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Solutions
Description
Compatibility Level
Clients
Product Capabilities
Use cases
EHR integrations
Client types
Differentiators
Keywords
Media
Company details
Jump to:
Categories
Solutions
Description
Compatibility Level
Clients
Product Capabilities
Use cases
EHR integrations
Client types
Differentiators
Keywords
Media
Company details

Categories

Solutions

Description

Product Description:

Care Continuity's PCP-to-Specialist Referral Management is a data-driven patient navigation designed to increase PCP-to-specialist completion rates and improve utilization of your aligned provider network by improving appointment completion rates for your most profitable service lines.

Care Continuity leverages a purpose-built software that utilizes AI and machine learning to analyze dozens of data points and social determinants of care that make it possible to prioritize patients for outreach based on their need, and to maximize the downstream effectiveness of a patient navigation program. In addition, the software is supported by a team of trained concierges that do the navigating on your behalf, allowing your team to continue working at the top of their license.

In addition to higher specialist attachment rates, health systems that utilize Care Continuity's PCP-to-Specialist program gain valuable insights into their network performance. Curated data dashboards provide an in-depth look at referral appointment completion percentages, procedure-to-appointment rates, median times to appointment, and more. This data can also be viewed at the service line and facility level, giving actionable insights into potential areas for growth.

About Care Continuity:

Founded in 2014, Care Continuity provides expert patient navigation solutions that are designed to bridge gaps in healthcare, providing seamless transitions between care settings, reducing network leakage, and promoting optimal health outcomes and patient satisfaction. Through a combination of advanced software, AI and a dedicated team of care concierges, we help guide patients through their care journey while maintaining the integrity of the health system network. This translates to greater patient satisfaction, better health outcomes, and increased margins for our clients.

Product Description:

Valer’s technology speeds and simplifies prior authorization and referral management by automating submissions, status checking, verification, reporting, and EHR synchronization across all mid-to-large sized healthcare settings, specialties, and payers from one platform and portal.

All built just for you.

About Valer:

Valer’s technology speeds and simplifies prior authorization and referral management by automating submissions, status checking, verification, reporting, and EHR synchronization across all mid-to-large sized healthcare settings, specialties, and payers from one platform and portal.

All built just for you.

Valer's automation technology enables our clients to reduce labor cost, claim denials from avoidable prior authorization errors, and writeoffs stemming from denials. With prior authorization approvals further in advance of scheduled treatments and procedures, Valer enables fewer rescheduled and abandoned appointments. Patients are happier, providers are happier, and staff are happier.

Compatibility level

Select which hospital or health system you work at and see a personalized compatibility level.

Clients

Select which hospital or health system you work at and see the client list

Product Capabilities

Care Continuity's software solution support bi-directional integration with the ability to ingest applicable data from a health system's EHR, as well as repopulate any applicable system post-navigation.

All of Care Continuity's systems meet HIPAA requirements and are HITRUST r2 Certified.

Care Continuity's software solution is designed to handle hospitals and health systems of any size. Today, Care Continuity works with a number of the largest health systems in the nation, medium-sized systems, and standalone institutions.

Care Continuity's patient navigation platform is equally proficient in both FFS and value or risk-based arrangements. Our product and software development teams boast decades of experience in the healthcare industry with a specific focus on patient navigation and provider network management.

Valer can be configured to identify highly targeted information regarding authorization requirements and/or services which are "no auth required." Valer has the ability to work with select payers to provide authorization requirements, "no auth required" alerts, and authorization submissions via real-time APIs (application programming interfaces) where available.

Valer comprehensively automates completion and submission of prior authorizations for 1,000+ unique payer fax forms and 75+ payer web portals.

Valer's form library maintains and updates over 1,000+ payer authorization fax forms across all service lines (diagnostic imaging, surgeries, procedures, chemo/infusion, medications, notice of admissions, DMEs, sleep, Worker's Comp). Valer's proprietary technology can add any new fax form for users typically within 24 hours to support authorizations and referrals.

Valer provides the ability for users to easily attach any relevant clinical documentation to a prior authorization for submissions. Valer supports various file formats needed for submission. Valer also captures documentation from payers regarding approval tracking codes, expiration dates, units of service, CPTs approved, which can be pushed directly back into EHRs/practice management systems to avoid manual data entry. Valer also has Epic's x275 clinical document exchange functionality live in production to directly exchange information from Epic to Valer and back.

Valer comprehensively SUBMITS prior authorizations across both fax and web portal modalities across all-payers and all service types. Valer provides ONE interface, deeply integrated with EHR workflows to automate both today's manual authorization submission and verification workflows.

Valer provides automated authorization status verification across 75+ payer web portals. Authorization information (tracking numbers, units, expiration dates, sites of service, CPT/family of codes approved can be automatically pushed back into EHRs in an automated process further eliminating the need for manual data entry.

