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What's new in Managed Care for I/DD services

 
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In December 2010, CMS announced the State Demonstrations to Integrate Care for Dual Eligible Individuals, a competitive solicitation for proposals to design person-centered models that coordinate primary, acute, behavioral and long-term supports and services for Medicare-Medicaid enrollees. There were 15 states that were selected to participate in this demonstration. The 15 states that were selected were: California, Colorado, Connecticut, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oklahoma, Oregon, South Carolina, Tennessee, Vermont, Washington, and Wisconsin. The main requirement for participation was to increase care coordination. From a managed care standpoint, this means getting providers , including medical professionals, to spend more time on care coordination and less time on authorizations and denial appeals. The health plans themselves need to increase member services. With that, let's take a look at some states that are currently implementing or running Managed Care for I/DD services.

MediSked Weekly News Roundup 4/14/14

 
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Here's the latest news from around the country affecting our provider agency partners...

Taking the Leap: A Computer System for Provider Agencies

 
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One phrase we hear all of the time from agencies we work with is "I don't know how we use to manage our agency before we implemented MediSked Connect."  And while it's always nice to feel needed, the real message is: For our agency to be around in 10 - 20 years, we HAD to move to electronic records.  There are signs and trends in our industry that point to the need for computer systems for provider agencies.  Some of them include:

MediSked Weekly News Roundup 4/7/14

 
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Last month we recognized National Disability Awareness Month and move into April with the same appreciation.  Please take some time to review the articles below.

April Fools! Why an EMR for DD Providers is misleading

 
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Over the years, we've found that the education on Agency Management Platforms is most often side-tracked by two words - Meaningful Use.  These two words are very misleading to DD providers as they search for an all-in-one electronic record solution.  It's a carrot that most DD providers will never get, reimbursement on their software platform (Certified EHRs and EMRs) from CMS.  An incentive to get PCPs, Hospitals and CAHs into the 21st Century.  But, CMS has ignored HCBS services in meaningful use as the requirement necessary to receive payments don't match the types of services or professionals that are usually present at provider agencies.  Unfortunately, we see DD providers investing in certified EHRs and EMRs only to find out later that they will never receive reimbursement on their software from CMS.  Remember, the target population for meaningful use is medical professionals.  Therefore, the requirements are very much driven by medical services, workflows and qualified medical professionals.  To learn more about meaningful use requirements, check out their website here: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html 

MediSked Weekly News Round Up! 4/01/2014

 
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Good afternoon, here are a few of the stories the MediSked team is tracking this week:

MediSked Connect Features Update for Q1, 2014

 
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With Quarter 1 coming to a close, we wanted to highlight some of the more exciting updates to the Connect product line in this week's post.  Below are three of the more popular updates and also the updates we are going to focus on in our online quarterly User Group Meeting; which is being held today and tomorrow.  Enjoy and please let us know if you have questions.

MediSked Connect, are you just using your computer for Facebook?

 
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If a person from 1900 showed up today and asked you, what was the most amazing advancement that you have witnessed, what would you say?

Next Stop: Sharing Electronic Records for DD Agencies

 
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With electronic records becoming more and more commonplace today - the majority of DD providers across the country having implemented an agency management platform, the next "big thing" will be sharing data outside of your agency's walls.  DD Provider software is crucial as CMS steps up its HCBS Waiver regulations.  The term "quality management" is used non-stop in CMS messaging and having electronic records is, inevitably, the only legitimate way to increase quality management and pass tighter CMS & state audits.  Assuming your agency has already invested in electronic records and is using them across your programs and services, the idea of sharing client records is the next natural step, especially with person-centered planning and services being the focal point of CMS's direction.  
This is relevant in two ways:

1. We could see more instances of individuals receiving a variety of services from different agencies, whereas in the past typically services for an individual tended to be bundled under one agency.  Agencies will probably become more specialized, i.e. Agency X's day program is the best, but Agency Y's residential is better.  If this is the case, a person-centered approach to electronic records must be in place.  This means it will become more and more important for agencies to transmit data back and forth amongst each other regarding shared clients.  To deliver the best service and care, you are going to need the ability to read records on what is going on with your clients as they receive services from other agencies.  In some cases, it goes even farther and you will need real-time alerts if an accident or emergency happens to one of your clients while they are receiving services at another agency. 

2. A more person-centric focus is also starting to pull in areas of the individual's medical and clinical services.  This coincides with more and more states electing to move in the direction of managed care for DD services.  This bundles the individual's entire health and human service delivery under one roof.  In this scenario, it's basically a requirement that provider agencies will have the ability to share data to the managed care companies and health and medical stakeholders to provide and manage the "wrap around" care. Sharing DD data with health and medical data has the potential to unlock never before seen trends and better manage their health in home and community based settings.
Sharing data with other agencies and with 3rd party insurance companies and stakeholders is getting closer and closer to a reality.  With security precautions aside, thinking about this concept opens the door for a lot of questions and possibilities.  It was always said that implementing electronic records at the agency level breaks down departmental and programmatic silos.  Taking it one step further and sharing records outside of your agency to other important stakeholders in your client's life breaks down even more walls.  Sharing of electronic records is not an earth-shattering new idea.  Primary care practices and hospitals have been involved with record sharing initiatives through Regional Health Information Organizations (RHIOs) for years.  However, focused on the DD population, record sharing and data trending between human services and health services has never been done in large scale before.  What possibilities and breakthroughs can be uncovered?  How will the lives of those you serve be better off as a result?  It's really exciting to think about and it is coming.  What would be some areas of information that you would be excited about potentially seeing through the sharing and reporting on dd electronic records at an aggregate level?  Let us know!




News Roundup for week of 3/17/14

 
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Here's the latest news in our world from around the country...

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