Value Based Care Services

Summit Strategic Solutions offers a broad range of Value Based Care Services to help healthcare providers realize the “Quadruple Aim.” 

Summits Value Based Care Services empower providers to reside as the coach of their patients care, creating a game plan and providing tools and encouragement, while the patient remains the quarterback, responsible for driving the plan. Summits population health services broaden clinical scope to consider the health and wellness needs for entire groups of patients. Regulatory shifts to value and risk-based contracting drive demand for a comprehensive approach to clinical, operational and financial workflows requiring providers to address patient experience, quality and cost of care. Summit’s Value Based Care Services use analytics to impact service at the point of care.

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Care Coordination

Studies show that approximately 5% of the population is responsible for almost 50% of the total medical expense. Implementing a care coordination strategy is key to successfully managing high risk patients and promoting the continuum of care between the Primary Care Physician and the patient.  A successful care coordination strategy helps shift healthcare from a reactive transactional delivery system, to a proactive and longitudinal care delivery system.

Summit Strategic Solutions Care Coordination Program is designed with workflows and tools to assist patients in organizing healthcare activities, to effectively manage their disease burden, to more effectively and appropriately navigate the healthcare system and to secure access to appropriate and needed healthcare resources.

Summit’s Care Coordination Program empowers patients to make healthcare choices to meet their goals, facilitate seamless care delivery across the healthcare continuum, improve outcomes and decrease overall cost of care.
Service Area Service Elements / Workflow Steps
Care Coordination Program Care Coordinators reduce the incidence of adverse health events leading to costly ER visits and hospital admissions through the organization of patient care activities across the continuum of care. The Care Coordination team manages pertinent data from a variety of sources, ensuring that the patient and care team have the information needed to support the patient’s health and self-management goals.
Working under the direction of the provider, the Care Coordinators provide longitudinal case management and episodic activities of care coordination. Risk stratification and provider referrals are used to identify patients who would benefit from case management outreach by Registered Nurses and Social Workers.
Episodic Care Coordination Summits LPNs contact patients discharged to home from an inpatient setting, Emergency Room or Skilled Nursing Facility within 2 days to review discharge instructions, complete medication reconciliation, complete needs assessment and schedule follow up visit with Primary Care Provider (to occur within 7 -14 days of discharge). Follow up phone calls are completed approximately 30 days post discharge.
Longitudinal Care Coordination Registered Nurses and Social Workers proactively engage the most chronically ill patients based on Transitions of Care (TOC) needs assessment, risk stratification, high or rising utilization, high or rising medical expense or Primary Care Provider referral.

 “Care Coordination and Pre-Visit Planning Coders have provided added support for the higher risk patients that allows for the right care to be done in the outpatient setting. This reduces the burden on my practice that unexpected complications would otherwise create. Also the guidance to set up shared medical appointments has helped to develop a more efficient means of providing patient care.”  – E Penniman MD

 

 

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Risk Adjustment

In moving to a risk-sharing, value-based payment model, it’s critical to capture and document your population’s health status. Summit is here to help with a range of Risk Adjustment programs and services.

At Summit, we understand Risk Adjustment and why it is so important. Our programs will shift the focus to risk-adjusted reimbursement, where the treatment of disease burden – rather than quantity of office visits – is critical for business success. This means the disease states that cause risk for the patient must be appropriately identified, documented and coded to the highest specificity.

Summit’s Risk Adjustment team consists of credentialed, certified coding professionals who will work together with physicians, showing them how to accurately capture the full risk burden of each patient. Complex documentation and coding regulations specific to CMS Risk Adjustment Data Validation require appropriate resources and training for success. Our programs will help you mitigate risk by training and educating coding professionals and managers in conservative decision-making processes and actions, while outlining expectations for making ethical decisions in the workplace specific to Risk Adjustment coding and clinical documentation. Learn how a commitment to integrity during the coding process, regardless of the purpose for which the codes are being reported, is relevant for all your coding professionals and those who manage the coding function.

The increasing need for providers to fulfill stringent documentation requirements has prompted Summit to develop a POINT OF CARE Risk Adjustment Program. The program assists and empowers providers to accurately document diagnosis at the point of care.
Why at point of care?
1. Increase accuracy by documenting and coding properly
2. Foster 24/7 partnership with provider team for consultation and questions
3. Provide immediate feedback to address risk, quality and star requirements

Summit’s Risk Adjustment Program is based on a three prong approach.

