EMDEON INTERACTIVE CARE MANAGEMENT Innovative Care Management Strategies for Payers Simplifying the Business of Healthcare
Emdeon Interactive Care Management Innovative Care Management Strategies for Payers The healthcare industry as we know it is changing. Payers are being pressured to cut expenses while also lowering premiums and expanding coverage. Providers are facing rate pressure and inconsistent data formats from payers that the promise of HIPAA never resolved. Consumers are being challenged to be more educated and engaged in their care, translating to the expectation of higher quality service and better outcomes. Perhaps unexpectedly, the administrative side of a payer s business can help address this change. What if you could leverage current connectivity and administrative workflows to deliver a more proactive, more meaningful, more interactive care management program than you do today? Emdeon Interactive Care Management offers payers a way to supplement and enhance their existing care management outreach initiatives or, if there is no current care management program in place, a simple, effective method to begin a care management initiative. With a new, interactive care management solution designed to accommodate the changing needs of the healthcare industry, Emdeon s Interactive Care Management solutions, comprised of Emdeon CareComm and Emdeon Utilization Alerts, help payers efficiently and effectively reduce medical and administrative costs and dramatically improve outcomes. By leveraging Emdeon s existing electronic network of connections, Emdeon can provide total population health strategy, utilization management support and care intervention to impact your member population and provider network. Our industry-leading electronic healthcare information network, along with our printing services that distribute healthcare communications to over 150 million consumers in the US, enables Emdeon to offer services that increase the benefits of sharing health information before, after, and throughout the patient encounter. Emdeon s healthcare information network encompasses: 340,000 Providers 55,000 Pharmacies 81,000 Dentists 5,000 Hospitals and Health Systems 1,200 Commercial and Government Payers Over 100 Labs Over 600 Software and Channel Partners With more than two decades of experience in electronic healthcare data interchange, Emdeon is the market leader in health information exchange and standardization. Whether interacting with a pharmacy, physician, hospital, member, or payer, Emdeon is dedicated to improving care by facilitating the exchange of timely, relevant and actionable health information that is needed to enhance clinical quality, support physicians, lower medical expenses, and improve the quality of life for healthcare consumers. The Emdeon Advantage Recognizing that traditional care management approaches don t always achieve desired goals, Emdeon has developed solutions that enhance a payer s care management, disease management and quality management program offerings. Our solutions are equipped with product implementation and utilization tools that can improve program effectiveness and provide measurable results. We offer: Alternative and inexpensive communication channels that can reduce costly outreach phone calls and act as a payer-to-provider communication outlet Connectivity to engage 100% of your provider community Personalized, relevant and actionable patient information and gaps-in-care alerts to providers Timely notification of patient events that require payer action Premium provider outreach services to creatively communicate, educate and encourage utilization of new care management resources at the provider s disposal Customized benefit measurement reporting tailored to individual business needs no one size fits all methodology here. You get analysis that helps you achieve your business goals! At Emdeon, we re here to help. To transform the way you run your healthcare business today, call us at for a complimentary review. 03
Emdeon Utilization Alerts Enhanced Utilization Management Emdeon Utilization Alerts expedites and improves healthcare encounter notifications, enabling more real-time decision-making and follow-up. Utilization Alerts allows payers to leverage Emdeon s existing electronic connections to receive early and timely alerts when members present for healthcare services, allowing for more meaningful and impactful member outreach, engagement and education. Timely Alerts Leveraging the standard eligibility verification process and existing provider/facility workflows, payers are notified earlier in the healthcare encounter when a member presents for a specific service, such as an Emergency Room Visit, Urgent Care Visit or Inpatient Admission. Timely notifications enable payers to engage members earlier in the healthcare encounter rather than relying on traditional solutions that utilize stale claims data for identification. Our solution provides notification either at the point of care or shortly thereafter, which allows the payer to start discharge planning earlier, begin utilization reviews much sooner, refer to care management and disease management programs, as well as support a teachable moment by providing meaningful intervention, education and follow-up in a real-time manner. Ultimately, Utilization Alerts can lead to administrative efficiencies, enhanced care coordination, improved quality and decreased costs. Actionable Information Informing payers early in the healthcare encounter enables a payer s case management to engage members on healthcare service alternatives that may otherwise go unaddressed until a member is further along in the treatment continuum. Timely information leads to increased adherence to evidence-based care, increased quality of outcomes, and a better healthcare experience overall. Features Early identification and prioritization of healthcare services for utilization and case management notification Automated health plan notification when a member presents for healthcare services Timely notification to the health plan when Emergency Services and other identified services are utilized enables Utilization or Case Management teams to rapidly intervene Eligibility-based notifications can replace other forms of required provider notification to payers Encourage care alternatives through earlier member engagement, resulting