VALUE BASED STRATEGIES

Summit Strategic Solutions offers a broad range of Value Based Strategic Services to help healthcare providers realize the “Quadruple Aim.”  Helping you bring together the program elements needed to achieve the quadruple aim is the focus of Summit Strategic Solutions’ Value Based Strategy Programs.

Our Value Based Strategy Programs and Services for population health management broaden clinical scope in order to consider the health and wellness needs for entire groups of patients. The payment model shift to value and risk-based reimbursement drives the need for a more comprehensive approach to clinical and business practice workflows. These new workflows require business processes that simultaneously address patient experience, quality of care, expense management and revenue cycle management.

Summit Strategic Solutions Programs and Services are designed to help your healthcare enterprise achieve its transformational clinical and business goals. Our programs incorporate individual, organizational and cultural interventions to help reduce the illness and injury burden, and to change the healthcare use behavior of defined populations. Our Value Based Strategy Programs and Services are differentiated from traditional disease management by including more chronic conditions and diseases, the use of a single point of contact and coordination, and by use of predictive modeling across multiple clinical conditions. Our programs include intensive care management for individuals at the highest level of risk and personal health management for those at lower levels of predicted health risk.

Let Summit Strategic Solutions help your healthcare enterprise make the transformation to value based care and population health. We offer a broad range of consulting and full service offerings that will help accelerate your move to value based care.

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 (PCP) and the patient. A successful care coordination strategy will help shift your healthcare enterprise from a reactive transactional delivery system, to a proactive and longitudinal care delivery system.

Summit Strategic Solutions Care Coordination Program and Services are designed with workflows and tools to assist your 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 Strategic Solutions has almost five years of experience in developing and managing care coordination programs, and we offer off-the-shelf and customizable packages to meet your particular needs. Our program includes several care management tracks that you can choose to customize your program to meet your current population needs and the care coordination service gaps in your organization you need to fill. These include:

Service Area Service Elements / Workflow Steps
Care Coordination Management Service Summit Strategic Solutions offers customizable programs that enable you to create your own internal Care Coordination capability, or to provide you with a shrink-wrapped service solution you can use to enhance your current care delivery system. Include individual program elements into your service mix, including Disease Management, Transitions of Care Management, and Care Delivery Management
Disease Management Program Empower your patients to effectively manage their disease through completing personal assessments, providing needed education, facilitating resource attainment and developing personal care plans addressing chronic conditions and other ongoing health needs specific to that individual.
Transitions of Care Program Manage transitions across the patient’s care network through supporting patient understanding physician-directed instructions, medication regimen, disease warning signs, managing symptoms and confirming timely appointment scheduling and attendance.
Care Delivery Management Program Organize resources and facilitate information exchange between participants of the patient’s healthcare team for a more comprehensive, non-duplicative and seamless delivery of care.
Patient Engagement Extend your physician’s care to build upon the existing physician/patient relationship by providing ongoing, personalized health-related support and communication. Improve adherence to the patient-physician established plan of care, timely healthcare needs recognition and appropriate services delivery.

Let Summit Strategic Solutions’ Care Coordination Programs help you empower your patients to make healthcare choices to meet their goals, facilitate seamless care delivery across the healthcare continuum, improve patient outcomes, and decrease overall cost of care.

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

Risk Adjustment

The healthcare community is in a period of transition. The concept of value-based reimbursement is centered on paying for quality and not for quantity of healthcare. The old “Fee for Service” way of doing things where “the more you do, the more you get paid” no longer applies. It’s a drastic change from what healthcare enterprises have been doing for the past 30-plus years. In moving to a risk-sharing, value-based payment model, it’s critical to capture and document your population’s health status. Summit Strategic Solutions is here to help with a range of Risk Adjustment programs and services.

At Summit Strategic Solutions, 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 Strategic Solutions’ Risk Adjustment team consists of credentialed, certified coding professionals who will work together with your physicians to show 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.

Key Risk Adjustment Services we offer include:

Service Area Service Elements / Workflow Steps
Risk Adjustment Assessment and Implementation Services With the Summit Strategic Solutions Risk Adjustment Assessment Service, improve your healthcare enterprise’s patient risk score accuracy to represent the maximum population disease burden. We will show you how to implement effective data validation operations to increase risk score accuracy and reduce audit exposure and improve financial performance. Included will be recommendations on how to apply advanced data analytics for year-over-year success. Learn how you can reduce audit risk by conservative practices, proper documentation, and coding for submission of accurate data to improve revenue and quality of care.

Additional services can provide incremental insight for targeting specific Risk Adjustment Opportunities, including Mock RADV audits to provide insight and solutions to improve clinical documentation and risk score accuracy.

Coding and Documentation Improvement Services Maximize your revenue and population outcomes with Summit Strategic Solutions’ Coding and Documentation Improvement Services. Let us show you how to educate your physicians and mid-level providers on proper clinical documentation to ensure accuracy of coding to the highest specificity for a successful transition into Risk Adjustment.

We provide a strong focus on education, including how to apply accurate, complete, and consistent coding practices for the production of high-quality healthcare data. We will show you how to accurately abstract, assign, and report only the codes that are clearly and consistently supported by health record documentation, in accordance with applicable rules, and guidelines.

Additional programs can be included to show you how to implement pre- and post-appointment reviews, and how to best communicate with providers and coders for success.

Coding and Documentation Full Service Summit Strategic Solutions offers a full customizable range of coding services to help your healthcare enterprise quickly and efficiently implement best practices without needing to invest in acquisition and training of new personnel.

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

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

For further information about Summit Strategic Solutions’ Quality Reporting and Improvement offerings, call us toll free at 866-777-4975 or email us at sales@summitstrategicsolutions.com.

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.

Typical education programs we offer include:

Service Area Service Elements / Workflow Steps
Living with Diabetes Living with Diabetes is a class that provides specifics on nutrition, exercise, and medications to help patients live with this chronic disease. Patients are provided general guidelines, which are then customized for 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 Steps to Wellness is 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 The Smoking Cessation Program is 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.

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

Special Projects

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 Special Projects Group.

Examples of Special Program Services we offer include:

Service Area Service Elements / Workflow Steps
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.

For further information about Summit Strategic Solutions’ Value Based Strategies Special Projects offerings, call us toll free at 866-777-4975 or email us at sales@summitstrategicsolutions.com.

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.