So you may have bad, ugly, horrible, scary data and internally you don’t have a means to lump it all together to give you a clear picture of what happened in 2010, 2011, and the challenges you are facing in 2012 with your members, your network physicians or your risk adjustment program.
You have twelve or more different revenue and quality initiatives and twenty different vendors supporting you. How can you combine these or give one clear picture? You need to build an internal repository for charts, claims, and risk adjustment data, which marries your claims and clinical data for each member and each network physicians’ profile. Here is how we provide clarity for our clients:
1. Actionable Member Profiles: by combining Censeo Health’s Advanced Evaluation, CareCurrent, and CareConnect analytics and reports, we can show you and your physicians the whole picture of the member’s history, current conditions, plus what case management programs they have triggered, and the documentation strength of the codes recorded for the member. The complete and actionable member profile is a “must have” output from your risk adjustment and quality systems.
2. Comprehensive & Insightful Physician Profiles: through our service offerings, Censeo highlights coding strengths and weakness, compliance areas of improvement, support documents and elements for a patient’s plan of treatment from labs to pharmacy to chronic conditions and possible gaps in care, clinical program and pathways needed, and a monitoring system for the resolution of condition or gaps in care by the community physicians. You need to support the network physician’s plan of treatment by providing actionable and insightful tools for the physician as the patient navigates the care pathway.
These are not static report cards with a problem list but rather a dynamic instrument supporting your clinical success and engagement programs. If your system has these elements, fabulous – you are on top of your game. If you are developing these, wonderful – you are on the right track. If you cannot develop these internally, we can create this complete clarity for you in ten (10) business days through our mapping system and integration engine.