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Supporting Efficient Clinical Decision-Making, Documentation, and Care Transitions...

MCG Health Partners with Performance Clinical Systems to Reduce Redundancy and Costs in Utilization Management Processes

Dynamic workflow improves response times and enables more precise communication supported by evidence-based decision support guidelines


SEATTLE, Wash., and SAN FRANCISCO, Calif., September 21, 2017— Performance Clinical Systems announced the integration of its cloud-based clinical workflow management platform, Symphony, with MCG Health‘s market-leading Cite CareWebQI solution. The hallmark of the Symphony solution is simplicity, which enables rapid implementation, adoption, and impact within an organization. Integrating Symphony with MCG enables payers to leverage the latest evidence-based care guidelines to support appropriate medical necessity determinations while taking into account the unique medical needs and optimal recovery standards based on industry best practices.

Symphony’s sophisticated, role-based hierarchy drives efficiencies across care teams by dynamically generating data and guided workflows based on the role of the user and the patient they are targeting. All of the critical functions required for a care management program are provided, including utilization management, care management, and condition management. Symphony leverages real-time information and existing health IT investments—such as claims, analytics, and electronic medical records—while allowing care managers to engage patients one-on-one in a context-sensitive way much more efficiently than traditional care management platforms.

CareWebQI allows users to capture the correct clinical documentation for medical necessity against MCG care guidelines while ensuring appropriate member care.  CareWebQI helps address unnecessary variations in care and maintain compliance. Health plans enrolling members with complex – and often costly – conditions require the right tools to effectively manage these populations. MCG care guidelines offer an evidence-based approach to the most effective care and are delivered seamlessly through Symphony, allowing for easy accessibility across care team roles.

“Partnering with other companies that are committed to improving healthcare, like Performance Clinical Systems, is an important component of MCG’s goal to proactively optimize patient care,” says Jon Shreve, President & CEO of MCG. “This integrated system will provide access to evidence-based best practices and care planning tools, supporting clinical decision-making and documentation as well as enabling efficient transitions between care settings.”

“Today’s value-based models require efficient coordination across multi-disciplinary teams as well as a renewed emphasis on quality, evidence-based care,” said Performance Clinical Systems Chief Scientist, Chris Johnson, MD, MPH. “This model calls for more transparency and innovative technology to support seamless communication across settings. Together, we can offer never-before-seen solutions that improve productivity from distributed care teams, enhance patient satisfaction, and realize a positive financial impact from overall utilization management effectiveness.”

Optima Health Plan in Virginia will be the first client to take advantage of this integration, enabling their care teams to better manage utilization by leveraging a common platform and clinical guidelines which serve various clinical roles and settings, contract parameters, and patient environments.

“The system will add efficiency, reliability, and accuracy to the utilization management process for all Optima users. This partnership automates the access and use of evidence-based clinical guidelines across all care team members,” said Patricia Curtis, Director of Operations Strategic Expansion Programs, Clinical Care Services, Sentara Health Plans.

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About MCG Health

MCG, part of the Hearst Health network, helps healthcare organizations implement informed care strategies that proactively and efficiently move patients toward health. MCG’s transparent assessment of the latest research and scholarly articles, along with our own data analysis, gives patients, providers, and payers the vetted information they need to feel confident in every care decision, in every moment. For more information, visit www.mcg.com or follow our Twitter handle at @MCG_Health.

About Hearst Health

MCG is part of the Hearst Health network, which also includes FDB (First Databank), Zynx Health, Homecare Homebase, MedHOK, Hearst Health International, Hearst Health Ventures and the Hearst Health Innovation Lab (http://www.hearsthealth.com). The mission of Hearst Health is to help guide the most important care moments by delivering vital information into the hands of everyone who touches a person’s health journey. Each year in the U.S., care guidance from the Hearst Health network reaches 84 percent of discharged patients, 177 million insured individuals, 60 million home health visits and 3.1 billion dispensed prescriptions.

About Performance Clinical Systems

Performance Clinical Systems is a privately held healthcare information technology company based in San Francisco, California. Founded by two physicians, its cloud-based workflow accelerator platform, Symphony™, proactively manages patient outreach and encounters across various roles and clinical settings within team-based care models. Algorithms tailor “on the fly” workflows based on case-specific care needs, prior patient encounters, payer contract requirements, and the specific role of a care team member. This approach enables efficient and scalable patient engagement models which are highly personalized. Additionally, Symphony ensures regulatory-compliant engagement and creates an electronic trail for care and contract compliance reporting. For more information, visit www.performanceclinical.com.

 

Media Contacts:

MCG Health
Arri Burgess
206 389 5405
Arri.Burgess@mcg.com

Performance Clinical Systems
Robert Murphy
415 830 3435
rmurphy@performanceclinical.com

MCG Health Partners with Performance Clinical Systems (PDF)

Population Health and Care Management Crossover Solution...

