eBooks: Understanding the Role of Open and Flexible Care Management Solutions

Understanding the Role of Open and Flexible Care Management Solutions

The healthcare industry is evolving rapidly, and care management teams within health plans are finding it challenging to adapt their legacy systems to meet the increasing demands of various stakeholders. To address these challenges, the need for open and flexible care management solutions has become evident.

The Current State

Healthcare stakeholders, including members, providers, care managers, administrators, and regulators, are facing significant challenges:

• Members desire a personalized approach to care.
• Providers need real-time data to collaborate effectively.
• Care Managers must develop effective care plans.
• Administrators aim to reduce costs while improving outcomes.
• Regulators demand transparency and interoperability.

The solution to these challenges lies in adopting open and flexible care management systems.

Three Modern Care Management Must-Haves

1. Data Exchange: Ability to ingest and openly exchange all types of data between systems and sources while adhering to industry interoperability standards.
2. Real-Time Data: Accommodate real-time data exchange to minimize the risk of adverse events.
3. Interoperability: Be open and capable of working seamlessly with other software systems and data sources to meet the unique needs of each patient population.

The Solution

Interoperable care management systems like HealthEdge’s GuidingCare® offer numerous benefits:

• Greater Data Access: Provides actionable insights for smarter business decisions on member populations, market expansion, and cost containment.
• Flexibility and Speed: Allows health plans to purchase, deploy, and scale specific systems from different vendors quickly to meet business needs.
• Best-of-Breed Solutions: Facilitates the choice of solutions from top vendors as data flows freely between applications and care settings.
• Reduced IT Burden: Standardized interfaces reduce the IT burden typically associated with integrating solutions.
• Better Patient Outcomes: Enables more informed decisions that result in better patient outcomes and lower utilization management costs.
• Rapid Deployment: Health plans can respond faster to market opportunities and challenges with quicker deployment times.

The GuidingCare Difference

GuidingCare^®, designed with interoperability and composability in mind, integrates seamlessly with other HealthEdge products like HealthRules® Payer and Source. Key benefits include:

• Streamlined Care Planning: Uses claims data to inform care managers, enabling the creation of effective care plans.
• 360-Degree Member View: Provides a comprehensive view of a member's history, eliminating manual data searches.
• Automated Data Entry: Reduces manual data entry for nurses, streamlining workflows and enhancing efficiency.

GuidingCare by the Numbers

• 75+ Unique vendor integrations across the payer IT ecosystem.
• 12+ Productized integrations with standard implementation and support models.
• 30+ Real-time APIs with clinical workflow rules built into GuidingCare.
• 5B+ Transactions processed annually on GuidingCare.

For more information about how your organization can benefit from the open and flexible GuidingCare® care management solution, visit www.healthedge.com or email us at [email protected].