Care coordination platform contributes to integrated payer-provider efficiency


Allscripts’ CarePort spin-off is gaining traction with post-acute care providers.

Coordinating post-acute care, a repetitive but routine series of tasks, often consumes vast staff resources, seeking vacancies in skilled nursing facilities, home health agencies and long-term care facilities . These tasks are often plagued by an endless stream of emails, faxes and phone calls.

A growing number of healthcare systems, hospitals, and even payers are converging on a more efficient platform that integrates with popular electronic health records and even enables close monitoring of key value-based initiatives such as programs. grouped payment.

“Partnering with CarePort was a great way to get a more complete data feed and get it in real time,” says Alex Brennsteiner, Network Performance Manager at Helion, a wholly owned subsidiary of Supplier Pay. integrated Highmark Health in Pittsburgh.

Alex Brennsteiner, Network Performance Manager at Helion, a wholly owned subsidiary of integrated provider-pays Highmark Health in Pittsburgh. Photo courtesy of Hélion.

CarePort is a care coordination technology platform from a company formerly a division of Allscripts, but recently acquired by WellSky, a software company spanning the continuum of hospital, post-acute care and community care. As CMS begins a new round of audits in the wake of its recent Healthcare Provider Interoperability Regulations, platforms like these are becoming increasingly important to demonstrate compliance with these CMS regulations. , said Lissy Hu, CEO of CarePort.

Using the CarePort platform, Helion has integrated approximately 125 skilled nursing facilities, representing more than 70% of those facilities in its western Pennsylvania service area, Brennsteiner said.

Previously, data circulated hesitantly between local hospitals, acute care facilities of Highmark Health, Helion, and these skilled nursing facilities, he adds.

Patients in the region could end up in large community hospitals in the region, outside the Highmark Health network, and then data regarding their admissions, discharges and transfers (ADT) would only be transmitted with difficulty to others. interested health organizations, he notes.

“We used to be lucky if something was faxed to us, mostly manually, and that was rare,” explains Brennsteiner.

The CarePort platform displays and transmits these ADT actions and statuses between connected care coordinators, nurse case managers and social workers in real time, and is able to ingest care plans generated by electronic health records , both in hospitals and in post-acute care facilities.

“We have doctors here and there using it,” Brennsteiner says. “One of our quality managers uses it every day for his practice, to review all of those transitional events from the day before and identify opportunities where readmission could have been avoided.”

Primary care practices using the platform run daily ADT reports and may even clear the report while looking to optimize a bulk payment or identify a frequent emergency service user, Brennsteiner explains. “Maybe I would try to schedule this patient for a three-day follow-up instead of a seven-day follow-up,” he says.

Real-time information makes it easier to bill for the management of transitional care in Medicare

Additionally, the platform helps participants bill for Medicare services provided. As of 2013, CMS has had a separate fee schedule for payments under the Medicare Physician Fee Schedule (PFS) for transitional care management (TCM) services rendered to beneficiaries whose medical conditions meet the following requirements. Medicare requirements.

To bill for a TCM meeting, suppliers must complete a 48-hour follow-up report.

“This is why the real-time nature of CarePort is so useful,” says Brennsteiner. “This TCM meeting is reimbursed at a much higher rate than a traditional assessment and management code. From a sustainability perspective, it is also a good income generator for the system.”

The increased visibility of these events, shared among CarePort users, enables stakeholders to make more informed decisions about patient care, Hu said.

“We are in over 1,000 hospitals and over 100,000 post-acute care providers at this point,” Hu said. In about 30% of transitions leaving American hospitals, “these patients [who] need post-acute care, community care or any type of post-discharge care, which will be coordinated through the CarePort platform. “

Hospitals are under increasing pressure over length of stays, a growing demand for post-acute care and the need for patients to be referred with safe discharge plans, Hu said.

For Helion, the transformation of care coordination at CarePort has meant almost 10,000 additional patient meetings, says Brennsteiner. Allegheny Health Network, the hospital system arm of Highmark Health, is using CarePort to move from a traditional model of fee-for-service primary care to a multidisciplinary model that integrates other services such as pharmacy resources and behavioral health, in order to optimize transitional care, he adds.

Another feature of CarePort allows care coordinators to tag certain patient attributes, such as congestive heart failure diagnoses, to enable physicians, using their Epic EHR software, to comply with American Heart criteria. Association, explains Brennsteiner. The platform eliminates duplication of effort to complete this compliance, he adds.

Highmark continued to contact outside hospitals to try and involve them in sharing ADT information through CarePort. “It’s been a mixed bag,” Brennsteiner says. “It’s interesting that one of our more advanced entity-at-risk health system partners was the first to sign up and had incredibly positive feedback on how it helped them.”

Helion is looking to further optimize its use of the platform, Brennsteiner said.

A tool to break down the silos between the operations of the payer and the provider

“Right now, the case management at the health plan does not have access to the electronic medical record of the health system, so there is just inherent blindness in different parts of the organization,” he says. “CarePort is really the first solution that I know of that we can use to break down some of these silos and start to coordinate better. “

For example, health plan specialist case management is starting to coordinate with the Highmark Cancer Collaborative to reduce duplication of effort, Brennsteiner says.

The CarePort approach has also proven to be superior to previous care coordination efforts centered on KeyHIE, the Keystone Health Information Exchange, he adds.

“CarePort has the ability to integrate data from an HIE into the system,” explains Brennsteiner. “That being said, there is quite a lot of variability in terms of HIE quality. Many of these HIEs miss a lot of the post-acute data we captured in CarePort. The other thing unique to CarePort is that we can build “the patient attributes mentioned above. A HIE is more of a traditional type of live broadcast of ADT events,” he adds.

“CarePort has allowed us to grow without too much abrasion for the staff,” he says. “From a primary care perspective, they are able to make sure they have the right time slots to accommodate transitional care visits. And with the additional income generated from the additional TCMs, this is something that can be reinvested in the practices. “

During the pandemic, Helion was tasked with managing hundreds of facilities, including isolation beds, and the changing acceptance criteria for post-acute care facilities, and CarePort was able to add capabilities that followed these resources and criteria throughout, says Brennsteiner.

Scott Mace is a contributing writer for HealthLeaders.


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