Client Background
The client is a leading healthcare provider in the United States, headquartered in Albuquerque, New Mexico, with 3,000 employees. They are healthcare professionals providing Chronic Care Management (CCM) services to multiple practices. With a growing number of patients dealing with multiple chronic diseases, the organization aims to implement a comprehensive CCM program in compliance with all CMS and HIPAA regulations. This organization serves as a provider of CCM services to various healthcare providers and organizations.
Business challenges
The client was using a digital healthcare platform to manage the patient's chronic illnesses by offering a CCM program. In the meantime, they faced issues that hampered the client’s practice efficiency, resulting in a loss of reimbursement amount from the insurance company. Some of the challenges faced by the client are:
1. Patient Management Across Provider Groups
Despite having the opportunity to manage patients from multiple practices, the providers were not able to capitalize on them due to the limitations of the software. This hampered the care provider’s ability to log the required time and earn maximum reimbursement.
2. Inefficient Call Recording and Scheduling
The client struggled with scheduling and documenting the calls for completing activities over the patient profile. This impacted patient-provider communication and care management, resulting in reduced quality of care and lower reimbursement amounts from the insurance company.
3. Manual Time Tracking and Billing
As the care provider performed multiple activities outside the platform, like text messages, calling via mobile, etc., the existing system was not able to monitor and document them into the system. That led to a loss of reimbursement opportunities for the client because of inaccurate time-logging functionality in their existing system.
4. Task Management and Workflow Challenges
The existing system lacked the ability to manage task activities efficiently. Due to this, the client struggled to prioritize and track patient-related activities, which led to delays in care delivery and gaps in the care management of patients.
5. Documentation and Reporting Complexity
The client was facing difficulties in documenting patient activities and generating comprehensive reports for billing and compliance purposes. Because of these issues, the client was unable to capitalize on the opportunity to earn maximum reimbursements.
Due to this, it became difficult for the providers to document the services provided to patients, which resulted in lower reimbursement, patient satisfaction, and engagement.
Solution
After multiple calls, demo trails, and interactions, our business analyst team identified the client's challenges and commenced work on fulfilling their requirements. Following successful configuration, our team presented the final demo showcasing how we can fulfill all their specified requirements.
After the client's go-ahead, our team implemented the eCareMD chronic care management platform of Medarch INC., with advanced technology and a patient-centered approach to managing patients' chronic conditions. Its successful implementation increased revenue and patient engagement, directly improving the quality of care for providers' CCM programs.
Solution Highlights
The eCareMD CCM platform offers numerous features that facilitate a patient-centered approach and contribute to providing high-quality care to patients.
Below are some solution highlights demonstrating how eCareMD addresses client challenges and problems:
1. Managing Patients from Multiple Provider Groups
For practices to receive higher reimbursements, managing more patients with efficient care coordination is crucial. Using the eCareMD platform, the tenant provider can access and provide CCM services to multiple patients from different provider groups.
By implementing this functionality, more patients were treated, which resulted in increased reimbursement for the practice. Also, the efficiency of the staff increased as a single tenant provider was able to treat more patients from multiple provider groups.
2. Effortless Call Scheduling Directly within the Platform
Healthcare professionals must constantly work closely with patients to plan monthly care activities like chart reviews and alert resolution to manage patients with chronic diseases effectively.
The eCareMD platform provided a manual call scheduling functionality with an add-on option of recurring call scheduling for follow-ups. The care provider was able to schedule calls with the patients on the specified dates and times using this feature.
The outgoing calls through the platform were automatically recorded and could be accessed by the care team with complete details, enabling an automatic time log. The recordings of calls help providers to make accurate decisions on patient health.
3. Automated Timer and Time Logging Functionality
The eCareMD chronic care management platform is designed to emphasize logging the time spent by the provider for each activity performed on the patient profile. The maximum logged time allowed care providers to accurately bill CPT codes to maximize reimbursement.
The platform now automatically tracks time to prevent missing time spent by the provider. Along with that, the manual time logging function enabled care providers to manually record the time spent on tasks completed outside the platform, just in case the system missed logging time automatically.
4. Task Management
Patients with chronic conditions need ongoing care from the provider to avoid complications and get the expected results. The overwhelming amount of work that needs to be done for patients makes it challenging for smaller care teams to manage additional patients.
The eCareMD platform provides task management functionality to streamline workflows. The care providers could now easily assign tasks like calling, SMS, and email activities for daily, weekly, and monthly reviews of patient health. Also, once the task is done, the providers just have to mark resolved, or they could reassign those tasks to other providers if needed.
5. Documentation of Activities
For practices that provide CCM services to patients, it is difficult to keep track of all activities done for the patient and also to maintain it.
The eCareMD platform provided a robust care management section where providers could document their updates and notes against patient care plans based on their communication with patients. That can be done as a part of monthly care plan updates, care plan progress, assessments, and physician reviews.
Value Delivered
1. 40% increase in patient management
With the implementation of eCareMD software, the care providers were able to manage 40% more patients than usual across different provider groups.
2. Improved Patient Engagement
The eCareMD Platform’s ‘Schedule Call’ functionality helped providers interact with patients and resolve their complexities. Due to this, the patients were more engaged with the care program and the care team.
3. 50% Growth in Reimbursement for Practice
Accurate automatic time tracking for activities done by the provider on patient profile and the feasibility of manually logging time for outside platform activities helped in documenting the correct eligible billing codes that resulted in 50% increased reimbursement amounts for the provider.
4. Enhanced Efficiency
By introducing robust task management features, our solution enabled the client to prioritize and track patient-related activities effectively. This streamlined the clinical workflow, minimizing care delivery delays and ensuring timely interventions, ultimately improving practice efficiency.
5. Structured Documentation Reducing the Complexities
Since the patients were not enrolled with the eCareMD platform, accurate documentation with proactive tracking of care activities was made possible. These drove data-driven care practices and audits done by the insurance companies.