in higher quality yet lower cost healthcare Engage provider networks with early notifications when members present for emergency care Benefits Complement your existing utilization and case management programs Lower ongoing emergency service costs through early engagement and diversion of non-urgent services to more appropriate levels of care Improve quality and cost through earlier Case Management engagement and referrals to other programs Features Identify and prioritize gaps-in-care and medication safety issues for your health plan members Actionable and relevant personalized health information delivered throughout the care continuum Total provider network engagement through pre-care eligibility response messaging Evidence-based clinical guidelines conveyed through print messaging encourage adherence from your member and provider population Self-service reporting and alert management tools, allowing payers to customize the solution to meet the needs of their population Benefits Complement and enhance your existing care management programs Meet employer group requirements for disease management programs Achieve high provider utilization through convenient workflow Improve adherence to evidence-based clinical best practices Avoid costs by encouraging preventive care Increase health plan revenue by offering an innovative communication strategy to employer groups Emdeon CareComm Improved quality. Enhanced care. Lower costs. Emdeon CareComm is a care communication tool for improving healthcare decision-making. It enables health plans to engage providers through precare messaging that leverages a real-time HIPAA-compliant eligibility connection, as well as engage members post-care through print messaging. CareComm helps convey important member health history and analytics at the right point in time to improve the health of your population. Pre-care messaging enhances care by delivering personalized information that enriches the physician-patient interaction. In addition to promoting healthy lifestyles within a health plan s population and provider network, CareComm facilitates cost avoidance by promoting evidence-based clinical best practices and encouraging proactive preventive care over more costly reactive care. Powerful Analytics Industry-leading clinical analytical tools enable Emdeon to identify members with specific care gaps or medication-related issues within a population, prioritize them, and tailor the CareComm message to address specific communication needs as determined by the payer. CareComm uses over 2,500 physician-maintained clinical algorithms, representing over 90 disease categories and more than 30 industry sources, including CDC, FDA, USPHTF, ADA, ACOG, HEDIS, NCQA, CMS and numerous other nationally-recognized clinical associations, to create some of the most relevant and actionable messaging in the industry. How it Works Prior to the patient encounter, through a provider-to-payer electronic eligibility request, providers receive in the returned eligibility response, personalized, evidence-based gaps in care and medication safety messaging that inform them of the member's specific clinical needs in a pre-care setting. Informing physicians with personalized, actionable health information allows the physician and member to address and remedy care gaps, medication issues and other concerns that may otherwise go unaddressed and lead to higher costs and poor outcomes. In the postcare setting, CareComm provides member-specific messaging through Explanation of Benefit statements (EOBs) as well as through other member and provider communications to encourage healthier behavior.. Reach members at the point of care and at home CareComm offers payers a total population engagement strategy: engaging providers with CareComm eligibility messaging, and members with CareComm EOB and letter messages. Complementing a payer s care management program with CareComm facilitates health information exchange throughout the care continuum. At Emdeon, we re here to help. To transform the way you run your healthcare business today, call us at for a complimentary review. 05
Benefits Across Healthcare Stakeholders While Emdeon Interactive Care Management solutions are tailored for a payer s benefit, Emdeon has the unique ability to look across healthcare stakeholders to see the most valuable points of interaction and craft our products so that payers, providers and members realize benefits. Emdeon Interactive Care Management offers the following benefits to each stakeholder: Payers: Timely communication of actionable healthcare encounters, such as notifications when a member enters an Emergency Room (ER) or is admitted to a hospital Earlier intervention opportunities, through gaps in care messaging delivered to the provider prior to, or at the time of the office visit Better informed care managers and health coaches Improved clinical and utilization outcomes Reduced medical and administrative costs Increased HEDIS scores Higher member and provider satisfaction Stronger provider relationships Providers: Integrates into existing workflow to provide easy access to additional patient-specific information Enhances view of patient needs and care gaps at an actionable time Enables more information-rich electronic health records Allows providers to deliver more robust evidence-based comprehensive care Strengthens the physician/patient relationship Harnesses the value of payer-provided resources and tools Supports requirements for Medical Home Models and Pay for Performance initiatives Members: Improves and maximizes the healthcare encounter Supports a focus on prevention and early intervention Provides better education and information to live healthy lifestyles Improves relationship with healthcare provider Changes member perception of the payer from a barrier to a resource At Emdeon, we re here to help. To transform the way you run your healthcare business today, call us at for a complimentary review. 07
Emdeon is a leading provider of revenue and payment cycle solutions that connect payers, providers and patients to improve healthcare business processes. To learn more about our company, our services and our commitment to improving healthcare, visit our website at www.emdeon.com. 2010 Emdeon Business Services LLC. All rights reserved. EMDA1010317 rev 4.10 3055 Lebanon Pike, Suite 1000 Nashville, TN 37214 USA