Visiting Nurse Service of New York

Founded in 1893, the Visiting Nurse Service of New York (VNSNY) is the largest not-for-profit home- and community-based health care organization in the United States, serving the five boroughs of New York City as well as Nassau, Suffolk, and Westchester Counties. On any given day, VNSNY has over 44,000 patients and plan members in its care, from newborn infants to our oldest seniors. While New Yorkers’ health care needs have changed over the years, VNSNY’s commitment to those in its care has not. VNSNY offers a comprehensive array of home- and community-based programs, services and health plans to meet the diverse needs of New Yorkers. From short-term nursing and rehabilitation services to managed-long term care plans and population health care, VNSNY’s programs, services and plans are designed to meet each person’s unique clinical, behavioral and social needs, allowing them to live safely in their homes and communities.

Challenge
VNSNY’s Data Science Team, within the Business Intelligence and Analytics (BIA) Department, has developed risk models to drive better care for VNSNY members and patients by identifying those at risk for certain outcomes. For those identified as nearing the end of life, Nurse and Social Work Liaisons in VNSNY’s Advanced Illness Management (AIM) team conduct a Review to evaluate whether these health plan members need additional services and then assist them in receiving appropriate interventions.
Solution
VNSNY implemented Dynamics 365 and Microsoft Healthcare Accelerator in an effort to streamline and automate the entire Advanced Illness Management review and evaluation process, including data management. But they sought more than just a technology platform to implement — so they partnered with HCL-PowerObjects to help them streamline and improve their workflows.
Key Benefits
  • Significant improvement in efficiency, output, quality, and conversion rate.
  • The Healthcare Accelerator cut implementation time and cost by a full 50%.
  • Real-time insight into data points allows for earlier detection of hospice-qualified patients.

Challenge

VNSNY’s Data Science Team, within the Business Intelligence and Analytics (BIA) Department, has developed risk models to drive better care for VNSNY members and patients by identifying those at risk for certain outcomes. For those identified as nearing the end of life, Nurse and Social Work Liaisons in VNSNY’s Advanced Illness Management (AIM) team conduct a Review to evaluate whether these health plan members need additional services and then assist them in receiving appropriate interventions.

Until VNSNY implemented Dynamics 365, this process was very manual. VNSNY pursued a technology solution to streamline and automate the entire advanced illness review and evaluation process. One must-have was the ability to manage the data. In so doing, they wanted to develop different stages within the case flow.

VNSNY implemented Dynamics 365 in an effort to streamline and automate the entire Advanced Illness Management review and evaluation process, including data management. But they sought more than just a technology platform to implement — so they partnered with HCL-PowerObjects to help them streamline and improve their workflows.

Microsoft’s Healthcare Accelerator emerged as an essential part of this solution. By providing ready-made entities to which the Observations, Medications, Episodes of Care, and other outputs from the source systems could be mapped, time-consuming and costly customizations to out-of-the-box Dynamics 365 were avoided.


Solution

Data Scattered Across Multiple Systems

Prior to moving to Dynamics 365, the AIM team had to consult member data from three different sources: the Health Plan system, the HomeCare EMR if applicable, and risk model data developed by the VNSNY Business Intelligence and Analytics (BIA) department, which identifies the high-risk members. This meant staff had to log into multiple systems to develop a profile of the member and his/her condition. By having this data consolidated and imported into Dynamics 365 once daily, AIM staff are able to review all the relevant information in one place.

Another benefit of bringing in data is that reviewers now receive an alert within 24 hours when an adverse event has occurred. For instance, a member in stable condition might be set up for monthly monitoring; but then that member has a fall. Dynamics 365 receives and displays an alert to the AIM reviewer, who can then take appropriate action. In the old world, there was no way to discover the adverse event outside of the next scheduled Review.

Relying on Excel Spreadsheets

The AIM team had been struggling to record their Reviews on Excel spreadsheets — this was completely unwieldy. Just three of Dynamics’ out-of-the-box features were able to capture most of this process:

  • A 5-stage workflow — with exception paths such as putting a member on hold for periodic monitoring — that guides the Reviewer through all the steps in the Review protocol.
  • The Notes feature wherein Reviewers record their findings.
  • The Schedule feature that allows Reviewers to schedule the next task. Users can see tasks that are due today, overdue, etc., and this assists greatly in managing their work.

HCL-PowerObjects built an additional tool using Power Apps. Reviewers conduct an extensive phone interview called a “script” with the member. The phone interview is a long list of questions, and the Power App is able to capture the answers.

Management & Reports

Managing the AIM team’s day-to-day work requires evaluating which new Reviews are most urgent, determining which Reviewers have capacity to take on new work, and making the assignments — including reassigning Reviews when a Reviewer goes on vacation.

Dynamics 365’s Dashboard feature presents the relevant information in list and/or graph form to enable the manager to tackle this task more efficiently. Staff also have their own Dashboard to help them organize their work.

The Manager Dashboard also displays productivity and other reporting information. VNSNY has discovered that by starting with a Dashboard report, we can use Advanced Find to create yet more reports on our own.

Summary

Probably the most important “tip” VNSNY team learned during implementation was to take the time to learn how to use Dynamics 365 properly, not just in the generic sense, but specifically for their unique process. This required a shift of perspective from “how to use the product” to “how to do our work using this product.” A number of “issues” that initially looked like system bugs turned out to non-issues after all.

The success of this implementation reflects a truism worth repeating: Innovative partnerships — like the one between VNSNY and HCL-PowerObjects — that focus on results-oriented problem-solving can bring even the most cutting-edge technologies like Dynamics 365 to a new level of effectiveness.