Projects
Target Market:
Business Need:
Challenges for Healthcare Industry include:
• Creating a personalized and engaging experience for better health and medical outcomes
• Defining the outcomes, measuring, and reporting on them
• Managing risk and compliance
• Reducing costs within the population health
Healthcare payers are constantly requested by patients to provide tools and expertise to reach out to patients for follow-up for preventive or screening services to their constituents. Many processes are still manual and the also current tools fall short since the relevant sources and data is in various databases, data warehouses and data marts, and other data sources to provide an automated and holistic view of patient’s population groups. Additionally, there is limited to no use of Predictive Modeling to help manage care identify needs and reduce costs in advance.
Project Summary:
The PC system is an application that manages Patient Connect workflow for Medicare and Medicaid patients who require follow-up for preventive or screening services. Some connects are federally mandated while others are required to meet regulatory requirements as well as improve health plan performance. PC includes Patient Connect application population from multiple sources such as the HEDIS measure, HEDIS like measures, and EPSDT.
Overall Project Description:
The PC system provides an Connect Associate or Manager with a proactively approach to working with clients to identify at-risk and rising risk patients and personalize connects and support efforts, streamline and automate care and utilization management processes, aggregate and analyze data to identify actions that lead to better revenue reimbursement and cost reduction, just as a few examples.
The system is an actionable repository for issues and inquiries where many different data sets can be seamlessly accessed and organized in a single interface, creating one view of a patient’s demographic, transactional, and other relevant information. The system provides users with the ability to manage and analyze patient issues and services with real time reporting tools, including canned reports, Business Intelligence tool and dashboards.
Improved customer management and response
Centralize a single audit trail of all patient and provider correspondence and interactions
Integration with patient services call center to improve patient care
The step-by-step approach helps produce quality patient engagement. By limiting calls-to-action to one at a time, for follow-up for preventive or screening services, the patient begins to see traction with patient responses. People will take action.
A Connect Associate or Manager shall be able to assign one or more patients at a time and to achieve this Connect Associate or Manager shall create patient list and then assign the list to the Connect Associate. They will be able to create patients list by entering all of the following information:
Market
Measure Name
Status
Source (Medicare, Medicaid, EPSDT, etc.)
Once the Search system is submitted the system shall display following information
Subscriber id
Patient Last Name
Patient First Name
Street
County
City
Zip
Patient Age From - to (in years and in months both); age range
Measure Name
Measure ID
Patient Connect Status
Patient searches shall be based on the data within patient connect database. Search results will display maximum 50 results per page. PC allows the Connect Associate or Manager to include Patient Connect application population from multiple sources such as HEDIS measure, HEDIS like measures and EPSDT.
PC helps delivers customized information directly to patients about their needed preventive and chronic care services such as:
Preventive service connect:
- Colon cancer screening
- + Breast cancer screening
- + Cervical cancer screening
- Pediatric Immunizations
Chronic care connect:
- Diabetic LDL and A1C screening
- Cardiovascular LDL screen
- Diabetic Eye Exam
- COPD & Spirometry testing (reminders sent monthly)
Web / UI Front End Business Requirements:
| #1 – Front End | |||||||
| Ability to Statement |
A front end that enables to select one or more reasons for unable to reach out to the patients for connect. |
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| User Story & Completion Criteria |
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| Detail Requirements (Business Rules & Variables) |
User Roles : Associate: This role shall be able to add/edit or read information for specified health plan, such as NJ, Manager: In addition to Associate role this role shall be able to add or remove associate in the system,filter measure list for connect for the specified health plan. Admin: In addition to Associate and Manager role this role shall be able to update contents such as drop down values, measure and action item links etc. in the system. This role shall have access to all health plans. |
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| Other Considerations |
By default user shall be able to access all products such as Medicare, Medicaid, EPSDT and HEDIS Like. In other words users shall not be restricted by product but the system shall have option to restrict users at health plan level. |
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