2013 Care Coordination Session Details
Tuesday, May 7- Wednesday 8, 2013
PRE-CONFERENCE: PLATINUM AWARDS BRUNCH TUESDAY, MAY 7, 2013
10:30 - 11:00 a.m.Platinum Awards Keynote Speaker: Thin Ice: Meeting the Demands of Today’s Healthcare System While Negotiating Personal and Professional Ethics
Using examples and stories from practicing managed care staff, this presentation focuses on the ethical dilemmas that case managers and review nurses face every day. This is not your headline-making medical ethics; rather, these are day-to-day issues that tear at managed care professionals even as we are performing the daily tasks that our jobs demand. These are the situations that keep us up at night. When we take a moment to think about what we would want for our own loved one, it is difficult to reconcile the professional and the personal. This presentation does not solve all of the problems of dealing with the managed care conundrums, but will help to identify areas of conflicting values. Using various tools, participants will:
Develop a better understanding of their individual code of ethics.
Identify “hot buttons” and threshold for tolerance.
Develop personal strategies for communicating ethical concerns to leaders.
Melanie A (Lonni) Schicker, RN, MHSA, CCM, EdD
Health Services Administration, School of Nursing and Healthcare Leadership Minnesota State University Moorhead
DAY 1: CARE COORDINATION SUMMIT, TUESDAY, MAY 7, 2013
1:00 - 2:00 p.m.
Registration, Networking and Meet the Vedors
2:00 - 2:05 p.m.
Welcome and Introduction: Conference Chairperson Anne Llewellyn, RN-BC, MS, BHSA, CCM, CRRN
2:05 - 2:40 p.m.
Opening Keynote: Healthcare at the Tipping Point: Creating the Infrastructure for a New System of Care
At its best, healthcare in the United States is world-class. At its worst, the system is plagued with questionable care, gaps in access, and spiraling costs that impact long-term sustainability. Continued efforts to limit the growth of healthcare spending are essential for the future of our country. Ms. Toomey opens the Care Coordination Summit with an incisive view into the current challenges we face, and highlights the opportunities for strong, lasting change by exploring today’s most innovative work, which combines a balance of cost-cutting initiatives with efforts to maintain and improve the quality and availability of care across the care continuum. In this session, we will:
Discuss the current challenges the healthcare industry faces in ensuring access, improving quality and slowing healthcare spending.
Describe the opportunities that exist for professionals and organizations who have the ability to lead and innovate during disruptive times.
Share ideas that balance cost-cutting initiatives with innovative work in an effort to enhance the infrastructure of a new system of care.
Presenter: Holly A. Toomey, RN, BSHM; Associate Vice President, Care Management Strategy, McKesson Health Solutions
2:40 - 3:40 p.m.Care Coordination: Bridging Silos in a Patient-Centered Medical Neighborhood
For most patients in the U.S. healthcare system, the “medical neighborhood” appears as a diverse array of clinicians and institutions with little or no coordination between them, leaving patients and their families to navigate this system on their own. This session will show how First Coast Advantage, a provider service network, implemented care coordination to improve quality, ensure efficient utilization of healthcare resources, and enhance payer and provider satisfaction. In this session, we will:
Describe the expanded role of care coordinators in provider service networks and medical homes with regard to improving quality and enhancing utilization.
Develop deeper understanding of the role of the embedded transitional care coordinator in reducing utilization.
Review the impact that care coordination has on improved patient and provider satisfaction in PCMH-based provider service networks.
Presenters: Kenyatta Lee, MD; Assistant Dean of Medical Management and Metrics, Associate Medical Director
First Coast Advantage
Michael S. Lawton; Vice President, Managed Care University of Florida & Shands HealthCare
3:40 - 4:20 p.m.Slimming Readmissions with the Innovative In-and-Out Approach
The innovative care coordination model at Bassett Medical Center focuses on “in and out” coordination of care. This multidisciplinary approach has improved the delivery of care, reduced avoidable readmissions, improved transitions of care and engaged patients, providers and families to be partners in care. Learn how this innovative and reproducible model can improve quality while containing healthcare costs. In this session, we will:
Explore innovative practices of a care coordination model.
