Case Study Reveals Improved Care Coordination for Patients, Savings
of $1,150 per Case
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.
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:
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.
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.
Katie Lilley, 703-722-3061
Source: MedSolutions and Orange Health Solutions