Optima Health Rolls Out Population Health & Care Management Crossover Solution For DSRIP Medicaid and Commercial Populations

Health plan arm of Sentara Healthcare partners with Performance Clinical Systems to address complex needs of Alabama DSRIP Medicaid program.


Additionally, Optima Health is rolling out Symphony for its diverse populations in government and commercial programs over the coming months in order to be best positioned for the requirements of population health management and risk-based contracting. Through the Symphony platform, the Optima Health care teams can more efficiently manage and engage patients in partnership with its provider network by leveraging a common platform which serves various clinical roles and settings, contract parameters and patient environments, including home health.

Significant efficiencies can be obtained through Symphony’s dynamic documents generated “on the fly”—in the form of assessments, protocols, care plans, etc.— which are regulatory-compliant and based upon patient history and needs together with the clinician-user’s skill set and license level required for each encounter.

“Our partnership with Performance Clinical has enabled us to scale our value-based payment models and population health programs in an incredibly efficient manner,” said Tom Lundquist, Senior Vice President and Chief Medical Officer at Optima Health. “Critical to our success with populations this size is empowering our provider networks to connect with patients, in coordination with our care teams, in the most timely, compliant and effective manner. Symphony delivers on all fronts” he added.

Symphony maximizes productivity across existing multi-disciplinary teams by allowing each member— RN, LCSW, LPN, MA, etc.— to work at the top of their license, providing greater staffing flexibility and task allocation.

“The new reality is that healthcare organizations are faced with how they can best affect the care for a wider population of patients using existing resources,” commented Chris Johnson, MD, MPH, Performance Clinical’s co-founder and chief scientist. “We designed Symphony to be lightweight for minimally disruptive deployment, extremely adaptable for a myriad of contract requirements and payment models and highly intuitive for all users, which is consistently identified as one of the most attractive benefits of the platform,” he noted.

“Our partnership with Sentara Healthcare and Optima Health continues to demonstrate how simultaneously improving the patient experience while creating efficiencies in care delivery is quickly attainable,” said Brian O’Neill, CEO of Performance Clinical. “Since Symphony is cloud-based, it is easily configured and rapidly optimized for shifting clinical, contractual and organizational requirements.”

About Optima Health
Optima Health, based in Virginia Beach, Virginia, provides health insurance coverage to approximately 450,000 members. With 30 years of experience in the health insurance arena, Optima Health offers a full suite of commercial products including consumer-directed, employee-owned and employer-sponsored plans, individual health plans, employee assistance programs and plans serving Medicare and Medicaid enrollees. Our provider network features 26,000 providers including specialists, primary care physicians and hospitals. Optima Health offers programs to support members with chronic illnesses, customized wellness programs and integrated clinical and behavioral health services as well as pharmacy management – all to help our members improve their health. Our goal is to provide better health, to be easy to use and offer services that are a great value. To learn more about Optima Health, please visit http://www.optimahealth.com. (1)

About Performance Clinical Systems
Performance Clinical Systems is a privately held healthcare information technology company based in San Francisco, California and Boston, Massachusetts. Founded by two physicians, its cloud-based workflow accelerator platform, Symphony™, efficiently manages patient outreach and encounters across various roles and clinical settings within team-based care models.

Symphony maximizes productivity across existing multi-disciplinary teams by allowing each member to work at the top of their license, providing greater staffing flexibility and task allocation. Additionally, Symphony ensures regulatory-compliant engagement and creates an electronic trail for care and contract compliance reporting.

The company’s solutions are attractive to performance-oriented health care payers and providers because they increase productivity, are quickly embraced by clinicians, can be deployed rapidly and work alongside or as a layer on traditional enterprise HIT systems. Most importantly, Symphony contributes significantly to a provider’s ability to handle shifts in value-based alternative payment models, such as Accountable Care Organizations (ACO’s), Patient-centered Medical Homes (PCMH), Medicare Advantage, DSRIP, LTSS and managed Medicaid, which reward better care at lower cost. For more information, visit http://www.performanceclinical.com.


(1) The membership figure includes total membership in all group and individual insured products, Medicare Managed Care Plans, Medicaid and Famis Plans, and self-funded health plans issued or administered by Optima Health. Total Medical Membership based on Membership History Report, June 2016. Includes members from all Optima Health Licenses, products, Medicare and Medicaid products. Optima Health is the trade name of Optima Health Plan, Optima Health Insurance Company, and Sentara Health Plans, Inc. Optima PPO plans, and Medicare Managed Care Plans are underwritten or administered by Optima Health Insurance Company. Optima Vantage HMO plans, Medicaid, and Famis products are underwritten or administered by Optima Health Plan. Sentara Health Plans provides administrative services to self-funded plans but does not underwrite benefits. Employee Assistance Programs (EAP) are administered by Optima Behavioral Health Services, Inc. Wellness programs are administered by Sentara Health Plans. Source for provider network is Optima Health, Provider Status Report, February 2016.

