Driving Operational Efficiency and Clinical Insights via Unified Care Management

Abstract

The integrated medical management platform merges Utilization Management, Care Management, and Health Information Line features into a single platform which is designed to enable broad clinical utilization. The platform is based on a modular architecture and uses APIs that have been deployed in a secure AWS cloud environment which allows it to easily connect into any existing claims, eligibility and pharmacy systems. The connectivity enhances the efficiency of case processing, clinical connectivity and reduced manual effort significantly. The artificial intelligence analytics further enhance the compliance with standard of care while enabling real-time reporting for population health and individual treatment. Staggered implementation and monitoring allow for both speed in innovation and reliability in operations for improved patient outcomes, operational and regulatory efficiencies. Future iterations will include social determinants of health, patient engagement via digital channels and learnings from AI on risk stratification for proactive monitoring of care. Future integration with IoT will enhance engagement beyond the four walls of health care and interchangeable with future electronic health accountability standards will enhance and streamline real-time ongoing monitoring and adaptive health care. Overall, this platform is positioned with all of these important benefits to disrupt and transform to become a leader in value-based health care.