Healthcare organizations are increasingly focused on Patient-Centered Clinical Risk Management Solution; and the value-impact it would have on your hospital, physicians and the patients/population that you collectively serve. In addition, this solution significantly increases the revenues for both your hospital and physicians (averaging $120,000+ per physician per year); it also fosters enhanced quality of care and care outcomes for your patients/populations served!

Value Summary

This solution specializes in the identification of high-risk patients by utilizing the Medicare Annual Wellness Visit (“AWV”) in a program and is seamlessly integrated alongside chronic care management and gap analysis to create a comprehensive best practice Clinical Risk Management Solution. The goal is to prevent re-admissions, chronic disease onsets and falls. At the same time, it enhances the utilization of appropriate hospital ancillary services and specialist intervention as patients with high-risk factors are identified and properly managed. Finally, a bevy of population health management predictive data, predictive analytics and reports are provided which quickly identify trends, outcomes and risk stratification.

Process & Value

Utilizing the Medicare Annual Wellness Visit Program as outlined in the Affordable Care Act as a robust data capturing platform, this company incorporates a proprietary process supported by a proprietary predictive/prescriptive analytics engine which will provide the following:

  • Provides significant new net revenues through prescriptive analytics utilizing evidenced based practice protocols
  • Saves time by streamlining and automating work flow processes;
  • Optimizes patient participation in Annual Wellness Visits (60% to 80% participation);
  • Provides clinical dashboard highlighting important patient care metrics—
  • Identifies patients that show a high degree of developing a chronic issue(s) and get them into care plans before the onset of the chronic issue(s);
  • Provides robust predictive clinical data to better manage patient populations, rather than look at historical billing/claims data; and concurrent EMR
  • derived data that only show what happened after the fact, enabling action;
  • Provides physicians HCC Risk Adjustment Codes (ICD-10) and supportive documentation optimizing Risk Adjustment Factors driving optimized revenue allocations;
  • Consents patients into Chronic Care Management (CCM) by identifying those patients that qualify for CCM;
  • Facilitates the transitioning of patients into appropriate medical management;
  • Provides Risk Stratification and Outcomes reporting data; and
  • Guarantees compliance with the strict CMS program guidelines/regulations
  • Facilitates Medicare Advantage Plans meet their required measures for Medicare Five Star Certification—

As a result, the Triple Aim of improved quality, improved outcomes and reduced costs are achieved—in addition to significant new net revenues for physicians and provider organizations. The value that would be realized by participating physicians and provider organizations would be:

  1. Time Savings (turnkey processes and automated work flow eliminates demand on physicians’ time)
  2. Money (significant new net revenues driven by proprietary Clinical Triggers™; and greater patient participation in AWV)
  3. Peace of Mind (100% compliance guaranteed with CMS Guidelines avoiding stiff penalties)
  4. Data (Predictive data with evidenced based practice applications and applied proprietary analytics)
  5. Financial benefit – Averaging $120,000 per primary care physician per year.

I hope this information is helpful. This company is worth evaluating as it brings great value to the patient, physician and health systems. If you would like to know the potential financial impact that this solution can have on your organizations, please send the total number of Medicare patients in your primary care physician practices and how many GO 438 and GO 439 that are billed by these practices.

To learn more about this company or set up a demo please contact us for a confidential review.

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