• Healthcare Simplicity

    Value-Based Operations + Human Centered Technology

  • Problem

    Administrative burden costs time and money; valuable resources not spent on care provision.

    $500B / year

    Total US administrative costs.

    $100K / year

    Per provider per year cost associated with billing and related functions (primary care setting)

    43 mins

    Per physician per day time spent on 'paperwork'.

    3x more

    Administrative costs account for 3x the amount we spend on cancer care per year.

  • Pilot Program Opportunity

    Given the complexities of healthcare roles and workflows, successful health technology solutions necessitate rigorous usability testing pre- and post-deployment to truly grasp the user's journey and deliver a solution as opposed to contributing to the burden. As such, carenodes is seeking pilot partners for testing -- business goals, scalability, and sustainability.

  • Program Eligibility

    Providers and payers meeting the eligibility criteria below should submit a request for an invitation to join the pilot.

    PROVIDERS

    Primary Care Service Lines

    • High-volume solo and small group physicians (1 to 10 PCPs).
    • Community clinics with at least 300 Medicaid assignments per provider or 1000 Medicaid assignments as a community clinic.
    • Mid-sized provider groups (10-50 PCPs) with an average of 250 Medicaid paneled lives per provider or 10,000 Medicaid lives combined.
    • Operating with capitated Medicaid contracts. 
    • Seeking an opportunity to receive significant revenue above capitation while increasing preventive screening rates and significantly improving performance on HEDIS metrics.

    PAYERS

    Health Plans and Risk Bearing Organizations

    • At-risk entities managing at Medicaid, Medicare Advantage, and/or Dual eligible lives.
    • At least 10,000 lives at-risk.
  • Approach

    Human-Centered Design (HCD) to developing adaptive digital health platform.

    Human-Centered Design

    Deploy a replicable method for scalable problem solving.

    Rigorous Methodology

    Value mapping pain-points to solutions based on root causes of concern.

    Scalable Sustainable

    Dynamic distributed technologies evolve with increasing use of the platform.

  • Process

    Processes are designed around the user, not the other way around.

     

    Methodological integrity and consistency established via a four-step evidence based model deployed within the context of Quality Improvement, Communications, and Data Aggregation.

     

    The focus is on preventive screenings, provider-payer collaboration, and data communications (harmonizing, aggregations, etc.).

    1

    Assessment

    We assess the current state of affairs and establish a baseline (workflow, quality outcomes, operational stressors, etc.)

    2

    Pre-deloyment

    We generate a plan; begin testing the platform. Iterative refinement,

    user-testing, tool building, and implementation.

    3

    Deployment

    Pilot testing / "live usability".

    4

    Post-Deployment

    Ongoing continuous quality improvement (CQI), peer to peer, and organizational support.

  • Provider Incentives

    Primary Care Providers can maximize their pay-for-performance opportunities while decreasing operational burden.

    BONUS PMPM

    Incentives + Capitation

    Solo and small group practices earned P4P payouts ranging from $1.20 PMPM to $3.65 PMPM.

    HEALTH ASSESSMENTS

    Preventive Screenings

    Captured incentives payable outside of capitation (Annual Wellness Visits, Initial Health Assessments).

    CAPTURE CODES

    Underutilized Codes

    Chronic, Transitional, and Collaborative Care billed. Find opportunities to better serve the population while establishing fiscal viability.

  • Features

  • Aggregation

    Big data aggregation consolidates up and down.

    • Roll-up to the highest level (i.e.: all providers in a group)
    • Drill-down to the patient level

  • Opportunity Tracking

    Multi-payer aggregation of Health Assessment rosters and Gaps in Care reports. Data is prioritized, trended, with actionable tools to capture time-sensitive opportunities.

  • Team Based

    Assign tasks within the organization - managing projects without disruptions from workforce turnover.

  • Notifications

    Alerts and notifications aggregated, organized, and prioritized.

  • Real-time escalation pathways

    Pathways allow escalation of issues presenting barriers to completing time-sensitive outreach (i.e. quality improvement, HEDIS, etc). Providers' reported barriers generate alerts up to the payer for support and resource allocation while there is still time.

  • Payer Insight Like Never Before

    Dashboards populate with context-specific widgets. Payers & providers gain "live" insight like never before.

    Delegation Oversight

    Extend visibility.

    Quality Monitoring

    Identify areas of opportunity.

    Compliance

    Downstream network access.

  • Experience it yourself. Ask for a demonstration.

    Request a demonstration of Payor and Provider platform experience

  • Connect With Us

    Email
    Phone

    LinkedIn

    Meet the Founder

  • Ecosystem Integration

    We are mission-driven, socially conscious, and ecosystem connected.