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Managed care groups turn to PCS

MEMPHIS, TN – Memphis Managed Care has completed implementing MEDecision’s patient clinical summaries (PCS) as part of its pay-for-performance pilot.

“The right way to provide the highest level of care for patients with chronic conditions is when primary care physicians have access to all their patients’ clinical information – from case managers to pharma directors,” said medical director Clarence Davis, MD.

The PCS, a payer-based health record, uses data analysis and applies evidence-based medicine to present treatment opportunities for physicians, said Henry DePhillips, MD, CMO of MEDecision.

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The PCS condenses claims data into a two-page actionable summary that is available 24/7. For physicians who are already burdened with managed care tasks, especially phone calls, Davis said “the PCS fits into a doctor’s workflow.”

Emergency room use in western Tennessee is increasing 7 percent annually. With the PCS, Davis expects to see a reduction in inappropriate ER use and inpatient days per thousand.

MMC spends approximately $4 million annually on ER cases related to high blood pressure. “With the PCS, we will be able to provide comprehensive care,” he said.

The PCS will also allow physician practices, the majority of which comprise five or less physicians, to take advantage of what Davis calls ‘EMR Lite’ without having to purchase a prohibitively expensive electronic medical record system.

Other payers have seen savings with MEDecision’s PCS, including Keystone Mercy Health Plan of Southeastern Pennsylvania. The payer has reduced its diagnostic testing and ER costs, as well as increased its appropriate medication therapy.

Christiana Care Health System of Delaware’s ROI studies have showed that the combined cost for ER and first day of hospitalization was reduced by $545, DePhillips said. The savings were realized in lab tests and cardiac catheterization either not being repeated or done unnecessarily. The reduction of tests and procedures eliminated the need for medical and surgical supplies.

Christiana saw a statistically significant increase in reimbursement for cognitive care through appropriate coding and billing for the medical complexity that was being addressed.