How does SeniorMetrix interact with physicians and/or case managers employed by the customer?

Although our contractual client is the health plan (which includes physician leadership), SeniorMetrix also works day to day with contracted physician groups, aligning expectations between the plan, the group, case management, the provider facility and the patient. Our relationship with case management is determined by the scope of our agreement. We may either work side by side with the current case managers, or SeniorMetrix staff may take over responsibility for certain segments of the case management continuum.

Who owns the clinical data that is collected?

Clients provide data on each patient entered into SMTX and related SeniorMetrix software applications. We have Business Associate agreements with each of our clients to ensure the protection of PHI under HIPAA regulations. Under our client contractual arrangement and HIPAA, SeniorMetrix is allowed to maintain all collected records in a de-identified form for the purposes of its business operations.

What types of benchmarks are available?

With our extensive database of actual patient records, we can provide benchmarks for functional improvement, cost, necessary levels of therapy intensity, appropriateness of post-acute placement, discharge to community and re-admission rates.

How do you know if an optimal level of care is being delivered?

From over 250,000 records, SeniorMetrix selects a "National Comparison Data Set." With our OPT tool, users indicate patient specific characteristics such as function at admission and diagnosis. They then receive the expected functional outcome, length of stay and discharge to community values. Retrospectively, provider facilities can be compared on the Dashboard for actual vs. expected outcomes that are severity-adjusted for each of the patient cases during the period of the report.

How long does it take before we begin to see results?

We generally observe a rather immediate impact on utilization due to the effects of training and an increased sense of accountability. This, along with a willingness from the clinical team to evaluate its utilization patterns in the context of severity-adjusted measurement and semantics, brings about a positive change in utilization rather quickly. Usually it takes 3-4 months to obtain sufficient data to establish the reporting and clinical management phases of the product and to reliably identify improvements from baseline levels.

Does SeniorMetrix replace the medical management function?

SeniorMetrix works with medical management systems and resources to enhance their effectiveness and efficiency. We can either provide management systems and information to your current case management team, or we can be an outsourcing option to deliver the case management services ourselves.

How are SeniorMetrix benchmarks different from other sources?

Currently there are no adequate, evidenced-based guidelines or benchmarks reflecting the proper relationship of utilization and patient outcome for the post-acute industry. While some sources may offer outcome and utilization data, it is not severity adjusted. Others offer "recommendations from expert panel" or "guidelines extracted from published literature." SeniorMetrix is the only source for evidence-based, severity adjusted decision support that is based on actual cost and outcome data from acute hospital, skilled nursing, home health and follow-up settings.

What kind of outcomes does SeniorMetrix use?

Various combinations of utilization data (e.g., LOS, rehab days, therapy units), clinical data (e.g., diagnosis, medical complexity, functional status) and cost data (e.g., cost per day) are used to determine performance against standards from a database of over 250,000 records.

How can you use outcomes to reduce cost?

Using over 250,000 records we can severity adjust cost and outcome expectations for an individual patient or a network of care providers. This information can be used to align expectations between patient and providers during the early stage of a post-acute episode of care and later to evaluate the appropriateness of provider care. "Variance" from a severity adjusted expectation allows the health plan to identify instances when more care may no longer be providing a meaningful patient benefit.