TCS Healthcare Technologies
In Northern California the grape harvest and crush is an annual tradition. The reward from the growing season is loaded into tanks, and then racked into another storage tank several days later before finally being laid to rest in French Oak Barrels where it will mature and mellow during its long winter’s rest.
Okay, what has this to do with hiring good people to make good software? Plenty.
Numerous parallels exist between developing and maintaining a company, and the challenges and opportunities associated with cultivating the vine. During the first years of cultivation, the vines are establishing an effective root system, being pruned and watered to optimize growth.
In a similar regard, building the right foundation for a company also requires selecting the best people and providing them with the proper environment and information to grow into a high quality and best-in-class team that exceeds industry standards.
TCS is much like a fine wine. We started with the best of ingredients—our outstanding employees. We selected and nurtured each one so that all will have the right stuff. This single element—our people—is the main reason for our success.
TCS is approached weekly by third parties to outsource our software development to India or Eastern Europe. We refuse to yield to the temptation for several reasons, including: 1) we can optimize TCS’ harvest annually using the employees that we have nurtured just like the grapes on a vine; 2) TCS staff, with their knowledge, experience, and focus on customer services, are our greatest asset; and 3) we wouldn’t be able to say that our products are 100% made in the U.S.A.
Customer satisfaction is of paramount importance to our company. Just like a fine wine will complement your meal, TCS staff have an unparalleled track record in optimizing the client’s experience with ACUITY Advanced Care. TCS products and services are in essence a fine, hand-crafted labor of love that leverages technology to help patients, providers, health plans and others. Nothing about us is generic or an off-the-store-shelf “box of wine.” Each employee and application is unique.
TCS Healthcare Technologies
In order to offer effective medical management programs, case managers need to be aware of key health care trends and try to stay “one step ahead” of them. Clearly, the expanding symbiotic interface between technology and care management workflow processes is a prime example.
It is imperative in most health care settings that nurses understand how technology solutions can improve patient care. On the other hand, we also need to be cognizant of those situations where technology is not meeting baseline expectations or could even be a detriment.
There are five key IT attributes that case managers should keep in mind when assessing the efficacy of information technology (IT) applications:
-
Integration: Are you working in an environment where technology is beginning or has already created an integrated IT platform? The elimination of “silos” and “paper” systems is an essential part of the equation.
-
Interoperability: Does your health IT system interface with other critical systems? For example, data from electronic health care records including medical charts, claims, pharmacy data, lab data, health risk assessments and other data should be linked or viewed through one portal to optimize the flow of information.
-
Automated Workflows: Does your IT system promote dynamic, rules-based workflows resulting in automated tasks such as “To-Do” lists, letter generation for patients or populations, etc.?
-
Evidence-based Decision Making: Does your IT application utilize pre-defined, evidence-based care plans that can be auto-populated with linked problems, goals, interventions and expected outcomes?
-
Enhanced Communication Links: Does your IT system allow you to communicate with patients, providers and other collaborators (and document those communications) through emerging platforms such as the Web, remote monitoring, texting, encrypted emails, and social networking?
In this new age of technology transformation, monitoring technology trends is more important than ever.
TCS Healthcare Technologies
As of January 1, 2012, regulatory changes for the 5010 transaction standard are now required by the Department of Health and Human Services (HHS). One of the changes to 5010 is that the field length for the diagnosis code is changed so that it can accommodate the larger field size of ICD-10 codes. ACUITY 6.0 was designed to help clients comply with the ICD-10 regulatory changes mandated by HHS.
AcuPort Advanced (APA), version 6.0, in conjunction with the new Acuity Advanced Care 6.0 suite (ACUITY) supports all ICD-10 regulatory requirements mandated by the Department of Health and Human Services (HHS).
AcuPort Advanced is considered the best-in-class ETL tool that allows TCS clients to load data into ACUITY faster than ever. The first version of APA was released during the fall of 2008. Since then, TCS has continued to upgrade and advance the application in both breadth of functionally as well as performance through several subsequent releases.
The premiere design for AcuPort Advanced was built around ease of use and performance. Due to the abundance of data available to TCS clients it was important for the company to build an ETL tool that could transform as the data changes and perform well under large data sets. It is middleware software used for importing and exporting data to/from ACUITY to other systems such as claims, pharmacy, predictive modeling, data warehousing, and electronic medical records.
AcuPort Advanced provides the ability to:
-
Create data maps between files (i.e., mapping patient demographic data from the claims system to ACUITY)
-
Schedule the data transfers (i.e., nightly)
-
Execute the data transfers from one system to another
APA 6.0 is significantly improved over its predecessor “AcuPort Classic” application which was released in 2008. The ETL tool has the ability to import and export hundreds of thousands of records in minutes versus days, and it allows our clients to react to the ever-changing healthcare requirements. In addition to performance, APA 6.0 also includes several other key features such as drag and drop interface, central area error logging, customizable error handling, historical tracking, preview data prior to loading and, best of all, comes with a built in scheduler for automating all imports and exports.
