11:15 AM – 12:15 PM

| Monday November 5 |

Inpatient Variance Tracking

Betsy Stumpf, BSN, Project Manager, Provider Service Center/UM
Dianne Beaven, RN, BSN, MS, Compliance and Program Manager
Kaiser Mid-Atlantic Region

Objectives

  1. Distinguish between potentially avoidable variances and medical necessary variances
  2. Understand the administrative denial process versus data collection on variances
  3. Demonstrate the link between variance tracking and inpatient utilization

This session will introduce the audience to a customized version of Inpatient Variance Tracking. Kaiser Permanente has refined the definition of variances to mean delays in service that result in medically unnecessary or potentially avoidable hospital days which may prolong the length of stay for the hospitalized patient. The goal of the Variance Tracking Project was to measure and report delays in services in order to maximize the quality and efficiency of health care across the continuum of care. The challenges and barriers encountered in the implementation of Variance Tracking will be discussed. Most importantly, reportable and actionable outcome data will be described. This exciting project has received interest from all levels of the organization.

Enhanced Care Management Across the Continuum

Barbara Wood, RN, BSN, MBA, Associate Director, Care Management
Group Health Cooperative

Objectives

  1. Describe the Enhanced Care Management program at Group Health Cooperative
  2. Discuss how the Care Guidelines, (especially the Chronic Care Guidelines) helped provide the needed tools for managing care across the continuum
  3. Discuss how CareWebQISM helped us to standardize assessments and documentation standards, and provide a basis for providing continuity of care in a very short time frame

This session will describe how Group Health Network Division has implemented a program with nurses assigned to physician panels to manage care across the continuum.

Using the Care Guidelines in Demand Capacity Management and as a Tool to Reduce Waste

Andrea Werner, MSW, CICSW Director, Bellin Heart and Vascular Center
Bellin Hospital

Objectives

  1. To understand the concept of demand capacity matching in a hospital setting
  2. To understand the financial implications of waste reduction via demand capacity matching
  3. To apply the concept of a deeper dive in demand capacity managment and work within a specific DRG to reduce waste

This session will explore use of the Care Guidelines in hospital-based Demand/Capacity Managment, with a specific application to the reduction of waste within a specific cardiac DRG.

1:30 PM – 2:20 PM

| Monday November 5 |

ThedaCare’s Experience Brings Milliman to the Bedside!

Beth Malchetske, MBA, RHIA, Project Manager, Collaborative Care and Manager, Health Information Security
Jamie Dunham, RN, Manager, Medical/Surgical
ThedaCare, Inc.

Objectives

  1. Demonstrate how one organization brought the Care Guidelines to the bedside and have it used by providers, nurses, pharmacists and other care giving disciplines
  2. Share lean methods used to impact process changes that can be used within other organizations
  3. Explore the results of this initiative

During this session, we will share how professionals from many disciplines learned to use the Care Guidelines at the patient bedside. This process was part of a larger initiative, called Collaborative Care Transformation, which we will also discuss.

Guideline Application When Evidence is Uncertain: Panel Discussion

John Schaller, MD, MPH, Medical Director
Schaller Anderson of Arizona, Inc.
David Evans, MD, Medical Director
ActiveHealth Management, Inc.
Helen Blumen, MD, MBA, Editor
Milliman Care Guidelines

(Session Repeats)

Objectives

  1. Increase understanding of the application of evidence-based medicine to the evaluation of new and emerging technologies
  2. Describe current health care payor approaches to technology assessment
  3. Improve decision-making regarding clinical use of new and emerging technologies when evidence base is incomplete

Kicked off by the co-presenters' description of how they manage areas of medicine where the evidence is uncertain, this session would like to engage the audience in a dialogue that explores the challenges and may lead to take-away strategies or solutions.

Disease Specific Care Certification

Jean Range, MS, RN, CPHQ, Executive Director
The Joint Commission

  1. Provide a broad overview of Disease-Specific Care Certification at The Joint Commission
  2. Assist audience in understanding the logistics of preparing for certification
  3. Provide audience with an understanding of the benefits of certification

The Joint Commission is the nation’s leader in certification of Disease Management programs. Since 2002, it has awarded the certificate of distinction to nearly 500 programs across 47 different clinical areas. Join Jean Range, executive director, Disease-Specific Care Certification, for an overview of the benefits, the evaluation framework and the certification review process from The Joint Commission.

