New Regulations of Medical Loss Ratio

New regulations issued by the Department of Health and Human Services (HHS) require health insurers to spend 80 to 85 percent of consumers' premiums on direct care for patients and efforts to improve care quality.

What does this mean to professionals involved in care coordination? It means professionals will have to clearly demonstrate how the work they do contributes to the improvement in direct care to patients and quality improvement.

The next Case In Point Webinar tackles this topic by bringing together four diverse professionals involved in care coordination at the point of care who will demonstrate how the work they do improves the care patients receive across the care continuum.

Continuing education credits have been applied for nurses, case managers, disability management professionals, social workers and behavioral health professionals.

About the Webinar

With healthcare costs reaching $ 2.5 trillion dollars, all eyes and minds are working on ways to ensure that healthcare dollars are spent on direct care and quality improvement efforts and not to duplication, overutilization or ineffective treatment. As a result, transparency and accountability for how we do our work is critical.

Up until now, case/care managers and other professionals involved in medical management/care coordination know intuitively that their work positively impacts patients, but could not clearly demonstrate how.

With the cost of healthcare escalating, delivery of care questioned, and quality concerns rising, lawmakers are searching for ways to ensure that the dollars that go to healthcare premiums are spent to care for patients and improve quality. This will require all professionals to demonstrate the value they bring to ensuring patients receive safe, evidenced-based, efficient care throughout the care continuum.

By facilitating access to the right care and treatment at the right time – and by avoiding unnecessary and duplicative tests and treatments – professionals involved in care coordination are able to improve the patient/family experience, ensure cost effectiveness of care delivery, and improve clinical outcomes, including enhanced patient safety.

Education of professionals regarding accountability and transparency will be important going forward. Also, taking advantage of advances in technology that enable data to demonstrate outcomes and improve process will also be essential.

Program Objectives

• Discuss the importance of transparency and accountability in today’s healthcare system
• Describe the role of clinical documentation specialists in ensuring appropriate delivery of healthcare resources
• Describe the technologies available to gather data and delivery information that will demonstrate outcomes and improve quality.

Our Webinar Will Answer These Questions

•  Who makes up the care coordination team?
•  Why are outcomes important to demonstrate?
•  How are professionals collaborating for improved outcomes and patient satisfaction?
•  What is the role of the clinical documentation specialist?
•  How is technology improving communication, access to evidence and data collection?
•  How are systems used in peer review?
•  Why is it important for frontline workers to demonstrate their outcomes?
•  With the new regulations, what will be the impact on frontline care management professionals?
• What training is being done to raise the level of awareness with regard to collecting data and documenting outcomes?
• What type of outcomes should case/care managers claim as part of their role as a key member of the care coordination team?

Speakers

Andrew Rothschild, MD, MS, MPH, FAAP, CCDS Director, FTI Consulting  Physician Educator, Auditor, Certified Clinical Documentation  Specialist	Connie Phillips-Jones, RN, MSN, CCM Principal Clinical Consultant
Doris Imperati, MHSA, BSN, RN-BC Associate Director, Navigant Consulting Inc.  Clinical Documentation Improvement Specialist	Moderator:  Anne Llewellyn RN-BC, MS, BHSA, CCM, CRRN  Editor in Chief, Case Management Products  Dorland Health, a Division of Access Intelligence

Who Should Attend