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Care Cohort Management Solution

A leap towards value-based care management

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Clinical gaps are costing valuable health care resources every single hour. Addressing the care gaps, improving patient lives, and optimizing cost have become critical components in achieving successful care outcomes. But you can turn it around by switching to comprehensive value-based care management using Virtusa's Care Cohort Management solution.

Virtusa's Care Cohort Management solution powered by Pega focuses on successful value-based care by delivering accurate patient information.

The solution allows payers to group patients into subgroups based on a simple query using specified criteria. This enables care managers to provide long-term benefits services by intervening at the right time with the right resources.  

The natural language processing enabled solution helps care managers to derive, convert, and distribute accurate information, ensuring care coordination and efficiency. The solution's dashboard provides a cohort-level summary that includes objectives, data, and measured success.

Care teams can set goals and targets, identify intervention strategies, address barriers to achieve the care goal, and formulate the appropriate and timely corrective actions.

Key features

A solution to empower clinicians and researchers to create patient data-centric cohorts to explore new frontiers in care management.

  • Alerts: Indicates any data gaps for a quick response 
  • Cross-functional Care Management: Role-based access enables care teams with the appropriate degree of access. 
  • Reports and Analytics: Accurate visual patient information to meet unique reporting demands 
  • Multiple User Access: Patient information access with multiple care coordinators to manage patient care.
  • Electronic Health Record (EHR) Integration: Links with various existing point-of-care and EHR corporate software applications that fit healthcare system operations.
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Key benefits
Our solution gives care management teams the tools they need to identify groups, manage care among team members, and successfully engage with patients. We have helped several organizations embrace new technologies and pursue innovation by combining our digital engineering heritage with healthcare domain expertise.
 
With our Care Cohort Management solution, built on Pega, clients can: 
 
  • Reduce treatment expenses
  • Increase patient confidence through engagement. 
  • Reduce the incidence of hospitalization among patients with long-term health issues.
  • Manage patient health issues with timely interventions, such as medication refills, medical devices, and more.
  • Provide caregivers immediate access to health records in line with CMS requirements.

 

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With Pega on our side, we crush business complexities smarter, simpler, and faster.

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Frequently Asked Questions
What is Virtusa’s Care Cohort Management solution?

Care Cohort Management solution uses Pega technology and Natural Language Processing (NLP), allowing payers to group patients based on a simple query using specific criteria. The solution delivers accurate patient information using a dashboard that provides a cohort-level summary that includes objectives, data, and measured success. It effectively identifies patients who need care because of long-term health conditions and requires specific resources.

The lifecycle of the care cohort within the solution identifies the patient population, routes it to a care manager for approval, and then measures cohort after multiple outreach stages.

For managing a cohort for a chronic health condition, such as diabetes or hypertension, identifying the correct patient population is essential to providing the proper care. Our solution identifies the correct records applying prebuild proprietary algorithm for sampling which can be extended based on specific customer needs. The application can integrate with the electronic health records, claims database, or consume the result set with a prediction algorithm. 

To help payers address gaps in healthcare, the care cohort management system will enquire through a vast dataset using specific criteria on the screen (i.e., gender, age, risk scores). This ensures that the right patient population is selected to be reviewed. Such payers and healthcare workers can assess the provided criteria and make the best health plan for each patient. 

The lifecycle of a care cohort is as follows: 

  1. Create cohort: Identify the patient population
  2. Care manager review: The medical director can view cohort criteria and add decision rationale to cohort cases
  3. Initial outreach process: A team member opens the case and selects a patient record, contacting them with a phone call with detailed care guidelines
  4. Follow up outreach process: Powered by Natural Language Processing (NLP), the application extracts the comments and highlights the keywords
  5. Final outreach: Care team member verifies information to see patient health progress provided by visual health progress chart
  6. Summary screen document generation: A quick snapshot of the initiative is generated as a PDF
  7. Cohort dashboard: Summarizes cohort activities such as the objective, total members identified, members participated, and measured success 

Companies need value-based care management to address clinical gaps that create lost revenue and deplete healthcare resources. The functional goal of the care cohort management solution is to enable payers to identify at-risk groups and efficiently coordinate care plans for their cohorts. 

NLP in Care Cohort Management solution derives keywords (e.g., hypertension, diabetes, etc.) from the data sources, making patient follow-ups, progress tracking, and care coordination more efficient. 

The solution’s dashboard provides a cohort-level summary that includes the cohort objective, the number of members identified, members who participated, and measured success. Care teams can set goals and targets, identify intervention strategies, address barriers to achieve the care goal, and formulate the appropriate corrective action.

 

Key features include alerts, cross-functional care management, reports and analytics, multiple user access, and electronic health record integration to empower clinicians and researchers to create patient data-centric cohorts. 

To help address the care gaps, cost inefficiencies, and lost healthcare resources due to the lack of management of patient data, care cohort management solution uses four different advanced features that include:

  • Basic workflow: Case management functionality
  • Advanced workflow: Upsells HIPAA authorization and multiple procedure codes
  • Business enablement: Portal and procedure code, configurable outreaches, and urgency configurations
  • Technology support: NLP extraction and analysis

With the Care Cohort Management solution, payers can:

  • Reduce treatment costs
  • Reduce hospitalization rates for those with chronic health conditions
  • Effectively manage patient health conditions with the right resources
  • Enable patient confidence in their healthcare plans 
  • Streamline access to health records and coordinated communication between PCPs, caregivers, and nurses compliant with CMS guidelines

 

 

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