Solutions for Health Plans

Tearing Down the Silos of Care Management

As the role of care management within health plans evolves to accommodate various new value-based care models and contracts, it is more critical than ever to be armed with agile tools that can support multi-disciplinary roles and engage patients wherever they are, from the physician’s office to rehab to their own home.

Historically, payers (who have important data and insights into member’s behavior) have used their own care management programs to engage their members independently from providers, often leading to duplicate phone calls, inconsistent guidance, and missed opportunities for effective interventions.  Providers, who are closest to the patients, are often unaware of opportunities to intervene because they lose track of their patients once they leave their office and they lack the data to see the complete picture.

Through collaboration, Payers and Providers have an enormous opportunity to improve the health of their member/patients while reducing overall costs.  And forward-looking plans are already taking steps to build closer relationships with their provider networks to achieve this through various alternative payment models.

The challenge lies in making these new models between payers and providers operational. 

How can we share real-time data securely?   How can we create a cohesive care team that doesn’t confuse the patient?   How do we make it easy for our care management team and providers support teams to communicate and care for the patient when we are using silo’d systems that are not designed for collaboration?

This “last mile” of care delivery, where team-based patient engagement is critical, is riddled with information silos, pocketed clinical encounters, and lagging claims data—all significant obstacles to the efficiencies required for performance-driven care teams to achieve the quality and outcomes metrics defining their success.

Performance Clinical Systems enables healthcare organizations to quickly and affordably bridge this last mile.

Our flagship product, Symphony™, is a robust cloud-based workflow management platform that addresses care management and population health management for health plans and providers, providing a lightweight shared platform for managing the care of patients and populations. It enables all of the critical functions required for a health plan’s care management program—including utilization management, care management, and condition management—while also giving their provider network and their support teams a clinically-driven user experience. All of which allows them to actively collaborate with the health plan.

This is not just a provider portal layered on to some legacy plan-based care management system.   Symphony is a cloud-based system from the ground up which provides rich care management functionality to provider care teams, enabling them to work closely with the health plan to improve their patient’s lives and enhance their value-based financial performance.

Symphony manages populations for many different lines of business, including:

  • Medicaid (Health Homes, MLTSS, DSRIP, ACO’s, EPSDT and other models of care)
  • Medicare Advantage
  • Commercial