Optimized Ordering and Referral Management
The HealthBASE Networks℠ Platform and Solution Set — including OrderBASE℠, CareBASE℠ and HealthBASE Networks℠ — are transformative, technology-driven solutions that help to better coordinate care and manage costs by ensuring that the right order is performed timely, at the right place, by the right people, at the right price.
HealthBASE gets all stakeholders ‘on the same page’ – aligning physicians and insurance claims administrators with organized clinical, care management, cost containment and other user groups. HealthBASE boosts performance and savings through shared access to highly automated and ‘appropriate’ e-Ordering, intelligent referral routing, on-demand reporting and transaction workflows that ensure uniform adherence to defined managed care policies, procedures and systems.
The HealthBASE e-Ordering and Care Coordination Platform makes optimized adjudication and management of ‘appropriate’ medical orders, referrals, information and costs … fast, accurate and easy.
With a comprehensive approach and tightly integrated web services, HealthBASE’s highly automated e-Ordering engages embedded decision support tools to subtly present ‘appropriateness’ levels and ordering guidance that references expert, evidence-based clinical algorithms and other medical and industry sources. Further, HealthBASE accelerates pre-authorization determinations and reporting, then, when allowed, seamlessly prompts intelligent referral navigation using client-defined rule sets and managed care instructions — with immediate linking, exchange and reporting between physicians and claims adjusters, as well as specified care coordinators, medical review queues, MCOs, Networks/PPOs and other cost containment vendors.
With HealthBASE, ‘appropriate’ orders, pre-authorizations and in-network referrals can all be completed instantaneously online — at the time-of-order and point-of-care — creating new performance, service and informatics levels … with only necessary people, processes and exchange involved. Payers and administrators, and the physicians and other stakeholders they coordinate with, all benefit from improved utilization management approaches, cost containment system coordination, and patient care that are better aligned and delivered from a commonly shared, technology-driven approach that offers reduced confusion, errors and headaches, lower operating and program costs, and elevated returns.
1.) HealthBASE enables physicians to quickly determine and place ‘appropriate’ medical orders, and navigate effectively through pre-authorization and referral processes in compliance with managed care programs — saving time, money and hassles for patients, specialists and busy clinical practices.
2.) Simultaneously, HealthBASE allows over-burdened claims adjusters and care managers to focus on the many things they need to do, while relieving them of other tasks — by providing a more optimal and automated way to communicate managed care procedures and systems, promote and monitor medical ordering ‘appropriateness’, direct referrals, coordinate patient care, supervise expenses, and, when required, engage with physicians, review agents, PPO Networks, specialists, suppliers and vendors using shared systems and information.
How is this done?
HealthBASE helps improve medical utilization management and cost containment by delivering mission-critical information and precise, highly automated workflows using decision support tools that incorporate specified managed care rules and clinical, industry and client guidelines for evaluating, certifying and coordinating orders and authorized referrals. HealthBASE does so using an easier, faster and more intelligent online ordering and medical management software system that, instead of residing only in remote medical review agent offices, can also be made available directly to ordering physicians, claims adjusters and/or care administrators, as the payer or client designates.
By instantaneously and intelligently matching clinical indications and diagnoses with the range of corresponding procedure and/or test order options – and presenting each option in descending scale from highest to lowest level of ‘appropriateness’ using easily identified color (e.g., red|yellow|green) and number coding (e.g., 1-9) with drill-down reference to the guideline details – the system user makes better value-based choices and optimally self-corrects when necessary. This transparent, more autonomous approach is well proven as both preferred by physicians and care managers, and highly effective in quickly promoting ‘inappropriate’ to ‘appropriate’ ordering … usually by 20-100% in a matter of only months.
Accessed securely via any internet-enabled device, our intuitive, simple-to-use, cloud-based ‘web services’ powerfully manage the same knowledge bases, information, workflows and tasks that are otherwise delivered by multiple 3rd parties and often with manual approaches and untimely exchanges – now instead capturing and processing critical data electronically, in ‘real time’, with the same requisite controls … but without unnecessary stakeholder burden or expense. Payer and managed care oversight is never compromised, but rather enhanced, as customized, highly modifiable administrative controls are implemented throughout the HealthBASE system — allowing preferred degrees of workflow automation, self-service use, and/or stakeholder participation to be engaged or modified at any time.