The Passage of the ACA and the movement toward advanced payment models have overhauled the American healthcare system. A greater emphasis on population health and valued-based care is significantly driving efforts to improve quality outcomes while reducing costs. It is expected that both providers and payors will continue to be challanged to innovate and design programs that allow for greater reimbursement of population health initiatives.
It is at this intersection, our team assists organizations to adapt and even thrive under these new demands. Through careful analysis of existing technology and workflows, we help organizations large and small capitalize on their unique structure to meet the challenges they are facing.
In every engagement we identify and address the Five P's of Population Health
1. Problem - Greatest Need
2. Population - Medicare, Medicaid and Commercial lines of business and/or Chronic Conditions, Prevention and Wellness
3. Policy/Program - Value-Based Care Programs and Risk Models for Fee-For Service, Managed Care and other Quality Initiatives
4. Payment - Incentive Programs and Advanced Payment Methods (APMs)
5. Procedure - Strategy and execution of an achievable population health program that is compliant, sustainable and reimbursed
To this end, we provide the following services:
Our team of experts will evaluate your specific needs providing deep analytics and expertise in the areas of systems integration, technology, quality programs, population health, wellness, chronic conditions, disease management, transitional care, alternative payment models, value-based care, public policy, public relations and the identification of new sources of revenue.
With a deep understanding of healthcare systems, public policy and analytics and a passion for transforming healthcare with new technology and innovations, we assist organizations in obtaining their unique initiatives and goals.
Skilled in PM principles, process improvement and organizational effectiveness, we assist teams across an organization to accomplish well defined project objectives and milestones that reflect outcomes that are measurable, sustainable and meaningful.
Great execution is at the heart of all we do. Successful in systems integration, program evaluation, curriculum design and training, we engage and empower health care teams toward greater efficiencies and optimal workflow redesign that provides increased quality, satisfaction and affordability.
On January 1, 2015, CMS began paying for non-face-to-face care coordination services for Medicare beneficiaries with multiple chronic conditions under new CPT codes allowing for physicians and organizations large and small to finally be reimbursed for valuable services provided to their patients. By January 2016, information suggested that only a very small number of providers were meeting the standards to be able to bill for those services. It was clear that something needed to be done to assist others in implementing a new strategy to capitalize on the CPT codes and their corresponding standards. In November 2016, further data supported this claim as public policy moved steadily toward chronic conditions management programs that consider aspects of behavioral health and social determinants of health on patient-centered value-based models of care.
As a result of these efforts, CMS created new behavioral Health codes allowing for greater integration of chronic and complex chronic medical and behavioral health conditions. In January 2017, theses codes, allowed for greater reimbursement of services provided across the continuum of care. Organizations and Healthcare Systems are just now beginning to implement this new approach.
The CCM implementation team at Virginia Burchett Consulting is confident that your organization has the ability to develop a fully reimbursed CCM Program and want to partner with you in achieving this goal. In working with our clients, we have determined that implementation and compliance issues are keeping providers from fully pursuing this new source of revenue that will also allow them the opportunity to improve the quality of healthcare they provide. Many institutions are already working on a CCM solution and need just a little guidance and some on-the-ground system integration review, workflow adaptation and physician office training and on-boarding expertise to successfully build a robust CCM program.
We’ve created a CCM implementation service that is fully customized to your organization’s needs. Our dedicated and knowledgeable team will work with you through an innovative project management approach that will allow you to begin enrolling and billing patients within the first month of implementation. With this offering, you receive the following:
Our lead CCM implementation consultant is Virginia Burchett, MPH, who has 25 years of experience with Kaiser Permanente leading initiatives that required physician office and support staff education specifically in the area of Chronic Conditions Management and IT solutions. Virginia will personally oversee the entire implementation process to ensure that your CCM program obtains and continues to maintain program consistency.
As your dedicated account manager, Virginia will lead a team of experts to provide the following implementation deliverables and continual support:
Under the direction of our System’s Integration Expert, Eric Odero, our team will provide a complete review of your CCM IT needs ensuring that a solution is found that meets your specific EMR and system integration and CMS CCM IT Solution requirements.
We are confident that like other organizations we've partnered with, you too can create a robust and thriving patient-centric CCM program - one that considers the whole person including behavioral health and social determinants of health. Together we can impact the quality of life for many with a cost-effective quality outcomes-driven model of care.
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