The right care level.
The right care management.
The right care transitions.
Although those three areas of skilled nursing have continuously been central to patient success, in a value-based landscape, they are vital. SNF operators must be able to stay one step ahead of their patients’ care needs so they can anticipate change in conditions and respond appropriately. They need the ability to adjust care delivery on the go, to provide the patient and family everything they need.
Success under value-based care (VBC) models demands this proactive work. Three new tools from Real Time Medical Systems (Real Time), the industry-leading and KLAS-rated interventional analytics solution, are providing SNFs the roadmap, enabling operators to improve care coordination and collaboration through their patients’ post-acute care journey.
Step 1: Ensure patients are receiving the right level of care
For SNF patients, their care journey begins at intake, and the operator’s ability to give them the right care at the start. SNF providers can now access the Real Time Resident Dashboard to help providers successfully identify each patient’s overall status with detailed, clinical information.
The live resident dashboard provides real-time patient status and updates, helps avoid readmissions and delivers the necessary information to improve transitions, lower unnecessary costs and manage length of stay (LOS).
This interactive dashboard includes:
- Basic patient details
- Vital signs
- Active diagnoses
- Clinical alerts
- Physician orders
- Lab results
- Quality measures
- Readmission risk scoring
“We are very excited to offer a variety of new solutions to our customers,” says Joan Neuscheler, Chief Executive Officer at Real Time. “Our agility to enhance our platform in offering value-based care solutions and aligning with the evolving health care regulations is a true testament to our team’s dedication to our customers’ success. We are looking forward to our continued efforts in advancing value-based care solutions and improving patient outcomes across the care continuum.”
The Real Time tool also helps post-acute facilities identify patients who require further examination due to the triggering of clinical alerts or keywords, and/or patients identified as high or moderate risk for readmission, all without having to access the EHR. Assessing and utilizing the dashboard can be a great proponent in instilling VBC across the post-acute network.
Step 2: Manage patient care more effectively
Once a patient is in the right setting, a SNF must be able to manage their care appropriately. With the Real Time Advance Care Planning (ACP) Alert, SNFs have the insights they need to allow them to initiate discussions with a patient and family members on their end-of-life decisions and provide the best quality of life care possible — respecting the patient’s choices while they are of sound mind.
This begins with the ACP alert providing the SNF with a measurable score utilizing clinical data from the EHR, as well as risk factors exhibited after the personal severity index (PSI) or once the MDS is completed. The ACP identifier, including ACP alerts, ACP reports and ACP tagging, provide a comprehensive view of the patient.
The score includes metrics relating to functionality, as well as clinical and mood status. A score of nine or greater helps providers identify patients who may be moving toward end-of-life and may require changes to their current care plans and advance directives.
Step 3: Coordinate care transitions with health care partners
To succeed in value-based care, collaboration is key. SNF providers can now use the Real Time Connect API tool to easily share key patient data from their post-acute network EHRs with their partnering health systems, ACOs and health plans. The Connect API tool also provides partners with the unique clinical analysis that powers Real Time’s industry leading, KLAS-rated and HITRUST Certified Interventional Analytics post-acute solution.
With this enhancement, operators can seamlessly share critical data, allowing them to monitor chronic conditions and effectively manage patient’s care collaboratively with health care partners to improve VBC outcomes.
With Real Time’s proprietary interventional analytics data solution, providers can decrease hospitalizations and improve care transitions by having access to three key capabilities:
- Live readmission risk scoring
- Capturing quality measures
- Capturing LOS
This live data delivers insights into post-acute networks to ensure patients are being placed at the right facility, with the right level of care, at the right time, thus driving VBC initiatives and outcomes.
“As value-based care continues to gain momentum, Real Time plans to add more features to our platform, ensuring post-acute partners have what they need to seamlessly collaborate with their network partners and provide patients with the right level of care.”
This article is sponsored by Real Time Medical Systems. For more information on Real Time’s Interventional Analytics solution, visit realtimemed.com.
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