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Secretary Alex Azar, Health and Human Services, spoke on March 5th, 2018, at the Federation of yank Hospitals. His presentation reaffirmed CMS’ commitment to value-based transformation. He said, “There is not any turning back to an unsustainable system that pays for procedures instead of the value”. Additionally, he said, “value must be rewarded handsomely”. With the repeal of SGR (sustained growth rate), provider reimbursement won't see a rise beginning of 2019. Therefore, the assessment useful (quality, stewardship of resources, appropriate utilization) will determine if and when providers will see additional reimbursement.

St. Vincent’s Health Partners (SVHP), Inc., the primary nationally-recognized clinically-integrated network by URAC, has developed a network and operational infrastructure to manage patients through quite 140 care transitions. SVHP is cooperating in most models of reimbursement counting Medicare Shared Savings, commercial and governmental payment models, and direct-to-employer contracting.

SVHP has partnered with PatientPing, a software company that permits care coordinators and therefore the medical management team to raised serve attributed patients and covered lives as they transition between healthcare settings. Our team receives a “ping” whenever a patient is seen within the emergency department, admitted to the hospital, or uses skilled nursing facilities and residential health agencies. 

The “ping” provides enough information to permit coordinators to make sure that the patient care plan is employed and maintained in which each member of our network has access to acceptable patient-level data timely to maximize the therapy plan at each step of patient service.

Each new model of reimbursement needs effective patient engagement both directly and indirectly. When our team knows that patients are admitted and discharged from an ED, inpatient, or skilled nursing facility, we will help each network provider offer coordinated and timely interventions effectively, and permit the entire system to satisfy operational, quality, and utilization objectives. Knowing when a patient expectedly and unexpectedly needs urgent, emergent, and continuous care provides opportunities to use most current support tools and assures those clinical guidelines and accumulated data enhance care. For instance, when a Bundle Payments for Care Improvement (BPCI) patient is transferred to a talented nursing facility after hospitalization, our care coordinators confirm that the patient is followed-up timely with their medical care provider and lots of times prevent readmissions.

Transformational software is SymphonyRM. It’s software that permits the translational care coordination record to reinforce the medical history between transitions of care and track the therapeutic plan while discretely recording efficacy of our care coordination processes. The software has allowed us to maneuver faraway from registries to specialize in patient-level healthcare success. The Quadruple Aim includes provider and patient satisfaction. SymphonyRM also allows us to enhance physician outreach, provide additional tools to facilitate the simpler clinically-integrated network, more adeptly keep conscious of government and payer economic credentialing, and meet utilization and quality goals. Ultimately, the patient and provider can leverage the effectiveness and advantages of a clinically integrated network.

SVHP, PatientPing, and SymphonyRM have emerged together to allow care coordination documentation to become the translational patient record in patient care sites. Working with these two companies has grown from a vendor relationship to a partnership that has allowed SVHP to start to discretely capture care coordination outcomes and show how SVHP is maximizing the Quadruple Aim. SVHP members collaborate every single day to face and solve unique challenges that have galvanized our network, transcended the restrictions of the EMR, and positioned us to figure in a subtle way with Secretary Azar and realize momentum to maneuver towards value care with less dependency on volume.