Our Technology | careoptimize

Current Landscape

Value based care benefits all stakeholders but requires considerable effort from the provider and support team. Many providers find themselves overwhelmed with trying to keep track of all the VBC initiatives while practicing care in a cost-effective way. This presents a big problem because missing even one initiative has significant impact on all stakeholders.

Ideal State

Providers receive data driven insights at the point of care.

Health plans and risk bearing entities can track progress real time.

Gaps are closed during the visit, not chased afterwards

The tool is flexible enough to be modified immediately as initiatives change

The Challenge

Fragmented systems create additional challenges for providers participating in risk adjusted programs. Payer initiatives are displayed through portals that are removed from the current workflow. Retrospective chart audits by coders often take months to complete. Having to consider each initiative is a distraction for providers that need to be focused on offering patients the best care.

To make matters worse, revenue is tied to how well each provider scores on each initiative. If performance metrics slip, then compensation is reduced.

CareOptimize

simplify workflows with intelligent solutions

CareOptimize combines clinical data and health plan quality performance metrics to cultivate autonomous documentation suggestions. Powered by a machine learning rules engine, our solutions are flexible enough to accommodate current practice workflows while simultaneously reducing friction at the point of care. Best of all, tedious quality and coding requirements now become a seamless part of each patient encounter.

Supported Workflows

Quality

Best Practice Guidelines

Coding/audit

Referrals

CareOptimize Solutions are designed for multiple user experiences that support quality of care and comprehensive documentation. Success in value based care requires a coordinated team effort, our solutions help achieve this.

User Experiences

Population

Utilizing dashboards and reporting, CareOptimize enables an organization to view relevant metrics from an entire population. The solution also allows for granular review down to the individual patient or provider level.

Embedded

For practices with participating EHRs, the engagement module can be embedded directly into the provider or support teams current workflow. Seamlessly allowing for presentable data without the need for changing workflows.

Point of Care

For all Meaningful Use Stage 3 certified EHRs, the engagement is delivered through an agnostic Point of Care banner. Interacting with an icon that contains pertinent details relevant to the workflow each user is currently executing.

Quality

Maximize quality scores, reduce chart chasing demands

Best Practice Guidelines

Minimize practice pattern variation to follow most effective clinical research

Coding/Auditing

Accurate coding by ensuring all diagnosis are supported by clinical evidence

Referrals

Assist PCP with selecting of the most effective specialist based on insurance and geography

Succeeding in a risk adjusted payment model requires a huge investment in resources and infrastructure. The care delivery model must be supported by technology in order to track and monitor the care continuum.

• Population Health Solutions
• Care Management
• Optimized EHR
• Payer Contracts

• Financial Durability
• Transportation
• Additional Staff
• Supportive Infrastructure

• Telemedicine
• Remote Monitoring
• Home Health Services
• Patient Engagement

CareOptimize Value

Coding and quality become an embedded part of the workflow. Clinicians are no longer required to conduct massive chart pulls or reviews.
CareOptimize works behind the scenes to autonomously incorporate health plan program requirements.

Coding Gaps

Presents coding opportunities at the point of care by reviewing available data from multiple sources and analyzing which gaps exist. Suggestions are consolidated by the coding team or medical director and then pushed into the module. This allows providers or health plans to consider these suggestions during each patient encounter. By integrating this solution, clinicians ensure accuracy of results, increased levels of engagement, improved compliance and enhanced patient care.

Coding Rules

Each coding rule is being updated continuously and refined for relevance. CareOptimize’s library uses thousands of coding rules that are built directly into the solution. Additionally, our solution can be customized to accommodate the care delivery methods currently in place at each practice. Custom rules can be configured quickly to incorporate meaningful, actionable data within 24 hours. CareOptimize has the unique ability to rapidly introduce new care initiatives or update quality program requirements.

Quality Gaps

The CareOptimize Quality Gaps offers innovative tools that allows users the ability to view performance across all quality programs that pertain to the organization. Compiling data from the entire population, across the care continuum, allows for granular performance items to become easily identifiable. The quality gap tool considers information from a variety of programs including: HEDIS, Star Ratings, PQRS, MIPS, HQM & more. Leveraging the ability to drill down for additional insight, we then utilize a direct integration to put these insights in front of providers when and where they need them most, at the point of care.

Real results with CareOptimize

Improved revenue by boosting
RAF scores 16-31%

Identification of codes lost in the
transmission process between the
provider and health plan.

Time saved per provider eliminating
reconciling gaps between health plan and
EHR.

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