Act 5: Care and Code Correctly the First Time
Act 5: Care and Code Correctly the First Time
Quality measurement, risk adjustment, and prior authorization are managed by Payers in silos, by different teams, often using proprietary tools and systems. Significant admin burden, and inefficient re-work across these fragmented use-cases leads to a loss of value, despite being driven by the same patient, data, conditions and best practices.
Reduce Fragmentation Across Clinical and Administrative Workflows
In this video, Dr. Matthew Burton, Principal Physician Informatician with the Clinical Intelligence team at Smile, explains how to embed precision best practices directly into the patient encounter to achieve quality care, the first time around.
Dr. Burton demonstrates:
- How to operationalize a unified workflow for quality, risk adjustment, and prior authorization, showing a dramatically improved outcomes
- How to eliminate the non-value added re-work within each of the three use-cases,
- Alignment potentials and synergies for both Payers and Providers
- How to leverage unified clinical data and precision clinical information to deliver high quality, cost-effective interventions in near-real time within a single encounter
- Implementation patterns and deployment options for Payers and Provider networks, adaptable to their structure and modernization goals.
Care & Code Correctly the First Time-Quality, Risk Adjustment & Prior Auth Embedded in Care Delivery - YouTube
Care & Code Correctly the First Time-Quality, Risk Adjustment & Prior Auth Embedded in Care Delivery
Smile Digital Health
The technology, expertise and implementation pathways exist to support healthcare’s move away from costly cycles of manual re-work, duplication of effort and administrative burdens for both Payers and Providers.