MediCheck
MEDICARE ENVIRONMENT
Impacting the Quality and Effectiveness of Healthcare
Healthcare is challenging and changing
In the healthcare industry, we want to make sure these
changes improve the health of the patient and assist medical
providers in providing appropriate care to their patients.
Healthcare reform, new policies, new regulations and the
challenges of the healthcare marketplace are forcing providers
and health plans to assure their processes and workflows are
efficient and effective. Diagnostic information needs to be the
highest quality and should properly support clinical decision
making so patients receive the right diagnosis and the right
treatment at the right time. This timely diagnostic information
allows providers and health plans to correctly assess patients
and also allows them to appropriately utilize evidence-based
care management strategies.
For Medicare Advantage members, we developed MediCheck
to utilize our already existing services enhancing the health
information workflow. Our experienced paramedical
examiners collect laboratory specimens and take physical
measurements at the member’s convenience in their home,
office or at one of Quest Diagnostics 700+ locations. Quest
Diagnostics Six Sigma laboratory performs the laboratory
analysis with the highest accuracy and precision. Our
experienced medical call center obtains a detailed medical
history, review of systems, and a detailed medication history.
This is all performed and completed for the Nurse
Practitioner’s/ Physician’s review prior to the member’s
in-home assessment. This allows the clinical provider to focus
on the member’s gaps in care as well as to share the results
of their evaluation and tests with the member, in person, at
the time of the evaluation.
Access to Diagnostic
Information and Insights
Empowers Better Health and
Identifies Gaps in Care
Fig. 1: Home health
visits that close the
gaps in member history
Our Call Center
captures medical
history.
Our phlebotomists
conduct a home
health visit for
specimen collection
and biometrics.
We gain HIPAA
authorization and
query our Rx
database for history.
Material is assembled
for Nurse Practitioners to
conduct an enhanced
version of the Annual
Wellness Visit including a
Personal Laboratory Report
and a Preventive Plan.
ExamOne understands and embraces the challenges and
changes within the healthcare environment. We quickly
identify and abide by changes in any regulations or policies
in order to assure that our value driven information is able to
be effectively utilized by our contracted nurse practitioners.
Our goal is to help people improve their health. An important
way of doing this is to constantly improve the workflow to
valuable health information so our clinical providers in our
Medicare Advantage service (MediCheck) can perform the
best in-home evaluation of the member.
Laboratory results can represent up to
70% of all health care information for
patients and providers1 and is the leading
clinical information for clinical diagnosis
and decision making worldwide. Studies
show the key component of most
electronic health records is the laboratory
result data.
Leading quality and disease management
organizations also know the importance
of clinical laboratory results and have
incorporated them into quality measures
like HEDIS (NCQA) and Stars measures. The MediCheck
service utilizes a laboratory testing screening profile that
best identifies potential disease states and member gaps in
care (see Fig. 1). The MediCheck laboratory testing
profile brings focus around cardiovascular, cerebrovascular,
metabolic/diabetes, renal (kidney), liver, hematologic and
more. Following the health risk assessment, each member
is provided a comprehensive personal laboratory report for
their personal use.
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Fig. 2: Closing the gap in workflow
data set provides additional
documentation and substantiation,
giving you greater confidence in your
care planning, audit preparation and
risk adjustment programs.
Clinical
Laboratory Results
Detailed
Medications History
Nurse Practitioner/
Physician
Member In-Home
Evaluation
More Focused Gaps
in Care Evaluation
Detailed
Medical History
All Completed Prior to
In-Home Evaluation
Our unique workflow empowers better health
assessments and identifies gaps in care
Almost all of us have had the experience of going to our
medical provider, having a history and physical performed
and then being sent for diagnostic laboratory analysis.
These results then come back to our provider after we have
left their office. This is a missed opportunity. If the medical
provider had results prior to the visit they could have asked
more specific medical questions; performed a more focused
physical examination and could have addressed, in person,
any gaps in care. Additionally, the patient would have been
able to become more engaged in their healthcare and ask
any clarifying questions.
Unique Clinical Assessment Model
More Informed 1:1 Evaluations and Member Education
Prior to in-home evaluations we perform in-home
biometrics and sample collection for a full laboratory panel
meeting HEDIS requirements. We provide laboratory results
and a five year Rx history to the nurse practitioners, along
with results from our telephonic HRAs. Nurse practitioners
receive a complete and up-to-date picture of the member
in advance so when they are with your members they
can focus on what they do best — evaluate, diagnose and
inform.
Greater Capture of HEDIS/Stars
Measures
In-home sample collection and
assessment translates into more
member participation for purposes
of capturing HEDIS/Stars metrics;
especially for members with limited
mobility or busy schedules, and those
least likely to visit their personal
physician. Our complete evaluation
process can be completed in days
versus months.
ExamOne continues to be the leader in developing life
insurance laboratory risk and predictive analytics to assess
the health risk of individuals and populations.3 These
advanced analytics have allowed many of our customers
to interpret insurance laboratory data at a more advanced
level and to more precisely assess the mortality risk to an
individual. 2,3,4,5
References:
(1) UK Department of Health Pathology Modernisation Team. Modernising Pathology Services, 2004.
Available at www.dh.gov.uk. 60-70% of NHS patients’ diagnoses depend on laboratory tests
(2) Palmier,J; Lanzrath,B; Laboratory and Biometric Predictors of Cancer-Related Mortality in an Insured
Population; J Insur Med 2012; 43:162 – 168
(3) Palmier, J; Dixon, A; Lanzrath, B: Leading Contributors to Mortality Risk in Life Insurance Appicants;
Society of Actuaries—Small Talk; 2012: 38:15-17
(4) Palmier, J; Lanzrath, B: Modeling Mortality in Life Insurance Applicants; Society of Actuaries—Small
Talk; 2012: 37:22-23
(5) Lanzrath,B; Palmier,J; Dixon, A: Individualized Mortality Projection and Product Pricing with Laboratory and Physical Measurement Data; Society of Actuaries—Product Matters; 2012; 83: 21-25
Resources
1 Results from the 2007 National Survey on Drug Use and Health: National Findings. September 2008.
Available at: http://oas.samhsa.gov
2 Substance Abuse and Mental Health Services Administration (SAMHSA) Injury/Disability/Workers
Compensation Fact Sheet. Available at http://www.workplace.samhsa.gov/ResourceCenter/r115.pdf.
3 U.S. Department of Labor – Occupational Safety & Health Administration.
Available at:http://www.osha.gov/SLTC/etools/safetyhealth/mod1_ estimating_costs.html
4 Insurance Information Institute – Worker’s Compensation. Available at:
http://www.iii.org/economics/income/wcpayouts/
5 Wisconsin Department of Workforce Development. Available at:
http://www.dwd.state.wi.us/wc/WC_Basic_Facts.htm
Greater Specificity and Clinical Substantiation for
Claims Submission, Encounter Data, HCC Coding and
Reimbursement Performing a full laboratory panel and
prescription history check for each member and delivering
results directly to members via our nurse practitioner
evaluators sets the stage for a more targeted, informed
evaluation, examination and conversation between your
member and a licensed healthcare provider. The resulting
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owners.© 2013 Quest Diagnostics Incorporated. All rights reserved. 06/2013