The Acuity Advanced Care product suite is compatible with Windows Server 2008, Windows Server 2008 R2, Windows 7, SQL Server 2008, SQL Server 2008 R2. TCS Healthcare's Acuity Advanced Care products are available for infrastructure as well as an online service.
TCS Healthcare Technologies
The concept of “external review” is familiar to most case managers. The ability for a patient or their provider to appeal an adverse medical necessity or benefit determination has been around for years. However, a new national framework for such appeals is being established through the Patient Protection and Affordable Care Act (PPACA).
Last June, the U.S. Department of Health and Human Services (HHS) and U.S. Department of Labor (DOL) issued a revised technical release updating the new federal “external review” requirements. Simply put, hhealth plans issuing new policies and offering “non-grandfathered” coverage must provide individuals an expanded reconsideration and appeals process when an adverse determination is made. After several draft regulations were published and a six-month delay, key provisions of the new federal law go into effect January, 2012.
The relationship between case management and external review is an important one. "The right to an external appeal is considered one of the most important consumer protections that you can have," said Steve Larsen, director of HHS’ Center for Consumer Information and Insurance Oversight. "Consumers do not want insurance companies making medical decisions for them or for their families." As a result, case managers play a vital role in helping patients navigate and find balance between their medical care needs and service reimbursement.
Unfortunately, identifying which set of appeal rules apply is not always easy. Under existing requirements and PPACA, several sources of external review requirements might apply to a given situation, including:
-
Section 2719 of PPACA
-
U.S. Department of Labor regulations adopted in 2002
-
The Uniform Health Carrier Review Model Act issues by the National Association of Insurance Commissioners (NAIC)
-
Most states have adopted an independent or external review regulation already (see comments below)
-
URAC and NCQA’s accreditation standards for external review and independent review organizations
The federal government notes that in some cases state-based external review requirements may be sufficient to meet and/or exceed the new federal requirements. Currently, HHS is determining which states meet or exceed the new federal requirements.
All of these potential variations can be overwhelming for patients, providers, and for all of us working in case management. However, this is where technology comes in. Several software applications are being configured to help automate some of these key external review decision points. When done correctly, key workflows and regulatory requirements can be integrated and streamlined, which in turn will allow providers and case managers to continue focusing on the patient.
I encourage you to take the time now to review the requirements to determine how they might affect your workflow processes. You may be surprised to find that you are lucky and they won’t affect you at all. However, if you do have to make changes to meet the requirements, at least you will have time to make them before they are needed. It’s always best to be prepared and plan ahead.
In the meantime, regulators still need to sort out all of the nuances associated with PPACA’s new reforms. Even if some of the reforms are repealed or scaled back in the future, IT systems and applications will continue to empower case managers and providers to do more for their patients. We are living in exciting times indeed. Challenging - but exciting!!
This blog was originally published in CMSA's December 2011 eNewsletter. To view this post go here.
One of the fundamental goals of care management software applications like Acuity Advanced Care is to empower care managers to help manage patient needs over the care continuum. Enhancing the opportunity to support patients during transitions of care is now paramount to ensure that the best clinical and financial outcomes are achieved.
One of the best resources for care managers is the nonprofit group, the National Transitions of Care Coalition (NTOCC). The organization was established in 2006 and brings together a wide array of stakeholders who are “dedicated to improving the quality of care coordination and communication when patients are transferred from one level of care to another.” Visit www.ntocc.org for information.
The website offers free tools healthcare professionals can use to assist patients including:
-
Patient bill of rights during transitions of care;
-
Guidelines for hospital stays;
-
Several health care and medication tracking forms; and
-
Access to a transitions toolkit.
In addition, the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) and the Case Management Society of America (CMSA) just announced a new sub-specialty certification for “Transitions of Care” and “Case Management,” which will be implemented in 2012.
For more details about the new certification program, go to www.abqaurp.org or send an email to info@abqaurp.org. See also TCS’ May 24, 2011 blog on NTOCC on its website.
TCS Healthcare Technologies
It is amazing to observe how quickly technology is changing the practice of case management. A review of the TCS website at www.tcshealthcare.com provides an illustrative example of how TCS is making its mark in the care management field through technology-based applications and clinical workflow support.
