Medecision’s acquisition of AxisPoint Health brings 58 VITALS and CCMS solution clients under the Medecision umbrella. These organizations have been aware of plans to sunset CCMS and VITALS since before Medecision’s acquisition, but they now have the opportunity to make a streamlined transition to Medecision Aerial platform, in addition to the option of selecting a new vendor.
HighPoint is working with Medecision around a simplified migration process that can help these organizations not only make the technology transition, but also capture opportunities to improve processes, workflow, and care management program effectiveness while making the transition. At the same time, for those who want to explore the possibility of working with a new vendor, HighPoint is prepared to conduct an independent vendor assessment and selection process.
You’ll first want to run an evaluation of your current and future system needs. A short evaluation can determine what system will work best in your environment.
If you decide on a new vendor, you’ll want to do an extensive evaluation of several vendors prior to making your choice. You’ll also want to evaluate your systems and those that interface to other systems.
Look at the present, but also to the future
During the evaluation, the health plan can determine which lines of business they’re strongest in — whether it’s Medicaid, Commercial or Medicare Advantage. This evaluation will examine the health plan’s Utilization Management, Case Management or Disease Management, Appeals & Grievances, member services and call center use.
From this evaluation, you can determine what analytics and modules are valuable to have today and create a roadmap to goals and objectives the health plan may be considering in the future.
Processes and procedures
The health plan should also evaluate its processes and procedures. This will determine how to best map one system (e.g., technical mapping vs. clinical mapping) to one or several other systems.
This roadmap also includes system design, go-live planning and implementation, go-live, and post go-live preparations.
An evaluation can also prepare health plans for government audits. For example, an evaluation can prepare health plans for the Centers for Medicare & Medicaid Services’ Medicare Advantage or Medication Therapy Management performance reviews.
Such an evaluation can assist health plans who may be considering entering a new market or offering a new service.
The health plan may determine it wants to expand into a new population market, such as Medicare. An evaluation can also identify new physicians to expand the provider network.
The evaluation can also work to improving the health plan operations. For example, we recently worked with a health plan in evaluating how to get provider authorizations faster by automating its medical policies. We helped the health plan with its processes by creating these auto-authorization steps:
- Identified the population to target.
- Developed an enrollment process.
- Move member data to claims and joins with provider data where it’s then moved to the care management system.
- The provider then accesses the care management system via the provider portal to request an authorization for service (where an auto-authorization may occur and the history resides within the care management system).
- The authorization approval is then sent back into claims for the claim to be paid.
That information is passed onto the provider and the member portal. For the provider, the process is seamless, as they log into the portal, and based on the criteria entered, request patient authorizations. The request is reviewed in the system and an automatic authorization is sent almost instantly to the provider. We help build the questions the health plan needs to ask providers. The authorizations are delivered back to the system and the provider.
The client benefits from the Return on Investment by having the fewest number of hands touch the authorization request, and the provider receives almost instant authorizations to their request.
If you’re one of the organizations that is currently on the VITALS or CCMS platform, you’ll want to make a sound, well-thought out decision about whether to transition to Medecision’s Aerial platform or to select a new vendor.
Evaluate your current and future needs and align your system implementation to meet current and future goals.