CareVio is an innovative care management organization that includes an interdisciplinary care coordination team comprised of Medical Directors, nurse care managers, social workers, pharmacists, support staff, and many more who work to support clinicians in caring for their patients. CareVio’s objective is to assist the clinician in improving quality, health outcomes, and member experience, while lowering cost and optimizing resource utilization. CareVio monitors patients virtually with the use of audio and secure texting. All phases of care are addressed, especially those transitions of care, that are typically difficult to manage.
CareVio is the first non-health-plan population health management organization in Delaware to receive NCQA accreditation for case management and population health.
CareVio provides a full continuum of care and disease management services and has the following capabilities:
- Support care transitions for patients who are admitted to the hospital, nursing home, or long-term acute care settings.
- Communicate with post-acute care and other health care providers to support the member’s plan of care along the care continuum.
- Receive real-time notification of ED visits, inpatient admissions, and discharges within the collaborative Health Information Exchange (HIE) platform.
- Proactively identify high risk patients and work with the patient’s primary care and specialty physicians to develop comprehensive and integrated clinical and care management plans.
- Receive real-time notification of pertinent lab results for ongoing monitoring of patients with specific disease management needs.
- Promote patient adherence to the care plan including self-management of chronic conditions, medication management and compliance with follow-up appointments, preventive care, testing and imaging.
- Assist patients and families to address social determinant of health needs.
- Connect and refer patients and families to local and regional community resources as available.
- Assure that the coordinated care plan is communicated and visible to other care team members across the continuum of the entire patient experience.
- Identify and address gaps in care.
Information Technology-Enabled Care Coordination (HIE Integration)
The components of CareVio’s information technology platform include a population health EHR, data analytics, and predictive modeling to support evidence-based care delivery.
CareVio’s efficient scalability is enabled by care management software that utilizes predictive analytics based on real-time clinical data from various sources including electronic health records, claims and demographic data. The collected information is integrated to provide a full view of a patient’s health status and to provide a comprehensive platform on which to run risk prediction models. This clinical and claims data integration as well as real time notifications are used to identify high risk patients and drive care management interventions.
As members are admitted, discharged, or visit the emergency room, notifications are sent to CareVio for care manager intervention. The automated identification of gaps in care that are related to lack of preventive care, chronic disease, and other Healthcare Effectiveness Data and Information Set (HEDIS) and quality measures allows immediate identification of needed interventions.
The use of predictive analytics is a critical component of CareVio. In any population, approximately 5% of the population with the highest health care spending is responsible for nearly half of all the costs. Historically, the challenge has been to identify these high-risk individuals in a meaningful way before events occur. Typically, when risk is identified retrospectively based on claims, the risk event has already occurred such that interacting with these individuals may have minimal impact on outcomes. The presence of chronic conditions is a clinical factor in determining risk but must be united with both social and behavioral determinants of health to obtain a true picture of a population or an individual’s risk. CareVio is unique in that the artificial intelligence, machine learning predictive engine can consume real-time clinical data married with historic claims information to alert the care manager of the continuously updated risk on any individual member.
The CareVio team employs multiple methods to engage the health care clinicians that are supported by CareVio. The case manager and other team members are an extension of the clinician practice, regularly communicating with the physician about his or her patients. There are discussions of complex patients who require comprehensive clinical and care coordination plans, communication of clinical and care coordination trends of their patients, shared implementation of plans to optimize care and minimize unnecessary utilization, and strategies to address gaps in care for patients receiving longitudinal care.
Access to Electronic Health Record Information
The CareVio team has full access into hundreds of primary care physician’s electronic health records which allows the team to document and communicate clinical and care management information directly to the member’s primary care physician and their support staff. This tight integration allows for seamless care coordination, alignment, and support of the member’s plan of care, and direct access to the member’s primary care clinician to assist in addressing clinical, social, and behavioral health needs of the member. CareVio also supports those members who seek care in primary care practices in which CareVio does not have direct electronic health record access.