TruCare

TruCare Collaborate

TruCare Collaborate is a module that providers health plans the ability to communicate and collaborate with providers, care teams, and members and to streamline conversations and information sharing for both UM and CM/DM initiatives.  Such collaboration is essential because now more than ever, payers and providers are coming together to manage an individual’s care.  Doing so effectively and efficiently requires not only adjusted practice patterns but also an integrated collaboration hub.

When you use TruCare Collaborate as part of the TruCare platform you receive:

Group/interdisciplinary care team chat

One-on-one chat with members, providers, and interdisciplinary care team collaborators

Texting/SMS and email message alerting

Video conferencing and phone calls

Secure file sharing (clinical attachments, assessments, care plans, etc.)

Integrated documentation/notes

Benefits to Care Management

Engage an interdisciplinary care team via chatrooms so they can collaborate to address a member’s problems, goals, and interventions

Secure and convenient member engagement with care managers via video conferencing and chat.  This allows for health coaching and performing or sending and submitting health assessments

Perform outreach to members’ providers via messaging

Execute discharge planning by having teams review plans, communicate with one another, and share updated information

Capture and update member care management information

Benefits for Utilization Management

Quickly and effectively follow-up with providers on authorization RFIs via chat

Send providers alerts about authorizations via SMS and email

Share authorization information back and forth between providers and health plan UM staff using secure file sharing for clinical attachments

Update authorizations based on new information received from providers

Facilitate and capture collaborative peer-to-peer review conversations and determinations

If your health plan is looking to make payer, provider, andmember communication and engagement more effective and efficient, TruCareCollaborate can help. Schedule a demo today.

TruCare Connect

Patient and Provider Portals

Connecting members, providers, and caregivers through a secure health portal provides an opportunity for shared information and allows members to take a more active role in their own care.  TruCare Connect, powered by HealthTrio, provides this module for health plans with TruCare.

Benefits of Member Portal

A member portal provides members an additional communication method to interact with their health plan. Member portals simplify the healthcare experience for members because it allows members to engage in their care on their own timeline. Further, improved outcomes and reduced costs are tangible benefits when members receive convenient online access to their healthcare record. Not only do members become more active participants of their own care, they are able to make changes to their information without calling into your service center, which saves you resources.

Interactive Member Care

Providers, members, and their caregivers can exchange care management data within the portal. Members and designated representatives can:

send real-time messages securely

view care plans

complete assessments

participate in wellness programs

access provider directories

view billing summaries

track authorization and referral status

view claims history

print ID cards

update demographic information and primary care physician of record

document and view prescription and over-the-counter medications

Further, because data is real-time data, it can be configured to drive alerts to members and providers thus increase care plan compliance.

Coordinated Care across All Stakeholders

Care managers play an important role in helping members achieve the best possible health outcomes, and TruCare Connect gives them greater access to the tools needed to drive those outcomes. Some of the functionality accessible allows care managers to:

view, create and modify care plans

capture assessments

review a member’s clinical history

add notes to the member’s record

submit, view and update authorizations

create and view referrals

compose messages or respond securely to other care teammembers

When multidisciplinary care teams are involved, these features help them better coordinate and collaborate which results in increased efficiency, quicker implemented interventions, and ultimately an improved member experience.

Communicate Securely

Users communicate securely, share files, and receive alerts. Role-based security and features create a personalized experience for each user. Real-time data drives alerts to members and improves compliance with care plans and contributes to better outcomes.

TruCare Analytics

Identifying high risk populations and segmenting them into groups for intervention allows health insurance plans to prevent individuals from developing medical conditions which ultimately leads to a healthier population, reduced risk for disease, and lower costs of care.  TruCare Analytics supports this work. It is a population health module of TruCare that uses machine learning to model risk, identify populations, and provide segmentation. Using this actionable information, organizational and provider dashboards outline quality and performance measures as well acute episode and transition risk.

Identify High-risk Members

TruCare Analytics mines claims, social determinant, and clinical data in its modeling process. The solution also utilizes certified HEDIS and other measures for performance analysis and individual members’ gap in care identification. By processing and synthesizing large quantities of data into consumable, readable information, the solution enables member population segmentation as well as individual at-risk member identification. Plans can design care programs, prioritize member outreach plans, engage providers, and define programmatic goals. Care managers can have at their fingertips a clear list of needs and risks so they can begin to provide the support needed and potentially prevent a negative health event from occurring.

