The 5 Principles Of Care Management

The ultimate goal of any medical practitioner is to provide high-quality service which results in better health results without a hefty price tag. Unfortunately, while this is a great idea, it often becomes difficult to practice because there are several stakeholders involved in the patient-care lifecycle, making it next to impossible to align all of them to achieve a seamless experience. Here is where the Care Management viewpoint fits in to smoothen out the creases.

With value-dependent reimbursement becoming the new buzzword, there is a pronounced need for a centralized entity that has a bird’s eye view of a patient’s fitness trajectory so that it can coordinate with all consulting physicians as well as social work agencies accordingly to not just improve the quality of care but also lower the costs.

Care Management is an all-encompassing theory that covers a broad range of activities cutting across a patient’s healthcare journey. It focuses on reducing healthcare costs and improving patient satisfaction by bridging the communication chasm between different providers, cutting down duplicate investigations, enabling patients to monitor and maintain their health, and working towards eliminating socio-economic roadblocks that hamper the patient’s ability to be healthy.

Mirra Health Care is a third-party administrator in Florida, standing at the forefront of this transformation as an industry leader. We offer a suite of services and healthcare software solutions designed to integrate payer, provider, and patient through a holistic and comprehensive approach with a prime focus on efficient care management. Our solution is crafted by industry experts and driven by the latest technology to ensure top-notch care.

5 Crucial Aspects of Care Management

1. Recognizing High-cost, High-risk Populations

The most critical task of any care management team is to identify individuals who are at a higher risk of developing certain chronic illnesses. These high-risk populations often require more intensive and frequent medical interventions, which can drive up healthcare costs if not managed properly. Care management teams can use advanced data analytics to recognize these individuals and create preventive action plans for them that consider their psychological, social, and medical backgrounds.

Mirra Health Care's health insurance member management and enrollment software offers end-to-end capabilities for onboarding and managing Medicare beneficiaries. By utilizing the data, it is possible to efficiently track and manage high-risk populations, ensuring they receive the appropriate preventive care and interventions.

On the other hand, our Member House solution serves as a single source of truth for member-related information, ensuring that all patient data is up-to-date and easily accessible. These data-based systems help health plans and healthcare business entities gain important patient insights for better care management services.

2. Encouraging Shared Decision Making

When patients are not bulldozed into making decisions based solely on their physician’s opinions they tend to behave more responsibly and follow preventive measures. Care Management teams aim to give patients an equal say in matters related to their health and make them more capable of managing their health. Shared decision-making involves educating patients about their conditions and treatment options, and encouraging them to participate actively in their care plans.

3. Coordinating Care

You must have heard patients complain about having to get the same panel of tests run several times when consulting multiple physicians. Such overlap leads to unnecessarily inflated bills and added nuisance regarding wastage of time and effort. Care Management teams form a link between all the necessary players to ensure smoother operations by breaching communication barriers.

4. Enhanced Patient Outreach 

Staying in touch with patients even after they leave the healthcare facility helps prevent post-discharge complications. Ensuring that patients understand and adopt any recommended medication changes, know when to seek emergency medical assistance, and have their follow-up questions addressed are all tasks handled by care management teams. Enhanced patient outreach is crucial for maintaining continuity of care and improving health outcomes.

Healthcare businesses should also focus on sharing relevant medical information through their online channels. Mirra’s Healthcare Growth Marketing solutions deliver efficient digital marketing strategies that keep patients informed and engaged through online channels.

Read More: Proven Digital Marketing Strategies for Healthcare Success

5. Implementing Cost-Effective Health Solutions

By using various healthcare-related knowledge repositories including journal publications, treatment histories of patients with similar conditions, research reports, etc., and churning the data gleaned from them using advanced analytics tools, it is possible to shortlist the most cost-effective treatment plans. Data analytics teams within the Care Management setup are responsible for such projects.

Integrating Care Management with Mirra’s Services

Care Management is a patient-centric approach that can help healthcare entities contain costs while providing ongoing support before, during, and after treatment. Mirra Health Care is a third-party administrator employing top-notch healthcare software solutions and services that can help healthcare establishments implement patient care management strategies more efficiently.

Automated Claims Adjudication for Care Management

Mirra's Claims Adjudication software plays a pivotal role in Care Management by streamlining the claims process and ensuring timely and accurate claims reimbursements. This solution translates paper claims into digital records, processes electronic claims, and maintains comprehensive records, acting as an all-in-one payment reimbursement system. By improving the auto-adjudication rate and reducing errors, Mirra's Claims Adjudication process enhances the efficiency of care delivery and revenue cycle management. It allows care management teams to focus on patient care rather than administrative tasks, ensuring that resources are allocated appropriately, and patients receive the necessary treatments without delay.

Advanced Premium Billing for Care Management

Mirra's Premium Billing module streamlines Care Management by automating the process of generating member invoices and posting related payments. As a result, it streamlines healthcare billing services, reduces administrative burden, and ensures member satisfaction.