In these fast-changing times, another important thing to consider is stability and consistency. I, along with my wife Esther Pock, founded TCS over 25 years ago. We are a family-owned business that has been dedicated to supporting patients, clinicians and various types of health organizations for decades. Our hope is that we will continue to deliver the same quality-based services over the next 25 years!
Without a doubt, TCS will continue its mission of delivering the most appropriate technology enhancements to the care management field. In addition, TCS’ clinical team of experts will identify and share with clients a myriad of best-practices supporting UM, CM, DM and Wellness Programs. This makes us not only a technology expert but a full-service “solutions” company.
In addition, TCS will continue pursuing many of our altruistic endeavors which include:
-
Technology Access. Partnering with CMSA to offer CMSA members, Acuity AnyWare, a hosted application for independent case managers and smaller organizations that is affordable with no long term commitments.
-
Educational Support. Financially supporting CMSA’s new nonprofit foundation to ensure that underfunded or public service case managers have an opportunity to attend CMSA’s national conference.
-
Research. Sponsoring the second annual health information technology survey, examining care management software trends and making the results available to all stakeholders at no charge (you can download a complimentary copy of the 2008 Survey results from our website).
If you are not familiar with us, the TCS team encourages you to become part of our growing community. Also, any feedback on our newsletter would be greatly appreciated. Please email us at info@tcshealthcare.com or call me at (530) 886-1700. ext 206.
TCS Healthcare Technologies
With all the buzz today about social networking, traditional methods of communication are being re-thought and re-defined. Web-enabled platforms like Facebook and LinkedIn, to name a few, are creating new opportunities to stay connected.
I would like to think that TCS has been in the “connection” and “communication” business since the company was founded over a quarter of a century ago. With Acuity Advanced Care™ (ACUITY) and its predecessor applications, TCS has led the way in providing technology-based platforms to help clinicians do a better job communicating with and taking care of patients.
Part of this includes keeping case managers and providers connected with their patients or clients, and helping health plans, hospitals and others to facilitate coverage decisions. In today’s environment, this includes bi-directional communications to manage chronic illnesses and promote healthier lifestyles.
To that end, applications like ACUITY promote the aggregation of disparate data into useful information streams to promote evidence-based decision-making and to automate key elements of the medical management system.
Charles Dickens reminded us over a century ago about some of the basic limitations associated with a technology-based solution when he said: “Electric communication will never be a substitute for the face of someone who with their soul encourages another person to be brave and true.”
Now, in this case, he was probably talking about the telegraph, which of course is a very rudimentary technology-enabled communication platform. However, there is truth in what he says even today.
Therefore, to heed Mr. Dickens’ advice, TCS applications do even more than just promote “electronic communication.” TCS applications enhance all types of connectivity between providers and patients – including face-to-face interactions. His quote touches upon a primary goal within the practice of case management – to really engage a patient or client in a meaningful way to improve clinical and financial outcomes in a given population.
Yes, the world, including health care, keeps on getting more complicated – but enhancing communication links at all levels will remain a top priority as TCS supports its customers and their patients.
TCS Healthcare Technologies
I’ve been surfing since I was 15 years old, and ten of those years were spent on the North Shore of Kauai. One thing I’ve learned is, “when in doubt, don’t go out.” This sport requires a great deal of patience, and to catch your wave you must spend considerable time in the lineup studying the rhythm of the ocean and the other surfers. Moving too quickly can result in a wipeout, but when it’s your time to go you must be totally committed. As in surfing, the medical management (MM) industry requires patience and study, and often can lead to a wild ride.
Among other influences, the Patient Protection and Affordable Care Act (PPACA) includes dozens of references to case management, chronic disease management and other medical management programs in the statutory language. As a result, we can expect literally wave upon wave of new regulation to be proposed and implemented over the next several years to operationalize these new programs.
It’s reassuring to know that TCS is ready to “catch the wave” no matter how turbulent the ocean becomes. This is for many reasons, including the fact that we have over 25 years of medical management software experience, and we understand how emerging trends could have an impact on the industry.
In addition, we are constantly enhancing Acuity Advanced Care™, our signature medical management system, to keep ahead of the curl. In fact, the 2010 Health IT Survey rated ACUITY’s ability to perform the following significantly higher than industry averages:
-
Automatically generate care plans for patients;
-
Stratify health data;
-
Use data to schedule or execute follow-up tasks; and
-
Use of Case Management Adherence Guidelines (CMAG).
These health IT qualities were less frequently reported by users of competing medical management systems.
Our core philosophy is to stay focused on medical management. Through our understanding of best practices, technological advancements and our creative problem-solving abilities, we provide our clients with the tools that allow them to serve their customers and patients efficiently and effectively.
And that isn’t all. TCS’ past successes have emboldened us to keep catching wave after wave and not wipe out. To learn more about how TCS plans to stay an industry leader, visit our website, shoot us an email, or just give us a call. We’d love to hear from you.
