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JAMA article confirms local solutions to community health

Ohio KEPRO leads 7 communities across Ohio in improving care transitions

January 23, 2013 — Seven Hills, OH

When Medicare patients make an unplanned return to the hospital that could have been avoided by better care coordination, it delays their recovery, unnecessarily exposes them to such hospital dangers as infection, costs taxpayers money and consumes increasingly scarce health care resources. In Ohio, the approach that seven communities are taking to improve the transition between hospital and post-hospital care now has been validated by research that will appear in the January 23, 2013 edition of JAMA, the Journal of the American Medical Association.

The JAMA article describes a project in communities in 14 states that produced an average 6% decrease in hospitalizations and re-hospitalizations over two years, at nearly twice the pace in participating communities as in comparison sites. Conducted between 2008 and 2011, the project was performed by Medicare Quality Improvement Organizations with funding from the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare. This project formed the foundation for work currently being spearheaded in Ohio by Ohio KEPRO. 

“Our data show that nearly one in five patients who leave the hospital today will be re-admitted within the next month, and that more than three-quarters of these re-admissions are potentially preventable,” said Dr. Patrick Conway, CMS Chief Medical Officer and Center for Clinical Standards & Quality Director. “This situation can be changed by approaching health care quality from a community-wide perspective, and focusing on how everyone who touches a patient’s life—whether part of the traditional ‘health care team’ or not—can better work together in the best interests of their shared patient population to prevent hospitalizations.”

In our state, Ohio KEPRO has mobilized coalitions focused on reducing avoidable hospital readmissions in Mansfield, Youngstown, Cambridge, Dayton, Lima, Wooster and Lake Erie (Lake, Geauga and Ashtabula) communities. Following the model described in the JAMA study, these coalitions bring together not only hospitals, but also nursing homes, home health care agencies, and social service agencies such as Area Agencies on Aging.

Ohio KEPRO coaches and educates local coalitions on:

  • Discovering the reasons behind the community’s readmissions rates;
  • Applying medical research findings in ways that reduce readmissions, such as methods for educating patients about caring for themselves when they return home, ways that health care facilities and providers can better communicate as patients move among them, and fixing complex and patientunfriendly discharge plans to give the patient what he/she needs to stay healthy outside of the hospital;
  • Tailoring best practices in reducing readmissions to the specific needs of the community; and
  • Analyzing data to gauge progress and impact. 

In addition, Ohio KEPRO connects coalition participants to other organizations in the state and nation to share best practices and lessons learned for helping patients transition out of hospital care, and serves as an informational resource for any community in Ohio that wants to reduce avoidable hospital readmissions.

“Patients, especially those with complex or chronic conditions, often rely on multiple heath care providers and community services,” said Ronald A. Savrin, MD, Ohio KEPRO Medical Director. “Providing quality care to these individuals requires effective and efficient collaboration among all of these professionals and service providers. Quality Improvement Organizations, like Ohio KEPRO, focus on a community-wide approach, working with all providers, to improve care. These efforts focus on the Health Care Team and emphasize that efforts are centered on the patient. Working together we can provide higher quality patient-centric care and reduce both hospitalizations and re-hospitalizations.”

The results of the project described in the JAMA article have informed other major national initiatives now underway to improve care transitions, including the Partnership for Patients and the Community-Based Care Transitions Program (CCTP). Ohio KEPRO helped three communities make successful applications for CCTP funding to support care transitions initiatives in the Cambridge,Dayton and Youngstown communities:

  • East Central Ohio Community Care Transitions Coalition, led by Area Agency on Aging, Region 9, Inc. (Cambridge)
  • Community Care Connection, led by Area Agency on Aging PS 2, Inc. (Dayton)
  • North East Ohio Coalition on Readmissions, led by Area Agency on Aging 11, Inc. (Youngstown)

More information about these programs is available from the Centers for Medicare & Medicaid Services at http://innovation.cms.gov.
The efforts that Ohio KEPRO is undertaking are part of a national project that is transforming health care in more than 400 communities across the country. Called “Integrating Care for Populations and Communities,” the project is part of the Medicare Quality Improvement Organization Program. More details about this national effort are online at www.cfmc.org/integratingcare/.

