HealthCollaborate™ Transitional Care Management Application

Overview

 

It is no secret that high-performing healthcare providers and payers must proactively engage, monitor and navigate population groups with complex medical, behavioral, and long-term care needs through multiple care settings.

“Single platform for payers and providers to coordinate, manage and monitor continuity of care.”

 

Effective transitional care management plays a major role in improving population health, maximizing reimbursements and reducing costs for Payers, Accountable Care Organizations, hospitals, physician networks, and PCMH.

 

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Health BI has developed an integrated suite of applications (HealthCollaborate™) that enables healthcare organizations and health plans to coordinated, manage and monitor patients’ continuity of care anywhere/anytime.  This EMR neutral Population Health solution, aligns patient-specific transitional care needs with data analytics, customized workflows, care team collaboration and patient engagement tools to efficiently navigate patients from hospitals to ambulatory and community care settings.   HealthCollaborate™ improves your clinical and financial outcomes with easy integration into your clinical workflow.

 

 

 

HealthCollaborate™ enables healthcare providers and payers to:

 

  • Deploy effective Technology Solutions for Integrated Care Model
  • Manage & Track Care for Large Patient Populations
  • Aggregate, Analyze and Report Population Health Data
  • Send Event Notifications and Data to Care Teams
  • Create & Manage Workflows and Care Plans
  • Proactively Engage Providers and Patients
  • Achieve the Triple Aim
  • Improve Patient Satisfaction Scores
  • Report Care Coordination Quality Metrics

 

HealthCollaborate™ can have direct impact on financial incentives, including:

  • Readmission Penalties
  • Medicare Shared Savings Programs
  • Bundled Payments (or Episode-Based Payments)
  • Pay-for-Performance / Hospital Value-based Purchasing

 

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Analytics & Reporting

Population Health Data Analytics and Reporting

Healthcare providers and payers are challenged to maintain quality standards, find solutions to improve financial positions and care delivery models while competing in an environment of escalating costs and increasing demand for care. Payers and providers must access multiple data sources to obtain the ability to view performance indicators, predict outcomes, determine trends and monitor performance.

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Health BI offers Business Intelligence architecture to unify reporting, data analysis and real-time monitoring for your organization. By Tracking clinical key indicators, Health BI data mining and analytic services will help your organization find and track patients by disease status, risk status, clinical history, lifestyle, community and family needs from both inside and outside of the HelathCollaborate ecosystem. By connecting with your data sources, Health BI will find patients with chronic diseases that are best candidates for Health Management. These patients will then automatically be added to the HealthCollaborate system and associated with evidence-based Care Flows, based on predefined categories. Health BI reporting services can provide your organization and provider partners with valuable insight into your Population Health Management performance, results, gaps and more

 

Whether you need a comprehensive data analytics engine or just to expose your internal data to provider partners, Health BI can help.

 

The Data Analytics Module includes:

 

  • Data Warehousing, Analytics & Reporting
  • Patient Identification & Stratification
  • Transitional Care Coordination Analytics & Reporting
  • Measuring & Reporting Performance
  • Measuring & Reporting Quality Metrics
  • At-risk patient Scoring & Comorbidity Index
  • Readmission Probability
  • High Risk Flagging
  • Cohort Categorization
  • Dynamic Risks Assessments
  • Utilization Reporting
  • Patient Outcomes Reporting
  • Patient Outreach Reporting
  • Care Coordination Efforts
  • Readmission Breakdown
  • Population Reporting

Notification & Exchange

Event Notification and Clinical Data Exchange

Many healthcare providers and health plans are unaware of their patients’ ER visits or hospital admits and discharges. The ability to quickly notify and mobilize the care team can reduce hospital readmissions and avert millions of dollars of spending on preventable hospitalizations. Notification

 

HealthCollaborate™ Event Notification System (ENS) connects, alerts and updates healthcare providers and payers of patients ADT events and outcomes. The available notifications can also include lab, radiology and transcription results and reports.This approach insures quick deployment of the care team and proactive engagement, monitoring and navigation of patients through the continuum of care.

