Crotched Mountain Community Care Wins 2018 Doyle Award for Optimizing Medicaid Outcomes

Community care management provider uses MCG evidence-based guidance to improve care transitions for clients with complex health conditions.

Community care management provider uses MCG evidence-based guidance to improve care transitions for clients with complex health conditions

GREENFIELD, NHMCG Health, part of the Hearst Health network and a leading provider of informed care strategies, has named Crotched Mountain Community Care (CMCC) a recipient of the 2018 Richard L. Doyle Award. Crotched Mountain is the first three-time winner of this national award.

CMCC is being recognized for using MCG’s interactive solution and evidence-based guidelines to coordinate care for patients facing complex health conditions combined with societal challenges. Factors such as poverty, unstable housing, and educational deficits can make navigating a complicated healthcare system even more difficult, leading to inefficient care transitions.

Through evidence-based care coordination, CMCC helped nearly 900 clients avoid nursing home placement, saving New Hampshire’s Medicaid program approximately $46 million in avoided costs annually.

CMCC is an independent case management agency funded under the Choices for Independence (CFI) Medicaid Waiver Program, a home and community-based waiver authorized by the Centers for Medicaid Services (CMS). In addition, CMCC’s services are integrated with New Hampshire’s Delivery System Reform Incentive Payment (DSRIP) 1115 Waiver Project, which distributes funds according to evidence-based interventions, infrastructure build, and quality indicator achievement.

Using MCG customization tools, CMCC created guidelines that support evidence-based case management within the community setting for patients with high-cost, high-resource conditions. Through Cite CareWebQI, CMCC case managers have easy access to evidence-based care paths to help Medicaid clients with traumatic brain injury, stroke, cancer, AIDS, and cardiac conditions.

“The key to providing effective care for this population is to begin home-based community support discharge planning at the point of catastrophic injury and/or illness,” said Lisa Perales, CMCC’s Chief Clinical Officer. “Not doing so can lead to delayed care transitions, poor outcomes for clients, and unnecessary costs to providers. To plan ahead, you need vetted information that helps clinicians anticipate the entire course of a patient’s recovery. That’s where MCG evidence-based guidelines come in.”

CMCC uses Behavioral Health Care, General Recovery Care, and Home Care guidelines from MCG to create shared care plans that help multiple institutions coordinate efforts across the care continuum. By anticipating obstacles to care transitions, the project optimizes time in high-cost acute, rehabilitation, and skilled nursing settings.

“A stroke patient admitted to hospital might end up staying in a nursing facility for nonmedical reasons—unstable housing, for example,” said Perales. “By identifying the housing issue during acute care intake, we can alert the care network and bring community resources to bear. When it comes time to transition to home care, the issue has already been or is being addressed. CMCC recognizes that the home is often the optimal site of care, but only when safe and adequately resourced.”

In addition to the substantial savings for New Hampshire Medicaid, CMCC’s implementation of MCG has achieved more rapid discharges for acute care hospitals and post-acute facilities with resultant cost savings, enhanced revenue, greater client stability in community placements, more efficient staffing for community care providers, and higher revenue for CMCC.

“Medicaid patients with complex conditions face a number of barriers to timely healthcare transitions, not all of them medical,” said MCG President Jon Shreve. “CMCC improves transitions by combining evidence-based clinical guidance with a deep understanding of the social determinants of health. The results are remarkable, and MCG is proud to play a role in their project.”

The Richard L. Doyle Award—which includes a $10,000 cash prize—will be presented to CMCC at MCG’s annual Client Forum in San Antonio, Texas, May 19-22, 2019. At the conference, Perales will discuss how lessons learned from CMCC’s award-winning efforts can be applied to larger insured populations for Medicaid, Medicare, and commercial insurance programs, resulting in significant savings and opportunities for revenue sharing incentives under value-based reimbursement contracts.

About Crotched Mountain Community Care

Crotched Mountain Foundation is a charitable organization founded in 1953 with a mission to serve individuals with disabilities and their families, embracing personal choice and development, and building communities of mutual support. Crotched Mountain provides special education, accessible recreation, and community and residential support services for people in New Hampshire, New England, and beyond.  For more information about Crotched Mountain Community Care please visit cmf.org/cmcc.

About MCG

MCG, part of the Hearst Health network, helps healthcare organizations implement informed care strategies that proactively and efficiently move people toward health. MCG’s transparent assessment of the latest research and scholarly articles, along with our own data analysis, gives patients, providers and payers the vetted information they need to feel confident in every care decision, in every moment. For more information, visit www.mcg.com or follow our Twitter handle at @MCG_Health.

About Hearst Health

The Hearst Health network includes FDB (First Databank), Zynx Health, MCG, Homecare Homebase, MedHOK, Hearst Health Ventures and the Hearst Health Innovation Lab (http://www.hearsthealth.com). Hearst also holds a minority interest in the precision medicine and oncology analytics company M2Gen. The mission of Hearst Health is to help guide the most important care moments by delivering vital information into the hands of everyone who touches a person’s health journey. Each year in the U.S., care guidance from Hearst Health reaches 85 percent of discharged patients, 205 million insured individuals, 70 million home health visits and 3.2 billion dispensed prescriptions.

About The Richard L. Doyle Award for Innovation and Leadership in Healthcare

The Doyle Award was developed to recognize organizations that make innovative use of the care guidelines to help deliver effective healthcare.

Dr. Doyle, the care guidelines founding editor, was a hospital chief-of-staff when he began creating clinical guidelines in the 1980s to help improve healthcare efficiency and quality at Mercy Hospital in San Diego. He later joined Milliman & Robertson and in 1990 published the first set of what was to become the care guidelines.

Judges for this award are independent healthcare quality experts, not currently associated with MCG. Applicants were judged on how well their projects supported the MCG mission to help drive effective care. Judges looked for evidence of improvements in healthcare quality and patient safety; patient/member satisfaction; staff efficiency, productivity and satisfaction; internal/external communication; and effective use of resources.

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