The Guardian HIE architecture provides the capability for
1. Electronically moving clinical information among and betwee disparate providers and information systems, while maintaining the meaning of the information being exchanged,
2. Building a complete and fluid real-time view of a patient (Patient Master Chart), through longitudinal integration of patient health data/information at points of care,
3. Accessing the right information at the right time for clinical decision-making, and avoiding duplication of services and reducing medication and medical errors,
4. Optimizing compliant and audit-proof medical risk adjustment,
5. Monitoring and comparing performance relative to outcome parameters across the network, and
6.Engaging the patient through portal access to their own personal medical data, and
7. Fully satisfying the technology requirements of MIPS and APMs.
1. Ensuring timely and effective transitions of care,
2. Analytic modeling and stratification of high risk patients with corresponding opportunities for engagement with formal complex care management services,
3. On-going identification and closure of quality performance measure gaps,
4. Effective referral management to ensure timely and cost-efficient coordination of care,
5. Systematic monitoring of medical risk adjustment and HCC coding and documentation,
6. Diversion of patients from inappropriate use of ERs, and
7. A comprehensive telemedicine program, and
8. Systematic monitoring patient experiences and satisfaction with care on the practice/provider level.
1) A Radiology Benefit Manager (RBM) program dedicated to integrating independent radiology centers and services and reduce unnecessary and costly imaging.
2) A hospitalist platform dedicated to providing timely, comprehensive, cost-effective, and appropriate evidence-based inpatient medical care to network patients and reduce leakage
3) A post-acute care platform dedicated to penetrating the hospital to SNF revolving door and significantly reducing costs
4) A network of services/setting (e.g., radiation oncology, cath labs, outpatient surgery centers) dedicated to providing high quality and cost-efficient alternatives like services provided in hospital settings.