We have seen organizations where more than 70% of the care they are responsible for managing is actually delivered by someone other than the ACO’s participating organizations. Even the better situations we see result in over 25% of care delivered outside of the ACO network. Proximare’s IRIS platform is purpose built to help coordinate care and bring more care under the management of your network participants. Learn more about the care coordination features of our platform here

Utilization Management

When looking at opportunities to mitigate trend it becomes clear really quickly that there are only a few large areas of opportunity that most clinicians would agree to support doing something about without much hesitation: transitions of care and better management of the highest risk patients. However, an organization can have tremendous success with those opportunities and still perform poorly because these improvements are quickly offset by the continuous rise in the use of specialty services. Proximare will leverage our hundreds of clinical protocols and work with your clinicians to design and integrate specialty and diagnostic focused clinical protocols into your workflows. By making this a physician led initiative we can secure the buy in of both primary care and specialty clinicians to make population health part of their daily workflow and deliver the utilization management your organization needs to excel under either shared savings or delegated risk business models. Learn more about our utilization management features here

Actionable Information

Often times organizations are made aware of their referral management opportunities at a level that is not actionable. For example, you might receive a report that indicates a large amount of a given clinicians care for a particular service category is provided by a competitor. What the report does not tell you is that the nearest specialty clinic in your network has a backlog of over 6 weeks. With IRIS you can track information for each and every referral and get answers to the following:

  • Where are my various clinicians referring patients for each type of service
  • What clinical reason(s) necessitated the referral
  • Where did the patient end up receiving care and what care did they receive
  • Which clinicians are more responsive to our referral requests and protocols
  • What are the demand patterns of my primary care clinicians
  • What is the backlog of each and every specialty/diagnostic service
  • Are specialists rejecting our requests and for what reasons

Learn more about our reporting features here.