ZeOmega Webinars

Medicaid covers the medical, behavioral, dental, and long-term services and supports (LTSS) needed by millions of low-income Americans of all ages. Historically, managing the complex LTSS population to deliver quality outcomes at low cost has been challenging for many health plans because:

• Often times, LTSS patients present disabilities and multiple chronic conditions. Typical patients include profoundly, developmentally disabled children; adults with trauma or acute debilitating illness; and seniors challenged with immobility, cognitive, or debility issues. Many require 24-hour services and support.
• It can be difficult to coordinate care among the complicated web of LTSS caregivers. Nursing facilities, custodial home services, transportation, daily living assistance, and family caregivers are just a few of the many teams that need to be sharing member information and alerted to crucial care updates in real time.

View this webinar to hear industry thought leaders and subject matter experts discuss how Jiva helps health plans effectively manage the LTSS life cycle, handling everything from eligibility and assessments to care plans, individual service plans, authorizations, and budget management.

In this final Part of our two-part series, we continue discussing how population health management (PHM) solutions can help health plans significantly scale care management to broader member populations. Many challenges arise with expansion of whole-person focused care. But with the right PHM solutions, many of those challenges can be overcome.

A powerful PHM platform helps organizations push past barriers by helping them:

• Utilize risk identification and stratification tools to factor in broad clinical and non-clinical factors, not just costs.
• Create assessments and care plans that are scalable and optimized for integrated care management.
• Manage patients with both chronic and behavioral conditions using an integrated platform and programs.
• Incorporate social determinants of health, not just clinical factors, for an enhanced and holistic delivery of care.

View Part II of this complimentary two-part series.

Join us to hear industry thought leaders and subject matter experts discuss how ZeOmega clients have successfully transformed their care management programs using innovative technologies for:

• Integrated Care Management.
• Managing social determinants of health.

Facing ever-increasing pressure to reduce healthcare costs, health plans have been looking for new ways to significantly scale care management to broader member populations. Newly released NCQA Population Health Management (PHM) standards—like the use of more patient-centered assessments to determine care needs—provide yet another catalyst for health plans to forge change.

However, expanding whole-person focused care (as opposed to disease-state focused care) to a sizable portion of the member population requires health plans to address several challenges, including:

• Risk identification and stratification to factor in broad clinical and non-clinical factors, not just costs.
• Assessments and care planning tools that are scalable and optimized for integrated care management.
• Integrated platform and programs to manage patients with both chronic and behavioral conditions.
• Effective assessment and management of social determinants of health, not just clinical factors.

View Part I of this invaluable, two-part series. Hear industry experts discuss how ZeOmega clients have successfully transformed care management using:

• Integrated identification and stratification.
• Integrated assessments and care planning.

High rate of readmissions is a significant burden for the U.S. healthcare system. Medicare spends $26B per year for readmissions and almost $17B for avoidable readmissions. In 2013, the average cost of all-cause readmission was $13,800 per readmitted Medicare beneficiary. Now in 2018, CMS penalty for readmissions under the HRRP is $564M in total for 2,591 hospitals (~80% of evaluated hospitals), a 6.7% increase over 2017.

Readmissions are costly and are also indicative of quality of care. They are a critical part of STAR, HEDIS, and ACO quality measures. Even though they are a significant challenge, change is possible. If health plans work together with providers, they have a better chance of addressing readmission issues than if either were working alone.

To succeed, health plans and providers must collaborate closely to address:

• Difficulties related to the identification of patients and risk levels of readmission.
• Barriers that impede care coordination among various providers across care settings.
• Problems with chronic conditions.
• Challenges related to medication management.

View Recorded Webinar from ZeOmega^® to learn how how innovative population health management (PHM) solutions can help overcome these challenges.

Listen as industry thought leaders and subject matter experts discuss interoperability, analytics, integrated assessments and care planning, disease management, and support for multidisciplinary teams that can assist health plan/provider collaboration.

