Inovalon, a leading provider of cloud-based software solutions empowering data-driven healthcare, today announced the addition of its EASE All-Payer claims management solution to the PointClickCare Marketplace. Building on a five-year partnership, Inovalon’s newest listing on the Marketplace offers healthcare providers sophisticated revenue cycle management (RCM) tools that are seamlessly integrated into PointClickCare’s Electronic Health Record (EHR).
The Inovalon EASE All-Payer claims management software, powered by the Inovalon ONE Platform, helps providers achieve a 99% first-pass acceptance rate among commercial and Medicare payers. The solution leverages an advanced payer rules engine that validates claims based on the latest requirements from the Centers for Medicare & Medicaid Services and Commercial insurers. The solution also allows users to easily create custom, facility-specific business rules that improve the accuracy of claims processed in each location.
Unlike other solutions, EASE All-Payer automatically checks claim eligibility and historical responses upon submission, enabling users to identify and correct upstream eligibility issues before transmitting to the payer. Additionally, the solution’s integration with Inovalon’s MORE2 Registry enables providers to easily source missing patient information, such as the Medicare Beneficiary Identifier, which can significantly reduce claims denials and improve first pass yield.
Also offered on the PointClickCare Marketplace is Inovalon’s Workforce Management solution, a fully mobile, real-time scheduling and open shift management application that scales from single units to entire enterprises. Inovalon solutions available on the Marketplace allow PointClickCare customers to operate within a single platform to launch, manage, and utilize applications, resulting in greater data accessibility and a unified user experience.
“We are pleased to enter the next phase of our long-standing partnership with PointClickCare supporting thousands of providers with the integrated tools they need to optimize financial and operational performance,” said Julie Lambert, president and general manager of the Inovalon Provider business unit. “Inovalon powers thousands of facilities with its industry-leading solutions, and our latest listing on the PointClickCare Marketplace ensures they are easily accessible to our joint customers.”
By Bill Chartnetski, EVP health system solutions and government affairs, PointClickCare.
For too long, long-term and post-acute care (LTPAC) facilities have not benefited from the same health IT investments or incentives as other care sectors.
Since the U.S. government introduced the meaningful use program as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, LTPAC organizations – notably nursing homes – and the vulnerable patients they serve have been left behind. As a result, these provider types sit outside of current interoperability and health information exchange efforts, and have been slow to adopt electronic health records (EHRs) due to a lack of government incentive programs. In fact, recent data show that only 18% of skilled nursing facilities (SNFs) integrate patient health information electronically.
The lack of investment impairs the necessary exchange of health information, exacerbates care fragmentation and disables the ability to transmit a patient’s critical health and demographic data across the trajectory of care. Patients of LTPAC providers are more likely to have chronic health conditions or behavioral health needs.
The complex nature of their health history and requirements makes care coordination more difficult as they transition between settings. So, why are we depriving the providers that care for them of critical infrastructure investments, especially as other sectors have received similar investments and adoption incentives in recent years?
Long-term care facilities are suffering from long-existing shortcomings exacerbated by COVID-19. On a daily basis, they contend with staffing challenges, infection control, oversight and regulation. Yet they are resilient and unwavering in their commitment to care.
Technology presents enormous opportunities to alleviate these issues, namely staffing challenges and the burden of administrative tasks that often take them away from caring for patients. One study, for example, found that six months after implementation of an EHR, nurses were spending significantly more time engaging patients in their rooms with purposeful interactions and less time at a nurse station. Using health information technology to capture resident health information in real time can also substantially reduce staff fatigue, burnout and the burden of relying on short-term memory, while also improving patient safety by enhancing the accuracy of the patient information.
Response from BJ Boyle, senior vice president and GM, acute and payer market, PointClickCare.
BJ Boyle
The one question healthcare technology professional should be asking right now is: how can we further address the COVID-19 pandemic and the challenges that came along with it with the help of technology?
There are a lot of ways to look at this and the ways technology has helped over the past year has already proven to be successful but we need to think about what’s next. With that in mind, healthcare professionals should look at this with a lessons learned lens. Interoperability will continue to be an important trend to watch this year.
We have entered into a new normal and senior care facilities and providers in particular simply need to share data to drive better health outcomes, which is where trusted data frameworks, come into play.
The objective is to connect, send-receive information, and automate admission workflows to help senior care teams ensure more seamless continuity of care for their patients through quickly reconciled medications, diagnoses, and more, with the ultimate goal of reducing readmissions and driving care plans forward.
