You’ve invested heavily in an EHR system to improve quality and compliance, but now find yourself responding to payer initiatives to “close gaps in care”. You log into payer portals, run reports, download or print spreadsheets, and then spend the next month trying to reconcile the member data in the spreadsheet with the patient data in your EHR.
By the end of the month you are less than halfway through, but now are faced with updated reports on all those payer portals. What do you do? Persevere with a report that is now out of date, or start again with fresh but unreconciled data.
Sound familiar?
Wouldn’t it be better if you had a tool that did this for you? That “remembered” the mapping between health plan member IDs and practice patient IDs. That updates rather than overwrites with the latest data. That is consistent across all health plan formats. That helps you manage your patients, and the attributed population who aren’t active patients in your practice.
Such a solution exists. Cedar Gate can read those PGIC files and export the “gaps in care” into Central Worklist: a care coordination tool for teams to target, communicate, and deliver services to patients through pre-defined workflows with integrated task and decision support.
A care team member – typically a Medical Assistant – can sort on number of open gaps and/or HCC score to find the “highest risk” patients, or filter to those with overdue annual wellness visits to address HCC coding opportunities. The tool has integrated communication capabilities to assist with outreach and scheduling from within the workflow.
The care team can also look up patients to find payer reported care gaps as part of pre-visit prep. If the clinical documentation exists and it’s a documentation and coding issue, they can close the gap with the payer before the visit. If it’s a true gap in care or intervention opportunity (such as med adherence) they can make a note in the chart for the physician to address it as part of the visit.
Additionally, Cedar Gate’s support for “Measure Value-sets” (as opposed to just code value-sets) means clinically equivalent measures, but with different n/d definitions, can be aggregated into single “measures” (such as “well child check”, or “uncontrolled hypertension”) so the practice doesn’t need to look at different reports from different payers for their total population – but can see them all in one report, one workflow.
All this without the need to ever look at a spreadsheet again.