Conduct and Act on Predictive Risk Analysis

The TruCare Analytics component integrates with the TruCare platform, and populates individual members’ records with risk, gap-in-care, and other indicators specific to that member. That information then resides in the member’s record for ready access by care managers, or for workflow automation through TruCare’s rules engine capabilities. Plans can define parameters for the Analytics data to automate tasks, referrals, messages, and/or case creation. This streamlines the population health cycle by connecting identification and segmentation with opportunity for intervention. Through both the TruCare platform and TruCare Analytics, plans can measure outcomes and use the findings to further refine their programs to their population’s needs.

Report and Analyze Health Outcomes Data

TruCare Analytics provides the data needed to oversee and evaluate both clinical and financial risk. When you report outcomes and share the results, including the percentage of your members enrolled in care management programs, this data can be used to decrease utilization and costs.

TruCare GuidedCare

Evidence-based Content

With TruCare GuidedCare, informed by MCG Disease Management, staying abreast of the most recent evidence based clinical content is made easy. Using the most up-to-date clinical content to manage members, TruCare GuidedCare’s assessments and care plans are automated and monitor for socio-economic, physical, behavioral and environmental risk factors.  Further, TruCare GuidedCare’s clinical content, including assessments and care plan elements can be used directly out-of-the-box or clinical content items can be copied and tailored to meet specific requirements using MCG’s configuration tool.

Evidence-based Clinical Assessments & Care Plans

TruCare GuidedCare provides an evidence-based framework for care managers to develop a personalized plan for each member. Care managers can select from more than 300 unique assessments and provide the assessment to members for completion. Member responses are then used to automatically generate care plans. There are over 45 unique diagnosis-specific and condition-oriented care plans (e.g., end-of-life,high-risk pregnancy, complex case management), and because the assessments use branching logic and trigger educational handouts, relevant care plan elements such as problems, goals, interventions, and barriers are available for each member.

Improved Care Team Efficiency

Care managers use integrated tools to build evidence-based assessments and care plans quickly and easily. Each diagnosis or condition-specific assessment and care plan covers the key components of how to manage the condition and specific education for that diagnosis, including detailed information on the diagnosis (e.g., definition, common treatment), self-care elements (e.g., daily monitoring, diet, medications), and signs of complications along with when and where to get help if needed. There are also many clinically-relevant screening tools and follow-up assessments that care managers can employ once a member is engaged in care management.

Complete Member Care and Education

To ensure the most accurate care plans are developed, care managers are guided through a series of considerations when assessing a member including socio-economic, physical, behavioral and environmental risk factors. This enables care managers to provide members with education and self-care advice based on their particular health status. Educational handouts developed for members are written at a fourth to sixth grade reading level ensuring the content is accessible for a wide audience.

TruCare Linx

Interoperability Engine

Ensuringinteroperability among the many digital tools used to manage an individual’scare and run a health plan is essential in today’s world. Through TruCare Linx,poweredby HealthLX, plans have access to a suite of interoperability componentsthat connect TruCare to existing clinical systems. Data from electronic healthrecords (EHR), health information exchanges (HIE), and other clinical systemsis translated using HL7 industry standard formats ensuring that care managerscan see when patients are admitted to a hospital, transferred to anotherfacility, or discharged through Admission, Discharge, Transfer (ADT)notifications. Further, they can see Continuity of Care Documents (CCD)afforallowing them to hae a summary of the member’s clinical information. Download the TruCare Linx brochure.

Real-time Data Connectivity

Care teams see member health-events in real time so they know the member’s location and can respond proactively to better manage transitions-in-care. Each ADT notification includes critical information such as admitting physician, reason for admission, transfer location - everything a care manager uses to facilitate a smooth transition of care. Further, notes, tasks, authorizations and discharge documentation can be configured according to your health plan’s specifications.

Multi-system Interoperability

TruCare Linx provides instant access to information about important health events, even when the data lives in disparate systems. It offers a simplified integration with electronic medical records and health information exchanges and engages providers within their current workflow. This allows care teams to access a holistic, real-time view enabling them to make informed decisions about next steps.

Data Standard Compliance

TruCare’s backward compatibility into the TruCare Linx integration product ensures messages from any of the previous versions are up-converted to the current. In addition, many institutions have customized their HL7 messages using Z-segments to add data not covered in the original specifications. TruCare Linx uses HL7 standard industry formats, which means care managers receive ADT alerts and CCD documents no matter which EHR, HIE, or clinical system the data resides in.

Data Governance

Data governance ensures that high data quality exists throughout the complete lifecycle of the data. The key focus areas of data governance include availability, usability, consistency, integrity and security. With TruCare Linx, health plans have full transparency to all of the transactions that occur between the connected systems including calls made, data exchanged, message enrichment, availability and data stewardship. This clarity provides a mechanism for compliance review.

