THE 'EDGE REPORT BLOG

Enabling the Why

We speak early and often about why we do what we do. We want to help people live the best lives they can, no matter their circumstances. We help care management teams achieve this "why" by offering the latest generation care management system.

It's all about automation to allow clinical teams to work at the top of their license. For example, our prior authorization portal allows providers to enter a request, and if it passes the criteria, the service is automatically approved without human intervention. Provider satisfaction increases because they don't need to wait for an answer, and as a result, the care clinicians can spend more time focusing on how they are going to help members live the best lives they can.

When you think about GuidingCare, the name, it should hopefully tell you that it is to guide the care journey—the platform offers evidenced-based next steps the provider should take to ensure the member receives the best care in their journey.

Compliance is another critical piece of care. The Affordable Care Act (ACA) caused the most significant shift in our business. After the ACA, health plans realized that the way to grow their business was through government programs. And, when it comes to government programs, regulations are complex, and compliance has a revenue implication. Take Medicare Advantage (MA), for example. As MA plans seek to grow their businesses, potential members are looking at which plans have the highest star ratings. If a health plan cannot achieve at least four stars in MA, it is very challenging to make it financially.

From the beginning of implementation, we're focused on compliance. We help the customer avoid configuring their system in a way that would impact their ability to report on compliance, whether they're NCQA, URAC or have CMS requirements for Medicare Advantage. We help our customers maximize their stars and make sure that they're successful when they get audited by whatever governing body.

Our customers want to know they're taking the best next step in the care model, that their people are efficient and working on the things that matter, and that they have the tools for regulatory compliance and reporting. GuidingCare enables all of that, and we're always enhancing our capabilities.

About the Author

Tom Joyer

Thomas Joyer, Chief Commercial Officer, Altruista Health (a HealthEdge Company) 
LinkedIn
tjoyer@altruistahealth.com 

Tom Joyer is the Chief Commercial Officer with Altruista Health and is responsible for developing strategic opportunities for new business development and growth for the organization. Additionally, he works closely with existing customers to increase the value they receive from Altruista’s products and services. He is a well-trained and highly successful sales leader with nearly 20 years of experience operating in large complex sales environments. Previously, he served for over a decade as Vice President of Sales with Health Integrated, a leading provider of care management services. In this role, he successfully contracted large, complex agreements with leading payers serving Medicaid, Medicare, Special Needs Populations; Commercial and Federal Employee Programs. Prior to Health Integrated, he served as Vice President and General Manager of Global Healthcare Exchange (GHX) Pharma Solutions Group where he was responsible for managing the Pharmaceutical Validation and Contract Management markets. Prior to being acquired by GHX, he served in sales roles with Neoforma, a supplier of healthcare supply chain solutions. Tom began his sales career with Southwestern Bell Corporation. He received a bachelor’s degree in Business from the University of South Florida.

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