SEATTLE, May 20, 2015 /PRNewswire/ -- MCG (part of the Hearst Health network), a leading provider of clinical guidance to payor and provider markets, today announced that Children's Community Health Plan (CCHP) has won the 2014 Doyle Award. The award recognizes the health plan's innovative use of MCG evidence-based care guidelines and CareWebQI® to help contain costs while improving member care and satisfaction.
CCHP, a Wisconsin-based Medicaid HMO, used the customization feature of CareWebQI, an interactive solution from MCG, to streamline risk assessment and post-discharge tracking of its 135,000 members. CareWebQI also enabled CCHP to efficiently provide the complex reporting required by different funding sources, including a $2.8 million Center for Medicare and Medicaid Innovation (CMMI) grant that supports a community and nurse navigator program. The goals of the grant include reducing costs by connecting with individuals who frequently use the emergency room for primary care.
"Good management requires good measurement," said Lynn Kryfke, director health plan clinical services for CCHP. "The CMMI grant required very specific data to allow tracking of staff productivity, visits, and referrals. Overall, using CareWebQI reduced documentation time by an average of 30 minutes per member. Three years ago, we had no way to track efficiency except manually, using spreadsheets and multiple databases – redundant, time consuming, and error prone processes. With thousands of members, that adds up."
Kryfke's team applied lessons learned from the CMMI project to other functional areas across the health plan. Using the CareWebQI Guideline Modification Module, they created 15 screening tools that touch five teams, including utilization management and case management. Staff can now perform risk stratification and can track complications, referrals, and post-discharge status across health plan membership. With these new tools, staff efficiency and productivity increased while also realizing a significant savings in staff time.
"All this talk of tracking can seem very dry," said Kryfke. "And then you get a note from a grateful member saying, 'Thanks for taking the time to call and see how I've been doing since I left the hospital!' Before the CareWebQI customization, we didn't have the time or tools to intelligently make that call. Now, we have one clinical documentation system used by staff across the organization. As a result, we can provide high-touch, coordinated care."
Based on positive results over the past three years, CCHP senior leadership has committed to using CareWebQI as its platform for the future, according to Kryfke.
"Medicaid managed care programs work within very tight budgets," said MCG President Jon Shreve. "This makes CCHP's ability to increase organizational efficiency while improving care even more remarkable. We're pleased to have them as a partner in providing high-value, accountable care to some of the country's most vulnerable families."
About Children's Community Health Plan (CCHP)
CCHP, owned and managed by Children's Hospital of Wisconsin, is an HMO dedicated to providing access to the highest quality health care and services to BadgerCare Plus customers of all ages. With the combined resources of Children's Hospital of Wisconsin, Children's Community Services, Children's Medical Group and our community partners, we are committed to improving the medical and social well-being of our members and the community. To learn more, visit www.childrenschp.com.
MCG, now part of the Hearst Health network, independently develops and produces evidence-based clinical guidelines and software used by more than 2,200 clients, including 1,300 hospitals and eight of the ten largest U.S. health plans. Updated annually by an experienced team of clinicians, the care guidelines support the care management of a majority of Americans. For more information, visit www.mcg.com.
MCG is part of the Hearst Health network, which also includes FDB (First Databank), Zynx Health and Homecare Homebase. The mission of the Hearst Health network is to help guide the most important care moments by delivering vital information into the hands of everyone who touches a person's health journey. Each year in the U.S., care guidance from the Hearst Health network reaches 76% of discharged patients, 133 million insured individuals, 30 million home health visits, 1.88 billion retail pharmacy prescriptions and 3.26 billion prescription claims. Extensions of the Hearst Health network include Hearst Health Ventures and the Hearst Health Innovation Lab. www.hearsthealth.com
About The Richard L. Doyle Award for Innovation and Leadership in Healthcare
The Doyle Award was developed to recognize organizations that make innovative use of the care guidelines to help deliver effective healthcare.
Dr. Doyle, the care guidelines founding editor, was a hospital chief-of-staff when he began creating clinical guidelines in the 1980s to help improve healthcare efficiency and quality at Mercy Hospital in San Diego. He later joined Milliman & Robertson and in 1990 published the first set of what was to become the care guidelines.
Judges for this award are independent healthcare quality experts, not currently associated with MCG. Applicants were judged on how well their projects supported the MCG mission to help drive effective care. Judges looked for evidence of improvements in healthcare quality and patient safety; patient/member satisfaction; staff efficiency, productivity and satisfaction; internal/external communication; and effective use of resources.
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