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Implementing an EMR
Client Profile: Mid-Atlantic PACE program
Project Type: PACE Services
Challenge: To successfully implement an electronic medical record (EMR) for a PACE organization. The client had planned to go live with the EMR, but saw warning signs that the implementation might require additional assistance in order to be successful.
DGA Solution and Results: DGA quickly assessed the situation. We found that though the client had invested over a year in customizing the EMR, the current PACE program staff had limited familiarity with the final product or its anticipated impact on operations.
DGA provided on-going assistance in a comprehensive interdisciplinary review of the system, helping management and staff prepare for the EMR’s impact on operational processes. We developed a comprehensive education program for the EMR users and supported this training program by leading discussions, documenting key decisions and providing hands-on training to key users.
The EMR went live with over 80 trained users in three physical locations. Users reported an extremely high level of satisfaction with the training program and the go-live support they received, and the EMR was implemented successfully.
Redesigning a Utilization Management Program
Client Profile: Large, multi-site PACE program
Project Type: Managed care operations
Challenge: To evaluate the utilization management program, which was in transition. The position of utilization manager had been vacant for many months and the UM program was being managed by a variety of approaches; the PACE program used this as an opportunity to assess its current program.
DGA Solution and Results: DGA assessed the existing utilization management program and identified opportunities for strengthening it. We recommended the development of a written UM plan that defines the program’s goals and objectives, along with an annual work plan specifying the targeted priorities and goals for the UM department. We also recommended development of a dashboard report to provide management with timely utilization data at an appropriate level, as well as the adoption of standardized metrics, and the capability to support drill down analysis into claims data.
The utilization manager position was elevated to a director-level position, and a new search was started.
Planning for EMR and Related Systems
Client Profile: A multi-faceted elder services managed care organization and provider
Project Type: Business and Functional Requirements for IT
Challenge: To plan integrated information technology (including EMR, claims processing, financial) across newly developing managed care services (PACE, SNP, and related services).
DGA Solution and Results: DGA led a multi-disciplinary team in defining the client’s information technology (IT) needs. We developed detailed documentation of the business requirements for the PACE program and other lines of business. We also assisted the team by preparing a Request for Proposal (RFP) for IT vendors, and helped the team prepare for an effective RFP review process.
The client indicated that as DGA had helped them identify business requirements, we had also helped senior management to identify opportunities for consolidation and centralization of its various business lines.
Developing Data Transfer Standards for PACE Organizations
Client Profile: National PACE Association (NPA) which supports PACE organizations
Project Type: Business and functional requirements for IT
Challenge: To develop national data transfer standards for PACE organizations. PACE organizations have a range of software that typically does not share data (e.g. claims processing, financial, clinical, etc.). As a result, the organizations may have to enter the same information repeatedly, introducing errors and taking extra staff time.
The NPA sought assistance in developing uniform specifications for the transfer of data across systems, which could be shared with all of its members. This assistance had to come from an organization with strong IT knowledge and an in-depth understanding of how PACE organizations operate. The NPA turned to DGA Partners.
DGA Solution and Results: DGA, working closely with NPA staff, facilitated a work group composed of system vendors and PACE organizations. Because group members were located throughout the country and have limited travel funds, the group’s work was accomplished through web meetings, phone calls and email correspondence. DGA integrated feedback from all parties, prepared, reviewed and revised various drafts of the specifications and guided the group in arriving at a consensus on a final specification.
We documented the specification set, which will be adopted by the NPA as a suggested standard for data transfer in PACE organizations. Implementation of the standard by PACE organizations will reduce their need for manual data re-entry, increase efficiency and reduce data errors.
Optimizing Performance for a PACE Organization
Client profile: A leading PACE organization experiencing rapid growth.
Project type: PACE Services
Challenge: Optimize financial and clinical performance for a PACE organization. PACE organizations provide comprehensive managed care services as an alternative to nursing home care for a frail population. Because PACE organizations receive a capitated payment to meet all of the needs of the frail, elderly population, PACE organizations must apply managed care principles to a small population needing intense and complex medical and social support.
DGA Solution and Results: DGA assessed every major aspect of the organization’s management and operations:
- Clinical care and protocols
- Service pre-authorization
- Claims payment operations
- Information systems, and financial and medical cost reporting
- Staffing, policies and policy adherence
- Performance monitoring approaches
- Contracting and credentialing
- Marketing strategy
We confirmed the appropriateness of much of the operation, and developed a focus set of recommendations for improvement that provided the management staff with a clear roadmap and specific tasks.
Helping a PACE Organization Define IT Requirements
Client Profile: A well-established PACE (Program of All-Inclusive Care for the Elderly) that is part of a larger health system.
Project Type: Business and Functional Requirements for IT
Challenge: To assess the client’s IT needs before significant investments were made. This was a particularly complex task due to the wide range of health plan, health provider and social service agency functions provided by PACE organizations, and the relative lack of specialized software for these organizations. In addition, as part of a larger health system, the PACE organization was expected to accept certain system IT services that did not meet the unique needs of PACE organizations.
DGA Solution and Results: We interviewed staff and management, defining the organization’s functional IT needs, including workflow, reporting and data analysis. We determined which data was now captured in systems (including an electronic medical record and a claims system) and which was paper-based.We identified risks and inefficiencies associated with duplication of effort and opportunities to provide better management information.
DGA recommended an overall strategy for information technology, refining a strategy recommended by the PACE organization’s health system parent. Our recommendations reduced complexity with only minimal reductions in functionality, an approach readily embraced by the PACE organization and the parent organization’s IT staff.
The strategy included use of an SQL database to improve data integrity for home-grown Access and Excel applications. In addition, the existing specialized stand-alone software systems feed a business intelligence data warehouse to support reporting and analysis.
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“DGA is our trusted advisor on a range of PACE issues from finance to IT to managed care operations. DGA understands PACE and they understand the broader healthcare world to help us address the complex issues we face.”
Christine Allen, Vice President, Research & Development
Genesis HealthCare Corporation, Kennett Square, PA
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