Three Prong Approach Program
Provider Education Program Summit assists providers in creating accurate views of patient’s conditions to establish a proactive care path. The program is designed for providers to build an understanding of Value Based Care Services and explains their role in accurate, complete and consistent risk adjustment. A thorough review of the Care Coordinators role in patient management and population health is foundational to the success of the program.
Coding Support Program Certified Coding Support Specialists provide real-time review of progress notes to ensure all diagnoses listed on the claim are adequately supported at the highest level of specificity. Specialists assist the provider in representing the entire disease burden at the highest level of specificity to achieve and maintain a proper risk score. Documentation reviews take place immediately following the patient encounter, prior to claim submission. If criteria are not met, the specialist communicates with the provider for clarification and documentation changes. Summit believes that coding feedback in proximity of the office visit is more meaningful to the provider.
Pre-Visit Planning Program Summits Pre-Visit Planning offers point-of-service support for providers to accurately capture and document the patient’s disease burden to the highest level of specificity. Pre-Visit Planning is completed prior to the patient’s scheduled encounter and provides behind-the-scenes support services to make the most efficient use of the providers’ time during the patient encounter.

“Thank you.  The RA team does a great job and their work is imperative to our overall success. Keep up the good work”. -A Jones DO

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Quality Reporting and Improvement

As the shift from fee-for-service to value based care accelerates, measuring practice and provider performance related to healthcare processes and outcomes is a critical factor for success. Summit Strategic Solutions services and programs in Quality Reporting and Improvement empower our healthcare enterprise clients to capture and review Healthcare Effectiveness Data and Information Set (HEDIS) data, conduct quantitative and qualitative analyses and develop action plans to address gaps and barriers.  The fundamental elements we provide for HEDIS measures can also be applied to Centers for Medicare and Medicaid (CMS) directed quality programs and healthcare payor-driven quality metrics.

Summit Strategic Solutions provides Quality Reporting and Improvement programs and services in the following areas:

Service Area Service Elements / Workflow Steps
Utilization Management Service Summit Strategic Solutions’ Utilization Management (UM) Services provide you with tools and a specific program to help evaluate medical necessity, appropriateness and efficiency of the use of healthcare services within your network. Examples of specific programs developed by Summit Strategic Solutions for its clients include:

  • Chronic Pain Narcotic Prescription Auditing
  • Laboratory Test Medical Necessity Review Program
  • Ancillary Imaging Services Utilization Review Program

We will review and assess your current healthcare delivery network and help you identify opportunities to leverage our Utilization Management Services.

Patient Quality Reporting System (PQRS) Reporting Service Let Summit Strategic Solutions help your healthcare enterprise more effectively and accurately report on Medicare Quality of Care with our PQRS Reporting Service. Our consultants will help your organization select appropriate measures, implement reporting and tracking systems and help your healthcare organization avoid negative payment adjustments.
Clinical Quality Dashboard Development Service Summit Strategic Solutions will develop quality reporting dashboards to meet the specific needs of your healthcare enterprise. Based on the key performance indicators your organization has prioritized for Quadruple Aim success, we can help you capture, analyze, report and present information in the most effective way.
National Center for Quality Accreditation (NCQA) Program Application Service Summit Strategic Solutions offers support and implementation services to help your healthcare enterprise achieve accreditation for the following NCQA programs:

  • Patient-Centered Medical Home (PCMH)
  • Diabetes Recognition Program
  • Heart/Stroke Recognition Program

Health Education

The goal of Summit Strategic Solutions’ Health Education Programs is to empower the participant to become an active member of the healthcare team by increasing his or her knowledge of general wellness and disease-specific self-management skills, so the participant can impact health outcomes positively.

Education programs offered include:

Service Area Service Elements / Workflow Steps
I.D.E.A. Program (Individual Diabetes Education Appointment) A comprehensive diabetes management visit that blends a traditional physician appointment with a management training session taught by a health educator.
Living with Diabetes Provides specifics on nutrition, exercise and medications to help patients live with this chronic disease. Patients are provided general guidelines, which are then customized to meet their plan for success. Monthly emails and Diabet-E-Bytes provide ongoing education on diabetes-related topics and continue to keep patients on track.
Steps to Wellness A 12-month program broken into six months of core learning in a classroom setting, followed by six months of maintenance in either a classroom or webinar setting. This program provides guidance on nutrition, exercise, weight management and general wellness to help patients achieve their best health possible. Participants are encouraged to avoid the “diet” roller coaster and instead make gradual lifestyle changes that will last a life time. Monthly emails, Health-E-Bytes, recommended recipes, suggested exercises and tips to maintain healthy behaviors are provided.
Smoking Cessation Program A series of seven classes over a six-week period that balance education and peer-to-peer encouragement. Through a targeted action plan created by the patient, the cessation rates for participants in our program are regularly four times that of the national average.
Shared Medical Appointments (SMAs) Offer an innovative, interactive approach to healthcare that brings patients with similar needs together with their healthcare team. While an individual appointment typically lasts 15 to 30 minutes, a shared appointment is 90 minutes long, allowing participants to spend more time with their provider and healthcare team. SMAs provide an opportunity for improved appointment access and an environment for peer learning, while improving the quality of care and strengthening the relationship with the healthcare team.

