Background: Preventative care is to identify gaps in patient care and notify the provider for important performance measure in health care where improvements can make a meaningful difference in patient health.
Problem: A major healthcare insurance company identified Emergency Room admissions by chronic patients as a primary driver of unnecessary claims costs. These patients tended to neglect planned care such as tests, medicines, or check-ups, and primary care physicians had no way to monitor these lapses in real time. This resulted in gaps in care that too often became critical, driving up the cost of care.
Soulution EIXSYS developed a monitoring system that monitored Claims information and provided early intervention when planned care was not followed. The solution involved collecting chronic care patient data from Payer databases and mapping this data with the Provider network rosters. This information was then ‘pushed’ automatically as alerts to the primary care physician in realtime, allowing the physician to intervene with the patient immediately. This solution can also generate patient alerts as reminders.
Result: The Insurance company was able to save $12 million dollars in annual costs. This money that had previously paid for Emergency Room visits was now diverted to low-cost preventive care, such as checkups, regular testing, and medicine.