Issue link: https://www.e-digitaleditions.com/i/207321
cooperative managed care services connections news magazine Where Connectivity, Care & Collaboration Converge by Andy Fry I t is a well-traveled maxim that in any crisis, there is opportunity. With the changes in healthcare being driven by an aging population and a renewed focus on promoting health rather than treating illness, the American healthcare system is at least at a crossroads. Fortunately, there are innovative companies like CMCS, strategizing to prepare for the changes in healthcare delivery by looking to the future needs of their partner organizations as well as the health of their members. I recently had the opportunity to discuss how the changes will impact CMCS with Executive Director, Tom Klages, who has been concentrating intently on this issue for the past four years. Klages is enthusiastic about CMCS' position. "We are responding to what we think is coming and not just reacting to what has happened," he explained. "We are flexible about how we approach things, looking to partner with other organizations to work collaboratively, because the health care system does not need more redundancies." A core change in healthcare reform is a paradigm shift towards the continuum of patient care, with financial incentives weighted towards prevention of patient problems instead of treating the medical SCAN ME! To teleport instantly to our website, simply scan this glyph with any QR code reader. The CMCS Newsletter is edited by Linda Grosser, July Holbert and Andy Fry. problems which may have been prevented in the first place. It is a change in how care is delivered and everything is reimbursed. Payers will reimburse providers based upon efficiencies and quality performance measures, with rewards for keeping people well, instead of the number of procedures performed. Basically, the system will work towards creating a payment model to manage a patient's care over time, with quality care and consumer satisfaction as drivers of enhanced reimbursement. c 3 v e rgn e ce The shift towards disease prevention will be driven by recent innovations in information technology. The integration of C M C S 's Q N X T ® , t h e c l a i m s processing software; MEDai®, the data analytics program for population health management; and Care Connections, the patient care management application, will allow care management opportunities with data previously unimaginable. This empowers CMCS and their partners to use data to design member or population specific care programs that account for different levels of risk, patient motivation and other complexities in an individual or population of members. There will also be new opportunities for convergence and collaboration with caregivers. "Ultimately," Klages predicts, "CMCS will take this population management approach and link it with community health management." Klages anticipates in the new healthcare paradigm, hospitals will work proactively with their surrounding communities, as CMCS connections 1 Connections 4 t h q ua r t e r 2 0 1 3 "We are responding to what we think is coming and not just reacting to what has happened." – TOM KLAGES anything they can do to influence wellness will positively impact their financial bottom line. A benefit of hospitals working with expanded populations should be an uptick in the amount and quality of data that can be used to study not only the healthcare needs of their community members, but also what keeps them well. It is exciting to envision the possible quality-of-life improvements for members using health data analytics. The increase in information available and the health data analytics capability provided by CMCS can lead to more sophisticated prediction of patient needs including who is at highest risk for costly care and who is motivated to stay healthy. Ultimately, engagement with a provider can lead to patients taking better care of themselves every day, and that is a convergence worth working towards! 4th quarter 2013