Patient engagement is a crucial component of improving patient care and attaining Meaningful Use. In 2015, Adventist Health, based in Roseville, Calif., launched an intense effort to assess and revamp its patient engagement strategy. A major component involved redesigning how patient care management is delivered.
With the Cerner RevWorks Care Management team, Adventist Health created a centralized Care Management Resource Center (CMRC) with the goal of supporting coordinated progression and transition of patient care, both clinically and financially. In order to accomplish this, the RevWorks team improved clinical care management of acute care managers who work directly with patients. Administrative burdens also needed to be centralized to non-patient facing staff with specialized knowledge.
“Lifting this burden from the on-site care managers allows them to focus on their patients and engage with them and their caregivers,” says Liz Miller, who manages care management site leaders for all Adventist Health facilities. “It allows for more collaboration between the care manager and the entire health care team so they can create the best plan for the patient to safely transition through the continuum of care.”
The CMRC, and the on-site coordination it supports, is designed to improve patient engagement, admission status, level of care, and provides appropriate post-discharge referrals and warm handoffs to outpatient service providers. It is also designed to reduce readmission rates, the length of stays, and medical necessity denials and underpayments.
Within six months of launching, the CMRC is already processing 52 percent of the clinical reviews for the entire Adventist Health system. The number will continue to grow as resources are added to the CMRC. The team moved into a dedicated space in December to support its growth, and the move resulted in advanced collaboration with on-site care managers. Another part of the CMRC is the role of the appeals manager, which has successfully secured over $250,000 in appeals on denied claims in the last quarter and $1.55 million overall. Using the eTARs (Electronic Treatment Authorization Requests) submission process, the CMRC has reduced the Medi-Cal three-month rolling average by 4.4 percent enterprise wide. The goal is to expand communication and be able to directly communicate with health plans and medical groups to increase utilization management review to 75 percent. There are also plans for a second CMRC in the northwest in 2016.
“With the CMRC in place, on-site care managers can more effectively plan their patients’ care, allocate the best resources and have those discussions and conversations with the patient and caregivers. We need to do as much as we can on-site to educate the patient and caregivers on what is planned at discharge, what is expected of them and arrange the resources they need to have a safe and successful discharge,” said Miller.
About the Adventist-RevWorks Partnership
In 2013, Adventist Health transitioned the responsibility of managing its revenue cycle functions to Cerner RevWorks. The partnership is focused on decreasing variability and driving best practices through the standardization of revenue management technologies and business processes, as well as fostering discovery and innovation on Adventist Health’s journey to population health. Ultimately, the alignment allows for continuous innovation of software and revenue management workflows to address current and future reimbursement models.
*The Adventist-RevWorks Partnership is unique in governance structure and naming conventions, and may not benefit another client site of equal size or patient population. The acute care managers are employees of the hospital and work on inpatient cases. This role is often referred to as Case Management and acute case managers within other organizations.