How Prioritizing Provider Workflow Impacts Patient Access: Inside CareMetx On-Site

Every day, more widespread implementation of health information technology is facilitating simpler access to patient health information and rapidly advancing patient-centered care. 

Today, online patient portals provide patients with convenient, 24-hour access to their health information, help them communicate with their providers, and access support between visits. Medical practice management platforms, or revenue cycle management systems (CMS) are widely used to manage activities in hospitals, clinics, practices, and nursing homes by dealing with day-to-day operations (e.g., scheduling, billing, payments). These software packages are also used to manage patient electronic medical records (EMRs), which are the digital versions of the paper charts in a clinician’s office. These records, managed in databases, consist of medical and treatment history for patients in a practice. EMRs allow clinicians to track data over time, identify patients who are due for screenings or treatments, keep track of a range of patient parameters, as well as monitor and improve the overall quality of care within their practice.

Function and Compatibility

The challenges that arise within this paradigm are related to the need for non-native software- ie: digital resources that exist outside the clinic or practice, to interface with  the CMS. These other interfaces chiefly consist of different hospitals, clinics and practices, insurance providers and other payers, pharmacies, and manufacturers that provide specialty medications.

The lack of connectivity creates additional complications with processing patient authorizations, insurance verification and eligibility information, consultation, and other data from providers outside the clinic and manufacturer portals. In such cases, this results in the provider having to exit their native workflow to engage with these outside digital resources, make or receive phone calls, or manually input information from fax transmissions. Today, ninety percent of surveyed physicians are  impacted by this- reporting that these administrative processes regularly delay patient access to care.

Instances such as these not only significantly slow the workflow and impede the efficiency of the digital solutions in place, but they increase the likelihood of human error such as transcription typos.

The Workflow in Practice

Let’s use the example of an infusion clinic that provides “Brand X” infused specialty medication to its patients. The provider in the clinic onboards a new patient through their CMS, but still needs to enroll the patient in relevant affordability programs on the manufacturer (Brand X’s) hub. 

Let’s estimate on average, this clearance process for an infusion center takes approximately 90 minutes over the course of a week - and that’s barring any administrative or bureaucratic complications. Operationally, it requires the provider to leave the CMS where the data lives, engage the manufacturer’s hub and fill out forms on that hub. The provider has to fill out the patient authorization (PA) form manually, fax it to the payer, wait for a response, and then document that information- and there are often waiting times in between many of these steps. 

The downside of this manual process is not only the inconvenience to the provider who has to exit the native workflow and learn how to navigate different brands (manufacturer hubs), but also the inconvenience to the patient who may be delayed from receiving life-saving treatment. 

CareMetx On-Site

Enter CareMetx On-Site, a strategic solution that’s been created to streamline this workflow and improve the experience for all stakeholders involved. 

CareMetx On-Site acts as an extension of the manufacturers’ brand hubs, allowing networks of thousands of providers to have the functionality of manufacturer hubs directly in their CMS. CareMetx On-Site unpacks the manufacturer hub and gives providers more access options. Rather than providing a solution for one specialty brand (as the manufacturer hub does), it provides access to all of them across all types of clinics. A provider has a “one-stop shop” with a consistent user experience to do everything they need to do, rather than 15 different manufacturer websites, all of which have different processes, logins, passwords, etc.

This helps providers holistically with their specialty patients, and represents a fundamental change in the industry.

Bidirectional Connectivity

Simply put, bidirectional connectivity is a digital communications mode that facilitates the two-way transmission of data (send and receive), as opposed to unidirectional (send or recieve). CareMetx On-Site provides bidirectional connectivity with manufacturer hubs, giving providers a new ability to address patient enrollment and a host of other processes from within their native workflows. The manufacturer hub still receives the same intelligence via CareMetx On-Site as it would if the provider engaged the hub manually, but CareMetx sources the data more effectively. CareMetx On-Site provides the same service, but at a higher level of service than the manufacturer hubs.

With CareMetx On-Site, all onboarding functions occur inside the CMS, including payer-specific benefit verification and the enrollment of patients in manufacturer hub programs. Not only does this save the provider time because they don’t have to leave their native workflow, but they’re able to leverage existing data within the system to prepopulate fields such as patient demographics, treatment codes, insurance information from existing systems into forms. 

Additionally, data queries are answered and digitally populated with relevant patient information from vehicles such as faxes, which are automatically imported. There’s no burdensome transcribing of the answers to queries back into the system with the inherent probability of error. 

In practice, CareMetx On-Site cuts the aforementioned 90 minute onboarding process for the patient requiring infused specialty medication down to approximately 10 minutes, which could reduce the turnaround time for an entire clearance process from weeks to days. CareMetx On-Site gives providers more choice, and more ways to access manufacturers’ services. It focuses on convenience with on-demand, 24/7 self-service tools that allow providers access to a core of services’ functionalities. 

Interested in learning more about CareMetx On-Site?