Agreement includes direct contract with an IPA for Anthem Prudent Buyer member population WOODLAND HILLS, Calif. and FOSTER CITY, Calif., Aug. 10, 2011 /PRNewswire/ -- Anthem Blue Cross and Individual Practice Association Medical Group of Santa Clara County (SCCIPA) today announced they are launching an Accountable Care Organization (ACO) program to provide coordinated, seamless medical care to Anthem PPO members in the Silicon Valley. The ACO is the first of its kind in Northern California, and includes a direct contract agreement between Anthem and the IPA. Anthem Blue Cross expects that initially tens of thousands of PPO members whose physicians participate in the SCCIPA network will benefit from the care coordination, chronic disease management, increased provider accountability, and improved availability of medical information for patient decision-making that are hallmarks of the ACO model. SCCIPA's network includes 284 primary care physicians, 550 specialists and ten acute care facilities throughout Santa Clara County. Members will be included in the program if they have received the majority of their medical care from these same treating physicians in the past and where there is already a strong physician/patient relationship. "We are pleased to expand our relationship with SCCIPA to include both a direct provider group contract and the launch of an ACO model," said Pam Kehaly, president of Anthem Blue Cross. "Individuals who receive coordinated, patient-centered care through a collaborative partnership with their physicians can better navigate their options and more effectively manage their health care needs. SCCIPA's investment in its innovative coordinated care IT platform and demonstrated quality clinical and administrative management performance across its electronically integrated network, make them an ideal partner to offer our first ACO model in northern California." J. Kersten Kraft, MD, a practicing urologist and president of SCCIPA notes, "We continue to refine our coordinated care model to deliver a better-quality member experience through enhanced communication, better compliance, optimal utilization of in-network providers and generic medications, and reduction of unnecessary procedures, hospital admissions and readmissions. We're looking forward to the opportunity to serve the needs of Anthem Blue Cross Prudent Buyer members through our new ACO structure." About Anthem Blue Cross Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross names and symbols are registered marks of the Blue Cross Association. Also follow us on Twitter at www.twitter.com/healthjoinin, on Facebook at www.facebook.com/HealthJoinIn, or visit our YouTube channel at www.youtube.com/healthjoinin. About SCCIPA With its roots in the heart of the Silicon Valley, the Individual Practice Association Medical Group of Santa Clara County Inc. (SCCIPA) integrates a network of more than 800 physicians and ten hospitals throughout Santa Clara County. SCCIPA cares for more than 65,000 health plan members who can choose from 284 primary care physicians (family practice, internal medicine and pediatrics) and 550 specialists. SCCIPA operates like a clinic without walls, linking patients and health plans electronically with an established network of physicians, hospitals, lab, x-ray, physical therapy and other providers. SOURCE Anthem Blue Cross Back to top RELATED LINKS http://www.facebook.com/HealthJoinIn    more...

AxSys Technology Article about Case and Utilization Management By Alan Gilbert There can be no question that recent health insurance and the health information technology reforms out of Washington have prompted stakeholders throughout the healthcare industry to seek solutions with the potential to increase access to quality care while better managing costs. This realization has motivated organizations wanting to achieve genuinely coordinated care and formal recognition by CMS as an accountable care organization (ACO) to integrate the administrative, financial, and clinical components involved in the care of patients. Specifically, this entails combining the case management and utilization management data with the clinical repository. This aggregation of data enables the development of chronic and acute disease and wellness programs designed to influence individual behavior and positively impact overall health. Case and utilization software empowers case managers by granting secure access to a patient’s longitudinal clinical history in real time. At any point in the care plan development and management workflow, a case manager can access their patients’ most recent laboratory results, medication prescriptions and refills, radiology images, diagnosis codes, Emergency Department admissions, consultation notes, discharge summaries, etc. Equipped with this level of detail, case managers can better coordinate with providers so patients and their caregivers have timely access to the most appropriate care available. To achieve this level of functionality, case management solutions should include features such as: Case activity captured in a single case record Online, user-defined assessments Link to track standard treatment guidelines User-defined tables to customize a unique list of problems, goals, barriers, interventions, status codes and acuity levels Outcomes for each case Ability to auto-assign a patient to case management when authorization referral requests are received, as well as to manually open a case from referrals outside the automated system (e.g., family member, social worker, etc.) Audit logging of important data changes Online work lists, easy search filters and helpful reminders that prompt case managers to ensure timely follow-up on active cases The latest utilization management (UM) solutions rely upon automation to help risk- and non- risk-bearing organizations to support cost-efficient delivery of medical services. Patient eligibility, benefits and patient clinical data determine acuity levels, which allows advanced rules engines to auto-adjudicate authorizations and referrals that have been entered online. Authorizations and referrals that are pended – because of outlier characteristics, for example, or the complexity of the case – are routed to a work queue for review and management. The UM software should be able to leverage clinical data to automatically route or refer the patient to case management. Organizations seeking this functionality from utilization management software should determine whether solutions under consideration include: Eligibility inquiry capability Provider inquiry capability Authorization guidelines and rules defined and maintained Care guidelines Immediate authorization status response functionality User-defined protocol rules that result in approving, pending, and/or denying authorizations Configurable authorization work-list queue functionality Routing of pended authorizations to another party for review Concurrent review notes and "level of care" information Secure internal messaging The new environment clearly places the patient at the center of all healthcare processes, with members of the extended care team considering options and making decisions in concert. Technology must be implemented to help these care teams monitor, track, treat and report on every patient at every point of service. Case and utilization management, combined with access to discrete clinical data, should be able to deliver tangible results such as: Reduced readmissions, Lower cost of care for patients through chronic disease management and preventive care Elimination of duplicate tests Greater efficiency with auto-approval of referrals and authorizations As Bob Dylan famously sang, “The times they are a-changin’.” But the emergence of new care models, supported by flexible and scalable care coordination technologies, will help healthcare organizations navigate the new landscape and reap the projected benefits more quickly. Alan Gilbert is the vice president of Business Development for AxSys Technology, Ltd., which specializes in the development and implementation of clinical solutions to improve and coordinate the delivery of healthcare.  more...

AxSys Health Article in Billians Health DATA Alan Gilbert, VP, Business Development, AxSys Technology Ltd. May 24, 2011 Since 2007 and 2008, the Centers for Medicare & Medicaid Services (CMS) and the Hospital Quality Alliance (HQA) have publicly reported 30-day mortality measures for acute myocardial infarction (AMI), heart failure (HF) and pneumonia (PN). More recently, CMS has also publicly reported 30-day readmission rates for AMI, HF, and PN. The Patient Protection and Affordable Care Act (PPACA) allowed CMS the ability to penalize hospitals for excess readmission rates starting in 2013 for AMI, HF and PN. Starting in 2015, CMS will evaluate withholding payments for 30-day readmissions in the areas of chronic obstructive pulmonary disease (COPD), coronary artery bypass grafts (CABG) and percutaneous coronary interventions, among other procedures. The report above shows the National Average Reimbursement for Heart Failure & Shock w/ MCC (DRG 291): $7,696 - $9,939 based on 3,844 hospitals that submitted readmission rate data for the reporting period of 7/1/2006 - 6/30/2009. Using technology to empower recently discharged patients to communicate their current health status to providers is one way to help lower readmissions rates. One example of this is Surgical Site Infection control (SSI) of recently discharged patients. In Scotland, Golden Jubilee - a facility that accepts surgical patients from across the country - found it difficult to monitor patients' post-surgery home-based progress. Patients would be discharged back to their local community with no way of obtaining feedback on their subsequent condition. The hospital recognized there was a need for continued communication between patient and provider in order to monitor for infections. It implemented an automated post-discharge SSI surveillance system, which provides an interactive telephone-based, patient home monitoring module linked to an electronic patient record. The surveillance nurse, who interviews patients before they are discharged, generates this record. All patients are given instructions on how to use the system. Patients are asked to access the system 15 and 30 days following surgery by calling a free phone number via a touchtone phone. The patient calls in and answers a customized SSI script with questions about the status of their wound. The patient responds to script questions by pressing corresponding numbers on the telephone keypad. Phone responses are fed directly into the system, which automatically assesses their answers and totals the predetermined numerical weight of their answers. It generates an alert if the patient's response scores between eight and 18. If the score is over 18, the system sends an e-mail alert to three members of the hospital's infection control team. All patients with a score greater than nine receive a follow-up phone call to discuss the wound and determine if an infection is present. Chronic Obstructive Pulmonary Disease (COPD) Care at East Elmbridge and Mid-Surrey Primary Care Trust, also in Scotland, is another example of enabling patients to communicate with their caregivers while at home. The process enabled patients to recognize changes in their own condition. The belief was that if patients could be encouraged to take an interest in their own disease and day-to-day care, the frequency of home visits during the year would be reduced. Patients are registered into the system after Respiratory Nurse assessment. After the initial assessment, the patient calls in from home and answers a customized COPD script with questions about the status of their COPD symptoms. After the call, a report is created and an alert is generated - based on defined criteria - if there is a detected deterioration in the patient's condition. This alert is automatically sent to the Respiratory Nurse via text message, who then calls the patient to give advice or take suggested action. After an incident, nurses enter their clinical notes directly into the system and clear the alert. Implementing this process lowered hospitalizations by 44%. Hospitals need to continue to find creative and cost-effective ways to reduce and prevent readmissions. Empowering patients through the use of technology that already exists in most patients' homes is one way to engage the patient in their own care. Alan Gilbert is the Vice President of Business Development for AxSys Health, which specializes in the development and implementation of clinical solutions to improve and coordinate the delivery of healthcare.  more...

Web-Based Technology to Speed Transition to Patient-Centered Model of Care and Enhance Communications Across Its Network Created May 10 2011 - 12:30pm LOS ANGELES & FOSTER CITY, Calif.--(BUSINESS WIRE [1])-- AltaMed Health Care Services, which has delivered quality care to the underserved communities of Southern California for more than 40 years, and Health Access Solutions, offering a Web-based multidisciplinary care coordination platform, today announced they will enter into a strategic relationship to improve care coordination across AltaMed’s network of staffed clinics, independent physician practices and community-based health centers. The announcement was made at the annual California Association of Physician Groups (CAPG) Healthcare Conference in Palm Desert, Calif. In 2010, CAPG added Health Access Solutions to its group purchasing organization, recognizing the value of the company’s integration of Access Express™ care management software and Excelicare™ clinical functionality. This first-of-its-kind platform is capable of enabling deeper levels of clinical integration and care coordination across diverse delivery enterprises such as primary care medical homes and accountable care organizations (ACO). The largest independent Federally Qualified Community Health Center in the U.S., AltaMed delivers primary medical care, dental clinics and complete senior long-term care services to more than 100,000 families at 43 sites across Los Angeles and Orange counties each year. Attuned to evolving clinical and reimbursement models, AltaMed will build upon its electronic health record system, which is widely deployed throughout its primary care physician network. The relationship with Health Access Solutions will allow AltaMed to expand care communication capabilities among staffed facilities and partner IPAs (independent practice associations) to improve care coordination and maintain a patient-centered model of care across its entire delivery network. “We are delighted with the extensive functionality that the Health Access Solutions’ platform offers,” says Martin Serota, MD, VP and CMO of AltaMed. “It will help us to create a clinically integrated organization, supporting our efforts to improve clinical workflows and clinical decision-making.” President and CEO Cástulo de la Rocha, JD, says, “This strategic relationship further leverages AltaMed’s continuing investments in information technology to improve patient care for the population we serve.” He adds, “This is more than a technology purchase for us; this is the beginning of a truly transformative process.” “Deploying the Health Access Solutions’ platform will help AltaMed fulfill its vision of being a completely integrated, patient-centered organization,” says Randall Frakes, CEO of Health Access Solutions. “We are pleased that our offerings are so well aligned with AltaMed’s strategic direction, and look forward to a long and successful partnership.” About Health Access Solutions Founded in 2000, Health Access Solutions delivers a patient-centric care coordination platform that enables physicians, hospitals, payers and patients to collaborate across the care continuum. Access Express™ and Excelicare™ together provide clinical and care management solutions to organizations in the U.S., Puerto Rico, Canada and the U.K., accounting for more than 31,000 healthcare providers as well as eight million patients and health plan members. The company’s integrated care coordination platform was designed from its inception to support patient-centric care collaboration models such as the medical home and Accountable Care Organization. Marketed under the Access Express Care Management and Excelicare Clinical Management brands, the transformative Web-based platform enhances clinical decision making through evidence-based clinical decision support and treatment reminders; gaps-in-care alerts; medication and care plan adherence notifications; and real-time quality dashboards, analytics and reporting for individual and patient populations. In addition, it enables secure patient access to summaries of current medical record information, while offering patients the ability to easily communicate online with care providers and office staff for appointment and refill requests or other secure communications. For more information, visit www.HeatlhAccessSolutions.com [2]. About AltaMed Health Care Services AltaMed has delivered quality care to the underserved communities of Southern California for more than 40 years. The largest independent Federally Qualified Community Health Center in the U.S., AltaMed documents more than 650,000 annual patient visits through its 43 sites in Los Angeles and Orange Counties. Accredited by the Joint Commission, AltaMed serves the entire family with primary medical care, dental clinics and complete senior long-term care services, including Adult Day Health Care Center (ADHC) services, senior case management, and the Program of All Inclusive Care for the Elderly (PACE). AltaMed also delivers disease management programs, health education, youth services, specialty HIV/AIDS care and substance abuse treatment. Committed to patient-focused care delivered through a caring team of culturally competent health care professionals, AltaMed’s integrated system emphasizes prevention and healthy living, and is designed to reduce health care disparities and avoid unnecessary trips to emergency rooms or other more costly forms of care.  more...

AxSys Health Blog Post on Carl Mercurios Inside View on the Business of Healthcare By Alan Gilbert Vice President, Business Development AxSys Health Managed Clinical Networks (MCN) are an important component in the support of better patient access and treatment through a coordinated care approach.  The MCN concept was created in Scotland in 1999 by the Scottish Department of Health. Their definition of MCNs is defined as “linked groups of health professionals and organizations from primary, secondary and tertiary care, working in a coordinated manner, unconstrained by existing professional and Health Board boundaries, to ensure equitable provision of high quality clinically effective services throughout Scotland.” Like a fine wine, this definition has aged well and seems to translate into the current goals of ACOs. Some features of a MCN include: The application integrates primary, secondary and tertiary care services A care plan is established which will serve all network stakeholders The care plan has the capability to incorporate evidence-based medical practices All participating members of the multi-disciplinary care team will have equality of access to the care plan (access rights can be granted, partly or whole) Multi-disciplinary team meetings are facilitated through the telemedicine and teleconferencing. Experts at remote sites are able to discuss the patient review patient notes simultaneously Automated generation of referral letters, summary documents and discharge letters Educational and patient advice leaflets can be accessed and distributed A specific client example is a Gynecological MCN for the West of Scotland that was established in 2000 to ensure the highest standard of care for all patients with gynecological cancers across the region. This was to be achieved by enhancing the referral system for specialist opinion and treatment, encouraging a multidisciplinary approach and educating all clinicians involved in the care of these patients by open discussion and debate. Participants would include medical & clinical oncologists, gynecologists, radiologists and pathologists. A weekly videoconference was instituted to enable clinicians from across the region to participate in discussions on their patients. The patient data was redacted so that the care-giver did not know if the patient was in their hospital or one of the other 9 hospitals in the region. Benefits Realized by implementation of the Gynecological MCN included: Reduced travel and delays – The MCN was able to discuss individual cases without extensive travel and patients are able to be referred and seen without delay Equitable access to care – Patients are guaranteed that they will receive specialist review regardless of geography and that all clinicians involved in their care participate in establishing and reviewing their care plans Improved care delivery – The speed of delivery of the treatment plan has improved as all relevant information such as laboratory reports and pathology is recorded and collated through one central system Improved education – Clinicians have benefited from the sharing of knowledge through the cross specialty discussions and the meetings also provide an excellent training ground for junior doctors and other clinical staff who attend Improved data quality – through a central repository with better audit trail and introduction of standardization and accountability I believe that as ACOs continue to form collaborative patient care in a community, that models like Managed Clinical Networks should be studied.  more...

AxSys Health Article in HIMSS News - Viewpoint: Technical Strategy By Alan Gilbert Aetna's acquisition of Medicity, Ingenix's acquisition of Axolotl, and the IBM/ActiveHealth Management partnership are three recent indicators of the changing healthcare IT vendor landscape - one that is in the process of consolidating to more sharply focus on the needs of collaborative and coordinated care. These merger and partnership agreements validate the need for an overall technology platform to support the rapid rise of healthcare models like Accountable Care Organizations (ACOs) and the revitalization of established approaches such as Patient-Centered Medical Homes (PCMHs). Emerging constructs for care coordination require technology to facilitate data sharing across organizational boundaries--a paradigm shift that will soon characterize healthcare. However, there's one major problem: Despite the industry buzz these company consolidations have created, there have been very few resultant technology platforms that have seen real-world implementation; and even fewer that have demonstrated true cross-organizational, comprehensive care coordination.   Anticipating the "market of the future," some technology vendors are taking a MacGyver approach: a little bit of twine, a bent paperclip and some chewing gum to create a workable IT solution. By cobbling together various software products, they hope to string together an approach that will permit customers to meet the goals of new models and regulations - and cement their own position in the marketplace. A superior approach may be found in a cohesive system that was built from the ground up to specifically serve the needs of a collaborative and coordinated care platform. The challenge facing forward-thinking healthcare leaders is where to find a solution that addresses the technology needs of today…and of tomorrow.  We’ll explore alternatives available in our next column – and examine questions and requirements savvy executives will consider before making any sizeable investment in technology that claims to provide the care coordination they seek. Alan Gilbert is the vice president of Business Development for AxSys Technology, Ltd., which specializes in the development and implementation of clinical solutions to improve and coordinate the delivery of healthcare. NOTE: Content repurposed courtesy of Porter Research/Billian’s HealthDATA; http://www.PorterResearch.com; http://www.BilliansHealthDATA.com  more...

Longitudinal Patient Record Systems – A Necessity for Accountable and Collaborative Care By Alan Gilbert In response to Dr. Jayne’s inaugural Curbside Consult regarding the lack of longitudinal care systems and the focus on episodic care, our experience has shown that a longitudinal patient record system is critical to realizing a goal of a more effective and efficient healthcare system that results in improved outcomes for patients. We believe that healthcare needs to be delivered at the point of need and not at the point of care. One example of a longitudinal patient record is the National Clinical Network for Cleft Lip and Palate Services in Scotland. This project was established in 2000 to deliver interdisciplinary care between health professionals providing care for cleft lip and palate patients between birth and 20 years old. The objective was to provide a single record for a patient, creating a virtual multi-disciplinary care team for that patient including dentists, orthodontists, oral surgeons, speech pathologists, ENTs, audiologists, as well as the patients themselves, who were active participants in their own care. The platform accommodated clinical imaging, generated email,and letter alerts to remind clinicians and patient alike of their particular responsibility at specific times, and supported and facilitated audit and outcome assessments. Benefits realized included: Improved communication – sharing of information across care providers Improved standards of care — a single source of patient information to monitor and analyze outcomes Improved coordinated care — interdisciplinary treatment planning and care has improved due to use of the platform Improved efficiencies — more effective use of clinicians’ time as well as the patients, their parents, and caregivers Improved data access — minimized risk of data fragmentation over multiple sites, reduced cost, time and effort incurred by offline data entry and replication Better patient satisfaction — through improvement in the organization of clinics and coordination among specialties Improved reporting — reports and analysis on a national basis Another example of a longitudinal patient record is the National Sexual Health System in Scotland (NaSH) that was started in 2005. This strategy set out a framework for improving sexual health by enhancing access to information and services while enabling flexibility for local services to respond to local requirements. It also highlighted the need to be able to review existing data and develop a data collection framework to provide a more accurate picture of sexual health and wellbeing, in terms of both sexual conditions (chlamydia, AIDS, etc) and behaviors and attitudes. Benefits realized included: Ability to produce and aggregate national sexual population and public health data Improved clinical care and access to patient clinical information by introducing more patient focused processes and the ability to communicate directly with patients through patient portals, secure email and text Streamlining of services enabling improved throughput and availability Increased ability to share clinical data across services nationally Removal of multiple manual record keeping systems Ability to address some clinical governance issues more effectively Reduced requirement for duplicate entry of patient data and better quality of data More efficient and increased integration of systems These examples, as well as others in diabetes, cancer care, COPD, and infection control, all focus on the need for a technology platform that can create a consolidated clinical view of the patient, no matter their care setting. Alan Gilbert is VP of business development for AxSys Health of New York, NY.   more...

