Tuesday, 23 August 2016 18:57

The Value Proposition of Long-Term and Post-Acute-Care Coordination

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This article, the final in a series, summarizes the May 2015 Office of the National Coordinator for Health IT (ONC)brief prepared for Karen DeSalvo, M.D. on the Health Information Technology Use & Value Delivered by the Long Term & Post Acute Care (LTPAC) Sector. Previous articles outlined the five major valued quality coordinated care (VQCC) differentials of long-term post-acute care when compared to hospitals and physician offices.

The definitions of the five VQCCs listed below tell a unique story in the value proposition and quality of care and quality of life required in the new care and payment models in the spectrum of care.

1. Duration of Care Differential
  • Prolonged care duration over a hospital length of stay for continued diagnosis, care, and clinical outcomes
  • Person-centric clinical care, activities of daily living, and social observations over a long course of care
  • The development of a person-centric electronic longitudinal care plan
  • The trending of clinical information to establish alerts, early potential intervention and prevention care as well as a beginning of care maintenance and wellness goals.
2. Electronic Assessments Differential
  • A comprehensive clinical and functional total patient electronic assessment (e-assessment)
  • An e-assessment under the Centers for Medicare & Medicaid Services’ (CMS) regulations and approved standards that is updated to a schedule and as necessary
  • An e-assessment conducted by a coordinated team of licensed personnel in accordance with CMS regulations
  • Clinical knowledge over a long duration of time to allow an electronic medical record (EMR) software application to develop trending and alerts to potential incidents and prevent possible rehospitalizations, regardless of the site of care.
3. Chronic Care Comorbidity Care Differential
  • LTPAC providers as one of the first providers after hospital discharge to coordinate care, have coordinated staff, and use health information technology (HIT) capability to conduct chronic care comorbidity e-assessments
  • A complete clinical profile of the patient identifying the diagnostic care, treatment and/or maintenance plan, and observation requirements for chronic care and comorbidities
  • A person-centric longitudinal care record based on coordinated team care in a controlled environment
  • A plan that prepares the person (and family) for the next level of care or the home of their choice.
4. Medication Management Differential
  • Provides a comprehensive review of the whole person’s medication management and reconciliation by a licensed consultant pharmacist as it relates to all factors that affect the clinical outcomes of medications including laboratory, diet, and therapy. Clinical information reconciliation (CIR) includes medication reconciliation and medication indication for use, allergies, allergy intolerance or reactions
  • Reviews the hospital transition of care reconciled medication results as they pertain to medications taken before hospitalization and the potential drug interactions and manages polypharmacy, ensuring that each medication has an indication
  • Includes a nursing center with a medication team of the nurse, medical director, primary care provider, institutional pharmacy, and consultant pharmacist who conducts a comprehensive integrated person-centric management of medications in the electronic health record (EHR), electronic medication administration record, and in some nursing homesan automated medication-dispensing instrument
  • Provides medication counseling when transitioning to another provider or home.
5. Technology Differential
  • Provides a person-centric electronic longitudinal care EHR that covers a long duration of care
  • Aggregates all medical data functions over a long duration of care allowing trending and alerts to prevent incidents
  • Uses devices to track activities of daily living
  • Provides a controlled clinical environment where advanced clinical technology can be tested and utilized by hundreds of persons to assist in public health technology. 

In spite of this impressive list, the story of the value proposition of LTPAC is not over. There are two very important requirements that all members of the person-centric electronic longitudinal care with a focus on prevention and wellness will have to have to achieve success in the new value spectrum of care. They are:

  • Transitions of care (ToC) (interoperability) through certified standards
  • Secure, privacy, HIPAA, hack- and ransom-proof trusted systems.

Although LTPAC providers did not receive HIT incentive funds to upgrade their infrastructure, the technology vendors have responded to the need for operational efficiency and better care coordination at a cost that is scaled to LTPAC. The top LTPAC HIT vendors have upgraded their applications and are certified. Additionally there are cost-effective electronic document exchange applications, like Kno2, that are available for LTPAC that meet the requirements of ToC, replacing manual fax workflows with more efficient methods and standards in healthcare, like Direct, Carequality, Commonwell and IHE profiles.

There are corporations that can provide a comprehensive assessment of a provider and health IT vendor secure, privacy, HIPAA, hack-and-ransom proof like BlueOrange Compliance. Their systems were designed for LTPAC and hospitals. The business model is to be a partner in compliance and not just provide a report that sits on the shelf.

The value of LTPAC is slowly being understood and realized, as CMS proceeds at full speed to provide the regulations that have to be put in place to assure the new models of care and payment are successful. If the five VQCCs are understood by the partnerships in healthcare, those requiring care will receive a greater benefit from post-acute-care providers and their vendor supporters. More about ToC and compliance to come in upcoming articles.

About the Author

John F. Derr, RPh is CEO of JD & Associates Enterprises specializing in strategic clinical technology with a focus on person-centric electronic longitudinal medication management and LTPAC. He has more than 50 years of top executive level experience Squibb, Siemens, Tenet (NME), Kyocera, MediSpan and EVP of AHCA. He was SVP, CIO and CTO for Golden Living, LLC. He is a member of Corporate Boards providing guidance on clinical Health IT and medication management. He represents LTPAC and Pharmacy as a member of HHS HITECH Committee on Standards. Derr is a graduate of Purdue School of Pharmacy and a 2006 Distinguished Purdue Alumnus.

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Last modified on Wednesday, 24 August 2016 05:14

John F. Derr, RPh is CEO of JD & Associates Enterprises specializing in Strategic Clinical Technology with a focus on person centric electronic longitudinal medication management and LTPAC. He has over fifty years of top executive level experience Squibb, Siemens, Tenet (NME), Kyocera, MediSpan and EVP of AHCA. He was SVP, CIO and CTO for Golden Living, LLC. He is a member of Corporate Boards providing guidance on clinical Health IT and medication management. He represents LTPAC and Pharmacy as a member of HHS HITECH Committee on Standards. Derr is a graduate of Purdue School of Pharmacy and a 2006 Distinguished Purdue Alumnus.