Oct 2, 2023 | 4 Min Read
Challenge
Our client, a distinguished national medical group, delivers personalized primary care at home to those confronting various health challenges. Operating under a value-based model, their services are rendered in unconventional care settings, focusing on client engagement, integrated systems and care documentation to realize revenue.
The client wanted to implement an enterprise operating clinical technology solution to fortify their distinctive business model. To ensure their future success, it was pivotal for them to foster customer engagement, secure payer approvals for member services, meet contractual requirements for Quality Assurance in documentation and coding, and meticulously document care for precise coding and revenue realization, all within a framework of integrated systems.
Emids was brought on board by the client to validate the system choices crucial for supporting their business model and addressing the various functionality assessment related to their CRM, Scheduling, Coding, and Revenue Cycle Management.
Solution
Emids initiated a rigorous fitness examination to clarify the client’s business model, document and facilitate a deeper examination and validation of the functionalities in accordance with their business needs. The solution involved a collaborative exploration to understand the complexities of the client’s unique care model and to refine the business model through in-depth workflow mapping leveraging a digital visual collaboration platform.
Emids led the assessment in three phases which involved reviewing existing processes, identifying possible solutions and determining the future course of action. This was implemented through meticulously documenting the workflow of the client’s business model and aligning the future functionalities to it. We spent time with their existing vendors to do a rigorous examination of the functionalities to deepen our understanding of the workflow/ functionality impact. We further developed options and impact to time/cost, day in the life of key stakeholders to determine the efficacy of the functionalities of the legacy technology systems and solutions. Through a thorough review of the functionalities against the business model requirements we successfully assessed the supportive capabilities of their existing enterprise operating clinical technology solution.
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Emids Digital Maturity IndexWe also created significant value for the client by discerning the need for a coding system tailored to support the specific business requirements of their payer customers. We recommended a solution that could plug those gaps seamlessly, streamline their Document QA and Coding QA processes in accordance with the payer guidelines.
Our assessment concluded that their existing platform worked for their EMR solution but did not cater to patient engagement, scheduling, billing and coding requirements of their business operations. We also evaluated various other vendor platforms and did their cost and functionality analysis. Accordingly, we recommended to the client an enterprise operating platform that was best suited to their business model and which included and supported integration of CRM, Scheduling application and Billing & Coding solutions along with EMR.
Emids also developed a unique patient journey map to help the client plug gaps in the patient delivery lifecycle and lay a foundation for effective patient engagement. We provided recommendations offering a detailed perspective on the requisite technology to bolster integration of sales enablement, CRM, documentation, and RCM.
Outcome
This collaboration and the subsequent solutions facilitated the client in authenticating the digital fitness of their operational technology, systems, and processes against the aspired business model.
The approach yielded in decoding incompatibilities in the functionalities of their operating technology in alignment with their distinctive care model. The insights from our findings empowered the client to optimize their workflow and processes and select the right technologies to support and address the specialized needs and complexities of delivering home-based care. The client was successfully able to validate their system choices and confirm their capability to effectively support the business model and operational needs, ultimately leading to improved patient care outcomes.
By identifying the need for a specialized coding system and recommending a suitable solution, the client was positioned to align better with the specific business requirements of their payer customers. Not only this enabled the client to streamline their processes but also mitigated compliance risks, ensuring adherence to payer guidelines. This shows how Emids’ proactively understood the client’s needs and created value with potential enhancements in their overall efficiency and compliance for improved satisfaction and trust among their payer stakeholder group.
This demonstrates Emids consulting expertise in creating a unique patient transformative journey map with tailored technical solutions to enhance the business model and services of the client. Thus, setting a robust foundation for a personalized home care experience.