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CareOptimize Technology: Paving the Way for a Smooth Value Based Transition

December 3, 2020 GMT

MIAMI, Dec. 3, 2020 /PRNewswire/ -- Spurred by government regulatory guidelines, pushed by the need for a better way to take care of patients, and accelerated by the COVID19 pandemic, value based care is on the rise. Effective and profitable value based care depends on efficient and extensive use of copious amount of data. Alternative payment models in their various forms shift risk from the insurer to the provider, so mastering that data and using it to improve care, increase reimbursements, mitigate risk, and monitor utilization is critical.

But getting to value based care is not easy.


Healthcare organizations are awash in data sitting in servers, on shelves, and in spreadsheets. CareOptimize, a healthcare consultancy firm based in Miami, found a unique way to harness it.

“Our team saw the need to create technology that would directly help providers in the value based care world,” said Ben Quirk, Chief Strategy Officer. “We had crafted solutions for specific problems for years, but with the advent of value based care, there was still the overriding need for technology that would actually change the way providers work, allowing them to get back to taking care of their patients.”

Their eponymous technology, CareOptimize, was the answer.

Risk adjustment and quality programs drive health plan revenue, but providers are focused on providing good medical care and consider coding and quality programs a frustrating distraction. CareOptimize aligns provider and insurer goals, helping make the transition to value based care a little easier by continuously compiling and measuring information from myriad data sources. That data is parsed and directed to the appropriate location, where it is all simply accessed at point of care. No need for a physicians to log into portals and search for the information. It’s all right there at their fingertips. More data to analyze means more functionality, leading to more information to use in determining care management plans and resource use.

“Medical practices have always relied on proven science to drive medical decision- making,” commented CareOptimize VP of Clinical Operations and Products Megan Halligan. “Practices now have access to a greater range of data and are able to apply that same principal to proactively improve quality of care and operation performance. However, doing so through unlimited spreadsheets and system is ending in data fatigue. CareOptimize simplifies the process.”


Currently, there are two primary modules in the technology, one focused on uncovering coding gaps and one that tracks quality measures across the care continuum. The modules can work individually or together, outside an EHR or within one, making the platform flexible and individualized.

Accurate coding is critical in capturing a more complete diagnoses, resulting in higher and more precise reimbursement and improved care delivery for complex patient populations. The Coding Module ceaselessly compiles and analyzes information from various sources of data, easily and efficiently exposing care gaps, allowing for their discovery at point of care. Information is available in a standardized checklist for perceived code and consistency deficiencies, resulting in higher scores and revenues. By streamlining the process and making coding part of the workflow, insurers gain direct insight into gap closures, and providers are able to concentrate more on patient care.

The Quality Module offers the ability to see all of a practice’s regulatory programs across their entire care continuum in a single, web-based solution. The ability to drill down for more information about specific measures and patients, allows greater visibility across a patient population. CareOptimize takes it a step further by putting that integration within the EHR, giving providers the ability to see information at point-of-care.

Beneficial Collaborations

Megan Halligan and her team worked for almost a year developing the technology before making the decision to put it to the test. The full-risk medical and wellness centers of CareMax with their senior Medicare Advantage patient population were the perfect test sites.

With CareOptimize, data is taken from myriad sources and translated to actions, putting it to use where it is needed the most. In a value based environment like CareMax, that translates to better care coordination, which helps keep the population healthier, resulting in higher scores and revenue. They saw the benefits soon after implementing the system when they compared their hospital numbers to those in traditional Medicare:

- 52 percent decrease in admissions

- 66 percent decrease in emergency room visits

- 32 percent decrease in readmissions

“Our members are primarily low-income seniors, and many have chronic conditions needing consistent monitoring,” said Albert De Solo, CareMax CFO. “With CareOptimize, we instantly saw the benefits of having all their information in one place: better care coordination keeps our patients healthier and our regulatory scores higher.”

The Technology is Ready

After extensive testing and reams of positive results, CareOptimize was rolled out to clients last year.

“This technology allows for the right care, in the right place, at the right time,” said Ben Quirk.

Value based care is here to stay. Technological solutions like CareOptimize help make the transition a lot smoother.

About CareOptimize
CareOptimize provides healthcare management consulting services and products, managed care solutions, value-based expertise, EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

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SOURCE CareOptimize