Care coordination services involve arranging patient care activities to ensure effective and safer care of a patient. The activities involve multiple participants with whom information is shared to dissipate the knowledge of caring. The common things communicated with care coordination are the needs of treatment and preferences of patients to administer high-value and high-quality health care. Healthcare providers use it as an important strategy to improve the recovery of patients. This in turn helps to improve outcomes for all stakeholders that include providers, patients, and payers.
Outsource2india has over 24 years of experience in providing well-designed and targeted care coordination to healthcare providers in the US. Our clients' bank on our services to improve disjointed processes, communicate clearly with patients and relatives, and facilitate understanding between primary care providers and specialists. As a care coordination service provider, we have, over the years we have supported multiple providers and practices across multiple organizations.
As a reputed care coordination service providing company, we provide a range of care coordination services to our clients some of which include -
With this service, we take care of care gap identification and closure. We primarily do this by uncovering care gaps with provider EHR or by leveraging an external system and then showcasing the care gap data in the EHR and reports. With the help of this data, we undertake patient engagement and other outreach initiatives. Once the care gaps are identified in the patient's chart, our expert care coordination members review the gaps to determine if a patient needs a home visit or should be contacted to walk in. After this, we draw the lists of patients who require outreach and get in touch with them either by phone or email or through printed letters.
As a care coordination company, we assist you to create a holistic patient profile to understand inside out of the patient's condition and verify and update patient demographics as and when needed. We have experience in handling a range of care gaps such as failing to share a new diagnosis with specialist of PCP, patients failing to comply with recommended preventative care or screenings, inability to schedule a behavioral health appointment promptly; inability to follow prescription guidelines for a chronic condition, children not scheduled for regular consultation or vaccinations, patients failing to find the right provider in their network area, etc.
The Annual Wellness Visit is a type of care coordination service designed to close the gaps in care among patients having two or more chronic conditions. Our patient flow coordinators assist providers to make the visit process valuable to the patient, provider, and mandated care coordination program. Medicare and Medicaid services established AWV primarily to keep Medicare beneficiaries healthy and encourage preventive care. With our AWV services, you can ensure that your patients receive an end-to-end health assessment and a customized prevention plan. This way we facilitate providers to improve patient service and confidence and keep them healthy.
Our AWV service is designed to make patients feel less confused and tense when a particular diagnosis or procedure is recommended. Our clients have leveraged our streamlined AWV services to boost recruitment in their care coordination programs. During the pandemic, we have assisted several providers to take up AWVs so that treatment can be carried out with a patient at home or the with the help of telehealth technologies such as videoconferencing.
Transitions of care support entail the shifting of a patient from one type of care to another type. The transition may happen other from home to hospitals or vice versa, or from hospital to ambulatory primary care practices, ambulatory and rehabilitation facilities, or even long-term care facilities such as hospices. As transitions of care increase the risk of adverse events due to change in the treatment environment and also increases the chances of miscommunication with new responsibilities given to new parties, we assist in the process by making the transition seamless.
We assist providers in the transition of care by taking care of the entire hospital discharge requirements which is a complex process with a lot of risks involved. Our role includes conveying provider communication to ensure accurate discharge instructions are understood, making it a point to deliver correct clinical information to support medical decisions in the post-transition period. Our experts have great experience in educating patients about the main elements of critical care, such as administering medicines, physical exercises, and other follow-up plans.
The role and responsibility of healthcare professionals do not end with helping patients heal. It also means to better engage with patients so that patients feel empowered to carry out the secondary aspects of treatment that would lead to a complete recovery. We assist healthcare providers in executing this process of healthcare. We don the role of health coaches to guide and train each patient through their healing process -
We help patients to understand diagnostic, educate them on ways to managing chronic diseases with evidence-based guidelines, comprehend the importance of continuity of care across multiple specialties, and explain the import of clinical and claims data. Our services have assisted our clients to improve self-management of chronic diseases, reduce readmission rates, ensure associated tasks for post-treatment care such as regular diagnostic tests and make proper use of resources thereby reducing loss of productivity. Our health coaches get in touch with your patients regularly to motivate them to follow treatment protocols and become more disciplined towards their health.
This service is related to the above-mentioned services. However, it is restricted to patients with chronic conditions such as high blood pressure, diabetes, multiple sclerosis, systemic lupus erythematosus, asthma, sleep apnea, etc. We have a dedicated team of coaches to assist chronic patients to understand their condition and learn how to deal with it. In other words, this service is a kind of disease management for chronic conditions.
Our chronic care management services place razor-sharp focus on a routine and productive relationship with any particular member of people taking care of the patient. We seek updates and provide continuous advice to the member on the patient's condition to help the patient keep their chronic condition under control. Our chronic care management program for providers provides 24/7 support to patients and members can get in touch with the care team any time or day of the week.
