Partners Health Plan (PHP), a not-for-profit managed care organization, focuses exclusively on people with intellectual and developmental disabilities (IDD). PHP is committed to providing the additional services and supports these individuals need to live the best and most meaningful lives that they choose. To support personal outcomes, health, safety, and independence, PHP offers benefits that include supervision in residential situations: job coaching, durable medical equipment, and other vital services.
When the government established regulations requiring individuals be enrolled in Medicaid managed care plans, PHP engaged with leading insurance consultants and health IT systems that connected people with problem-based services. Many people with IDD, however, are not primarily defined by immediate health problems. The tools provided by the leading vendors did not meet the needs of these individuals for day-to-day human services. So PHP approached MediSked for a software solution that connected individuals to the services and supports they need and health insurance that covered these services, while collaborating with the interdisciplinary team of their choice.
Featured SOLUTION
The MediSked Care Coordination Suite
Centralize care management processes from assessment through planning, authorizations & budgets, documents & forms to claims & billing
The Opportunity
PHP sees people with developmental disabilities as individuals with needs specific to their situation and abilities, and tailors service plans and support according to each person’s unique requirements. They needed a solution that connected individuals to the services and supports they needed, and to the health insurance that covered these services too.
“We had to develop a whole care management system. We started with another company who made promises for a year, but when we finally went to produce it, it was clear they couldn’t do it. We had six or eight weeks before we were to start the pilot with the government. I had worked with MediSked in another position, so I asked them to do it. They did.”
– Jan Abelseth, Chief Operating Officer at PHP
MediSked worked closely with PHP to test a suite of solutions. The MediSked team observed the disconnect between service providers and insurance companies, and how managed care solutions could improve quality of life for the individual. Managed care plans have grown in popularity because of reduced costs for the taxpayer—but that could mean a reduction in available services as well.
“One of the risks is that people can lose services,” said Doug Golub, MediSked president. “It’s really important to get it right.”
The Outcome
“We went live on April 1, 2016. Now it’s the only system in the country that’s DD-centric. This has allowed us to implement a major initiative. Everyone in the country is watching to see if this succeeds or fails. It has allowed us to work effectively.” – Jan Abelseth, Chief Operating Officer at PHP
In addition, PHP increased its revenue significantly. “Now they know how every dollar is being spent,” said Golub. “Partners Health Plan is leading the way across the country for providing supports to individuals with disabilities.”
Elements of the Solution
MediSked’s technology is goal-based instead of focusing on problems. The individuals PHP supports are receiving better care at a lower overall cost.
MediSked implemented a holistic suite of solutions that meet government regulations.
The MediSked Care Coordination Suite includes:
- MediSked Coordinate – Care Management Platform
- Medisked Connect Exchange – Multi-Agency Business Intelligence Platform
- MediSked Connect – Agency Management Platform
- MediSked Portal – Person-Centered Platform
- Integrated Assessment Tool
Using MediSked assessment integration tools, PHP can interview the individual using a questionnaire loaded with the IAM assessment to ask questions on topics from health status and lifestyle to personal goals, dreams, and ambitions.
This assessment information then moves into MediSked Coordinate. In Coordinate, the individual and care manager begin the Life Plan Process: to set goals and determine the services and supports needed to achieve these goals. Coordinate also tracks progress, allows team members to input notes, generates emergency print sheets, holds required forms and documents, and produces reports to keep the team moving forward.
At the heart of the architecture, MediSked Connect Exchange (CX) moves data from one platform to another. CX also allows interaction with other health record platforms, including MediSked Connect, which centralizes and manages information for a provider, and MediSked Portal for the individual and their circle of supports.
“The information from Coordinate is sent to the Connect Exchange data warehouse along with ongoing progress on an individual’s tasks and goals. Together, these platforms build a comprehensive record for each individual, providing texture not often available in standalone software systems,” said Andrew Wheeler, MediSked Director of Product Strategy and Design.
Reporting tools allow users to zoom in on specific information, from clinical and social history to goals and outcomes, claims, authorizations and utilization. “CX allows users to consolidate data across their various IT systems and analyze that information by population or sub-population, identify trends, and define thresholds for real-time alerting,” said Wheeler.
“The system is so sophisticated, but in a person-centered way. Every clinician has a thing to do.”
– Jan Abelseth, Chief Operating Officer at PHP
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