The current situation has heightened the need to have access to all of patients’ vital information, comorbidities, allergies and medication information and having the ability to share through technology has made all the difference for providers. The ability to see the full view of the patient will allow clinicians to better track patients throughout their entire journey.
Part of this is through tracking referral network patterns.?There is a pattern between hospitals, homecare, and hospice, but it all needs to be brought together through interoperability, which is where technology plays an important role.
The ability to seamlessly transition patients between care settings needs to be addressed through one way or the other.
To say the least, 2020 was a difficult year for skilled nursing providers. Aside from the rapid, ongoing changes necessitated by COVID-19, providers are still reeling from recent, sweeping regulatory changes, including the CMS Patient Driven Payment Model (PDPM).
A year into life under the new model, some skilled nursing facilities are adapting to the new case-mix classification system mu
Russ DePriest
ch better than others, according to Russ DePriest, vice president and general manager of skilled nursing at PointClickCare.
“Under PDPM, CMS wants you to up your game when it comes to care outcomes, so fewer of your residents end up being readmitted to the hospital,” DePriest said. “As part of the new model, Medicare can withhold as much as two percent of reimbursements if a SNF has high readmission rates.”
The good news: Medicare pays facilities in full when they have low readmission rates, and offers added incentives up to 1.6 percent for exceptional performers. But what contributes to high readmission rates? For starters, a lack of automation, integration, and digitization across the resident journey.
Electronic Health Reporter recently spoke with Russ DePriest and Lauren Talbot, an EHR Consultant for Reliance Healthcare. Here, they discuss PDPM, the pandemic, and how digital transformation is driving outcomes in skilled nursing.
Question 1: Russ, how has the pandemic affected PDPM? And how have providers been leveraging technology to adapt to those changes?
Prior to COVID-19, PDPM was one of the biggest changes the SNF industry had seen to its system of operations. Prior to COVID-19, rather than focus on therapy, the new system incentivized treating the needs of the patient as a whole.
In terms of dealing with a high-needs population, PDPM is arguably better designed for a pandemic than the prior RUG system. Given COVID, where we know patients with co-morbidities are at a higher risk, paying on patient characteristics rather than therapy is beneficial to SNFs. So, although it wasn’t designed in anticipation of a pandemic, the new system is well-matched.
To help us further understand the impact of our technology on skilled nursing providers’ operations, including PDPM, we commissioned Forrester Consulting – part of an independent, objective research firm – to conduct a study and talk to some of our skilled nursing customers. I should note that Reliance Healthcare and Heritage Living were not among those customers.
Some of the interviewed facilities were able to save over $200,000 per year in PDPM-related penalties. This is because our platform enables digital transformation, and allows facilities to trace all treatments and associated results delivered to a resident. As a result, it’s easier for management to standardize and improve their evidence-based care plans, translating into better outcomes for residents. The result: facilities using the PointClickCare platform are better positioned to maintain the low readmission rate necessary to avoid penalties.
From a senior care perspective, we are starting to see many senior living communities shift their focus towards putting technology first. In fact, the shift over the last three years is exponentially more than all the progress from the last ten years combined.
As we continue to see an increase in the implementation of technology, we’ll also see residents’ quality of life improve because we are enabling them to age in place longer and remain in their preferred care setting.
In actuality, technological advancements and innovation are more likely to come to the senior living industry over any other care setting. Since these types of facilities are largely privately funded, senior living facilities are more likely to adopt these new innovations over those organizations that are funded by the government.
Overall, technology is starting to be more widely implemented to improve senior care by managing resident data more efficiently, all with a primary focus of helping our seniors to maintain the independence, health, and general wellness.
We have officially entered into a New Normal and technology overall will continue to play a larger role within the senior living space. Mobile technology will be even more critical and engaging family in care through the use of family engagement solutions will become foundational.
Leveraging an EHR as an underlying platform to improve overall care quality allows care providers to truly see resident needs and find creative ways to address them.
By taking a comprehensive approach to an EHR, providers in the senior living space can gain insight into the community’s key operating metrics, then adapt and adjust accordingly by regularly tracking clinical outcomes, staffing, and quality indicators.
From a data perspective, more and more senior living communities are recognizing the importance of interoperability. Data being collected shouldn’t just tell us where we are at, it should tell us where we are going by helping us predict potential issues before they happen.
By B.J. Boyle, vice president and general manager of post-acute insights, PointClickCare.
