South Florida Hospital News
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January 2017 - Volume 13 - Issue 7
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Healthcare Navigation Systems Can Help “Connect the Dots"

Consultation and support. That's what Judith Scott offers clients as a senior consultant for Healthcare Navigation Systems. HNS is an organization that is experienced in the health care delivery system, providing consultation for outcomes improvement programs. Areas of expertise include the Bundle Payment program, the development and implementation of strategies for length of stay reduction, readmissions rate reduction, care coordination, the management of the transitions of care process, and gaps in care. Ms. Scott described her job as "connecting the dots” in the health care delivery system.
 
She explained that Obamacare introduced new health care reform policies, the switch from fee for service to value-based reimbursement being one of them. "With new programs, the provider is responsible for the patient for a 90-day episode of care," she said. "Over that period, whether it's elective surgery or whether the physicians are caring for the patients long-term, if there are re‑hospitalizations or emergency room visits, there are financial implications for health care providers." With this program, instead of getting paid for the number of visits the patient makes to their office, physicians are getting paid on their performance, and for the patients’ outcomes.
 
To help alleviate this, Ms. Scott said HNS provides care coordination services, which she says is a key strategy that has the potential to improve safety and efficiency in the health care delivery system. "Encouraging collaboration among all the stakeholders involved with the patient's care helps to connect the dots, and ensures that all eyes are on the patient, and that the patient does not fall through the cracks. Effectively managing the care transition process is important for great patient outcomes."
 
As an example, Ms. Scott said she has been talking with Accountable Care Organizations (ACO). An ACO is a group of health care practitioners that is accountable to patients and third-party payers for the quality and cost of overall care. Health systems like these have to report on quality measures that determine important incentives and penalties. She believes that care coordination is an asset to busy physicians, in assisting them to stay connected with their patients and helping to prevent unnecessary readmissions and emergency department visits.
 
She states that physicians receive a Quality and Resource Use Report (QRUR) from Medicare with information regarding their performance on quality and cost-of-care measures delivered to patients. Their performance is compared to benchmarks of similar peer groups in the country as it relates to emergency room visits or readmission rates. This report can be used to their advantage to streamline use of resources, and to identify care coordination opportunities for patients. She believes that data analysis is very effective in impacting the delivery of value-based care.
 
She went on to say that care coordination clinicians play an important role in helping to close gaps in the patients' care. "A lot of changes may be happening in the patient’s support system at home, which the doctor is not aware of. These changes can result in low levels of adherence with medication and disease management regimens. Telephonic outreach by a clinician care coordinator can ameliorate these situations and improve on patient outcomes. An office assistant making outreach calls to such patients may not be a cost-effective method in managing the gaps in care."
Ms. Scott helped to pilot the Bundle Payment program at NYU Langone Medical Center in New York City. "I worked for the past three years with the Bundle program at NYU orthopedic hospital, which has given me first-hand knowledge and experience. I am very aware of the cost-effective measures of providing value-based care and how to improve care quality through effective care coordination." She stated that NYU has had one of the most successful Bundle programs in the country – reducing readmission rates, re-hospitalizations, and the overall cost for the episode of care.
 
"I actually relocated (to South Florida) six months ago because I wanted to bring that expertise here. I can't wait to get really involved, because I would honestly like to add value to what's being done. I'm passionate about it."
 
Consultation and support is what Ms. Scott provides. Support for the patients to have better outcomes, and consultation for executives who are concerned about the financial implications of their performance, as they seek to provide the highest quality of care in the most cost-effective way.

 For more information, call (561) 444-9011 or visit www.healthnavisystems.com.

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