 

Through integration and processing of HL7 ADT messages, HealthCollaborate™ (ENS) provides real-time or daily batch notifications with critical information to payers, private physicians, care management teams, ACOs–alerting them of their members’ acute encounters with participating hospitals.

 

The HealthCollaborate™ Event Notification System can be deployed as a standalone system or as part of the complete Population Health Management Solution. All notifications are delivered via HealthCollaborate™ multi-channel secure messaging platform. HealthCollaborate™ Event Notification System helps healthcare payers and providers to:

 

  • Integration with HIEs
  • Create Master Patient-Provider Index
  • Receive detailed notifications of acute care episodes
  • Receive clinical data and reports
  • Be notified of readmissions
  • Quickly deploy a transitional care team
  • Timely execution of care plans
  • Improve patient satisfaction scores

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Workflow Management

Workflow Management Engine

HealthCollaborate™ provides the care team with a comprehensive library of evidence-based Care Transitions protocols. The system enables care managers to utilize data-driven workflows, task lists and best practices to manage continuity of care for high-risk patients. The application is designed to enable Screen Shot 2013-05-15 at 11.35.38 AMcare managers to create various customized transitional care workflows based on patients’ care plans and national Transitional Care standards.

 

HealthCollaborate™ workflow engine automatically executes each step of the workflow, enabling the care team to navigated and monitor patients’ care coordination across the continuum on the navigation dashboard.

 

 

By implementing evidence-based protocols and effective plans of care, we can track patients’ progress, adjust their treatment plans, address preventative health needs and implement measures to reduce costs while improving outcomes.

 

 

HealthCollaborate™ delivers your care team a software application that includes:

 

  • Standard Care Transitions Library
  • Customizable Care Transitions workflows
  • Automated workflow engine
  • Patient Navigation Dashboard
  • Multiple Data Source Integration
  • Standardized Care Coordination Models

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Patient Engagement

Patient Engagement Platform

Your patient engagement strategy should rely on actively pushing and pulling information to and from patients through different means of communication. That can be achieved by deploying technology solutions that connect with providers and patients based on the best method of communication available to them. The idea of waiting for patients to access portals to be engaged is a failure. platform

 

HealthCollaborate™ multifaceted Patient Engagement Platform offers patients several options to provide and access information based on users’ preferred method of communication.   This approach helps healthcare organizations to manage provider-patient engagements based on users’ preference and convenience.

 

HealthCollaborate™ Provider-Patient Engagement Platform includes:

 

  • Interactive Voice Recognition (IVR)
  • Secure Mobile Messaging
  • Secure Email
  • Secure Provider/Patient Portals
  • SMS (Text Messaging)
  • e-Fax

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Continuity Toolset

Continuity of Care Toolset

In addition to data and processes, your technology solution must provide the care team with number of tools and capabilities to manage patients’ continuity of care in integrated care settings.Health BI has spent years and invested heavily on developing the most powerful technology stack to power a comprehensive Care Continuity Toolset. HealthCollaborate™ creates a connected community of providers, patients and payers on a single secure platform and allows all stakeholders to communicate, collaborate and share information. HealthCollaborate™ Continuity of Care Toolset is designed to incorporate all essential technologies and tools to help the care team operate in a unified virtual environment.

 

HealthCollaborate™ delivers the most comprehensive Continuity of Care Toolset that includes:

 

  • Intelligent Care Team Links
  • Appointment Requests and Scheduling
  • Appointment Notifications, Reminders and Follow-Ups
  • e-Referrals
  • Patient Monitoring
  • Medication Notifications/Monitoring
  • Automated Post Discharge Assessment Calls and Follow-Ups
  • Patient Education
  • Medication Information
  • Assessments & Notes
  • Patient Health Record

 

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