Empowering Tanner Clinic & Connect TCM
Connect TCM + Tanner Clinic
Transitional Care Management (TCM)
The Challenges: Readmission Rates, Limited Data, Buy-In, Inefficiencies
Before adopting the CHIE, Tanner Clinic and CONNECT faced significant hurdles:
Readmission Rates: High readmission rates were a concern, compounded by inadequate proactive care.
Limited Patient Data Access: Reliance on home health and hospice agencies for discharge notifications led to delayed and incomplete patient tracking.
Stakeholder Buy-In: Convincing providers and administrators of the importance of TCM and its impact on MIPS (Merit-based Incentive Payment System) measures and reimbursements required extensive education and advocacy.
Workflow Inefficiencies: Existing tools lacked the depth and precision needed for effective care management.
The Goals: Reduce Readmissions and Streamline Workflows
Tanner Clinic and CONNECT aimed to:
- Enhance patient outcomes by reducing hospital readmissions.
- Streamline workflows for TCM, CPO, and chronic care management (CCM).
- Improve access to actionable patient data in real time.
- Maximize reimbursements through accurate coding and improved MIPS scores.
The Solution: Tanner Utilizing the CHIE Alerts
Tanner Clinic and CONNECT leveraged the CHIE’s powerful data in various ways.
- CHIE Real-Time Alerts: CHIE Admit, Discharge, and Transfer (ADT) alerts automated timely delivery of notifications for nurses to contact patients within 48 hours.
- CHIE LACE Scores: By integrating LACE (Length of stay, Acuity of admission, Comorbidities, Emergency visits) scores, the CHIE enabled accurate assessment of patient acuity and complexity, streamlining coding and care prioritization.
- Tanners Workflows: Using the CHIE’s configurable data feeds aligned with Tanner Clinic and CONNECT’s unique needs, enhanced efficiency and focus.
- Tanners Proactive Patient Engagement: Licensed Registered Nurses conducted two-way phone calls within two days of discharge, educating patients on diagnoses, medication management, and follow-up care. By establishing direct contact with recently discharged patients, TCM nurses could intervene promptly, preventing severe health deterioration.
The Results: Tanner Utilizing the CHIE Alerts
The utilization of CHIE data yielded remarkable improvements:
- Reduced readmission rates
- Modernized workflows
- Improved patient outcomes
- Maximized reimbursements
By the Numbers: Readmission Rates
“The CHIE has been a game-changer for us. It’s not just about the data; it’s about how you use it to improve patient outcomes. The tailored feeds and LACE scores have transformed our workflows and made a tangible difference in patient care.”
–Kim Nielsen CEO and Registered Nurse at Connect TCM
By the Numbers: Readmission Rates.
Connect TCM Panel Average
Reduced readmission rates across panels from 11% down to 4% average
Utah Average
Utah’s Readmission Rates is 13.9%
National Average
National Readmission Rates is 14.6%
