Care management programs allow for coordination among practitioners, UM clinicians, care coordinators and customer service representatives. This coordination results in improved outcomes for members and patients.
Corporate wellness programs are delivered by a team that delivers a spectrum of services to its members.
Historically, many health plans, providers, corporate wellness teams and elderly wellness organizations have relied on a set of fragmented information systems for executing on a care or wellness management model.
As in many industries, there has been an effort within these types of organizations to consolidate disparate applications into fewer systems without compromising functionality or adversely affecting current process flows.
A comprehensive care management software solution should house information and contain functionality that spans the entire continuum of member/patient care and interactions.
Vertical care management solutions excel in certain areas. However, some may be lacking the functionality required to support key member or patient touch points along the care and wellness continuum.
EMR systems serve an important role. However, many EMR systems are not extensible beyond a core of factory-designed functionality and therefore remain a point solution for billing.
What capabilities should be part of an extensible care management software solution? Here are a number to consider.
Consolidated patient information and interactions
The above referenced push to consolidate disparate databases often requires both one-time data migration and ongoing data integration.
A care management system should support the database structure and have the tools needed to accommodate secure movement of data into a more all-encompassing system.
Varying user experience by role
Each type of internal user should have a role-appropriate user experience within care management software. A health coach may have a different view of a member’s information than a clinician.
The ideal software solution allows for anyone who is connected to a member or to a patient to view the information they need to see and have the ability to easily manage their part of the patient or member experience.
Secure access from multiple devices
Some legacy systems have mobile device functionality that is added on to the system, after the fact.
Native mobile device functionality allows for consistency of the user experience across devices and the same per-role user interface flexibility mentioned above.
Workflows & approvals
The system should have an administrator friendly interface for setting up workflows & approvals. In other words, workflows should not have to be created programmatically.
Assessments & surveys
Transferring case management assessment response collection from paper into a software system ensures that all patient-provided data is shared with appropriate care management system users.
Shifting member and patient evaluation surveys from telephone calls and paper to fillable online surveys represents a cost savings and could mean a higher survey response rate.
Task assignment & management
An important component is the ability to assign tasks either manually or automatically, as a step within a workflow.
A task management component allows for a system user to enter detailed notes that relate to a member or patient. These notes are automatically timestamped for the date they are typed in or spoken in. They are also tagged with the name of the user who logged the task.
Customer service functionality
Integrated customer service functionality on the same platform provides multiple benefits compared to using a separate contact center solution.
Customer service agents can have access to the same core patient or member record as other user types such as clinicians, minus any information that should not be shared with someone in a contact center role.
This single view of the patient or member can make it more efficient to handle calls that relate to EOBs and other common inquiries.
Care management software should provide the ability to administratively create care plan templates. A user-selected template should be tailorable to a specific member’s needs.
Each care plan should include sections for problems, goals, tasks, and linked team members.
The software should support traditional mail merge functionality for written correspondence.
For example, an authorization letter may need to be mailed to a patient indicating a provider’s acceptance, along with the admission date and coverage details.
Patient communication & engagement
Specific member or patient communication preferences vary based on demographics and other factors. Ideally, the system should support a number of different HIPAA compliant options for communicating with members or patients. These can include:
- Chat (LiveAgent)
- A member/patient community (portal)
- SMS messaging
- One-to-one emails
- Newsletter and other marketing emails
Reporting & analytics
The system should have a native report writer and dashboard editor so that analytical views do not have to be developed and delivered outside the application.
Which reports and dashboards are accessible by a user should be determined by the user’s role. Administrators and authorized users should be able to create their own reports without having to always go to the system vendor.
When all of the frontline and office staff are on a common system, the system can be used to collaboratively discuss approaches with a patient or a member.
The system should also have an internal communication capability that is not necessarily specific to a patient or a member, such as collaboration among team members on best practices.
A care management software platform
The combination of Salesforce Health Cloud’s core functionality and value added by a Salesforce partner can address a broad spectrum of care management requirements.