MCG Health Partners with Performance Clinical Systems to Reduce Redundancy and Costs in Utilization Management Processes

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Dynamic workflow improves response times and enables more precise communication supported by evidence-based decision support guidelines.

MCG

MCG

Together, we can offer never-before-seen solutions that improve productivity from distributed care teams, enhance patient satisfaction, and realize a positive financial impact from overall utilization management effectiveness.

Performance Clinical Systems announced the integration of its cloud-based clinical workflow management platform, Symphony, with MCG Health's market-leading Cite CareWebQI solution. The hallmark of the Symphony solution is simplicity, which enables rapid implementation, adoption, and impact within an organization. Integrating Symphony with MCG enables payers to leverage the latest evidence-based care guidelines to support appropriate medical necessity determinations while taking into account the unique medical needs and optimal recovery standards based on industry best practices.

Symphony’s sophisticated, role-based hierarchy drives efficiencies across care teams by dynamically generating data and guided workflows based on the role of the user and the patient they are targeting. All of the critical functions required for a care management program are provided, including utilization management, care management, and condition management. Symphony leverages real-time information and existing health IT investments—such as claims, analytics, and electronic medical records—while allowing care managers to engage patients one-on-one in a context-sensitive way much more efficiently than traditional care management platforms.

CareWebQI allows users to capture the correct clinical documentation for medical necessity against MCG care guidelines while ensuring appropriate member care. CareWebQI helps address unnecessary variations in care and maintain compliance. Health plans enrolling members with complex - and often costly - conditions require the right tools to effectively manage these populations. MCG care guidelines offer an evidence-based approach to the most effective care and are delivered seamlessly through Symphony, allowing for easy accessibility across care team roles.

"Partnering with other companies that are committed to improving healthcare, like Performance Clinical Systems, is an important component of MCG’s goal to proactively optimize patient care,” says Jon Shreve, President & CEO of MCG. “This integrated system will provide access to evidence-based best practices and care planning tools, supporting clinical decision-making and documentation as well as enabling efficient transitions between care settings.”

"Today’s value-based models require efficient coordination across multi-disciplinary teams as well as a renewed emphasis on quality, evidence-based care," said Performance Clinical Systems Chief Scientist, Chris Johnson, MD, MPH. "This model calls for more transparency and innovative technology to support seamless communication across settings. Together, we can offer never-before-seen solutions that improve productivity from distributed care teams, enhance patient satisfaction, and realize a positive financial impact from overall utilization management effectiveness."

Optima Health Plan in Virginia will be the first client to take advantage of this integration, enabling their care teams to better manage utilization by leveraging a common platform and clinical guidelines which serve various clinical roles and settings, contract parameters, and patient environments.

“The system will add efficiency, reliability, and accuracy to the utilization management process for all Optima users. This partnership automates the access and use of evidenced-based clinical guidelines across all care team members,” said Patricia Curtis, Director of Operations Strategic Expansion Programs, Clinical Care Services, Sentara Health Plans.

About MCG Health
MCG, part of the Hearst Health network, helps healthcare organizations implement informed care strategies that proactively and efficiently move patients 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 http://www.mcg.com or follow our Twitter handle at @MCG_Health.

About Hearst Health
MCG is part of the Hearst Health network, which also includes FDB (First Databank), Zynx Health, Homecare Homebase, MedHOK, Hearst Health International, Hearst Health Ventures and the Hearst Health Innovation Lab (http://www.hearsthealth.com). 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 the Hearst Health network reaches 84 percent of discharged patients, 177 million insured individuals, 60 million home health visits and 3.1 billion dispensed prescriptions.

About Performance Clinical Systems
Performance Clinical Systems is a privately held healthcare information technology company based in San Francisco, California. Founded by two physicians, its cloud-based workflow accelerator platform, Symphony™, proactively manages patient outreach and encounters across various roles and clinical settings within team-based care models. Algorithms tailor “on the fly” workflows based on case-specific care needs, prior patient encounters, payer contract requirements, and the specific role of a care team member. This approach enables efficient and scalable patient engagement models which are highly personalized. Additionally, Symphony ensures regulatory-compliant engagement and creates an electronic trail for care and contract compliance reporting. For more information, visit http://www.performanceclinical.com.

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Arri Burgess
MCG Health
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