Solutions for Quality Cycle Management
Enli delivers purpose-built and customizable solutions to meet an array of population health management, care coordination, and value-based care challenges. We define the interplay of analytics, data-driven care coordination, and health outcome measurement as Quality Cycle Management. Our solutions enable clinical, financial, and IT stakeholders to leverage data and coordinate care to pursue value and quality initiatives, using tools that are built on our industry leading technology platforms: CareManager and Value Navigator.
What is Quality Cycle Management?
Quality Cycle Management is the new business process used by health systems engaged in value-based care agreements with government and private payers. These provider organizations are striving to understand and manage the relationship between the quality of care, its costs, and its contribution margin. The common denominator among the factors in the value equation is health outcomes.
We bring relevant clinical, socioeconomic, and financial data together in one place to identify patient risk earlier, perform coordinated outreach and data-driven care delivery, and support evidence-based decision making.
We link quality improvement with reimbursement measures under value-based care models, delivering an 8x return on investment, according to actual Enli customer data.
We integrate with existing information management systems and data sources, resulting in minimal impact on IT resources and security.
Value-Based Care Analytics
Health system decision makers are accountable for optimizing organizational performance in value-based care programs. Detailed insights linking quality performance to contract parameters are required to identify the specific quality levers that will impact the bottom line.
Enli delivers tools that compare enterprise performance to contract parameters using EHR, claims, and any other data source. This enables continuous reporting on the effectiveness of health improvement programs. Under-performing measures indicate opportunities for management intervention.
Data-Driven Care Coordination
Population health strategy leaders are charged with connecting analytic insights with care delivery. Task-based care coordination tools are required to align care team action with quality and financial objectives.
Enli delivers risk stratification and care coordination solutions that creates cohorts and assigns them to programs. Once enrolled, the care team utilizes a task and role-based workflow application, helping to improve efficiency and reduce variation in care delivery.
Intelligent Care Plan
Providers and care coordinators must rapidly assess patient health and focus on care gaps aligned with clinical needs and contract performance measures. A single care plan is required across the continuum.
Enli delivers tools that automatically create a care plan for every patient, leveraging data from multiple sources incorporating patient goals, preferences and actions to improve health.
For a Quickly Evolving Market
Value-based care arrangements have become a material source of revenue for health systems. The Centers for Medicare and Medicaid Services continues to shift the payment model toward risk, and commercial insurers are following their lead. At the same time, providers who are closing care gaps are generating incremental fee-for-service revenue, while positioning themselves for downstream risk.
Enli technology can be applied to challenges emerging under value-based care. The solutions below reflect some of the opportunities our customers are pursuing with help from Enli.
The Centers for Medicare and Medicaid Services (CMS) reimburses providers who actively manage care delivery for Medicare patients suffering from two or more chronic conditions. The program, known as Chronic Care Management or CCM, was designed to help participants build the competencies required to succeed in value-based care and reimbursement.
PRIMARY CARE PLUS
PRIMARY CARE PLUS
CPC+ is a region-based, multi-payer program that rewards value and quality through an innovative payment structure tied to the medical home model. It represents CMS’ largest investment in primary care to date. CPC+ offers participating practices a new revenue stream, a scalable model to implement other value-based initiatives, and an exemption from the Merit-based Incentive Payment System (MIPS).
The Medicare Shared Savings Program was established by CMS to facilitate coordination and cooperation among providers to improve the quality of care for Medicare Fee-For-Service beneficiaries and reduce unnecessary costs. Eligible providers, hospitals, and suppliers may participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO).
PCMH defines a philosophy of care—and provides an operational model—that is centered on the needs and preferences of each patient, delivered by a coordinated, physician-led team of care providers, across a healthcare system that uses new workﬂows and technologies to make care more accessible. The focus is on quality and safety, providing the information and support that patients need to participate in their care and make more informed decisions about their health.
Volume and throughput continue to impact the patient-provider relationship, measures of patient and care team satisfaction, and the financial performance of physician practices. Technology and configurable programs systematize clinic workflow and prioritize care team tasks to improve practice efficiency, as well as satisfaction and financial performance. Enli programs, including Pre-visit Planning and Team Huddling, are accessible via forms directly integrated into your existing system of record—maximizing opportunities to plan for, and close, all prioritized gaps in care.
Tracking referrals ensures patients are properly managed through the entire episode of care—enhancing the patient experience, improving quality and outcomes, and maintaining the integrity of established delivery networks. Enli’s Referral Tracking program offers direct integration with electronic health records to accept referral orders in real-time. It provides a single-screen view of the workflow, including the steps required to complete a referral. And it populates a referral tracking dashboard to monitor performance.
TRANSITIONAL CARE MANAGEMENT
Patients eligible for Transitional Care Management (TCM) are tracked and managed in a shared workflow program powered by Enli’s team-based tasking software – CareManager Central Worklist. Critical actions supporting CMS’s TCM reimbursement program are asigned to members of the care team, and progress is tracked and recorded for easy reporting.
Enli population health management solutions bi-directionally integrate with leading electronic health record platforms to ensure data integrity, maintain workﬂow, and support clinical decision-making. Established integrations include:
Supported by Partners
Strategic partnerships and alliances extend Enli’s industry-leading population health IT capabilities and provide solutions in international markets
NTT is an IT services provider recognized for its depth in vertical industries, including health IT, and for its offerings around infrastructure services, cloud services, application services, and business process outsourcing.
Healthjump allows organizations to aggregate and gain access to data that resides within health information systems. It provides connectivity, extracts data, and securely transmits it to Enli population health management applications.