Care management for payors

Article
10/27/2023

The 2023 release wave 2 of Microsoft Cloud for Healthcare introduces enhanced capabilities tailored to healthcare payors, aimed at elevating the care management experience. Payors can now access advanced care management tools, empowering them to efficiently optimize the care provided to their members. By leveraging these advanced tools, payors can track health trends and proactively intervene to improve health outcomes.

The update facilitates seamless coordination among healthcare providers, enabling effective care transitions and minimizing gaps in care. This comprehensive care management solution includes the following key benefits:

Personalized care delivery: Empower payors to deliver personalized, high-quality care by utilizing advanced care management capabilities.
Enhanced member satisfaction: The tailored care management solution is designed to enhance member satisfaction by ensuring a seamless and personalized healthcare experience.
Improved efficiency and cost-effectiveness: Drive improved efficiency and cost-effectiveness within the healthcare ecosystem by streamlining care management processes.

In addition to supporting existing care management capabilities, the updated payor experience also offers the following features for users:

Introduction of a new security role called Care Manager for enhanced access control and management within the care management system.
Sitemap changes customized to align with use-cases specific to payors.
Refined views and forms to reference individuals as Members.
Refined views and forms to reference organizations and accounts as payors.

As an administrator, you can control the provider and payor experience for users. To learn more about the care management payor experience, go to Care management for payors.

Configure care management for payors

To tailor the care management experience for payors, you need to update the settings as outlined in the following sections.

Configure security role

The updated payor experience introduces a new security role called Care Manager. This role grants access to specific forms and views relevant to payors.

Update terminology

For the Contact resource, we currently support the contact types "Patient", "Practitioner", and "Related Person". Depending on your business scenario, we recommend renaming the label Patient to Member for a more suitable representation.

Set up views

Since the care management solution now accommodates both providers and payors, it provides tailored views for both. With the configuration section shown in the following screenshot, you can select or remove the views that align with your user's requirements.

Configure sitemap for users

When you sign in to the care management app as a system administrator, you visualize a sitemap that showcases both provider and payor experiences. Based on your user's business requirements, you can configure the sitemap to suit their specific needs.