Provider-Focused Solutions

We support providers, no matter where they are on their journey to transformation.  Our comprehensive approach includes everything from practice assessments and recommendations to helping you achieve national recognitions, such as Patient Centered Medical Home or Patient Centered Specialty Practice.  Our team of experts bring diverse backgrounds and skillsets to complement a whole practice approach with experts in practice optimization and transformation, data analytics and quality reporting, and integration of services, such as clinical pharmacy and behavioral health.

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Advanced Medical Home (AMH) Support Program

The Advanced Medical Home model is the focal point of North Carolina Medicaid’s shift from fee-for- service to a value-based model. It also represents a unique opportunity for practices to regain control of patient care, equipped with the tools, support, and higher reimbursement rates necessary for success and sustained operations.

The AMH program is divided into three different categories, allowing current Carolina ACCESS practices to continue operations with few changes (Tiers 1 and 2); however, practices ready to take on more advanced care management functions will receive additional care management fees if they meet Tier 3 requirements. This requires in-house care management capabilities or contracting with an external entity such as Emtiro Health. In exchange for these enhanced functions, the Tier 3 AMH receives an additional monthly capitated care management fee (“per-member, per month”) over and above that of the baseline medical home payments available as a designated AMH.

As a Tier 3 Advanced Medical Homes (AMH), practices must, in addition to all standard AMH requirements:

• Receive claims data feeds while meeting state-designated security standards for their storage and use

• Risk stratify all patients

• Provide care management services to all high-needs patients

• Develop a Care Plan for all patients receiving care management

• Provide short-term, transitional care management along with medication management to all patients who have an emergency department (ED) visit or hospital admission/discharge/ transfer or who are otherwise at high- risk of readmissions

Performing these functions requires a strategy for data aggregation, exchange, and analytics, in addition to comprehensive, tailored care management and monitoring of high-needs patients. Emtiro Health, with over 20 years' experience in the vanguard of data analytics, population health, and care management is equipped with experienced teams of interdisciplinary staff and deep partnerships across our communities to help your practice succeed as an Advanced Medical Home.

AMH Development

We offer a menu of effective care management, behavioral health, and insightful data-analytics support services. With our in-depth knowledge of AMH program requirements and our strong track record of successfully coaching practices through similar provider recognition programs (including NCQA’s PCMH and PCSP products), we can tee up your practice for success as a Tier 3 practice, lining it up for future success.

Data Analytics and Support

Emtiro Health has a robust population health analytics suite designed to handle the data ingestion, integration, reporting and care management operations expected of a Tier 3 AMH. Furthermore, we recognize that no “one-size” fits all. Our analytics team can tailor a solution to fit the practice’s needs, regardless of a practice’s current capabilities in care management or quality reporting.

Practice Transformation and Care Integration

The AMH model requires enhanced integration of care across previously siloed specialties. We offer expertise in NCQA PCMH Recognition, Clinical Pharmacy Integration, Community and Clinical Integration Support, and Behavioral Health Integration. More specifically, under the AMH model, practices will need to report on several quality metrics that relate to the behavioral health of their empaneled patient populations. Primary Care practices will require support as it relates to behavioral health integration. Emtiro staff bring the skills and knowledge to make behavioral health integration a much less cumbersome and intimidating process.

CARE MANAGEMENT

Emtiro Health employs a local, team-based approach to care management that includes RN Care Managers, Social Workers, Community Health Workers, Care Management Assistants, and other professionals.  Our Care Management programs meet NC Medicaid and PHP Tier 3 AMH expectations for:

• Coordination of care for all enrollees via a Care Coordination Program which assumes responsibility for patient access to an ongoing source of care, communication between providers (physical health, behavioral health, and LTSS), and linking patients to community resources to address unmet health-related social needs.

• Disease management for all enrollees through a Prevention and Wellness Program that addresses identified care gaps, priority public health programs (tobacco cessation, opioid misuse and prevention), chronic health conditions (diabetes, asthma, hypertension, obesity), and social determinants of health.

• Identification of high-need populations (through care needs screening and risk stratification) and delivery of a Complex Care Management Program targeted at top utilizers. A Chronic Care Management Program is focused on the specific needs of the rising risk population. Each patient identified and enrolled in either of these programs will receive a Comprehensive Assessment and a Patient Specific Care Plan that includes specific interventions and measurable goals. 

• Delivery of transitional care for enrollees in transition between settings provided by a Transitional Care Management Program that places specific emphasis on early and frequent contact for 30 days following high-risk transitions. 

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Practice Optimization

Healthcare providers today feel the challenge of delivering quality of care versus delivering personalized care to their constituents.  Emtiro partners with you - the provider, practice or organization - to formulate and execute programs and processes to maintain the provider-patient relationship, while meeting quality driven metrics.  Practice optimization is important in today’s growing value-based care arena to create a balance for providers and to maintain and increase profits.

Quality Improvement

Emtiro Health partners with practices to evaluate quality improvement data for providers, practices and organizations and create a customized blueprint that will achieve practice specific goals that meet organizational and payer needs. Our highly trained and skilled professionals specialize in practice optimization, quality assurance and quality improvement. They use multiple techniques, including Lean for Healthcare methodology and Kaizen events, to gain practice and employee engagement in improvement activities.

Practice Workflow Enhancement

Emtiro Health will work with you to identify and optimize practice workflows that will maximize patient outcomes, resource efficiencies and revenue.  We will deploy a team of individuals to thoroughly evaluate your practice and specific opportunities in staffing, quality reporting, and EHR optimization.