Our clinical care coordinator assists providers in assisting patients to extend their treatments at homes or even in a new treatment set up especially if the patient undergoes a transition in treatment conditions. We follow few well-defined steps to monitoring transitions in care at home or a new provider unit so that patient conditions do not fall through the cracks. Our care coordination in healthcare service consists of the following steps -
We go through the patient's release documents and gain an understanding of all the vital parameters of health at the time of release. We also pour through physician recommendations and other diagnostic reports made available to us
We reach out to the patient or the patient care team and enroll them into the care coordination program. We brief them of all the processes and procedures to get in touch with the care coordination team
Once the patient is enrolled into the care team we document the procedure. The name of the patient care team and relationship is entered into the registry along with consent for treatment and sharing information
Here we draw the pal for systematic screening, interpreting, administering, and adjusting care based on some well-defined guidelines and measures
In this stage, we facilitate referrals and keep a tab on all the referral materials got from other providers. We also track the completion of referrals and updating them regularly in the clinical registry data
In this stage, we identify the updated list of all the medicines and injections being administered to the patients including, dosage, frequency, etc.
In this stage, we encourage the patient, care team, and other support providers in acquiring the skills and abilities needed for self-care
As part of care coordination, our team also ensures that all your patients have easy access to appropriate urgent care services such as specialty MH, SUD, or primary care
Outsourcing care coordination services bring a host of benefits to providers. As a renowned care coordination service provider, we provide the following benefits to our clients -
We assist both patients and providers realize costs savings. We enable this for providers by ensuring physicians do not have to spend more time than needed with patients. Likewise, we work with the patient's team to weed out inefficiencies that lead to higher costs such as unnecessary procedures, appointments, and tests.
Our data-driven care coordination services assist physicians to gain access to data that can point to a range of insights including risks and health recovery levels. The data throws light on the overall value of the health benefit plan thus enabling them to know how successful they have been in their efforts as well as get a heads up on the tweaks needed. This keeps them continuously involved in delivering quality healthcare services and in the process enhance their learning through continued exposure.
Our care coordination services understand the challenges faced by every physician network in closing gaps in care. We leverage this understanding to bridge the gap in delivering overall quality improvements. In the process, we assist physicians to save on their precious time particularly when it is believed that physicians spend an average of 15 hours every week closing gaps in care and satisfying quality measures. Our services equip the provider in improving the quality of care gap especially when they are held back by lack of resources and finances.
We ensure that a care coordination program is successful by establishing a platform for collaborative learning. Our approach ensures there is a proper creation of space to discuss ever development inside out; to encourage team members to have up-to-date knowledge of the patient condition and necessary remedies and sharing of disease knowledge outcomes of recovery practices, challenges encountered, and successes. We also ensure the platform is used as a feedback space to assist the leadership to fine-tune the program.
We assist providers to improve quality measure performance, by ensuring every connection addresses more than one objective towards closing care gaps. When we reach out to patients or team members we ensure we address multiple HEDIS measures in every interaction. At the same time, we use each point of contact to build the right understanding for collaboration and collection of data for the study. In this way, we help build a proper environment for patient care that is taken to a higher level with every interaction.
Quality healthcare banks on proper education and dissemination of information. We strive to achieve this by being in constant touch with team members and the patient. Our care coordination-related teaching entails explaining technical jargon and procedures simply and effectively. The most important part of the coordination is to ensure that a patient's fears, concerns, and barriers are addressed to their satisfaction so that physical recovery is accompanied by proper mental recovery. Our experts are available round the clock to address every requirement of post-care recovery.
Our care coordination program serves as an extension of your practice's care team. As additional care team members, we monitor and interact with your patients and keep the PCP updated of progress and clinical improvements and even ER visits and recent admissions which they may not be aware of until the patient's next visit for a check-up.
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Hello, I wanted to reach out to you directly and express my gratitude for the hard work that the Data team, as well as the AR team, has done with EJ practice. I have pushed both teams extremely hard over the past month and their efforts, as well as ours, have paid off.RCM Account Manager, EMR System Provider, FL, USA More Testimonials »
With over 24 years of experience in care coordination, Outsource2india leverages the fully integrated chronic care management solution to assist you to reach out to patients in less time, without interfering with your workflows. By staying in touch with discharged patients we provide them regular health coaching on your behalf to improve engagement and ensure proactive management of diseases, particularly chronic conditions. In the process, we have effectively assisted providers to ensure there are fewer hospitalizations and ED visits, complete compliance with Medicare requirements, and lower care costs.
If you are looking for care coordination services in India please talk to us now.