Case Study

Partners Health Plan

Making the Transition to Managed Care Easy for Individuals and their Families

Background

Partners Health Plan (PHP), a not-for-profit managed care organization, focuses exclusively on people with intellectual and developmental disabilities (ID/DD). PHP is committed to providing the additional services and supports these individuals need to live the best and most meaningful lives that they choose. To support personal outcomes, health, safety, and independence, PHP offers benefits that include supervision in residential situations: job coaching, durable medical equipment, and other vital services.

PHP sees people with developmental disabilities as individuals with needs specific to their situation and abilities, and tailors service plans and support according to each person’s unique requirements.

When the government established regulations requiring individuals be enrolled in Medicaid managed care plans, PHP engaged with leading insurance consultants and health IT systems that connected people with problem-based services. Many people with ID/DD, however, are not primarily defined by immediate health problems. The tools provided by the leading vendors did not meet the needs of these individuals for day-to-day human services.

Opportunity

PHP approached MediSked, LLC, for a software solution that connects individuals to the services and supports they need and the health insurance that covers these services, while allowing collaboration with the interdisciplinary team of their choice.

Solution

MediSked implemented a holistic suite of solutions that meet new government regulations while providing tools for care management and coordination, employee and provider management, and real-time reporting and oversight.

Result

MediSked’s DD-centric technology is goal-based instead of focusing on problems. The individuals PHP supports are receiving better care at a lower overall cost.

The Opportunity

We had to develop a whole care management system,” said Jan Abelseth, PHP chief operating officer. “We started with another company who made promises for a year, but when we finally went to produce it, it was clear they couldn’t do it. We had six or eight weeks before we were to start the pilot with the government. I had worked with MediSked in another position, so I asked them to do it. They did.

PHP approached MediSked, LLC, for a software solution that connects individuals to the services and supports they need and the health insurance that covers these services, while allowing collaboration with the interdisciplinary team of their choice.

MediSked worked closely with PHP to test a suite of solutions. Here the team observed the disconnect between service providers and insurance companies, and how managed care solutions could improve quality of life for the individual. Managed care plans have grown in popularity because of reduced costs for the taxpayer—but that could mean a reduction in available services as well.

One of the risks is that people can lose services,” said Doug Golub, MediSked president. “It’s really important to get it right.”

The Solution

MediSked implemented a holistic suite of solutions that meet new government regulations.

The MediSked Care Coordination Suite includes:

  • MediSked CoordinateCare Management Platform
  • Medisked Connect ExchangeMulti-Agency Business Intelligence Platform
  • MediSked ConnectAgency Management Platform
  • MediSked PortalPerson-Centered Platform
  • Integrated Assessment Tool

Using MediSked assessment integration tools, PHP can interview the individual using an iPad-based questionnaire loaded with the IAM assessment to ask questions on topics from health status and lifestyle to personal goals, dreams, and ambitions.

This assessment information then moves into MediSked Coordinate. In Coordinate, the individual and care manager begin the Life Plan Process: to set goals and determine the services and supports needed to achieve these goals. Coordinate also tracks progress, allows team members to input notes, generates emergency print sheets, holds required forms and documents, and produces reports to keep the team moving forward.

At the heart of the architecture, MediSked Connect Exchange (CX) moves data from one platform to another. CX also allows interaction with other health record platforms, including MediSked Connect, which centralizes and manages information for a provider, and MediSked Portal for the individual and their circle of supports. “The information from Coordinate is sent to the Connect Exchange data warehouse along with ongoing progress on an individual’s tasks and goals. Together, these platforms build a comprehensive record for each individual, providing texture not often available in standalone software systems,” said Andrew Wheeler, MediSked director of product strategy and design.

Reporting tools allow users to zoom in on specific information, from clinical and social history to goals and outcomes, claims, authorizations and utilization. “CX allows users to consolidate data across their various IT systems and analyze that information by population or sub-population, identify trends, and define thresholds for real-time alerting,” said Wheeler.

The system is so sophisticated, but in a person-centered way,” said Abelseth. Every clinician has a thing to do.

“Instead of focusing on problems, the MediSked system is goal-based. “We don’t think in terms of problems, we think in terms of the solution,” said Abelseth. “We use a single platform for everyone involved. “This population has a lot of providers that are non-medical. Most systems only give tasks to the care manager: ‘Make this appointment, do this, do that.’ Our system gives assignments across the spectrum of providers. That’s what we couldn’t get any other system to do. This transforms the way we work.

– Jan Abelseth,
PHP Chief Operating Office

The Result

With clearer data and the results of the assessment questionnaires, managed care providers could define aspects of individuals’ lives that were never apparent before. With the lessons of the 2014-2016 pilot integrated into the system, the suite was ready for launch. “We went live on April 1, 2016,” said Abelseth. “Now it’s the only system in the country that’s DD-centric. This has allowed us to implement a major initiative. Everyone in the country is watching to see if this succeeds or fails. It has allowed us to work effectively.

“Groups have never before been able to share plans, health data, outcomes summaries, hospitalizations, and major life changes in real-time,” said Golub. “They can finally do that, for the first time ever, because PHP has this cutting-edge system.”

Equally important, PHP increased its revenue significantly. “Now they know how every dollar is being spent,” said Golub. The result is better care for individuals with I/DD, at a lower overall cost. “Partners Health Plan is leading the way across the country for providing supports to individuals with disabilities,” said Golub. “The key is to respect PHP’s members as individuals, and support these individuals to live the most meaningful lives they choose.

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