Care Management

A major shift in the healthcare industry is that from volume based care to value based care. The program and physician centric approach has shifted to patient/member centric approach.Member and Population centric care have evolved significantly with the advances in Digital Technologies and evolution of new products and business models in the Industry. Advances in Digital experience Management, Digital Front Door based Member/Patient engagement, Advanced analytics, Intelligent automation, Interoperability and Real time member Information sharing capability and regulations around electronic prior authorization have all been redefining the way care management is addressed. Adaption of value based care, value based benefits and value based contracts in the Health Eco system along with MLR regulations have accelerated the transformation of care management.

Coforge has invested significantly in defining Care Management related services and champions Member centric Integrated Care Management model that aids in offering Digital Front Door based program which integrates Member Engagement with Wellness Management, Disease Management, Utilization Management and Complex case management effectively to offer complete life cycle solution aiding in managing both quality and cost.

Our care management service portfolio includes services such as:

• Member Identification Risk Stratification: We offer risk scoring, population segmentation, preventive and responsive care plans, and member outcome analysis
• Integrated Care Management: This includes services for wellness management, preventive care, complex case management, utilization management seamlessly integrated
• Member Experience Management and Digital Front Door: Streamline your member experience with interactive patient care, web/mobile apps, campaign management, remote monitoring, and others
• Provider Performance: Serves you with clinical and financial performance, setting performance standards, analyzing current and future population health risks, re-credentialing, etc.
• Interoperability and FHIR compliance in Information sharing for Care
• Member Centric Care Analytics

We leverage predictive algorithms for case identification, Patient adherence pattern, Care Plan Enrollment trends, Susceptible catastrophic cases, Disease Progression, Symptoms Triage, Service utilization forecast etc., to name a few.

Our capabilities in care management is bolstered by a strategic partnership with Zeomega whose Jiva platform drives workflow efficiency, quality and cost savings while CareIntel offers complete Analytics solutions and services that aids in improving the quality of care. Jiva is a confluence of advanced case management, utilization management, disease management, appeals and grievances, and community care simplifying care management even in the most complex ecosystems.

Our in house digital capabilities in Domain Consulting, Digital Experience Management and Digital Front Door definition, Automation, Digital Integration, Product Engineering, Data and analytics, Cloud Enablement, Application development along with solution accelerators complement Zeomega’s offerings.