If you’re like most people tackling this challenge head-on, you feel like your head is about to explode as you try to navigate the maze of learning what you need to know to starting or optimizing a community healthcare collaborative for safety-net services. Just bringing together all of the data and resources required can seem like herding cats.
You feel the tug and pull of devising something that will improve patient outcomes, while also saving providers money, and, more importantly, time.
You need a trusted advisor who has the experience to guide you through this process. That’s where we come in.
We work with you to help you put systems in place that allow for comprehensive coordinated care between providers, in order to provide solution-driven outcomes by optimizing available healthcare data, maximizing efficiency, and lowering the costs associated with providing safety-net services to the community.
In short, we can help you establish an effective community healthcare collaborative that saves time and dollars while maximizing revenue and providing top-notch care. After all, that’s what you really want, right?
What is a Community Healthcare Collaborative?
In short it is the providers – hospitals, clinics, EMS and other organizations impacting a patient’s health – coming together to coordinate care for select groups of patients. In the funded world – commercial insurance and Medicare – insurance companies are frequently a driving force. In the safety net world where patients have no insurance or minimal insurance in the form of Medicaid, insurance companies are absent. A Safety Net Community Care Collaborative can take many forms. Providers might form and fund an independent not for profit. Providers might fund an initiative within an existing regional advisory council. The purpose of the collaborative is twofold: 1) to improve healthcare for safety net individuals by reducing fragmentation of care; and 2) to make this more affordable to the community by increasing revenue and decreasing costs. To a large extent, healthcare for the safety net population is funded by the local community in a series of ways that are essentially invisible to the average citizen. The cost is there regardless, the question is whether it will be managed.
Challenges Facing Community Healthcare Collaboratives
In an ideal world, each patient treated would be insured and have a medical “home,” somewhere to receive preventative care and seek referrals to specialists and other providers. In addition, the medical home would coordinate care and maintain comprehensive records of each visit. Each patient’s medical records would be accessible to the providers serving them, and information would move seamlessly, maintaining one up-to-date medical history.
Unfortunately, things don’t run so smoothly in the real world. Today, many hospitals are struggling to provide safety-net services to their communities, and lack the proper collaborative-care infrastructure necessary to provide cost-effective care to uninsured patients. For example:
John Doe is a 46 year-old patient who comes into the ER. John suffers from bipolar disorder and diabetes, and recently lost his job, insurance, and home. The comorbidity of mental and physical illness makes it near impossible for John to go back to work, a problem that is common amongst homeless populations in city centers. Because John is exposed to adverse outdoor living conditions, he frequently needs to use the EMS system. Each time he accesses the emergency department, he is taken to a different area hospital, with multiple trips to each location.
Without a medical home, the hospital is left without a comprehensive medical history, and scrambles to gather records, taking up more staff time and attention, and delaying needed care. Even if John can list every office that’s treated him, the providers use different electronic health records systems that aren’t set up to communicate. This means that lab results, medication lists, past diagnoses, and other crucial information is scattered throughout the city, hindering treatment. Worst of all, John takes several medications that aren’t in his record, which creates a risk of dangerous interactions between drugs.
As you can see, John Doe and his providers would have both benefited from having a comprehensive community healthcare collaborative, had it been in place before his visit, to save his providers precious time, without compromising quality of care.
Whether you’re just beginning to establish your community healthcare collaborative, or need help optimizing a pre-existing collaborative, call Management Information Analysis for top-notch expertise, as well as increased efficiency and savings!
We Can Help
We hold the belief that creating a community healthcare collaborative is a strong solution to keep care costs down, while providing better outcomes for patients, and greater ease for doctors and providers. Let Management Information Analysis help you:
- Develop a community budget between providers, based on estimated cost of care for the safety net population
- Decide whether it is easier to focus on maximizing community revenue or reducing costs
- Monitor utilization and implementation of community healthcare collaborative plan
- Agree to community wide interventions where a new service could benefit all providers
- Decide how to coordinate care for the most expensive and/or most vulnerable, do not focus on the healthy at the outset
Considerations for Building Strong Collaborative Healthcare:
COST: The community already bears cost whether anyone calculates it or not. With awareness comes the ability to manage.
FOCUS: In some communities, moving outpatient clinics into FQHC’s is an easy way to maximize revenue. Creating insurance-like products for the unfunded where the premium may be $10 or more a month helps create a stake in the system for patients. In other cities it may be easier to focus on costs – managing very expensive patients, moving services out of hospitals where possible, creating needed specialty services, i.e. a psych ED, to unpack existing med/surgery ED’s. Every community is different.
ASSESS(monitor): communities need quality baseline data before any interventions are made, so the effectiveness of intervention can be measured.
INTERVENTIONS: the more standardized the approach across the community, the easier it is to assess return on investment. Once the community healthcare collaborative focuses on cost and monitors utilization, interventions will suggest themselves.
COORDINATE: In healthcare, roughly 80% of the effects come from 20% of the causes. In other words, a very small subset of the safety-net population will drive a huge proportion of the community expense. Focusing on the patient with chronic health challenge is not only empathetic (being sick is no fun), but it can also save community and provider resources.
So Where Do You Start?
Contact us today!
Contact Information
Management Information Analysis
P.O Box 30132
Austin, Texas 78755-3132
512-478-3848 p
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