This module is fully integrated with the Membership Management system, eliminating manual entry and minimizing errors related to CMS-driven membership information, enrollment, and termination. The user-friendly interface and high level of automation make it easier for care management teams to handle customer service queries and manage member premiums efficiently.

By ensuring accurate and timely billing, Mirra's member billing module supports the financial stability of healthcare plans, allowing them to focus more on patient care and less on administrative tasks.

Encounter Data Processing System (EDPS)

Mirra's Encounter Data Processing System (EDPS) for Medicare Advantage plans plays a crucial role in Care Management by ensuring the accurate and timely transmission of encounter data to CMS. This data processing system receives, processes, and transmits complete and compliant 837 data, helping healthcare plans maintain data quality, ensure regulatory compliance, and avoid penalties.

Accurate encounter data is crucial for effective Care Management as it provides a comprehensive view of patient interactions, enabling care managers to track patient progress, identify gaps in care, and coordinate appropriate interventions. By integrating EDPS with Care Management, healthcare providers can ensure that all patient data is accurately reported and utilized to improve care delivery.

Best Utilization Management Practices in Healthcare 

Mirra's healthcare Utilization Management system provides a customizable solution for managing resource utilization and streamlining the prior authorization process. This system helps health plans optimize the use of medical resources, reduce unnecessary procedures, and ensure that patients receive the most appropriate and cost-effective care.  

By integrating Utilization Management with Care Management, healthcare businesses can ensure that resources are used efficiently and patients receive timely and appropriate interventions. 

Provider Portal for Care Management 

Mirra offers healthcare providers a comprehensive and user-friendly platform to support their administrative needs. This secure web portal provides quick and convenient access to member prior authorization and claim information, significantly enhancing the efficiency of care coordination.  

By enabling providers to self-register and access real-time, accurate information, the Provider Portal streamlines service-related processes, reduces administrative burden and ensures that providers can focus on delivering quality care.  

Healthcare Customer Service Solutions 

Effective customer service management solution is an integral part of Care Management as it provides health plans with a comprehensive system to manage all service-related processes for customers, applicants, providers, agents, and prospects.  

Mirra's healthcare customer service solution enhances productivity and service levels through real-time monitoring and improvement via dashboards and standardized CMS reports. By offering customer service representatives (CSRs) a web-based interface to view detailed claim information, pre-authorizations, and member verification, Mirra ensures that service interactions are efficient and accurate. The integration of the best customer service software with Care Management enhances patient satisfaction, improves operational efficiency, and ensures regulatory compliance. 

Appeals, Grievances, and Complaint Tracking Module 

Mirra's Appeals and Grievances solution is a comprehensive system designed to manage all types of Medicare Advantage appeals, grievances, and complaints. This solution is crucial for Care Management as it ensures compliance with CMS requirements through automatic due date calculations, centralized case history, and detailed reporting.  

By integrating with enrollment, claims, and authorization systems, Mirra's solution reduces data entry and improves accuracy. The ability to track and manage appeals and grievances efficiently helps care management teams address patient concerns promptly, enhancing patient satisfaction and trust.  

Member House Solutions 

Mirra's Member House solution serves as a single source of truth for all member-related information, providing real-time integration and updates across dependent systems. This solution is essential for Care Management as it ensures that accurate member information is available for all transactions, supporting effective claims processing and clinical requirements.  

By maintaining comprehensive member data, including demographics and plan mappings, Member House facilitates seamless care coordination and enhances the overall efficiency of Care Management. The ability to retrieve historical data and generate insightful reports helps care managers make informed decisions, improving patient care and satisfaction.  

Provider Villa  

Mirra’s Provider Villa is a comprehensive solution that caters to provider integration needs of health plans and their operational processes. This includes facilitating communication, streamlining administrative processes, and ensuring that all provider-related needs are met. By using Provider Villa, healthcare providers can enhance their operational efficiency, improve care coordination, and ensure that all provider-related processes are handled smoothly.  

Healthcare Growth Marketing  

Mirra’s Healthcare Growth Marketing solutions deliver compelling engagement and goal achievement for healthcare providers. This includes developing and implementing marketing strategies that drive patient engagement, improve patient satisfaction, and enhance overall care delivery. By using these solutions, healthcare providers can attract and retain patients, improve their reputation, and achieve their growth objectives.  

Read More: 6 Ways in Which Digital Marketing Can Enhance Your Healthcare Business 

By leveraging Mirra’s comprehensive suite of services, healthcare businesses can enhance their operational efficiency, improve member satisfaction, and ensure better health outcomes. Whether it’s managing high-risk populations, encouraging shared decision-making, coordinating care, enhancing patient outreach, or implementing cost-effective health solutions, Mirra’s services are designed to support every aspect of Care Management.  

For more information on how you can partner with Mirra and utilize the services in their Medicare in a Box solution, get in touch with us.