Use Cases

Description:

A health system is looking for ways to drive more patients to their cardiology service line. Historically, cardiology has been one of their more profitable service lines. With a provider network featuring multiple facilities and other service lines, the system has struggled to track the downstream progress of a patient after their primary care referral. 

Leveraging Care Continuity's PCP-to-Specialist Referral Management solution, a data feed of referrals is sent to Care Continuity where the software's AI uses dozens of data points -- including diagnoses, discharge notes, patient information, social determinants of health, and more -- as well as a set of customizable prioritization rules to create a navigation queue for a team of expert navigators to personally contact and navigate.

This allows for a multi-dimensional approach to patient navigation that can predict which patients are most in need of, as well as open to, navigational assistance. 

The trained team of navigators contact the patients based on their priority ranking and can coordinate the specialist appointment between both patient and office. On average, a patient navigator can schedule a higher percentage of appointments at a faster rate when compared to other self-navigation methods. In addition, appointments scheduled via a patient navigator are statistically less likely to result in a no-show. 

After the program is implemented, health system stakeholders receive a data dashboard that shows the downstream impact of the navigation, including the total number of appointments scheduled, the number of completed appointments, the number of appointments that required procedures, and median time to appointment. 

With this data broken down by both service line and facility, a health system can focus on a profitable service line such as Cardiology, looking for areas to improve their network and make a positive financial impact. 

Pediatric use cases:

None provided

Users:

Medium to extra-large health systems

Description:

Valer provides health systems, hospitals, and ambulatory clinics with one place to streamline, automate, and manage today's manual prior authorization workflows. Valer saves time, cost, and reduces patient access denials and avoidable write-offs.

Pediatric use cases:

Pediatric health systems and clinics utilize Valer to reduce the time and cost involved with today's manual prior authorization and referral workflows.

Users:

patient access teams, ambulatory clinic authorization teams,  admitting/scheduling teams, revenue cycle teams

EHR Integrations

Integrations:

Acute care EMR, Ambulatory EMR, Ancillary EMR, ERP system, Patient portal, Pop health platform

EMR Integration & Relevant Hardware:

Required

EMRs Supported:

Epic, Cerner, Meditech, Allscripts, NextGen, athena, GE, eClinicalWorks, McKesson

Hardware Compatibility:

Not applicable

Integrations:

Acute care EMR, Ambulatory EMR, Community based organizations, ADT, Access +/or revenue cycle, Website / public online sources

EMR Integration & Relevant Hardware:

Recommended, but not required

EMRs Supported:

Epic, Cerner, Allscripts, NextGen, athena, GE, Athenahealth, Other

Hardware Compatibility:

Desktop

Client Types

Differentiators

Differentiators vs EHR Functionality:

Leading EHR functionality takes a very basic approach to patient navigation. When utilized, the EHR prioritization queue is binary, labeling every patient as urgent or non-urgent. Instead, Care Continuity not only expands the total number of evaluated data points needed to properly prioritize a patient, but Care Continuity also expands the priority listing to 10 levels, allowing for a more nuanced and tailored navigational experience. 

In addition, the EHR functionality requires the health system to staff a team of navigators. Unfortunately, this largely non-clinical function is staffed by clinical staff, severely hampering their ability to work at the top of their license. 

Care Continuity pairs their purpose-built software with a team of trained, non-clinical concierges who are experts in patient experience and proper navigation.

Differentiators vs Competitors:

With more than a decade of experience working with the nation's leading health systems, Care Continuity has had the honor of navigating millions of patients through the healthcare continuum. 

Leveraging purpose-built software with proprietary algorithms designed to efficiently navigation patients, Care Continuity can provide a customizable, high-ROI solution for health systems of any size.

Differentiators vs EHR Functionality:
  • Single platform and payer portal consolidates payer management
  • Comprehensively submit, verify, manage prior authorizations and referrals
  • All payers and service lines
  • Continuous real-time payer updates
  • 2-way data integration with EHR systems
  • Real-time workflow visibility and reporting
  • Integrates with any EHR or billing system for seamless workflow
  • Clients using Epic, Cerner, Veradigm, Athenahealth, NextGen and more
Differentiators vs Competitors:
  • Valer focuses exclusively on automating submissions, status-checking, and verification with all payers- national, regional, local
  • Valer supports every service type, specialty, and care setting except formulary medications and dentistry
  • Valer integrated bi-directionally with any EHR or system of record

Keywords

Images

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Sample Referral Dashboard

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Valer Reporting Screen Shot.png

Videos

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Valer Explainer Video_Final.mp4

Downloads

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Care Traffic Control for Your Health System
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VALE144-Glossary_v7.pdf

Alternatives

Company Details

Founded in 2008

Founded in 2010

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