Care Episode Management

Overview

In the healthcare industry today, efficient coordination of care amongst various entities (e.g. providers and payers) is a major challenge. In most scenarios, a patient visits multiple care facilities for treatment. There is no incentive for individual providers to coordinate care across entities because of which a patient-centric approach to manage care settings is completely missing. Payer lacks visibility into events and entities related to a specific case. This can lead to potential repeat or unwarranted treatments and higher claim costs. There is a need to facilitate collaboration between the provider entities involved in complex Episode of Care (EOC) cases. Cognizant's Care Episode Management application can handle complex scenarios by using Appian's intelligent, adaptive and dynamic case management capabilities.

Key Features

Case initiation for a patient including the ability to process bundled claims
Routing of cases across entities
Support for data sharing between entities per HIPAA compliance
Adaptive case management functionality for efficient tracking and management of claims
Real-time data aggregation for visibility into the process by all stakeholders
Reporting and dashboard capabilities to offer payers insights into case progress and outcomes

Entity	Potential Benefits
Patient	Improved quality of care
Patient	Less burden of coordination
Provider	Cost savings for the treatment
	Ability to spend more time in patient care and less in administrative tasks
	Better control on operational costs
Payer	Reduced overhead due to ability to receive refined claims from the Providers
	Reduced time in coordinating claims amongst providers
	Lower cost of claim settlement – due to avoidance of redundant treatment
IT	Lower time to market for the application
IT	Ability to reuse the application across multiple Providers