B.J. Boyle
In my last post, I discussed how our healthcare system is approaching a critical time in which the looming “silver tsunami” will drive baby boomers into hospitals and post acute care facilities in record numbers. Similarly, we will see dramatically increased patient transfers between care facilities, as an aging population moves between hospitals, skilled nursing facilities and senior living facilities in unprecedented numbers. At the same time, a seamless and accurate patient data transfer process is critical, given our current and predicted future nursing shortage, and the time-consuming and error-ridden nature of manual data transfers.
In order to determine if our system is optimized to deliver what is needed, PointClickCare recently conducted a Patient Transition Study in partnership with Definitive Healthcare, which found that alarmingly, many facilities haven’t yet fully embraced all of the possibilities of integrated electronic health record (EHR) platforms and are, instead, still relying on manual-based processes to handle patient transfers.
Respondents to the survey, which included c-suite executives from acute and post-acute care facilities, explained their current data sharing policies, interoperability issues, as well as other care delivery and coordination concerns in this important blinded voice-of-customer quantitative study. The data shows that while EHRs are nearly ubiquitous in hospitals and skilled nursing facilities, many healthcare professionals still struggle with — or have reservations about — sharing critical patient information with their care partners.
Instead of relying on secure, simple, HIPAA-certified technology to streamline patient transitions, providers have been utilizing manual processes like phone calls and faxes — systems that require a human touch and are prone to inefficiencies, mismatched details, and omissions.
The Over-Reliance on Manual Processes = Inefficiency
As patients move from acute-care facilities to LTPACs, the sharing of critical patient information and associated data safely and securely is extremely important for coordinating care. But despite best efforts and intentions, many providers still aren’t sharing all patient data and information.
The most startling findings from the survey dive into the number of acute care and LTPAC facilities that still use manual-only strategies to coordinate patient care. In fact, thirty-six percent of acute care providers use manual-only strategies to coordinate patient transitions with the LTPAC community, compared with only 7 percent of LTPACs with acute care providers. Although a majority (84 percent) of LTPACs use a mix of digital and manual strategies to manage processes, only 56 percent of acute care providers do.
One respondent to the survey, a CEO of an LTPAC facility, explained that their local hospital “uses faxes to accommodate HIPAA and [to] be confidential.” He (or she) found this particularly frustrating as it creates more work and slows down care delivery: “Almost everything we touch is obtuse. You have to search it out, figure it out, and confirm it by phone,” adding that the absence of standardized forms and data-entry fields makes faxes especially inefficient.
By B.J. Boyle, vice president and general manager of post-acute insights, PointClickCare.
B.J. Boyle
As every nurse, physician,
clinical case manager, and healthcare IT professional knows well, we have
passed the stage in which locking up patient data is an effective care
practice. In fact, ineffective data siloing can slow down operations and can
drastically and negatively impact patient care, as well as put unnecessary
strain on an already overtaxed workforce. In short, data silos are a great
barrier to realizing a fully
implemented state of interoperability.
We must unlock — and
importantly, share — critical health data to improve the quality of
patients’ care throughout their medical journey. Data sharing will
improve efficiencies in our nation’s health facilities by reducing
readmissions, reducing negative drug interactions, and improving care to
decrease patient length-of-stay, to name a few. Acute providers know that
reducing readmissions is critical in a value-based payment environment because
the penalties can be detrimental to the financial health of the facility.
That makes the need to share data quickly and efficiently more
pressing than ever. Only by embracing technological innovations and sharing
data can care providers see a holistic view of the patient — from potential
injuries and emotional challenges to drug interactions and comorbidities.
That’s not to say that keeping
up with demand while offering high-quality patient care will be an easy task.
But we know it certainly isn’t possible with the way things are.
Further, by accessing data about previous patient outcomes, case
managers can help patients and their families determine the right treatment
facility for them, increasing the effectiveness of referrals and increasing the
chances that your facility will become the preferred provider. When patients
are matched with the right facility for their specific needs the first time,
their recovery time and health outcomes will improve. That’s good for everyone:
decreasing costs and increasing hospital ratings by reducing readmissions is a
win-win.
More confident care
Data that has been removed from silos and integrated into a
cohesive and actionable digital chart allows providers to follow their
patient’s journey post-discharge, improving the speed and quality of
information exchange with skilled nursing and acute care facilities, which
leads to more confident care.
