Powering Family Medicine Growth Through eCareMD’s Streamlined PCM

Client Overview:

The client is a fast-growing family care practice in Florida, operating with their eight physicians across three locations. They currently serve 4000+ patients, and the practice has experienced a 40% patient population within 18 months. Aiming to meet the rising need for principal care management programs and achieve revenue opportunities, as demand grows in chronic services, the current operation faces some major business challenges in managing care programs effectively.

Business challenges:

1. Inefficient Staff Resource Allocation and Workflow Management:

As the patient volume increased, the practice faced challenges in assigning PCM tasks and balancing care team workloads. Some staff have difficulty managing many patients, leading to lower-quality care delivery and growing frustration. The lack of structured task management makes it difficult to prioritize follow-ups and track responsibilities, resulting in care delays and staff burnout.

2. Complex Multi-Payer Billing and Revenue Cycle Management:

As a client's practice grows, managing PCM billing becomes difficult as PCM reimbursement requires accurate reports, which frequently leads to reimbursement delays. This complexity resulted in a 22% denial rate for PCM claims and an average of 45 days of reimbursement delays. The provider staff has to spend significant time correcting and resubmitting claims, which slows the overall revenue cycle.

3. Scalability Limitation in Patient communication and patient outreach:

With the rising patient outreach, manual communication methods, such as individual phone call scheduling, become unsustainable. Provider staff spend a large amount of time managing routine outreach, which limits their ability to engage a growing PCM population. As a result, the practice was only able to manage a few PCM patients, unable to achieve the required goal. Lack of automation directly impacts the scale of service.

4. Lack of performance Analytics and Program Optimization:

The client's practice lacks reporting tools, which are needed to measure and improve the PCM program. With clear reports on patient outcomes, staff inefficiency, and performance analytics, the client was unable to find an area of improvement. This made it difficult to make decisions regarding their business. As a result, growth was limited, and opportunities in PCM were missed.

Solution offered:

By recognizing the need to streamline operations and to increase the scale of the client's business in the PCM program effectively, the client's practice partnered with Medarch Inc. to implement the eCareMD platform with the goal of efficient PCM workflow and maximizing revenue. The solution provided a centralized system for patient outreach, care management, and performance tracking with an aim to reduce provider staff burnout to manage a large patient population. Some of the key solutions were implemented as follows;

Solution Highlighted:

1. Integrated Workload Management and Task Automation:

eCareMD provides workload management tools that automatically identify patients' program eligibility from their chronic conditions and suggest to the provider they assign a care team from the practice. The platform streamlines daily operations with task assignment functionality for both patient and provider-centric, allowing provider task prioritization and automated reminders, with a personalized performance dashboard. The care team receives daily scheduled reminders for their to-do tasks, which reduces administrative burden, prevents task duplication, and streamlines workflows.

2. Billing Module Integration and Revenue Cycle Optimization:

eCareMD offers an integrated billing and claim module that simplifies PCM reimbursement. The platform automatically generates CPT code-specific documentation, tracks billing rules, and encourages quality reports to boost monthly reimbursement. With real-time eligibility checks and built-in revenue cycle analytics, the system reduces claim denials and speeds up the reimbursement timeline, helping practices to improve revenue flow.

3. Scalable Patient Communication and Engagement Platform:

The eCareMD platform has smart communication tools that help practices stay connected with patients on a large scale. The features like bulk email and messaging, scheduled reminders, and educational material assignments are integrated across phone, text, email, and the patient app. The platform also includes automated scheduling and follow-up workflow, enabling the care team to engage more patients consistently with any workload and supporting timely outreach in the growth of PCM patient volume.

4. Comprehensive Analytics and Performance Reporting Dashboard:

eCareMD includes a powerful reporting dashboard that delivers real-time insights regarding PCM-enrolled patients and each provider's time logged. It tracks key insights like patient outcomes, provider staff productivity, and billing eligibility. The billing admin and physician receive automated billing and clinical reports each month, respectively, making operations clear and the return on investment.

Value Added:

1. Increased PCM Program Capacity by 180% Within 8 Months:

With eCareMD's Automated workflows and Communication tools, the client's business expanded its PCM program from 180 to 504 active patients, The staff productivity increased by 65% and care managers reported higher job satisfaction cause of automated workflows which reduces paperwork and sets tasks on priority while maintaining high standards and patient engagement.

2. Improved revenue cycle performance with 89 % Clean Claim Rate:

Using eCareMD's Integrated billing tools, the practice reduced claim denials from 22% to just 4% reaching an 89% clean claim rate, leading to faster cash flow and more predictable revenue. Within a year, PCM revenue increased by 34% while billing-rated costs reduced by 28% thanks to automated billing reports, real-time eligibility checks, and streamlined documentation.

3. Enhanced Operational Efficiency and Staff Satisfaction:

eCareMD's automated workflow and task management tools reduced administrative workload by 40% allowing the care team to spend more time on direct patient support. As a result, employee satisfaction grows by 42% and the PCM program Outcome

4. Data-Driven Program Optimization and Strategic Growth:

By the detailed analytics, the client was able to make the required strategies and allocate resources more effectively. The additional reimbursement amount the client is using to expand more in the PCM Program, focusing on further improvement in business. As a result, the program's return on investment increased by 56% cause of data-driven analytics.