Our Take on Eligibility & Enrollment and RME
With the bling of integrated care management workflows bringing together your provider network and the promise of data ecosystems that allow for point-of-care quality metric review, it can be easy to forget where this all starts: with the patient. And if you’re a payer, with your members. Think for a moment:
Can you imagine the lack of success a mail-focused marketing campaign would have if instituted with the wrong addresses of your target audience? What if you’d spelled many of the recipients’ names wrong or mailed them multiple versions of the same copy? Now imagine starting an integrated care management and analytics platform that didn’t put member record management first on the list of design priorities. See any cascading implications?
It’s okay to be inspired by the grandeur of glossy goals. We are too at Downshift, but we recognize the importance of putting a solid foundation in place to be able to achieve them. Your successful value-based care solutions require a member-first organizational footing. If you partner with us, we’ll help you to roadmap everything from staffing to effective planning for changes to member identifiers coming from CMS in the future.
Our Experience
We have experience designing and implementing solutions to maximize:
Positive RME and E&E impacts on registries
Focusing on business needs as drivers for the detailed member matching and creation logic required to accommodate and remedy conflicting inputs from numerous upstream partners
Collaboration of your data aggregation team from square one and throughout your initiatives
The integration of your testing efforts to complement your diligent design
Interoperability as it relates to the success of these efforts
Preparedness with regards to budgets and resource allocation so that mitigation of errors and duplicates related to these core processes don’t lead to dead-ends once your journey has begun
Your Benefit
Getting your population management right from the get-go has a tremendous number of impacts on all of your teams’ focus capabilities:
Your Data Aggregation team can focus on optimizing their solutions and incorporating additional feeds
Your Healthy Planet team can focus on ‘real’ go live issues more likely to endear end-users to the solutions revolutionizing the care continuum
Your Analytics team can focus on deriving the tremendous value that a clean, true data ecosystem has held as promise
Finally, we’d be remiss to say that your operations team can have the confidence they need to focus their efforts on that mailing campaign you’ve been dreaming of getting off the ground!
Derive the Value
Effectively integrating your care management solutions and deriving value from your massive investment in data requires a thoughtful member-first foundation. You know patient engagement and consumerism-driven initiatives are what drives healthcare in the modern environment. Combined with the sharing of records given interoperability requirements, value-based reimbursement paradigms, and forthcoming integration of CRM solutions (if you’re not already there), you can’t afford to assume your populations’ specifics will work themselves out. Partner with a trusted partner to get this right. Downshift now, so you can accelerate later.