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Orange Health Solutions Announces Results of Innovative Post-Acute Care Partnership with MedSolutions

July 22, 2014

Case Study Reveals Improved Care Coordination for Patients, Savings of $1,150 per Case

JACKSONVILLE, Fla.--(BUSINESS WIRE)-- Orange Health Solutions (Orange) published a case study today revealing the results of an innovative post-acute care partnership with MedSolutions, a diversified medical cost management company based in Franklin, Tenn.MedSolutions worked in partnership with Orange Health Solutions and their fully owned accountable care organization, Orange Accountable Care (OAC), to make the fragmented post-acute care experience more coordinated for their Medicare Fee for Service (FFS) patients. Together, they ensured that quality post-acute care was provided in line with evidence-based medicine, and in the most appropriate care setting for each patient’s unique circumstances.

OAC is part of the Medicare Shared Savings Program, which rewards ACOs for lowering health care costs while maintaining or improving quality of care standards for Medicare FFS patients.

During the case study period, OAC realized a reduction of more than 38 percent in utilization of Skilled Nursing Facilities, and a reduction of more than 25 percent in Inpatient Rehab Facilities for patients engaged in the jointly developed post-acute care program. These reductions generated savings of approximately $1,150 per case and $24 per member per month. The majority of these members were directed toward home care as the most appropriate avenue based on their individual clinical, environmental, and psycho-social resources and needs.

“In a previously unmanaged patient environment, Orange and MedSolutions partnered to develop a unique solution for managing post-acute spend,” said Nicole Bradberry, president and chief operating officer at Orange Health. “Orange’s management of the patient-physician relationship and patient profile coupled with MedSolutions’ expert staff and clinical guidelines resulted in positive behavior change that out-performed traditional payer denial methodologies. The achieved success utilizing influential techniques rather than denial truly embodies the transformation of healthcare today.”

This post-acute care partnership was initiated due to the lack of visibility the ACO physicians had into what was happening with their patients in the hospital, and subsequent concerns about patient outcomes and overall costs. Additionally, most hospitals lack the resources to coordinate care in the community and do not have the support resources to engage in patient follow-up once treatment is completed at the hospital facility. We were able to address these challenges by applying evidence-based guidelines, taking into account each patient’s unique needs and resources to best determine the most appropriate site and course of post-acute care.

This post-acute program was able to deliver savings to OAC and its members without making any large-scale changes to the processes already in place. Instead the focus was solely on making the process more efficient and effective.

“Our focus was on making the fragmented post-acute care experience more coordinated, efficient and engaging for all constituents of the ACO, as well as the patient and their caregiver as part of the solution,” said Ken Van Cara, vice president of new products and innovation for MedSolutions. “By bridging the communication gap, we were able to have greater impact on post-acute care – improving patient outcomes and experiences and generating significant cost savings.”

In the FFS model used with OAC, MedSolutions was only able to make recommendations to the discharge planners at the hospital. Under the company’s fully-managed model, MedSolutions coordinates discharge to the appropriate site of care.

Two examples of real patient scenarios illustrate the effectiveness of OAC’s post-acute program:

  • Patient A, a 79-year-old male, was being administered IV antibiotics on the second day of his inpatient stay at the hospital and was therefore referred to a Skilled Nursing Facility for discharge. However, when a MedSolutions case manager reviewed Patient A’s notes on the third day of his inpatient stay, she noted that he had been transitioned to oral antibiotics. The case manager then contacted the discharge planner and proposed that the patient be given the option to go home with home health services.
  • Patient B, a 64-year-old female smoker with COPD, was to be discharged with no services. However, a MedSolutions case worker reached out to her to discuss her case, and Patient B admitted that she did not fully understand her condition, why she was required to use oxygen, or how to take care of her condition after her release. As a result, the case worker spoke with the discharge planner to provide recommendations, and the hospital helped arrange for Patient B to go home with home health to provide additional support.

    To read the complete case study, please visit http://www.medsolutions.com/news/downloads/orange_casestudy.pdf

    About Orange Health Solutions

    Orange Health Solutions is forging the new era of healthcare by focusing on proactive care management and medical cost management, supported by best-in-class patient engagement delivered via highly trained personnel. With the recent acquisition of MZI HealthCare LLC (MZI) they have built one of the most innovative companies in the healthcare industry. Established over 25 years ago, MZI provides transformative healthcare technology solutions designed to meet new clinical and performance requirements. Their products help healthcare organizations harness clinical, financial and administrative information, giving them a unique perspective to make smarter decisions about patient care and payment, resource allocation, provider and contract management and more. The healthcare services of Orange Health, in combination with MZI’s technology, allow providers from small physician practices to large health systems to maximize the increased revenue opportunities of these new models of care. Visit www.NewEraOfHealthcare.com.

    About MedSolutions

    MedSolutions offers proven, diversified medical cost management solutions that help clients reduce costs while increasing quality of care for their members. Powered by its team of specialized medical professional resources (over 70 doctors and over 220 nurses), extensive evidence-based guidelines, and advanced technologies, MedSolutions supports clients and their providers in ensuring the right (evidence-based) care is delivered at the right time to the right patient at the right site.

    Flexible management solutions are offered in: Diagnostic Testing and Imaging; Comprehensive Musculoskeletal; Oncology and Cardiology Services, and Post-Acute Care (including participating in the CMS Bundled Payments for Care Improvement Initiative). MedSolutions provides solutions for Commercial, Medicare, Medicaid and other leading healthcare organizations. MedSolutions is proud to help over 33 million Americans receive higher quality, lower cost healthcare. Visit www.medsolutions.com.




    Hillenby

    Katie Lilley, 703-722-3061

    katielilley@hillenby.com

    Source: MedSolutions and Orange Health Solutions


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