Health plans that incorporate the appropriate end-to-end care management technology achieve significant ROI with respect to top-line revenue improvement as well as cost savings.
FREMONT, CA: Care management involves a range of activities to enhance patient care and decrease the requirement of medical services by assisting caregivers and patients in managing health conditions effectively. A true care management system offers a suite of products that stratifies patient risk, integrates data from various sources, manage patients via comprehensive care coordination, organize patient intake, and measure the care team’s performance.
Current health plans that center on care management have ambitious goals that include operating more profitably, deliver more value to the stakeholders, optimizing member health, and strategically aligning with regulatory performance standards. Technology has immense potential in the achievement of these goals. The technology to support care management begins with Electronic Medical Records (EMR) but goes much beyond the mere digitization of patient’s medical history. While EMRs are crucial sources for collection and storage of data, they are not the ideal tool that clinicians require for judicious decision making. Moreover, technology is also being leveraged to optimize the existing processes and to make the system more affordable. Health plans that incorporate the appropriate end-to-end care management technology achieve significant ROI with respect to top-line revenue improvement as well as cost savings.
Here are the primary considerations to gain maximum value from care management technology:
Addressing Gaps in Code Capture
Medicare Advantage plan comes under the parameters of the Five-Star Rating Program from CMS. It is designed to assess performance across nine domains to determine a health plan’s reimbursement level. Unfortunately, codes impacting performance are often missing for many health plans.
Accurate capture of claims code is possible with the help of Infrastructure ROI. Enhanced care management solution automates the capture of correct diagnosis-related groups and ensures submission of speeding revenue cycle processes and a clean claim. Moreover, the appropriate platform addresses possible gaps in code capture and assists players to stay compliant with evolving regulations.
Delivering Actionable Insights and Resource Access
Improving member health and reducing care costs is the primary goal of any technology investment. It requires the health plan executives to tie bottom-line improvements to outcomes such as decreased high-cost interventions, reduced hospitalizations, or lower medication consumption. The achievement of this goal demands to drill population health initiatives to an individual.
Apart from accurate code capture, actionable interventions from real-time access to social aspects of health data and support for interdisciplinary collaborative workflows, robust analytics, and social service are the other factors involved in care management. For instance, if care managers know the transportation needs, they can proactively get involved to allow patients to get medical appointments. A care management platform that offers both resource access and actionable insights enhances the effectiveness of outreach efforts.
Providing an Interoperable and a Highly-Configurable Framework
Earlier, the care management platforms failed to provide the flexibility required to enable deep analysis needed to improve population health outcomes truly. Players need to draw on extremely-configurable, cloud-based infrastructures that combine disparate legacy solutions and offer broad-spectrum interoperability. It means that data can be assimilated from various sources and distributed across healthcare channels in a meaningful way without the need for additional costs in writing new computer codes.
Moreover, cloud-based solutions naturally lead to a lower cost of ownership via highly-modular designs that need minimal ongoing management. They also offset the need for additional resources to deal with security disaster recovery, which are managed by cloud vendors. Software enhancements and updates can also be pushed out on demand. The massive potential of care management technology is clearly evident, especially when stakeholders are thoughtfully considering the ways to optimize their investments. Since health plans provide the most effective approach to enhance member health, the three technological considerations will certainly be somewhere on the top of their priority list.