We believe hospitals should possess a care coordination model, which aligns compliant processes, infrastructure, and roles to promote quality and continuum-based patient care. Components of the model should:

  •  Facilitate patient flow across the continuum
  •  Reduce fragmentation and improved quality of care
  •  Facilitate patient care services across patient settings and departments
  •  Proactively manage level of care
  •  Monitor clinical resource utilization
  •  Manage medical necessity, avoidable and denied days
  •  Support compliance management program
  •  Proactively execute discharge planning
  •  Support Physician advisor services
  •  Identify readmissions and have processes in place to manage/reduce inappropriate readmissions

We have helped clients achieve and exceed their goals.

The following are some examples:

• Led clinical transformation team for a major non-profit academic medical center to reconstruct their medical management process, including case management, clinical safety, capacity management, clinical documentation, and Emergency Department case management. The initiative identified an $8 million impact.

• Provided executive advisory and implementation services for a major academic facility with respect to patient placement, bed management and clinical resource utilization resulting in new capacity management tools and processes resulting in an increase of 28 virtual beds.

• Directed a comprehensive engagement for an academic hospital in the North East to design and implement a continuum-focused care management model. Key changes included a new organizational structure, integrated core processes, Emergency Department improvements and clinical documentation management program.

• Directed and implemented an operational improvement and redesign initiative, which exceeded targeted savings by 150%. Tactics included productivity analysis, supply chain management, revenue cycle improvements and clinical transformation.

• Provided executive oversight for academic and non-academic performance improvement engagements resulting in significant reduction of length of stay (LOS), avoidable days and clinical denials. Clients have experienced up to 50% decrease in avoidable days and 0.5 day reduction in LOS within a 6 month period.

• Designed and implemented new case management (CM) models for academic and community hospitals which involved developing core processes, creating staffing plans, defining new roles, responsibilities and departmental reporting structure. Results included an increase in medical necessity screening by 150%.

• Reduced Emergency Department length of stay; patient arrival to triage decreased by 71%, discharged LOS decreased by 21%, registration time decreased by 34%, and left without being seen decreased by over 200%.

• Partnered with Physicians to develop and implement cardiac pacemaker and nerve stimulator medical necessity screening tools yielding increased physician compliance and decreased number of payor denials to zero denials (as of 6 months post-implementation).

• Implemented new processes related to Case Management compliance: increased compliance with Patient Choice process, discharge planning documentation, and delivery of initial copy of the Important Message from Medicare to 100% compliance within 90 days.

• Partnered with six-hosptial system to provide an innovative consulting approach, which included interim management paired with process redesign for a period of 3 years to transform their case management program.