Employing powerful data and technologies can greatly simplify the workflow and number of chart retrievals.
Many providers, and especially their office staff, are having a tough time today. Managed care has besieged physicians for decades with increasing documentation, pre-authorizations, and other administrative chores. The rate of rise in traditional and specialty pharmacy costs requires much closer scrutiny of and influence in prescribing decisions. Risk adjustment and quality ratings have only made these demands more burdensome and pressing.
Complexity abound–many plans segment these departments by line of business (LOB) overseen by different senior executives. That is six business units from the same plan for risk and quality–before adding medication management or pharmacy benefits–plus another handful of disease management programs. Assuming those are shared among LOBs, we’re talking upwards of 15 programs from just one plan contacting mostly the same providers, but at different times, with overlapping and often conflicting data requests from the same patient’s charts. Then, multiply this by the number of plans with which a typical medical practice works and also note that these programs use different software applications, most of which were designed from the perspective of what the plan needs and not from how the provider offices actually operate. It’s easy to realize how all of this can become very overwhelming.
Now, consider the organizational flux within these provider practices. Many practices, especially the smaller ones, focus on cash flow and submit just enough clinical data so that the claim adjudicates and pays promptly. Often working without a certified medical coder, smaller practices rely on either a biller or one of the physicians to code the diagnoses, which impairs the quality of claims and hinders the practice’s risk factors and quality ratings. Additionally, the practice can experience frequent turnover and complexity, hence frustration by providers is easy to understand yet very difficult to rectify. Enter Pulse8’s Strategy of One that practices the Power of One.
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