One of our clients, a value-based care enabler, partnered with health insurers to improve patient population management amidst growing challenges in care coordination, chronic condition management, data integration, and telemedicine. To address these complexities, they integrated blueBriX’s EHR system with its Salesforce Health Cloud platform, achieving seamless data sharing and enhancing workflow efficiency. This strategic solution improved patient outcomes and resulted in significant cost savings for insurers by streamlining operations.
The Challenges – Multifaceted & Complex
Care Management: They faced challenges adapting to different compliance guidelines from insurance providers and states. When partnering with new providers, they had to adjust workflows to avoid revenue loss quickly. Coordinating care between telemedicine services and in-house therapy teams was also complex, requiring seamless communication. Customizable care plans for patient cohorts, such as pregnant women or cardiac patients, were needed to ensure participation in multiple programs without redundancy. Telemedicine support was vital for reducing hospitalizations and managing after-hours care effectively.
Patient Engagement: Expanding patient engagement and marketing value-based care was a struggle. Tools were essential to boost service awareness and enroll patients. Providing consent forms in multiple languages like Spanish, Arabic, and Hebrew helped serve a diverse population. Managing overlapping patient programs, such as for diabetes and chronic cardiac disease, without creating duplicate records was also important to streamline care.
Finance and Administration: They encountered difficulties with billing under capitated payment models, needing to file precise claims for proper reimbursements. Managing multiple clearing houses increased costs and complexity. Additionally, adhering to varying state billing and data handling regulations was necessary to avoid penalties.
Systems: Aggregating data across multiple states while complying with regulations was a technical challenge. The team needed a flexible system that could integrate with partner technologies, like telemedicine platforms, without creating silos. Migrating from legacy systems, including handling multilingual support, was key to ensuring a smooth transition while maintaining data integrity.
The blueBriX Strategy – Building Solutions Brick by Brick
blueBriX tackled their challenges with a strategic rollout of customized digital health solutions. Each component was carefully selected and tailored to address specific pain points:
