Signature Care Management: Improving Patient Outcomes with Value-Based Care

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Mike Medler, Senior Director of Technology and Analytics

The medical industry is inching toward value-based healthcare, bundled payment models, and an analytics-driven approach to provide better care services. Contrary to the fee-for-service model, value-based healthcare integrates primary, specialty, and acute care on a single platform to bring in the elements of accountability and transparency to medical services. More importantly, the value-based model reduces financial expenditures for patients, providers, and physicians collectively, as well as improves clinical outcomes. Although value-based care models are becoming more prevalent, the market features very few solutions for healthcare organizations to transition from fee-for-service to value-based care models of reimbursement.

In an interview with CIOApplication, the leadership team of Signature Care Management (SCM), which includes Ann Conrath, Director of Business Development, Matt Civili, Senior Director of Program Management and Mike Medler, Senior Director of Technology and Analytics, discuss how their solution is transforming the healthcare industry from a capitated approach to value-based healthcare.

How does your solution address some of the prevailing challenges in the healthcare sector?

Mike Medler: Medical services have historically been expensive for patients owing to the charges levied based on the number of services delivered. At various stages under such a model, starting from the stages of consulting the physician, medical services are often not coordinated and become unnecessarily overwhelming, which results in higher cost for the patient. SCM has crafted a state-of-the-art software, CareMOSAIC, which is a cloud-based case management and data analytics software that keeps track of patients in realtime across the continuum of care.

In the traditional health care ecosystem, the physician admits the patient to the acute care setting where discharge planning often occurs at the last minute. Following this, the patient may be discharged to a skilled nursing facility that does not know the patient and initiates a different plan of care than originally designed. Each of those stages lacks coordination, despite being systematically organized, with no tracking through the continuum of care. CareMOSAIC ensures that healthcare providers adopt the right workflow for the best outcomes.

What features and functionalities does your solution offer? How does it work in accordance with a value-based care model?

After patients' consultation with a physician and the subsequent scheduling for surgery, we start to evaluate, track, and conduct a risk assessment with the patient to check if any additional services are required before we optimize the workflow of surgery.

Our analytics-driven platform, CareMOSAIC supports decision-makers to understand the current utilization for each of the different services and accordingly, they can make adjustments as the patients go through the continuum of care

For this, a highly-experienced case manager performs a detailed risk assessment of the patient to ensure that the patient has an appropriate care plan, from pre-admission all the way through post-acute services and full recovery. Along the way, CareMOSAIC keeps track of the patients across different stages of care, from pre-operative surgery through discharge. Not to mention, we also track them through all of the post-acute treatment modalities, ensuring that each patient receives the appropriate level of care in the right setting.

Our analytics-driven platform, CareMOSAIC, supports decision-makers in understanding the utilization of the different services, and accordingly, helps healthcare professionals make adjustments as the patients traverse through the continuum of care. Enabled with an agile workflow software development platform, our in-house development team virtually sits in the same room with case managers and account managers. The feedback is instantaneous, and within no time, the team can craft a prototype and beta-test the update to fit the workflow of our users.

By merely observing the dashboard of CareMOSAIC, case managers have immediate access to critical information sets pertaining to patients, such as the different phases of service delivery. It allows them to easily keep track of their daily workflow. Executives, on the other hand, can access financial reports to determine where they stand from a business standpoint.

Matt Civili: Until SCM stepped into the market, there wasn't a single episodic management platform that was shelf-ready for the users. The journey to innovate the product was unique; instead of adopting a traditional development approach, we employed IT coders who created CareMOSIAC based on the feedback obtained previously. We brought in clinicians, orthopedic physicians, and nurse case managers for a thorough assessment of the platform.

Can you elaborate on the services and support provided by Signature Care Management through value-based consulting to its clients?

Ann Conrath: Our consulting services are varied and flexible to the needs of our clients. Not only does SCM support hospitals and physician group practices in government value-based care initiatives such as bundled payments, we also help clients when it comes to implementing commercial bundled payments. We believe that the core components to achieve success in value-based care relate to the incorporation of a case management team, care coordination, and data analytics on a single platform.

What are the key differentiating factors that set your company apart from your competitors?

Mike Medler: As SCM is physician-owned and physician-led, we have a team that has been participating in these value-based arrangements for six years now. By crafting customized and effective strategies for healthcare organizations, SCM assists its partners in navigating the care redesign process to improve efficiency, quality, and the overall well-being of the patients.

What's the next big step that your company would be taking,12-18 months down the line?

While SCM continues to innovate and expand the functionalities within CareMOSAIC, it also focuses on the interoperability between electronic health records and hospitals. Signature has plans to capitalize on Centers for Medicare & Medicaid Services' initiatives to build value-based models for primary care, oncology, and participate in upcoming programs similar to the Comprehensive Care for Joint Replacement program in orthopedics. In addition, we envision branching out of the historical healthcare programs to help partners take a more global approach to episodic management in population health, primary care, and in other sub-specialties.