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Price Efficiency and Quality

Advanced Cost Containment Solutions

 

When we speak about cost containment in healthcare, we don't mean cutting back on necessary care or taking away patient benefits.  Instead, we address finding intelligent ways to identify waste and improve efficiencies.  In addition to providing our core products, we can provide a host of products and services that complement one another and bring additional value.

Provider Optimization Program

Provider Optimization Program

 

  • Price efficiency per procedure and on a longitudinal basis (all costs for treating a specific diagnosis)

  • Quality using multiple, independent credible data sources with all metrics weighted for diagnostic relevance.

  • Every condition, primary/secondary/tertiary diagnosis (both episodic and chronic)

  • Proactively matching patients to optimal providers (price efficiency and quality on a diagnosis-specific basis with Intel Innovation Award-winning technology)

                                          HIGH-VALUE SERVICES

PROACTIVE PATIENT ENGAGEMENT/CONCIERGE

Early and ongoing patient engagement is the key to treatment compliance and referral optimization.  Initially  we assesses, segments and assigns each member to the appropriate patient engagement program based on health segment.  Then the appropriate program proactively engages members to provide support in every possible way (referral optimization, remote patient monitoring, appointment assistance, customized care plans, unified communications, etc). we then monitors members for new diagnoses to determine if changes in medical management/patient engagement programs are warranted.    

COMPLEX CHRONIC CARE MANAGEMENT

CCM or Complex Chronic patients are the highest cost patients with six or more chronic diagnoses who require intense proactive care coordination to ensure patient engagement for reduced costs and better quality of life.  Identifying and engaging these patients is a result of our analytics and Proactive Patient Engagement/Concierge service. Our care management efforts rely on flexible care plans, the best in unified communications and activities that are patient-centered. 

TELEMEDICINE, RPM & UNIFIED COMMUNICATION

Unified communications is the key required to effectively execute Monocle’s proactive patient engagement/concierge function.  Unified Communications is broadly defined to include: telemedicine, remote patient monitoring, medication adherence, customized care plans, appointments, patient reminders, facilitating communication between providers and patients and many other care management tools.  

There is a lot of information out there and most of it is uncoordinated.  Lack of coordinating information is a glaring omission contributing to lack of compliance, redundancy, waste and medical errors.  We fix that.  While others have “call centers” waiting for calls, we take the initiative to make the right things happen.

 

Our state-of-the art unified communications technology has over 19 million users world-wide. We are capable of providing communication services between patients and providers and providers to providers allowing for a a continuity of care across the continuum of care to be realized. We provide fully integrated remote patient monitoring with flexible care plans to assist physicians and patients in patient-centered care designed for and by the patient. 

 

With this highly integrated patient-centered technologies, we are able to facilitate and track a variety of activities including appointments, transportation, referrals and engagement with the patient's entire community of providers. With the support of the entire health care team and the patient's community, we actively track the patient's progress using clinical pathways and evidenced-based medicine as our guide.  

DISABILITY MIGRATION TO MEDICARE SSI

Disability Migration is probably the most valuable and yet ignored opportunity to reduce health plan sponsors’ and members’ costs.  Due to our initial analytics phase, we identify those members who have a high probability of being deemed eligible for Medicare SSI Disability. There is a high denial rate and the overwhelming cause is lack of documentation by the member.  

 

We identify the member, prepare the documentation and marshal the member through the process to increase the approval rate. Why is this important?  Members who qualify pay no premiums and no out-of-pocket costs and if their provider accepts Medicare, which 99% do, they don’t need to change providers. In addition, they receive a monthly disability payment (supplemental security income, aka SSI) in addition to any other income.  

 

For health plan sponsors, they avoid the cost of coverage of a high cost member now, in the future, and in the past. Once someone is deemed Medicare SSI Disabled, the Medicare program reimburses the plan sponsor for the past 12 months claims’ costs.  The average cost of a Medicare SSI Disabled patient is $300 K.  Assume you have a 50 year old with 12 chronic illnesses who qualifies. In this situation, the plan sponsor will incur $300 K for 17 years until the member qualifies for Medicare (assume 67 as qualifying age). With our assistance, the plan sponsor avoids 17 years of future cost and recoups one year in past cost. That’s 18 years of savings of $5.4 million (without inflation) per qualified member.