Identify risk factors that result in high readmission rates.
Describe the elements that create smooth care transitions and "in and out" coordination.
Presenter: Margaret Kiss, RN, BSN; Director of Care Coordination, Bassett Medical Center
4:20 - 5:20 p.m.Optimizing Pharmaceutical Care in a Collaborative Drug Therapy Management Program
PerformRx, in partnership with the AmeriHealth Mercy Family of Companies, created a drug therapy management (DTM) program to reduce the incidence of medication-related problems, improve the delivery of care, and control healthcare costs for diabetics who are high utilizers. This URAC-accredited DTM program has demonstrated reductions in emergency room visits and inpatient admissions, as well as significant cost savings, through the integrated collaboration of pharmacist-based and care management interventions. In this session, we will:
Discuss the challenges patients with chronic medical conditions face across the continuum.
Describe a drug therapy management program.
Review the outcomes that integrated collaboration of pharmacist-based and care management interventions can reap.
Presenters: Eric J. Berman, DO, MS; Regional Chief Medical Officer, Northern Division, Managed Care
AmeriHealth Mercy Family of Companies
Lauren C. Brophy, Pharm.D; Director, Drug Therapy & Formulary Management, PerformRx LLC
8:40 - 9:30 a.m.
Opening Keynote: Shared Decision Making: Effectiveness at the Point of Care
Most people don’t realize how many medical decisions are made every day: 82% of adults over the age of 40 have made a decision about having a surgery or screening test or taking a new medication in the past two years. Shared decision making allows individuals to have the best possible chance to improve their decision quality, which ultimately improves both the patient’s well-being and lowers healthcare cost. Join us to hear how shared decision making significantly improves health outcomes and lowers costs while transforming the way providers and patients communicate for better delivery of more effective, efficient care. In this session, we will:
Describe the medical decision process and the challenges individuals and healthcare professionals encounter.
Discuss the impact of shared decision making on the impact of patient engagement, adherence to care and cost containment.
Learn how shared decision making can improve care coordination and transition of care.
9:30 - 10:15 a.m.Redesigning the Patient Care Delivery Model through Care Coordination
The Affordable Care Act has spurred health systems to develop new structures of care delivery, including participation in the Medicare Shared Savings Program, formation of accountable care organizations, the use of patient-centered medical homes, and the leveraging technology to be more efficient. Implementing these new structures requires a redesign of the patient care delivery model, with a newfound emphasis on collaboration with case management and the intraprofessional healthcare team. This session will provide insights into change management strategies professionals can use to achieve successful implementation of an innovative patient care delivery system to meet the needs of today’s changing healthcare environment. In this session, we will:
Identify change management strategies for implementation of an innovative hospital-based patient care delivery model with decentralized case management.
Explore role redesign requirements of the unit-based RN case manager and unit staff RN that can eliminate rework and redundancy between roles.
Describe intraprofessional requirements for successful collaboration as an integrated healthcare team.
Presenter: Cherona J, Hajewsji, MSN, RN, NEA-BC; Vice President, Patient Care Services and Chief Nursing Officer, Deaconess Hospital Inc.
10:45 - 11:45 a.m.Professionalism: The Integral Competency for Case Management Success
As technology promises to streamline care processes, it carries a risk of blunting the analytical, communication, and professional skills of those working in case management and care coordination. This session focuses on the importance of maintaining and advancing the art of case management practice in the face of a healthcare system focused on raising efficiency and reducing the cost of care delivery. Topics include: the intellectual processes of case management, including critical thinking and emotional intelligence; evolving elements of technology solutions; and leveraging professionalism as a core competency for success in case management practice. In this session, we will:
Distinguish the intellectual case management process vs. the technical steps associated with business processes.
