Promoting Evidence-Based Medicine
Evidence-based medicine shall serve as the clinical foundation for the care and treatment we provide to Medicare Fee-For-Service Beneficiaries whose physicians participate with UniPhy ACO. Our ACO will continue to build on these clinically proven methods through a systematic effort to promote quality of care in all patient interactions.
Evidence-Based Medicine Defined
“Evidence-based medicine (EBM) or evidence-based practice (EBP) aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments (including lack of treatment) and diagnostic tests.”
*footnote: British Medical Journal's Clinical Evidence, the Journal Of Evidence-Based Healthcare and Evidence Based Health Policy. (2000)
Establishing Evidence-Based Practice
Evidence-based medicine will be implemented primarily under the authority of the Clinical/Quality Committee, through the electronic health records already in use in our physicians’ offices, and/or through the proactive outreach of our Care Navigators. Uniphy ACO will build upon the advantage that our existing providers have relied upon the EHR to follow evidence based guidelines for a number of years. We will work to share best practices among our participants to improve population health.
The Uniphy ACO Clinical/Quality Committee will discuss and determine the appropriate evidence-based practices to incorporate into our ACO operations. Once the guidelines are adopted, they can be incorporated into practice. This includes the implementation of Electronic Health Records with automated reminders set to alert the physician whenever a diagnosis is entered. In addition, physicians will have access to written educational materials, with information in line with our accepted evidence-based guidelines for distribution to patients that present with certain diagnoses.
Care Navigators will reinforce these guidelines during their discussions with physicians and patients. As deviations from these guidelines occur, either during treatment pathways or as the patient manages their own conditions, the Care Navigators will rely on these guidelines as a tool to bring care back to appropriate levels and interventions.
The results of all Clinical/Quality Committee deliberations, including those on evidence-based medicine, are reported to the Uniphy ACO Board of Directors by the Chairman of the Board/CEO, who is co-chair of the Clinical/Quality Committee. This structure has been set to establish a high level of accountability for the Board of Directors.
UniPhy ACO has adopted and recommends the adoption, dissemination and implementation of the US Preventive Task Force (USPTF) Guidelines.
Quality And Cost Metrics
UniPhy ACO reporting, clinical intelligence, and business analytic functions are at the core of our effort to improve the health status of our attributed population. Our reporting tools will allow our participants improved insight into Medicare Fee-For-Service beneficiaries’ needs, thereby facilitating improved care and well-being.
Our reporting infrastructure was designed specifically with the goals of improving patient health, delivering improved healthcare, and the reduction of costs as its principle goals. Our integrated system, which includes, reporting, in-bound call center, care coordination, and outbound call reminders, establishes a continuity of services allowing for the “seamlessness” of information, meaning that the results of our reporting will be both comprehensive and actionable.
Internal And External Data Sources
The effectiveness of our information system results from the integration of multiple data sources, which ultimately allows our participating providers to have a comprehensive view of their beneficiaries’ health from multiple perspectives.
Use Of Analytics And Reporting
Uniphy ACO will rely on our Health Cost and Trend Analysis (HCTA) report to gain in-depth insight into medical cost and its components at both a detailed and overview level. We will use these reports to understand issues related to the utilization and unit costs underlying overall medical costs, as well as variance in provider patterns and industry benchmark comparisons.
Evaluating And Updating Processes
Implementation and updating of these reports, and their application to our participants’ practices, will be a continuous effort carried out at the direction of our Clinical/Quality Committee. Case managers and participating providers will be provided with regular training on the use of tools, including (when available) real-life examples of reports and Medicare Fee-For-Service Beneficiaries that may benefit through report review and application of evidence-based guidelines.
As these reports give Uniphy ACO an understanding of barriers to patient access, comprehension, or reliance on evidence-based medicine, we will turn to education and training to address shortfalls.
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