For background on this particular project, please visit Winning With Singles and Doubles.

Situation …

Our client provides pharmacy benefits management services to hospices. One key requirement is to have a pharmacist review a hospice patient's medications for:

  • Drug combinations having undesirable side effects not anticipated by doctors.
  • Necessity, efficacy, and coverage under the Medicare hospice benefit.

The second point is important, because Medicare provides a large portion of a hospice's revenues.

Opportunity …

As part of implementing the Affordable Care Act of 2010 (ACA), the Centers for Medicare & Medicaid Services (CMS) established a variety of new reporting requirements.

These requirements included more detailed and frequent documentation of medications provided to hospice patients. Thus, our client needed to provide this additional documentation to hospices it served.

Furthermore, the ACA also mandated use of electronic medical record (EMR) systems for certain providers, including hospices. Because our client works with hospices on a variety of EMR systems, a flexible solution was needed.

Solution ...

All the information needed to provide this required additional documentation was already available in our client's Pharmacy Benefits Management (PBM) system – however, our client did not want to provide hospices direct access to their PBM system. Thus, we made information required for reporting available to the hospices they served by:

  • Identifying the specific sources for all the required information.
  • Developing a small data mart to separately and securely house this information outside our client's PBM system.
  • Populating the data mart at a client-determined frequency.
  • Working with our client to determine the EMRs in use at their hospice accounts.
  • Researching the import file formats for the needed EMR systems.
  • Writing reports to gather and format all information in EMR-specific formats, as well as a few universal formats.
  • Developing a basic web portal to allow hospices to securely logon, select their facilities and specify date ranges to include in the download file, selecting the appropriate EMR and desired file format, and download a file reflecting all information requested by the hospice.

Because EMRs are very complex systems, we worked with each hospice wanting to access the system to test the downloadable information and ensure it could be accurately and successfully imported in their specific environment.

Based on feedback from their hospice accounts, our client populates the data mart twice a month, checking the accuracy of the data loads before making it available for download.

SystemFlowChart

The process and data flows among our client's PBM system, the Pharmacy Benefits Reporting System (PBRS), and the hospice's EMR are fairly straightforward.
 

Admin and Login

The PBRS includes an easy-to-use administration interface to configure preferences and security for each hospice it serves.

 

End User Login Screen

An authorized user at a hospice logs onto the PBRS, and then proceeds to the only screen they can access.

 

Selection Screen

The hospice user specifies various parameters to select and format the desired information:
          • Begin Date and End Date – Date range to select.
          • Account(s) – These are the Facility(ies) to be selected.
          • Report Type – This is either "Standard" or an EMR-specific file format.
          • Output Format – This is only used for a Report Type of "Standard" and provides several output format options (CVS, EXCEL, PIPE, and TAB) various programs can import.

Results and Benefits ...

Our client is now able to securely provide on-demand data requested by its hospice accounts. Each hospice can now select and download information twice a month for import and use in their EMR system, including providing CMS with the additional required reporting.

Conclusion ...

Projects like this – where information desired by an organization's customers or vendors is already readily available – represent an opportunity for a big win with a small investment. To discuss how this might work for you, please call or email anytime.

For More Information ...

To discuss how technology usage and business process improvements could be applied to the issues facing your business, call us at 336.297.4200 to schedule a no-obligation consultation, or click here to contact us online.

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