Even in today's technology-driven environment, many of the interchanges in the healthcare industry remain manual. These manual processes are adding complexity and cost to the healthcare system. A large amount of money is spent solely to reduce administrative complexities. Automating the processes to manage cost wastage is the only available solution. Medical chart exchanges, void in care communications, and electronic prior authorization can be automated to reduce waste from the system.
Millions of medical record requests are made to healthcare professionals and those are exchanged through manual methods like traditional paper or analog fax. Value-based health plan audits of medical records can help reduce the waste. The audit process can be made efficient by electronically delivering medical records, providing data in an easy to use format, encrypting data to ensure security and providing complete patient historical data for deep analysis. Likewise, gaps in care communication should be avoided. Manual communication processes such as fax, email or snail mail cause a significant lag in the time taken for communication and integrating instant messaging tools to the workflow positively impacts communication and quality care. Electronic prior authorization tools enable health plan to interact with prescribers to flag the need for prior authorization.
Apart from this, it is important to review how can make use advanced analytics, predictive techniques, and targeted interventions to meet quality outputs while yielding the improved return of investment. The prescribed measures include
Maximizing quality measures: Health plans should continually improve the quality of care and maximize risk adjustment opportunities, requires focusing on limited resources. Precise targeting analytics and predictive modeling techniques enable health plan to insight member population risk factors and identify focus areas with the highest potential to yield desired results.
Delivering effective payer-to-provider communications: Health plan initiated messaging tools between payers and providers can promise efficiency and maximize return on investment. It can also facilitate payer-provider exchanges around claim coding maximizing risk scores.
Strengthening member management: Engaging more members and promoting care plan compliance can be achieved using mobile customer relationship management. This tool can improve patient experience and the quality of care by driving them in for needed services. The automated outreaches include reminders to schedule appointments, promoting care plan adherence, proving post care instructions, and educating members on cost-saving options.
Opportunities to reduce waste in the healthcare system aid in improving the payer-provider relationship and enhancing patient satisfaction.