contracted hospitalists, and employed and contracted skilled nursing facilitators (SNFs) to support us as well.”

The idea is that the team is tailored for the patient’s need at enrollment, and it can then be augmented as the patient’s health status changes, he observed.

This model scales best when you can target large patient populations with a fairly common list of conditions, which allows you to hire and assign clinicians with the appropriate expertise to each patient.

“For example, we can afford to hire and assign a registered nurse (RN) or a nurse practitioner (NP) who has experience in a dialysis clinic or a nephrologist office if we have enough renal disease patients to fill their case load,” LeClair said.

For more information or to order your copy of Tactics from a Top-Performing Pioneer ACO: Engaging Patients and Providers in Accountable Care today, please visit: http://store.hin.com/product.asp?itemid=4841

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Just Released: Guide to Embedded Case Management

Guide to Embedded Case Management

 Care coordination is at the core of value-based healthcare delivery models like the patient-centered medical home and the accountable care organization (ACO).

Healthcare case managers embedded within the physician delivery system help to put a face on care coordination while reducing readmissions and improving quality of care for high-risk populations such as dual eligibles. Continue reading

Just Released: Guide to Embedded Case Management

Guide to Embedded Case Management

 Care coordination is at the core of value-based healthcare delivery models like the patient-centered medical home and the accountable care organization (ACO).

Healthcare case managers embedded within the physician delivery system help to put a face on care coordination while reducing readmissions and improving quality of care for high-risk populations such as dual eligibles. Continue reading

Evaluating Oncology Management Programs: Trends in Payer Oncology Management and What You Need to Know for Success

MANASQUAN, NJ — Payers and providers across the country are grappling with choices for programs regarding oncology management and potential collaboration to control costs while also increasing the effectiveness of care.

There is a lot of discussion and many models being proposed for management of oncology costs. Both physicians and payers are seeking information to help in separating the wheat from the chaff and looking for help in choosing the best model for their needs especially in this challenging climate.

Evaluating Oncology Management Programs:Trends in Payer Oncology Management and What You Need to Know for Success is a 60-minute audio webcast scheduled for December 2, 2010, at 1:30 p.m. EST.

This program identifies the issues of concern in oncology management, outlines the current seven models under discussion/implementation, and reviews the players, pros and issues with each model.

Participants will learn how to:

  • Evaluate the results of two oncology trend reports while learning key perspectives on oncology policy and management from both payers and physicians as well as implications of the study results
  • Review the details of oncology management and collaborative models in play across the country, including drug pricing, guidelines and pathways
  • Understand how to evaluate the current models and what questions to ask in choosing a best fit for your organization
  • Develop strategies regarding oncology management and take away steps for implementation and collaboration with oncology providers

The session also includes:

  • Live Open Line question and answer session

The presenter for the program is Dawn G. Holcombe, president of
DGH Consulting and is sponsored by The Managed Care Information Center.

For complete details, please visit:
www.healthresourcesonline.com/edu/Evaluating-Oncology-Management-Programs.htm