How do you work with contracted care management vendors to effectively manage member care?

Furthermore, how do you ensure that you are only working with FDRs that can meet CMS compliance requirements?

Medicare Advantage (MA) plans work with a broad range of FDRs. Some are Accountable Care Organizations (ACOs) while others are vendors offering services such as utilization management, case management, health reimbursement arrangements (HRAs), STAR gaps-in-care closure, and behavioral health. CMS recently expanded the definition of supplementary benefits, adding various and diverse service providers to the mix.

With so many organizations involved in care, major challenges arise. One of the biggest road blocks is trying to figure out if the services delivered by these FDRs meet your requirements. Additionally, it is difficult to confirm that they are compliant—which is imperative—because the consequences of noncompliance can be significant.

Ensuring compliance can positively impact your organization by avoiding:

• Corrective action plans.
• Civil Money Penalties (CMPs).
• Intermediate sanctions.
• Immediate termination of CMS contracts.

View this webinar from ZeOmega^® to learn how innovative population health management (PHM) solutions can help you get what you want, and need, out of an FDR.

Hear industry thought leaders discuss how a comprehensive care management platform for data integration/sharing, timeline monitoring, co-management, communications and reporting can help MA plans work with FDRs more effectively. With the right solutions, delivering improved care and services becomes easier while ensuring CMS compliance becomes more straightforward.

Behavioral health (BH) issues are a multi-faceted challenge for the U.S. healthcare system. In 2014, the U.S. spent $220B on mental health and substance use disorder treatment (SAMHSA). One in five adults experiences a mental health condition each year (NAMI). Over 24M Americans age 12 or older had illicit drug use in the past month (NIDA), and 11.5 million Americans misused opioids in 2015 (HHS).

Managing behavioral health has many challenges, including:

• How do you effectively identify BH patients when many are under- or mis-diagnosed?
• How do you manage BH issues within complex BH conditions, comorbidities, low adherence and high risks in transitions, as well as frequent social and familial issues?
• How do you coordinate care across highly fragmented BH services, including distinct and substantial public services, disparate community resources, and other BH providers?
• How do you track BH patients’ medication effectiveness when provider prescription patterns are difficult to gather, patient adherence to medication is low, and medications are often misused?

View this webinar from ZeOmega^® today to learn how innovative population health management (PHM) solutions can help overcome these challenges.

Industry thought leaders and subject matter experts will discuss the challenges facing BH management today. Learn how innovative solutions in data integration, analytics, integrated assessments and care planning, holistic care management, utilization management and stakeholder engagement can help BH programs more effectively manage challenging BH issues.

What is the impact of the prior authorization process on your organization? The total cost of a single authorization is $35-$100 when faxes, phone calls, clinical time and other aspects are considered. Both providers and health plans conduct duplicative medical reviews. This process is redundant, inefficient, and time-consuming.

But now, with InterQual Connect^TM from Change Healthcare, integrated into Jiva, the end-to-end population health management (PHM) platform and Sentinel Rules Engine (SRE) from ZeOmega^®, near real-time automated authorization decisions within a single platform are a reality. This industry-leading integration enables providers and health plans to:

• Provide easier access to updated content and criteria through the cloud-based Medical Review Service available in the core Jiva platform and Provider Portal.
• Improve collaboration by establishing connectivity between providers’ existing Utilization Management (UM) and Care Management (CM) workflows and the Jiva platform through the Authorization Gateway.
• Automate authorization requests submitted either through the Jiva Provider Portal or a provider’s UM/CM system, using the SRE engine to leverage both clinical and business rules.

View Recorded Webinar from ZeOmega to learn how the Jiva/InterQual Connect Integration strengthens health plan-provider collaboration, delivers a unified authorization workflow, and drives efficiencies.

Industry thought leaders and subject matter experts will discuss how this partnership unleashes the power of cloud connectivity to change the future of the prior authorization process.