Alan Gilbert, Vice President of Business Development at AxSys Technology Ltd., chats with Porter Research about the conversations going on at HIMSS revolving around Accountable Care Organizations. HIMSS11: Getting Down to Business on ACOs  more...

CGI, AxSys, and Endeca are completing design work for the Chronic Disease Management System - Diabetic Registry according to eHealth Ontario's specifications and a limited-production release Diabetes Registry is planned for later this year. The Diabetes Registry will help patients and health care providers manage care for Ontarians with diabetes according to recommended guidelines. Axsys role in ehealth ontario diabetes chronic diabetes disease management   more...

Alan Gilbert, VP of AxSys Health, will facilitate Feb. 17 forum hosted by HLNY Foster City, Calif. - Feb. 8, 2011 - Health Access Solutions, offering a Web-based multidisciplinary care coordination platform, announced today that Alan Gilbert - Vice President of Business Development for AxSys Health, the North American division of the company's strategic partner, AxSys Technology, Ltd.  more...

Community-Based Hies are a Model of Interoperability Among Clinical Information Systems by Mark R. Anderson. EXECUTIVE SUMMARY Many health providers have focused on community-based health information exchanges (HIEs) as a useful platform to help them take the next steps in implementing electronic health information. Recent research by a healthcare technology advisory firm is an attempt to characterize various HIE models, with an eye on achieving that goal.  more...

Alan Gilbert, Vice President of Business Development, AxSys Health Aetna's acquisition of Medicity, Ingenix's acquisition of Axolotl, and the IBM/ActiveHealth Management partnership are three recent indicators of the changing healthcare IT vendor landscape - one that is in the process of consolidating to more sharply focus on the needs of collaborative and coordinated care.  more...

Jennifer Dennard, E-Media Marketing Specialist Like many acronyms in healthcare today, the phrase ACO has gained somewhat of a cult following. It generates newsworthy water-cooler buzz, is considered a panacea for the healthcare industry by many, and truly understood by few.  more...

Two contracts bring quicker, safer healthcare to approximately 1.1 million Southern Californians and Puerto Ricans Glasgow, UK, October 2010 - AxSys Technology (AxSys), a provider of patient-centric clinical information solutions, has announced the signing of two major overseas contracts with one of the United States' largest providers of managed care services, Aveta.  more...

eHealth Ontario's new province-wide enterprise chronic disease management system to use AxSys' Excelicare platform Glasgow, UK, October 2010 - AxSys Technology (AxSys), a provider of patient-centric clinical information solutions, has been selected as the key software solution provider in a major eHealthcare project in the province of Ontario, Canada.  more...

California's largest independent healthcare network invests in Excelicare to provide better, safer and less costly healthcare for around 60,000 patients  more...

California based Health Access Solutions, which offers provider organizations and payers a suite of industry-leading, Web-based solutions that enable meaningful use and support collaborative care, and AxSys Technology Ltd.,  more...

The contract was signed in San Juan, Puerto Rico in May and as part of the agreement AxSys will deliver the complete Excelicare platform which includes a health information exchange, clinical data repository, ePrescribing, patient personal health record (PHR) and the Excelicare clinical application development environment.   more...

Based in San Jose, California, Santa Clara County Independent Physician Association (SCCIPA) links more than 800 physicians who practice independently throughout Santa Clara County. SCCIPA cares for more than 90,000 members of most major HMOs and Medicare Advantage plans, who can choose from 280 primary care physicians (practicing family practice, internal medicine and pediatrics) and more than 550 specialists.  more...

After a competitive procurement process Excelicare was chosen as the Health Information Exchange connecting 1500 providers and 7 hospitals in Southern California. The Excelicare platform will be deployed as a clinical data repository and will deliver a web based continuity of care document (CCD) on over 300,000 patients to 1500 providers based upon clinical data harvested from Electronic Medical Records (EMR), Laboratories, Hospitals and Radiology systems across the Inland Empire region of Southern California. Additionally, AxSys will also be delivering a Surescripts certified ePrescribing solution and a personal health record (PHR) based upon its Excelicare platform.  more...