TCS Healthcare Technologies
At TCS, we know that there is mobility in our future.
What kind of impact can we expect from mobile applications?
This is not an official survey, but if you are client of TCS, or use UM, DM, CM software, we would be happy to hear your thoughts about where mobile applications fit into the processes of utilization, disease and care management.
We have a lot of ideas ourselves, and we think that mobility is in our future, but we want to do it in the right way and meet the real needs of your business – not just make a pretty or catchy app.
So far, we have visions of patients interacting with our applications through a mobile device – maybe answering assessments or reporting on how they are doing to manage a chronic medical condition. We can see care managers as mobile users. We envision them out in the field, moving from patient to patient, needing the ability to capture how each patient is doing, including recording basic medical information as well as measuring how the patient is doing in relation to his personalized care plan. This information would be captured in ACUITY Advanced Care™, ready for evaluation and refinement of the care plan. And we think C-suite executives will be receiving management level reports and dashboards to keep on top of business objectives.
As we think and plan for mobility, one of our primary concerns is the security of PHI. A lot of personal information is currently successfully passed along the web (think of banking), and we want to replicate that high level of security when we release our mobile app(s).
Whoever the user is, we plan to develop apps that can save you time and lead to increased productivity (always a benefit).
We would be interested to hear what you think –send us a message.
TCS Healthcare Technologies
With all of the market forces at play and major reform efforts underway, both at the federal and state levels, it’s important to understand how these trends are impacting the practice of case management. Clearly, one trend is the need to promote and move to integrated “care” solutions. The move to enhanced clinical and administrative workflows often is dependent upon linking existing activities and interventions through emerging ideas, technologies, business platforms, and evidence-based clinical pathways. This column highlights some of the ongoing challenges and opportunities to promote a more seamless environment for case managers and the patients they support.
Delivery System Integration
The bi-furcation of the insurance function from the provider delivery system is common throughout the United States. Almost everyone agrees that the delivery and financing of patient care is fragmented, and attempts to better coordinate care often face legal, market and institutional barriers.
However, efforts are underway to figure out how to increase the payment, efficiency and connectivity of healthcare. The formation of accountable care organizations (ACOs) is one example of an emerging concept that is being discussed. ACOs are viewed as a mechanism to allow physicians, hospitals, case managers and other clinical caregivers to address some of the perceived delivery and coordination challenges in the current healthcare delivery model – while at the same time allowing clinicians to assume some of the financial and business risks associated with patient care. CMSA also has addressed the issue of fragmentation in some detail with its support of effective transitions of care (see March 2011 column).
Information Technology Integration
Healthcare system fragmentation also is perpetuated by information technology (TI) platforms. In most cases, IT systems need to improve interoperability and other data interfaces to optimize the ability to better serve providers, patients and payers. We addressed the need to connect disparate IT systems deployed in the U.S. healthcare system in a CMSA column published earlier this year (see January 2011 column). While much work still needs to be done in this area, there a few care management software systems that are fairly effective in integrating various sources of data in a way that case managers and others can act upon.
Consistent Regulation
Inconsistent regulation also can hurt the ability of case managers and others to work in an integrated and seamless manner. A microcosm of this tension is highlighted by efforts to implement the Patient Protection and Affordable Care Act (PPACA) as both the federal government and the states develop the exchange-based marketplace that will offer qualified health plans to individuals and the small groups. It will be interesting to see if the regulators implementing PPACA can establish a more level playing field than the current regulatory system, with a primary goal of preventing adverse risk selection from one insurance pool to the next. Another example is the over-lapping and sometimes inconsistent regulation covering utilization management, case management and external review activities.
Program Integration
Sometimes there is enough integration of the clinical, business and IT workflows to do something special with chronically-ill populations. Through an integrated and coordinated platform, case managers can do wonderful things as they identify, track, and improve targeted patients, who often suffer from a wide-range of co-morbidities and social problems. There are a number of care management organizations and health plans that have the right mixture of activities in place to do something special. In such cases, integrated care management programs often produce improved clinical and financial outcomes.
Meaningful Integration
Clearly, one size does not fit all. But the power of integration is becoming even more important in this ever-expanding world of complexity. Facebook links us virtually, cell phones and texting keep us connected no matter where we are, ATMs make accessing cash easy, and iTunes makes downloading music a snap. It is going to be exciting to see how case managers adapt and change in this technology-dependent age. Although we will have many “tech” challenges ahead, case managers (and their patients) should not fear change. Good things are going to happen. Integration must become a fundamental value.
Originally published in the CMSA's Member eNewsletter (October 2011)