2:30 PM – 3:20 PM

| Monday November 5 |

Deployment of a Complex Medical Management Platform

Stephanie Thompson, RN, BS, MS, CCM, Core Team Lead
BCBS of New Mexico
Ruth Galyon, RN
BCBS of Illinois
Michelle Milcarek, RN
BCBS of Illinois

Objectives

  1. Identify the roles and responsibities of the Core Team in the Integrated Total Health Management Project
  2. Identify the objectives of the Integrated Total Health Management Project
  3. Identify the lessons learned post-implementation of the Integrated Total Health Management Project

Health Care Service Corporation (HCSC) has recently completed a successful system implementation called the Integrated Total Health Management (ITHM). This deployment moved four Health Plans (IL, TX, OK and NM) on to a single medical management documentation platform. Multiple vendor products including Milliman CareGuideQI®, with multiple applications, multiple regional processes, multiple geographic locations and multiple work flows were brought together in a single platform in the course of a two year phased-in approach. Our goal is to demonstrate how this task was accomplished using a collaborative approach, with lessons learned and future enhancements planned. Throughout the process a quality perspective was maintained, leading to process refinement and improvement.

Evidence in Action: Guideline-based Care Management (Medical Director Training group discussion)

James Schibanoff, MD, Editor-in-Chief , Milliman Care Guidelines
Helen Blumen, MD, MBA, Editor, Milliman Care Guidelines
John Semmens, MD, Healthcare Management Consultant, Milliman

Objectives

  1. Review essential attributes of medical guidelines
  2. Discuss management of uncomplicated and complicated patients
  3. Provide an overview of standards of evidence-based medicine

Deploying an Integrated Medical Managment Program within a Military Setting

Ginnean Quisenberry, RN, MSN, MS, Nurse Consultant, PHMMD
TRICARE Management Activity (TMA/HA) 

Objectives

  1. Discuss the current Medical Management (MM) Model utilized within the Military Health System
  2. Identify the utilization of the Care Guidelines within the military treatment facility
  3. Identify the current training plan and challenges associated with the use of the Milliman tool within the Military Health System

3:30 PM – 4:20 PM

| Monday November 5 |

CareWebQISM: Implementation and Use From an Early Adopter Perspective

Peggy Shaw, RN, BSN, Team Leader of Care Management
Community Health Plan
Lynn Nemiccolo, RN, Director of Business Product Development
Milliman Care Guidelines

Objectives

  1. Share how Community Health Plan was chosen as a beta site for CareWebQI
  2. Describe the implementation of CareWebQI
  3. Explain the changes that have occurred since the implementation

Peggy Shaw RN, BSN works for Community Health Plan (CHP) in St. Joseph, MO. CHP was one of the first beta sites to use the new CareWebQI program. Peggy will present an overview of CareWebQI and how Community Health Plan was chosen to be a beta site. She will also explain the process that CHP went through to implement CareWebQI and how the variance tracking and web based interactions have been beneficial in implementing changes to their health plan.

Practical Care Guidelines Usage to Improve Hospital Throughput and Efficiency

Howard Epstein, MD
Beth Heinz, Director, Care and Risk Management
Regions Hospital

Objectives

  1. Learn how to embed Care Guidelines into daily care plan for continuous process improvement
  2. Identify ways to use Care Guidelines and their applicability to improving hospital efficiency
  3. Participant will be able to cite several examples of data collection, presentation and results based on Care Guidelines in order to identify access and flow and delay system issues

This session will show how the Care Guidelines may be used to move beyond simple data collection in the hospital setting. An advanced data collection process will be reviewed. Experience using targeted strategies and action plans for reducing length of stay, and improving throughput and efficiency in a large, urban teaching hospital will be shared with participants.

Milliman Implementation: A Truly British Affair

John Cowman, Director
Havering Primary Care Trust

Objectives

  1. Outline the National Health Service Structure
  2. Outline the perceived benefits in using the Care Guidelines within the UK system
  3. Discuss United Kingdom implementation

The talk will briefly describe the structure of the NHS and will go on to discuss the main challenges facing healthcare provision in the UK. The session will then discuss the perceived benefits and UK implementation of the Care Guidelines.