Identify two competencies at highest risk of negative impact due to advancing technology.
Define three strategies to mitigate the blunting of analytic and professional skills aligned with case management practice.
Presenters: Teresa M. Treiger, RN-BC, MA, CHCQM-CM/TOC, CCM; President, Ascent Care Management LLC
11: 45 - 12:30 p.m. Impact of Evidence-Based Health Promotion and Disease Prevention for Older Adults
Older adults are among the fastest growing population group, with the first “baby boomers” having turned 65 years old in 2011. It is estimated that by 2030 more than 37 million people in this group (60%) will manage more than one chronic condition. The scientific evidence suggests that involvement in health promotion and disease prevention programs is likely to improve health outcomes and help maintain older adults’ quality of life, wellness and independence. Ensuring the delivery of quality healthcare for older adults is challenging, but the federal government has numerous programs designed to improve this population’s health and healthcare, as well as monitor the impact of these wellness and prevention programs in their lives. In this session, we will:
Review the indicators of well-being currently addressed under Healthy People 2020.
Highlight potential research priorities toward health promotion and disease prevention for older adults.
Discuss the impact of community-based wellness and prevention programs focusing on promoting healthy lifestyles and chronic disease self-management for older adults.
1:50 - 2:30 p.m.Post-Luncheon Keynote: Recognizing the Value of Transitional Care & Care Coordination: New Codes & Policies Encourage Payment
New coding and reimbursement policies recognize the value of care coordination in keeping patients healthy and preventing costly hospitalizations. New CPT codes describe “Transitional Care Management Services” (TCM) and “Complex Chronic Care Coordination Services” (CCCC), which the RUC valued in 2012. Medicare began paying for TCM services in January. Medicare may also decide to pay for CCCC services in the future. This presentation gives details on how the codes were developed at CPT and valued at RUC; the Medicare reimbursement rates and policies; and what the future may hold for the reimbursement of care coordination. In this session, we will:
Discuss new coding and reimbursement policies impacting professionals responsible for care coordination.
Recognize the value care coordination brings in keeping patients healthy and preventing costly hospitalizations.
Describe what the future may hold for the reimbursement of care coordination as the healthcare industry works to improve access, contain costs and ensure safe, quality care for all who transition through the care continuum.
Presenter: Eileen Carlson, JD, RN; Associate Director of Government Affairs, American Nurses Association
2:30 - 3:15 p.m.Working Double: Managing the Dual Eligible Population with Cutting-Edge Practice Designs
Tallying a staggering 40 percent of the cost of Medicare and Medicaid, the 9 million dual eligibles, who receive benefits from both Medicare and Medicaid, are the focus of efforts to slow growth in entitlement spending. This session will present a model of care designed to address direct and indirect care needs for this population that, if not addressed appropriately, will have a negative impact on individual outcomes, optimal individual wellness, and costs of care. In this session, we will:
Recognize the importance of treating patient and family care needs holistically.
Develop care coordination strategies to address care needs across the continuum.
Establish synergies with care providers for a coordinated approach to addressing care needs.
Presenter: Mary Jane McKendry, RN, MBA, CCM; Vice President Clinical Affairs, Network Health
3:45 - 4:30 p.m.The Patient Experience as the Center of Attention: How Patient-Centric Models Are Now Financially Viable
In Accountable Care Organizations the focus on care coordination includes transitions in care to prevent readmissions, a strong focus on use of technology and use of defined guidelines by participants. The patient “experience” has finally become the center of attention by CMS along with the push to find innovative ideas to improve the healthcare system. This presentation will provide ideas for how to create projects and ensure that they meet the regulatory requirements in organizations looking to share savings with the government. In this session, we will:
Share ideas for patient experience and care coordination projects that can assist ACOs in being innovative.
Provide guidelines surrounding policy, procedure and process for new projects that can enhance healthcare savings.
Enhance participant understanding of ways to develop new programs, use technology and maximize cost-savings in the ACO world.