HL7 FHIR

Casenet and HealthLX are founding members of the Da Vinci Project, an initiative that is leveraging HL7 FHIR to improve data sharing in value-based care arrangements. The HL7 FHIR technology enables easier sharing of health information across plans and practices, reducing duplicative tests and supporting better health outcomes.

TruCare ProAuth

Streamlining the Authorization Process

To build strong relationships with providers and ease the administrative burden of fax and phone authorization requests, health plans must offer web-based technology that is intuitive, dynamic, and aligned with business rules so that plans and providers can effectively work together to reduce over utilization, erroneous requests, and back-and-forth all while improving timeliness and appropriateness of care.

TruCare ProAuth is an interactive digital authorization management tool designed to make the authorization process easy for providers and display real-time updates regarding prior authorization decisions from the plan. For plans, authorizations can be automatically approved based on rules about providers, diagnoses, procedures, services, service thresholds, and other information in the authorization request.

TruCare ProAuth provider benefits

When using ProAuth, providers need enter only minimal information to confirm if an authorization is required. When authorizations aren’t required, or if a duplicate authorization exists, TruCare ProAuth lets the provider know instantly. If an authorization is required, TruCare ProAuth prepopulates fields to make data entry more efficient. Further, health plans can implement rules-based configurations to prompt providers to include specific clinical information to expedite decision making.

ProAuth increases provider engagement by providing access to:

Immediate confirmation number of submitted authorization

Real-time authorization status and rationale

Digital submission of both inpatient and outpatient prior authorization requests

Immediate determination feedback (approve, pend for further review)

Clinical criteria guidelines from InterQual IQ Connect and Cite AutoAuth by the TruCare ProAuth integration

Viewing authorizations where the user’s associated provider is Requesting or Servicing Provider.

TruCare ProAuth can be seamlessly embedded into a parent portal via single sign-on which allows providers to maintain a single login for portal access. The module gives them 24x7x365 access to submit prior authorizations and receive real-time responses.

The TruCare pre-screening feature provides immediate feedback to users when:

An authorization is or is not required

A member is not eligible for treatment

A service or procedure outsourced to 3rd party

There is a potential duplicate authorization

A Clinical Review is required (determined by client defined rules)

Benefits for Health Plan

Health plan staff members experience administrative savings by:

Decreasing manual data entry, outbound calls, and requestsfor information

Reducing turnaround times for authorization requests

Aligning TruCare business rules via automated authorization workflow processing

Monitoring and reporting of authorization volumes

Simplifying user account setup, user management and audit trails.

TruCare Reporting

Designed for non-technical users who need on-demand access to run reports, TruCare Reporting ensures a critical part of running an efficient business operation.  TruCare Reporting offers standard and ad hoc reports such as user activity, metrics monitoring, and audit and compliance oversight.

Identify Data-Driven Strategies

Reports can be scheduled and automatically distributed, and access can be restricted based on permissions. The module is powered by Jaspersoft and reduces dependency on IT for new reports or changes to existing ones. TruCare Reporting extracts real-time care management, utilization, and operational data to identify actionable activities in easy-to-understand reports and exportable files. TruCare Reporting provides robust standard and ad hoc reporting and dashboard capabilities from the Jaspersoft reporting module. TruCare Reporting offers sample reports including, user activity, metrics monitoring, audit trails and compliance reports. Reports can be scheduled and automatically distributed, and access can be restricted based on permissions.

TruCare Reporting includes a library of standard and configurable ad hoc reports to help manage and assess healthcare operations. They are intended to be used as a starting point, and the tool allows users to easily modify and save them as their own custom reports using drag-and-drop field functionality. Among other things, the standard reports may be used to:

leverage TruCare’s Differential Care Management framework so all views can be filtered by population segments

view user activity and balance workloads,

monitor performance metrics,

view audit trails (user, modifications and changes), and

examine compliance and outcomes reporting.

Reporting Benefits

Real-time visibility allows business units to reflect on their own performance and improve the member experience by:

scheduling reports and related distribution lists in advance,

exporting reports into multiple formats,

generating effective case management outreach,

ensuring timely notification of authorization decisions, and

identifying trends such as types of grievances, to quicklyrespond to member concerns.

Database Integration

TruCare’s production database is replicated in real-time to an operational data store (ODS) for immediate data access without disruption to application users. Organizations can connect to the database using their preferred data visualization tools and/or extract TruCare data into other repositories.

Powerful Data Analytics

In addition to reports that can be run by non-technical staff, Jaspersoft Studio allows IT to create complex reports using SQL queries and Stored Procedures allowing for a more detailed analysis of data. Users may create complex data aggregations, build report queries, write complex expressions, and layout components such as charts, maps, tables, crosstabs, and custom visualizations. They can also develop templates and dashboards to be published and available within the module.