“I consider health education to be step one with many of my chronic disease patients. I have found the patients who attend health education are the best informed and much easier to manage. A typical day rarely affords adequate time for health education.  Better awareness better compliance. Our data suggests that health education is more effective than many of the expensive medications that we have available for lowering HA1C rates.  Think health education first. “ – M Passarello MD

Integrated Programs

Summit Strategic Solutions’ Value Based Strategies Group can help your healthcare enterprise lower total population costs of care and provide for better patient care and outcomes through our Integrated Programs.

 

Program Description
Shared Medical Appointments (SMAs) SMAs offer an innovative, interactive approach to healthcare that brings patients with similar needs together with their healthcare team. While an individual appointment typically lasts 15 to 30 minutes, a shared appointment is 90 minutes long, allowing participants to spend more time with their provider and healthcare team. SMAs provide an opportunity for improved appointment access and an environment for peer learning, while improving the quality of care and strengthening the relationship with the healthcare team.
Primary Care Behavioral Health Primary Care Behavioral Health addresses both physical and behavioral health needs in primary care settings through systematic coordination and collaboration among health care providers. The model embeds behavioral health clinicians with the primary care team and offers real time behavioral health consultation to the primary care provider. The Primary Care Behavioral Health model emphasizes population-based care and operates via a healthcare team model. It offers consumer-centered “one-stop shopping” to patients who might not otherwise seek out behavioral health services. Clinical outcomes are strong, showing improved self-management skills for patients, high patient and provider satisfaction, high levels of patient retention in treatment, and significantly improved levels of emotional, social and physical functioning following treatment.
Advance Directive Program Advance care planning affords patients the opportunity to make determinations regarding their medical care in advance in the event they become incapable of active participation in healthcare decisions. Discussing advance directives and end-of-life care is a conversation that should be led by their trusted primary care provider. Primary care providers require support from the healthcare team and tools to help with this important process. Encouraging the patient to have a voice in making important decisions in their healthcare takes a team effort, and resources need to be in place to make that possible. With an advance directive completed and distributed properly, patients can rest assured that their wishes will be honored.
Pharm D Program Clinical Pharmacists work with providers to make sure patients are on the safest, most cost-effective medications and provide patient education as needed. Referrals are often recommended for patients who have been recently discharged from the hospital, taking > 10 medications, confused about their medication(s) or have questions, need device training (insulin, inhalers etc.), and experiencing possible side effects from medication or have challenges with medication adherence.
Embedded Retinal Screening Program Over five and a half million individuals over 39 have diabetic retinopathy with an estimated annual cost of $1 billion in direct medical expenditures. The Embedded Retinal Screening Program offers patients the convenience of getting screened in their primary care provider’s office, removing a major barrier of outpatient screenings.

Transformation Consulting Services

Through our experience in health plan partnerships, physician engagement and performance improvement, Summit Strategic Solutions can help you navigate the fee for value landscape and transform your organization.

Key Transformational Services we offer include:

Service Area Service Elements / Workflow Steps
Population Health Readiness, Assessment, or Implementation Service Summit Strategic Solutions will provide your healthcare enterprise with a comprehensive review of current capabilities and gaps and provide you with a detailed plan of action and road map for implementation of Population Health select program elements. Based on your current workflows, information technology infrastructure, capacity and tools for decision support, and your priority clinical- and patient-outcome quality matrix, we will develop and present a customized plan for your transformation to value-based care.
Health Plan Partnership Engagement Services Summit Strategic Solutions cross-disciplinary teams will work to systematically improve performance in the key areas outlined in your risk agreements. This approach has been enhanced to address the challenge of new Medicare Advantage partnerships.

  • Performance incentives, gainsharing and percent of premium contract development
  • ACO infrastructure
  • Data sharing infrastructure
  • Member/patient marketing and enrollment
Physician Engagement Services Summit Strategic Solutions understands the critical role the physician plays in the transformation of healthcare to value based payment and clinical quality outcomes models. We offer a range of prepackaged and customizable programs to ensure successful physician engagement in your healthcare enterprise transformation. These include:

  • Medical Director or Regional Medical Director Programs
  • Clinical Quality Dashboard Development Services
  • Learning Management System Education Modules
  • Physician Side-By-Side and High Opportunity Reporting
  • Clinical Documentation Prompts
  • Physician Rewards and Engagement Program
Performance Improvement Services Summit Strategic Solutions can help your healthcare enterprise achieve its shared savings goals with our Performance Improvement Services. We offer a multi-disciplinary Project Team that includes clinical, business, information technology, operational and financial/accounting expertise to offer a 360° view of your healthcare delivery system. Includes capabilities in:

  • Risk Adjustment: documentation and coding for risk score accuracy
  • Expense Management: focus on Medical Expense Ratio (MER), inpatient admissions, emergency room visits, readmissions and specialty spend
  • Quality: key performance indicators tied to NCQA, HEDIS and payor-specific quality measure success
  • Patient Experience: strategies to improve the patient experience to build relationships and attract and retain patients

For further information about Summit Strategic Solutions’ Transformation Consulting Services, call us toll free at 866-777-4975 or email us at sales@summitstrategicsolutions.com.