Care Coordination System
Up to 40% of existing patient referrals fail to convert to a patient visit
Patients who don’t make their appointments delay their care, leading to further complications down the line. Care Coordination directly addresses the breakdown in communication between patients, their specialists and primary care physicians.
Patients often arrive at the wrong location or without proper appointments and lack adequate clinical documents leading the specialist’s office asking “Why is this patient here?” The Care Coordination System allows physicians to easily consult with specialists and manage complete and accurate patient referrals in a single system interface for both in-network and out-of-network patients.
Physicians are able to quickly identify the best physician or group related to the patient’s clinical needs, geographic location, and insurance plan. Patients are cared for in a more timely and effective way, assuring higher satisfaction and improved clinical outcomes.
Critical patient information including medical images, clinical history, clinical notes, results and other key clinical information can easily accompany the electronic referral in a simple-to-use solution integrated into the patient’s electronic medical record.
How it works
Electronic referral management allows referring physicians to easily create a comprehensive referral including all patient demographics, insurance information and referring physician information creating a complete and high quality referral.
Benefit and Administrative Rules
Over 2,300 configurable benefit and other clinical rules are available to better manage referrals and ensure that all aspects of the referral are in compliance with the patient’s coverage and best practice standards.
Automated prompts notify the referring physician of various benefit and clinical care rules, ensuring a more complete referral. The reminders are configurable based on member benefits, networks, or other components of the patient’s coverage.
Complete referral management allowing referring physicians to attach electronic patient information, including clinical notes, diagnostic test results, and diagnostic images.
Location and Facility Management
The system will recommend the most appropriate provider facilities and locations based on factors including specialized skills, patient location, and other benefits information. Providers are listed in a ranking order based on numerous configurable factors.
The network management function within the CCS solution provides for management of an unlimited number of provider networks. Networks may be configured based on various member benefits, and stratified based on provider metrics such as specialized training or equipment, location, cost, or any other factor required by the client.
The CCS includes a secure messaging system to facilitate bi-directional communication between the referring physician and specialist or facility. This feature improves communications between providers and simplifies transmission of reports and other patient information.
As referrals are created and processed, those that do not meet pre-established rules may be pended for further review. The CCS includes numerous review queues and clients can add others based on their needs. This feature enables quick and easy access to the case for case managers to review and process pended cases.
Clinical Decision Support
HealthFortis Clinical Decision Support functionality is also available in the Care Coordination System. As referrals are created, evaluation of the request through the CDS platform is as simple as clicking the CDS button, further enhancing the quality of the order.