Contact
Ronald A. Savrin, Medical Director
216-503-5787
rsavrin@ohqio.sdps.org

About Ohio KEPRO 
Ohio KEPRO, the Quality Improvement Organization for Medicare in Ohio, is committed to continuous quality improvement in healthcare through the provision of innovative products and services provided at no charge to healthcare providers and Ohio’s 1.8 million Medicare beneficiaries. Visit Ohio KEPRO’s Web site at www.ohiokepro.com for more information.

About the QIO Program
The QIO Program is a major force and trustworthy partner for the continual improvement of health and health care for all Americans. The program achieves national health quality goals through a network of 53 QIOs located in every state, territory and the District of Columbia. QIOs bring together patients, providers, practitioners and other stakeholders to improve patient care, improve population and community health, and lower the costs of care through improvement.

About KEPRO

KEPRO, the nation’s largest CMS-designated quality improvement organization and care management organization, offers innovative and outcomes-focused solutions to reduce the utilization of health care resources and optimize the quality of care for public and commercial clients. KEPRO’s comprehensive, member-centric care management solutions go far beyond traditional utilization and case management by coordinating the care provided to members with acute, chronic and complex conditions across the continuum, and identifying members who are at the highest risk for future services, but have not yet had an acute event. Tailored programs maximize members’ quality of life, and realize greater cost savings for members and clients.

Headquartered in Pennsylvania, KEPRO also has offices in Alabama, Florida, Illinois, Maine, Maryland, Massachusetts, Minnesota, Ohio, Oregon, South Carolina, Tennessee, Virginia, and West Virginia. KEPRO is URAC accredited in case management and health utilization management. We are also National Institute of Standards and Technology (NIST) and Federal Information Security Management Act (FISMA) certified.

 

 

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Please describe KEPRO data security that ensures member information is protected.

As an organization that is charged with storing and transferring Protected Health Information (PHI), KEPRO is bound by HIPAA regulations, and is accustomed to managing the security and privacy of PHI. KEPRO currently exchanges data successfully and confidentially via secure encrypted means in support of all of our federal, state, and local government programs, and with commercial clients.

KEPRO has been implementing and supporting systems that require medical record, data security, and transmission for more than a quarter of a century, and has always placed primary importance on using systems that allow for fast and efficient connectivity, while still providing the highest level of data and system security. Our proven internal and external policies and protocols ensure compliance with state and federal laws and regulations, as well as any additional security measures you may require.

We have a stringent KEPRO Comprehensive Confidentiality Plan that governs our processes. KEPRO’s Privacy Officer, Security Officer, and the Compliance Officer have ultimate responsibility for oversight of the processes and procedures contained in the KEPRO Comprehensive Confidentiality Plan.

KEPRO's system is secure. Our information systems are secured by an in-depth strategy that utilizes multiple layers of operational, management, and technical controls to protect KEPRO assets. We also employ software programs designed to prevent unauthorized use by staff or outside entities.

All KEPRO information systems employ common security controls such as Firewalls, Anti-virus, Role Based Access, FIPS 140-2 Encryption for mobile devices, and the requirement of strong passwords. Information system users are assigned a security role based upon access requirements relevant to their positions and information/program privileges.

The HIPAA Security Rule requires entities to implement information systems that control access to healthcare and related systems. KEPRO adopts a subset of NIST 800-53 Rev 3 Security controls to maintain compliance with HIPAA. Based on these security standards, KEPRO mitigates risk to its Information system by focusing on such controls as:

  • Log-In Security. HIPAA security requires the use of secure User IDs and the use of passwords. KEPRO requires multiple account authentication processes within its information systems to verify the identities of our end-users. KEPRO's policy requires strong passwords that are changed frequently.
  • Access Control. HIPAA requires one of the following: Context Based Access, Role Based Access, or User Based Access. User Based Access is part of the Log-In Security component. KEPRO's Role Based Access gives individual users access relevant to their function in the organization.
  • Audit Trail. HIPAA requires the use of an audit trail to identify who accesses PHI. KEPRO systems track those who change the patient record, the date and time the record was modified, and the specific information changed. The system includes a read only audit trail that captures each time a system user views a case.
  • Session Time-out. KEPRO information systems account for session inactivity by locking screens after 10 minutes of inactivity.
  • KEPRO's physical space is secure. KEPRO’s computer, telephone, and hardware systems are located in climate controlled rooms with fire-suppression and electronic locking system. We allow only authorized access to the room.
  • KEPRO focuses training on confidentiality and security issues. All KEPRO employees undergo rigorous training on security and confidentiality of PHI. We have successfully provided this training to all staff regardless of their respective roles/duties.

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