Modern EHR technologies and cloud-based solutions can finally make
interoperability possible and can increase efficiency so providers can stop
waiting by the fax machine and instead get back to doing what is most
important: helping patients heal.
Patient discharges, for example, can be extraordinarily labor-intensive and are further complicated when they are transferred to a post-acute care provider. As a result of the inherent complexities, hefty paperwork and need for seamless transitions, manual processes, a lack of transparency and data silos can cause significant negative impacts on patient health and frustration for families and providers alike.
The cloud-based technology we need already exists to assist with such paperwork, cutting down discharge time and allowing providers to get back to the myriad of other tasks awaiting them. Faster discharges mean more free hospital beds, helping with overall efficiency and an improved bottom line.
More information sharing between clinics also means patients can make informed decisions about their own health. Both patients and physicians or case managers will have a full picture of both acute and chronic issues while referrals can be made more effectively based on past results of patients with similar conditions.
When you think about it, using integrated technology to share success rates is a no-brainer. People research their meals on Yelp before going to dinner, or read reviews on a pair of shoes before buying them, so why shouldn’t patients be equally as informed about something as important as their health in real-time?
Data sharing can also effectively eliminate issues like drug or
medication problems. Researchers estimate that nearly half of all seniors between the ages of 70 to 79 take five
medications a day. A patient might be given his or her medication twice—or perhaps
not at all—because their care information is siloed between facilities. It’s a
problem that can easily be solved.
We know that outdated, labor-intensive processes that involve manually transmitting data to separate servers doesn’t make sense in a cloud-based world, especially when it comes to solving a crisis we know is coming. While a piecemeal data strategy might have worked in the past, we can’t afford to be less than buttoned up now or in the future.
With the anticipated increase in demand for skilled nursing and acute care services, innovative and integrated data systems are critical. Increased interoperability means patients and providers can make informed decisions, quality care is improved, and paperwork-heavy tasks are simplified, improving hospital and clinic efficiency and making life easier whether we’re the patient, caregiver, or provider.
We already live in a data-driven world, but it’s up to us to
embrace a better way to take care of our patients’ health information now and
in the future.
PointClickCare, the leading cloud-based software vendor for the long-term and post-acute care (LTPAC) and senior living sectors, announced today the launch of PointClickCare Companion. The new mobile app leverages the powerful design possibilities of iOS to significantly improve the way senior living providers track and manage the delivery and documentation of care services, medication, and billing. In addition to Companion, PointClickCare will be showcasing a variety of significant new enhancements to its senior living platform while at the Argentum Senior Living Conference.
PointClickCare companion
“After gathering direct input from senior living communities, as an Apple mobility partner, we’ve harnessed iOS, the most robust development platform available to thoughtfully and confidently create a mobile experience that addresses providers’ complex needs while still keeping the simplicity and the user experience in mind,” says Travis Palmquist, vice president and general manager of senior living, PointClickCare. “As a result, we believe Companion’s sophisticated user interface and streamlined workflow capabilities will drive mobile-led business transformation and help to redefine and improve how communities provide resident care.”
By simplifying the critical task of patient documentation in an easy-to-use iOS app, PointClickCare Companion delivers unique benefits without interrupting the resident caregiver interaction, and provides senior living communities several significant outcomes, which include:
Enhanced resident experience: With immediate access to information on their iPhone or iPad, caregivers may reduce the time typically required for documenting a task. Tasks can be completed accurately and efficiently, in a timely and less clinical manner, increasing resident satisfaction with the service they are receiving.
Improved financial health: Senior living communities can quickly identify, capture, deliver and bill for ancillary services, as well as justify additional service billings (scheduled or unscheduled), with accurate documentation.
Expanded talent retention: Companion’s user-friendly tools empower staff to manage their day by simplifying the medication distribution and documentation process with intuitive workflows. Many activities of daily living (ADL) can be completed in 30 seconds or less at the point of care. Caregivers can spend more time focusing on patient care and less on administrative tasks
These outcomes can be further enhanced when Companion is integrated with other PointClickCare solutions, such as its point of care (POC) and electronic medication administration records (eMAR) modules.
Inovalon, a leading provider of cloud-based software solutions empowering data-driven healthcare, today announced the addition of its EASE All-Payer claims management solution to the PointClickCare Marketplace. Building on a five-year partnership, Inovalon’s newest listing on the Marketplace offers healthcare providers sophisticated revenue cycle management (RCM) tools that are seamlessly integrated into PointClickCare’s Electronic Health Record (EHR).
PointClickCare