SOLUTION: How It Works

End-to-End Program Enablement and Comprehensive Care Delivery

Comprehensive and exceptional remote clinical care coordination using your best practices resulting in optimal patient outcomes.

Transforming Healthcare Delivery
Through Enterprise Virtual Care

Step 1 - Practice Enablement

Orb Health utilizes a unique framework based on our extensive experience to rapidly get your practice, doctors, and nurses ready for  your program. Our proven workflows are imprinted with your Best Practices so we provide the highest quality care available.

These workflows and standards are codified into our Virtual Care Cloud that securely and compliantly connects with your EMR. Your existing billing, compliance, portals, etc. are all automatically enabled since we require no additional changes and all interaction data from the Orb Clinical staff is synchronized with your “patient record of truth”.

We then create dedicated enrollment and care staff numbers for your health system.  We then work to train your providers on awareness of the system, how to talk about it with patients, and what to expect if there is an issue that is discovered by one of Orb’s care providers.

Once this work is complete, then the practice is ready to go live, normally in 6 weeks or less.

Step 2 - Automated Patient Eligibility Discovery

Orb Health’s first action is to auto-discover all eligible patients for any of the programs (Chronic Care, Patient Support, Outbound Campaigns) that you provide through our Enterprise Virtual Care.  These patients are automatically organized for proactive patient outreach by either the Orb Health enrollment team or the virtual care clinical or admin teams.

Step 3 - Patient Enrollment Campaign

Orb Health’s enrollment team executes a systematic outreach campaign through multiple methods of communications, including physical letter, SMS text, and phone outreach resulting in a short discussion with the patient.

A CMS code-compliant script that explains all of the benefits, requirements, and verbal consent questions needed for the patient to compliantly agree to the service is followed and each response is documented for auditing purposes.

In addition, your clinics are provided with data sheets and posters that draw attention to the benefits of the program and your providers are trained on the explaining the benefits of the program if they feel it is appropriate for the patient.

In the case of Chronic Care and using this approach, Orb Health is able to see an average 68% enrollment rate, 300% higher than the CMS average.

Step 4 - Enrollment Compliance Check

As the patients confirm their acceptance into the program, their responses and interactions are checked by the Orb Health compliance team before final enrollment is processed. This is to ensure all actions were taken compliantly and the record is audit-ready.

Step 5 - Care Delivery

Depending on program, a care team may be assigned and simply reach out to the existing base to perform their care protocols including receiving inbound calls. In the case of Chronic Care, once a patient is enrolled, a care pod is assigned, a personalized care plan is created and recorded in the EMR, and the first appointment is scheduled.

Subsequently, each the month, a nurse will proactively reach out to meet the requirement for 20 minutes of non-face-to-face time between office visits. They will coordinate a wide variety of care services across multiple Medicare reimbursed codes. The nurse pod is also available 24/7 to speak with patients.

Every interaction is noted and synchronized with the EMR system so the Primary Care Physician and team is always up-to-date on the patients status.  Orb’s care team also ensures the proper coding is applied so systems such as billing are streamlined post EMR synchronization.

The infrastructure also provides predictive algorithms through AI-Driven Patient Intelligence that warn the nurse pod about any possible patient issue that could be forming. The nurse can proactively reach out to the patient to head off an incident.

If a crisis does occurs, the nurse pod will contact the Doctor to coordinate proper care for the patient.

Step 6 - Interaction Compliance Check

Interactions and documentation are routinely checked by Orb Health’s dedicated compliance department to ensure that all information meets requirements before it is synchronized back to the EMR, including all coding.  This ensures that your health system’s CCM program is always audit-ready.

Step 7 - Billing

Your existing billing systems or Revenue Cycle Management partner process the coded reimbursements as they normally would through their own normal workflows.  Once the reimbursements are received, then the appropriate split is sent from your system to Orb.

Step 8 - Measure Patient Outcomes

Data from the EMR system combined with Orb Health’s interaction meta-data and other key data sources fuel historical and predictive analytics on patients metrics. The resulting insights reveal important observations that help streamline care, improve patient outcomes, measure Return on Investment and Return on Care, and set your health system up for Value-Based Care success and MACRA/MIPS compliance.

Step 9 - Identify Additional Services

As your practice decides to add additional Medicare services, Orb Health can analyze the patient coding to identify patients who are eligible for these added services.   When you are ready, our patient enrollment services and subsequent care delivery and analysis processes will then continue to expand value for your patients while adding reimbursements for your health system.

Step 10 - HCC Scoring

Every year, chronically ill patients must be re-coded per HCC guidelines.  Orb Health helps streamline this re-coding process as well as identifies new coding opportunities so your patients don’t miss out on critical services and your health system doesn’t miss reimbursements.

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