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, data analytics and quality reporting, and integration of services, such as clinical pharmacy and behavioral health.  We can assess your practice(s) and make recommendations of exactly how Emtiro Health's Provider Focused Solutions can bring value, enhance patient satisfaction, and make your practice sustainable for the long-term.

 

 
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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 patientsProvide 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 and Attestation

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 has a robust IT and data analytic platform 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.

Care Coordination

In providing care coordination, Emtiro Health’s goal for your practice is two-fold: (1) to identify and address opportunities to make the patient more successful with managing their health and achieve better outcomes; and (2) to ease the administrative, operational and clinical burden practitioners face.

Complex Care Management

Emtiro’s Complex Care Management represents an enhanced care coordination, coaching, and monitoring service for patients with complex, chronic, and co- morbid conditions.

Practice Transformation and Care Integration

The AMH model requires enhanced integration of care across previously siloed specialties. We offer expertise in NCQA PCHM 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.

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Practice Transformation

Emtiro Health can work with your practice to provide innovative solutions to drive your practice to value-based care.  Our experts have researched and understand the best models to drive efficiency, ensure high-levels of patient satisfaction, all while building efficient processes—not adding unnecessary work.


Patient-Centered Medical Home and Patient-Centered Specialty Practice

Emtiro’s team of NCQA-certified Content Experts offer superior, in-depth assistance to practices seeking NCQA recognition for becoming a Patient-Centered Medical Home or Patient Centered Specialty Practice.  Our staff will examine and improve workflows, analyze new and existing practice and patient data, and develop distinctive policies and procedures fitting for the practice and overall recognition program.  By working with our CCE’s, practices will achieve the highest level of recognition while also becoming well-positioned for other payer-based incentives.

behavioral health integration

We know that research has demonstrated that behavioral and physical health are closely related; therefore, Emtiro Health supports a whole-person approach to care.  We believe that primary care providers are faced with treating many of these conditions inside of their office; but that they need great support in doing so.

Emtiro Health supports providers and practices through implementation and continual technical assistance of models such as the Collaborative Care Model (CoCm).

CoCm is an evidenced based model that provides care management and psychiatric case consultation to primary care physicians who are actively treating patients with depression and other mental disorders. Through measurement based care, behavioral activation and psychiatric treatment recommendations primary care physicians can effectively improve clinical outcomes in patients with behavioral health diagnoses.

Pharmacy Integration

Drug-related morbidity and mortality cost nearly $200 billion annually in the US. Integrating pharmacists into primary care can prevent avoidable spending by increasing patient adherence, optimizing prescription regimens, and preventing medication related-complications. To address these opportunities, progressive practices and provider networks are expanding the role of the pharmacist as a central component of primary care transformation.

Emtiro Health will work with providers to: 

  • Establish a pharmacy support service based upon a careful assessment of the practice’s needs which may include administrative, analytic, quality improvement, and patient care

  • Leverage available data sources and risk stratification criteria to identify eligible patients for pharmacy services

  • Engage staff and patients and educate on the value of the pharmacist as a member of the care team

  • Institute mechanisms for interdisciplinary collaboration between pharmacists and primary care physicians

  • Use standardized tools to efficiency track and coordinate pharmacist activities

  • Carefully select, monitor, and report on clinical and quality outcomes

  • Measure program impact on reimbursement, total cost of care, and downstream utilization of healthcare services.

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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 to create a balance for providers and to maintain and increase profits.

 
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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 transformation, quality assurance and quality improvement and use Lean for Healthcare methodology and Kaizen events to gain practice and employee engagement.

Practice Workflow Enhancement

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

Staffing Resources

Emtiro can work with you to identifying adequate staffing needs, or reassigning staff to different positions to allow the practice operate in a more efficient manner.  We can assist in finding relief staff for gaps in positions due to expansion, illness or transition; and we also provide staff education and development programs. 

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Data Analytics and Performance Improvement

In a value based health care environment, data, analytics, and reporting capabilities are critical to success. Emtiro works with health care providers to effectively use data to drive quality performance and ensure success in value-based payment arrangements. 


Data Activation: Enhancing Practice Quality

Emtiro Health will help you optimize financial, operations, and clinical quality measure performance to achieve organization success in a value-based care delivery and reimbursement environment.  We utilize advanced data visualization and comparative benchmarking techniques to direct practice and provider specific performance improvement opportunities.  We can create or enhance your population health management competencies, enabling success in at-risk payment models by using EMR claims and other disparate data sources to enable patient-specific care planning.

Data Analytics

In addition to enhanced quality improvement services, Emtiro Health provides customized business intelligence and analytics solutions to facilitate sustained success in your organization. Our solutions will help identify opportunities for improvement and provide valuable insights tailored specifically to your organizational needs.

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Community and Clinical Integration

It is well established that social, behavioral, and environmental factors unrelated to the medical care that a patient receives drive health care outcomes and expenditures. Across the country, community-based organizations and health care providers have collaborated to find new ways to connect patients and their families with community-based services. These include services to address social determinants of health, such as safe, affordable housing, as well as preventive services and chronic condition management. We know the value of community-based services, especially when they are linked with the health care provider. Not only does this lead to improved outcomes, but also patient and provider experience, and helps providers succeed in a value-based care environment. We work with CBOs and providers to integrate clinical and community services in an efficient and effective way.

 
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Provider & CBO Asessment

Using a standardized process and established assessment tools, we conduct organizational assessments, in conjunction with leadership and staff, of the provider and CBO. Through this process we gain insight into the operations of the provider and CBO, including current capabilities, workforce, and performance.  

Developing Necessary Business Functions and Operations

Using the information from the comprehensive assessment, we work in close collaboration with the CBO and provider to help build necessary business functions and operations, such as a well-structured referral process. Through this process, we assure alignment of the objectives and goals of the CBO and provider and open communication, both of which are necessary to a successful partnership.     

Sustainable Financial Arrangements

In order to maintain integration of clinical and community services, both the CBO and provider must find sustainable financial arrangements. As providers work with payers to find innovative ways to reimburse for care, they are better positioned to enter into contractual arrangements with CBOs to provider services. This creates a new stream of revenue for CBOs, thereby increasing their sustainability and capacity. We work with the provider and CBO to find innovative financial arrangements and provide assistance in contracting.

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