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FOR MORE INFORMATION:
Robert Murphy
Performance Clinical Systems
rmurphy@performanceclinical.com
415-830-3435

DOWNLOAD THE PDF: Optima Press Release

Contract-driven Interactive Workflow Platform...

Optima Health Selects Performance Clinical Systems’ Platform with Contract-driven Interactive Checklists to meet its Population Health Goals

Symphony™ Drives Patient-specific, Role-based Activities to Simultaneously Comply with Clinical Protocols and Payer Contract Requirements


San Francisco, January 13, 2015— Optima Health, a Virginia based health plan with over 451,000 members and over 20,000 participating healthcare providers, today announced a phased rollout of the Symphony workflow management platform from Performance Clinical Systems to select primary care practices within their network. Symphony provides a tool that standardizes robust outreach protocols while allowing for detailed data capture of clinical, social and environmental factors relevant to care management success. Symphony allows for proactive management of patient outreach across various roles and clinical settings within team-based care models. Algorithms tailor “on the fly” checklists based on case-specific care needs, prior patient encounters, payer contract requirements, and the specific role of a care team member.  Additionally, Symphony creates an electronic trail for care and contract compliance reporting.

“One of our key population health initiatives is improving outcomes by intensifying care management for our members with chronic conditions while simultaneously improving care delivery efficiency and standardization among the care team delivering that care,” said Tom Lundquist, Senior Vice President and Chief Medical Officer at Optima Health. “We want the care teams not only to be able to improve the clinical care and impact of the outreach, but also to work more effectively in improving care quality and cost efficiency. The Symphony platform enables a systematic approach for our provider teams to efficiently focus on delivering high-quality care without requiring them to be experts on each patient’s specific payer contract,” he added.

The cloud-based Symphony is accessible across clinical settings and locations and works in unison with traditional electronic medical records. It is highly configurable and rapidly optimized for shifting clinical, contractual, and organizational requirements.

“Optima Health is on the forefront of building infrastructure to support new chronic
condition management programs and payment models that enables them to better partner with physicians in their network. We’re very excited to be part of their vision,” said Performance Clinical Systems co-founder, Jeremy Nobel, MD, MPH.

Through Symphony, Optima Health can enable their provider network to take advantage of Medicare’s new Chronic Care Management (CCM) code, which allows for billing of non-face-to-face chronic care management services as of January 1.

“The new CCM code relies heavily on electronic data capture and documentation by physicians and non-physician clinicians for things such as physical, mental, cognitive, psychosocial, functional, and environmental assessments. This is a core capability of our Symphony workflow platform,” Dr. Nobel noted. “Being able to take advantage these new value-based payer opportunities is critical to a provider practice’s economic success and survival,” he added.

About Optima Health

Optima Health, based in Virginia Beach, Virginia, provides health insurance coverage to more than 451,000 members. With 30 years of experience in the health insurance arena, Optima Health offers a full suite of commercial products including consumer-directed, employee-owned and employer- sponsored plans, individual health plans, employee assistance programs and plans serving Medicare and Medicaid enrollees. Our provider network features 20,000 providers including specialists, primary care physicians, and hospitals. Optima Health offers programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services as well as pharmacy management – all to help our members improve their health. Our goal is to provide better health, to be easy to use and offer services that are a great value. To learn more about Optima Health, please visit www.optimahealth.com.

About Performance Clinical Systems

Performance Clinical Systems is a privately held healthcare information technology company based in San Francisco, California and Boston, Massachusetts.   Founded by two physicians, its cloud-based workflow management platform, Symphony™, proactively manages patient outreach and encounters across various roles and clinical settings within team-based care models. Algorithms tailor “on the fly” checklists based on case-specific care needs, prior patient encounters, payer contract requirements, and the specific role of a care team member.  This approach enables efficient and scalable patient engagement models which are highly personalized.  Additionally, Symphony creates an electronic trail for care and contract compliance reporting.

The company’s solutions are attractive to performance-oriented health care providers and payers because they are quickly embraced by clinicians, deployed rapidly (within 60 days) and work alongside or as a layer on traditional enterprise HIT systems. Most importantly, Symphony contributes significantly to a provider’s ability to handle shifts in payment models, such as Accountable Care Organizations (ACO’s) and Patient-centered Medical Homes (PCMH), which reward better care at lower cost. For more information, visit www.performanceclinical.com

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FOR MORE INFORMATION:
Robert Murphy
Performance Clinical Systems
rmurphy@performanceclinical.com
415-830-3435