How This Accountable Care Organization Improved Transfers
Advocate Medical Group
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Advocate Medical Group (AMG), a Chicago-based medical group with more than 200 practice sites, has a Managed Care Population Program (MCPP) as part of their Accountable Care Organization (ACO).
The MCPP handles risk-based financial contracts for the managed care population and assumes the full financial risk of patient care.
The program’s utilization is managed by Lata Patel and Virginia Stasaitis. Patel and Stasaitis work closely with the physicians in both Advocate Medical Group and Advocate Physicians Partners to provide cost effective, quality care to reduce overall medical costs and maintain continuity of care for patients who are high utilizers of services across various practices.
To ensure that costs are monitored closely and that patients continue to receive the levels of care their Advocate physicians provide, the MCPP regularly communicates with other hospitals and healthcare facilities in the area, as well as Advocate physicians, to maintain members’ healthcare needs within the insurance plan’s network.
According to Stasaitis, accountable care organizations, and those working toward value-based care, need to have a mechanism in place to keep managed care population patients in network. This isn’t just to reduce medical costs, but also to provide more comprehensive continuity of care, which is important for achieving improved outcomes.
A Process Filled with Redundant Steps
When one of the patients served by the MCPP seeks medical care or treatment at an out-of-network facility, the staff at that facility contact Patel and Stasaitis’ team, just as they would a traditional payer, to seek pre-qualification for the reimbursement of service fees.
Upon this notification, the team at MCPP works quickly to identify the clinical status of the patient and determine the financial risk involved. After that, assuming it’s safe to do so, they work to transfer the patient to an in-network provider.
Before implementing PerfectServe to help coordinate patient care, out-of-network providers would call the notification line and leave a voicemail relaying the patient’s clinical status and treatment needs. This line was manned by an agent who then retrieved the message and called the appropriate MCPP nurse. Subsequently, this nurse contacted an AMG provider, waited for a call back from the provider, and coordinated the transfer, admission, and initial care of the patient.
It was a process filled with repeated calls and multiple messages that led to unnecessary follow-up work and delays in patient care.
Because of the need for more direct conversation, the MCPP needed another solution. “Conceptually,” Stasaitis said, “the idea was that by using PerfectServe, we would be able to reduce the amount of time it took for the right nurse to contact the right physician and begin to coordinate care.”
Now, PerfectServe automatically identifies the nurse on duty and allows the agent to leave a text message versus having to speak directly with the nurse. Additionally, the nurse can contact physicians faster by messaging them through PerfectServe’s secure, cloud-based application. The solution has helped the MCPP team eliminate hours of wasted time and guide more patients back to in-network hospitals where they can receive more comprehensive care.
Reduced Time to Treatment and Direct Communication with Physicians
Today, with PerfectServe facilitating MCPP’s communication process, instead of a lengthy workflow involving multiple parties and more than a few opportunities for communication breakdowns, one message is all that’s needed to quickly connect to the on-call nurse or physician who can help with transfer and admission.
The biggest benefit? The reduced time to treatment for Advocate patients.
“That reduction in time is one of the goals we wanted to achieve,” said Stasaitis. “If there is a delay in reaching physicians—or if there’s no call back—the chances of the patient being admitted to an out-of-network hospital or experiencing a delay in care are much greater.”
By reducing the amount of time it takes to contact physicians, MCPP nurses are able to move faster and coordinate time-sensitive care when it’s needed most.
Additional Benefits of Seamless Schedule Management and Message Tracking
Another benefit the MCPP team has realized since implementing PerfectServe is the ease with which they can manage the nurses’ three shift schedules.
“We have a unique shift schedule to manage for weekday mornings, weekday afternoons, and weekends,” said Patel. “When schedules change, it’s less time consuming for us to make updates now, and we can easily see in real time who’s on call and when.”
Keeping track of the number of members who have been transferred to an innetwork facility is an important metric to report for the MCPP team, which is tasked with ensuring the value and continuity of care while controlling costs. Because PerfectServe affixes date and time stamps for all incoming and outgoing messages, leadership can quickly calculate the number of patients treated for any specific time frame.
“It’s a big benefit to have a history of the messages sent,” said Stasaitis. “So when it’s necessary to follow a paper trail to address an issue or concern, I have an actual record of what was sent and when. Before PerfectServe, I didn’t have that capability.”
Continuity of Care: The Bottom Line
All things considered, the biggest benefit of PerfectServe for AMG’s Managed Care Population Program is the ability to quickly bring patients back to in-network hospitals to ensure they continue receiving the highquality care for which Advocate Health Care is known.
PerfectServe helps Patel and Stasaitis succeed in these efforts by reducing the amount of time it takes for the correct nurse to contact the correct admitting physician and begin to coordinate care for patients.