Healthcare Success Story Panel:

Using our BPM solution, hospital readmissions are reduced by 25% in 6 months

Using a business process management approach, Coriendo configured from the ground up a new system in less than four months for a New York-based payer services company with service centers in New York City, NY, Rochester, NY, Nashville, TN, and Puerto Rico. The company specializes in face-to-face services for Medicare Advantage, Medicaid, SNP, and commercial plan members. This care management company provides services to thousands of members in some of the largest health plans in the country. The solution included a Master Patient Index (MPI), and automated processes for on boarding of new patients, tracking and monitoring the successful delivery of individualized care plans, and the provision of customized reports for systems users and management.

Staff and managers can view all patient and business related information (as appropriate) on demand via an integrated web portal screen view. Coriendo created an embedded rules engine to support established protocols for care; should there be any deviance or variation from the protocol, and alert is sent to supervisory personnel. Supervisors are able to monitor clinical outcomes in relation to care protocols and make appropriate interventions to keep patients on track and manage expenses. Utilizing proprietary predictive modeling that factors both history of medical conditions and behavior, the care management company has the ability to identify the right members for engagement along with delivering the right interventions at the right time in the right setting. As a result, the care management company has provided its customers with quality care management, return on investment, and revenue from appropriate risk adjustment.

The hospital readmission rate has decreased by up to 25% within the care management company’s book of business and, on average, medical and pharmacy costs to the company’s health plan partners decreased $255 per member, per month after the first six months of automated care management program engagement.