Client Overview
The client, a Maryland-based healthcare provider, is dedicated to managing chronic conditions. With extensive expertise and a network of hospitals across the United States, the client is committed to achieving optimal patient health outcomes, maintaining patient engagement with treatment plans, and ensuring high patient satisfaction. This dedication has earned them a strong reputation in the surrounding areas.
Business challenges
While delivering care to patients, the client encountered the following challenges:
1. High Operational Costs
The client faced high operational costs due to the extensive resources required to manage chronic conditions, including staff time, technology, and infrastructure. These costs limit the potential for profit margins and pressure the organization's financial sustainability.
2. Inefficient Patient Enrollment in CCM Programs
Identifying and enrolling eligible patients into CCM programs was challenging for the client due to existing inefficiencies of EHR software in patient tracking and eligibility determination. These inefficiencies in the software led to revenue loss for the client.
3. Regulatory Compliance and Billing Challenges
Ensuring compliance with CMS regulations and accurately billing for CCM services can be complex and resource-intensive for the client. Errors in billing or non-compliance resulted in denied claims, penalties, and reduced revenue.
4. Patient Engagement and Retention Issues
Engaging and retaining patients in CCM programs is critical for sustained revenue. The client had struggled with patient adherence to treatment plans and participation in CCM programs, leading to reduced program effectiveness and potential loss of recurring revenue.
Solution
To address these challenges and find a sustainable solution, the client approached Medarch Inc. for the eCareMD software. Our team of business analysts thoroughly understood the client’s challenges and requirements. We then demonstrated how our eCareMD product could streamline their practice operations and maximize recurring revenue.
With the client’s full approval, our team implemented the eCareMD software into their practice. Following the implementation, the client experienced increased revenue with minimal resource expenditure.
Solution Highlights
1. Bulk patient invite and enrollment
The eCareMD software effectively addressed the client’s inefficient patient enrollment issue by allowing care providers to send a consent to hundreds of patients within seconds and streamline the enrollment process. This functionality increased practice efficiency, reduced the manual workload for care providers, and minimized resource dependency.
2. Comprehensive, CMS-compliant billing mechanism
To maximize reimbursement, accurate billing is crucial. The eCareMD software supports automated billing by logging eligible CPT codes based on the role of care providers and the time spent on clinical activities. These codes are then displayed in the billing and claims section. This automation eliminated the need for manual time tracking and reduced the risk of selecting incorrect CPT codes. As a result, billing accuracy has improved, the claim denial rate has significantly decreased, and practice revenue has increased.
3. Robust patient engagment features
Keeping patients engaged over the long term was a significant challenge for the client, especially since treating chronic conditions requires extended care. The eCareMD software’s teleconsultation capabilities, including secure voice calls, SMS, and real-time chat, have enabled care providers to maintain consistent patient communication. The software's configurable reminder feature also allows care providers to set reminders for medications, sleep, diet, exercise, and appointments. This has dramatically improved patient adherence to treatment and their engagement with the care plan.
4. Access to multiple provider group functionality
To address resource constraints and cost challenges, the eCareMD software’s "Ultra Super Provider" feature allows a single provider to manage patients across multiple practices. This functionality significantly enhanced provider efficiency, increasing the practice's revenue.
Value Delivered
Here are some key value-delivered highlights following the implementation of the eCareMD software in the client’s practice:
1. Improved efficiency and reduction in resources required
Efficiency Improvement: Enabled sending consents to hundreds of patients within seconds.
Resource Reduction: The eCareMD software reduced the manual workload by 60% and minimized dependency on staff resources, providing a significant relief and comfort to the care providers.
2. Increased billing accuracy and reduction in claim denials
Billing Accuracy: Automated logging of eligible CPT codes improved billing accuracy by 50%.
Claim Denial Reduction: Decreased claim denial rate by 40%, increasing practice revenue.
3. Improved Patient Engagement and retention
Increased Engagement: Enhanced patient adherence to treatment plans by 30% through teleconsultation and configurable reminders.
Increased Retention: The eCareMD software boosted patient retention in CCM programs by 25%, a significant achievement that contributes to sustained revenue and success.
4. Increased provider efficiency and practice revenue
Provider Efficiency: The 'Ultra Super Provider' feature of the eCareMD software allowed a single provider to manage patients across multiple practices, increasing provider efficiency by 35% and empowering them to handle more patients effectively.
Revenue Increase: Resulted in a 20% increase in practice revenue by optimizing resource allocation.