Medicalincs LLC brings a unique understanding of healthcare delivery systems across healthcare settings & payer groups; and in-depth experience applying strategic fusion of clinical, business, and technical expertise -- to drive comprehensive and long lasting solutions to advance networks. Our key areas of expertise include:
CHALLENGE: Medicaid accounts on average, for 23.6% of total state healthcare expenditures. Medicaid State managed care organizations (MCO) need to maintain an MLR percentage (~85%). A Medicaid health plan had issues with maintaining their MLR and associated health outcomes (clinical measures and patient satisfaction scores). They also observed that approximately 5% of their highest cost beneficiaries accounted for 50% of total spending. The health plan then sought to develop and implement an Ambulatory Intensive Care program within a Primary Care Practice to manage the care of its’ highest risk-highest cost patients.
SOLUTION/CONTRIBUTION: Our expert led the multi-disciplinary team - consisting of health plan staff and clinical staff - who partnered to design, implement, monitor, and develop evaluation for a new care delivery model, and to establish methodology for patient identification and enrollment. The program design was rooted in fundamental components of primary care, including access, comprehensiveness, coordination, and continuity, coupled with integration of behavioral and social services; additional social needs support was established to address social determinants of health. The program was successfully stood up and monitored progress using as-close-to real-time clinical and claims data, and group surveys.
“… Because of the AIC program, I am able to refer my highest risk patients to a care team that can invest the time to really address their medical and psychosocial concerns …”
– Primary Care Provider
“… This program has really transformed how we address our highest risk patients; and the ROI is quite promising …”
– Health Plan Board of Director Member
CHALLENGE: The State Agency Program Management Office (PMO) sought training experts to assist with the development and delivery of a comprehensive training program for a group of practice transformation coaches. The State’s practice coaches will be part of a multi-faceted team of experts supporting the primary care practices in their care transformation journey. This training program will enhance the practice coaches’ expertise with the advance primary care model, and their ability to support the practices and care transformation organization in implementing change to meet the program care delivery requirements.
SOLUTION/CONTRIBUTION: Medicalincs’ qualified team will develop, organize, schedule, and deliver training activities based on our team’s collective knowledge, learning/instructional design expertise, and experience with advance care models. We applied Medicalincs’ E.A.I.D© Management and Learning model which provided added learning benefits over the traditional approach such as rapid understanding & assimilation, and long-term memory & retention. We developed training schedules & agenda, and training curriculum (identifying transition flow from topic to topic). Medicalincs developed and maintained training production coordination and ensured participants registration, and content development. Training sessions were successfully delivered using onsite and online using the GoToMeeting & GoToTraining platforms. Practice coaches were also provided with detailed, yet easy-to-digest snapshots of available learning resources.
“… Look forward to working with your team in the New Year; Thanks for all you have done for us …”
– Executive Director
“… Your coaching especially on change management and how to achieve buy-in among healthcare providers was very informational. I feel better equipped to engage providers and coach them through their transformation …”
– Practice Transformation Coach
“The trainers plainly worked hard on these sessions and I appreciate it; Very effective presentations!”
– Practice Transformation Coach
CHALLENGE: A large health system in the Mid-Atlantic Region with over 10 health center, was experiencing lag time (over 30 days) between time of diagnosis of a patient with breast cancer and the time treatment is actually initiated. The strategic leadership team identified this as a problem in effective, efficient, and timely care delivery, and sought an expert to develop and implement a solution.
SOLUTION/CONTRIBUTION: Our expert worked with the strategic leadership team to develop an implementation plan to set up a multi-disciplinary clinic for breast cancer. This involved discussions with several department staff on both the clinical and business side of the health system. The clinical team included specialty department leads for Radiology, Surgery, Oncology, Rad Oncology, and Ob/Gyn – to develop clinical procedures & process flows that also identify handoffs. On the business side, this involved the benefits team – to adjust the patients’ benefits package and co-pay structure, the EHR/IT team – to develop new configurations for new encounter types and scheduling protocol, the billing team – to modify the adjudication process. Our expert supported with development of business requirements document (BRD) and end user acceptance testing (UAT) of the program health IT solution. The implementation plan was piloted and with necessary adjustments, the multi-disciplinary clinic was successfully launched across other healthcare centers.
“… I am happy that I can have all my options discussed at one time so I can quickly make a decision about my treatment. It also feels good for me and my family to be included in the decision making process …”
CHALLENGE: A Federal Agency Innovation Group launched a Comprehensive Primary Care program as part of its effort to transform the healthcare delivery system from a volume/fee-for-service based system to a value-based system. The client's leadership team sought experts in program/change management and practice transformation to support the its program's national learning system. This includes faculty experts to guide and inform content for series of learning activities and peer-to-peer learning facilitation - on primary care transformation for primary care providers across the country.
SOLUTION/CONTRIBUTION: Our expert led a faculty of 25+ Multi-discipline Subject Matter Experts (known as the Faculty Team) who have in-depth experience in advanced primary care models to develop learning content for: Program Implementation Guide, Change package, Webinar series, Action group series, Affinity group series, Newsletters, and Targeted Primary Care function learning packages. For successful execution, our certified project and change management expert performed a variety of duties, including resource management, time management/scheduling, risk management, project reporting, engagement/recruitment of providers to co-facilitate peer-to-peer sessions, and present/facilitate learning sessions to providers.
“The learning series have been well ran and provides content relevant to our care transformation process …”
– Primary Care Practice
CHALLENGE: A Community Health System and Managed Care Organization sought expert support to evaluate a 3-year quality improvement/population health program involving seven federally qualified health center, and assess program success & readiness for participation in alternative payment and innovative care delivery models. The evaluation was to include qualitative (policy & procedure changes) and quantitative (process and outcome measures) elements.
SOLUTION/CONTRIBUTION: The evaluation was done using a mixed-method evaluation approach that provided participating health centers with regular, formative feedback. The evaluation combined impact and implementation studies, and was structured based on key primary care domains of the PCMH model and key patient safety drivers to support care delivery across settings. Implemented tactics and interventions were analyzed and potential confounders identified. Qualitative data (interviews, site visits, & surveys), and quantitative data (payer data & supplemental clinical data) were analyzed using SPSS and Tableau. Findings were documented in an executive summary report and seven health center-level reports (eight reports total). The report was submitted to the managed care board of directors for review and approval.
“…This evaluation exercise got us thinking more about some of our care delivery strategies …”
– Quality Improvement Director
“…The review encouraged me to track the trends in our data to better serve our patients and identify room for improvement …”
– Community Health Advocate Supervisor
“… This evaluation report was very detailed and went above and beyond my expectations and was very well received by the board!”
– Health System CEO