A program supervisor would like to evaluate a cohort’s cost and utilization before and after the start of a program intervention to evaluate its efficacy.
A practice administrator would like to identify high and rising risk patients, and provide patients with adequate support, education, appointments, and services to prevent a decline in health.
Practice staff wants to help coordinate care while their patient is hospitalized or at a sub-acute treatment facility. This could include providing support or information to hospital/facility staff, and potentially avoiding hospital admission or reducing length of stay.
Practice staff can identify patients who have been discharged from hospital-based care. The physician can support her patients’ safe transitions from inpatient hospital settings.
A provider is responsible for ensuring that a patient completes preventive health screenings, and may need documentation of these screenings for quality measurements (ex. MIPS, HEDIS). They need to distinguish between patients who are out of compliance and those who may have completed screenings for which the provider has not received results.
A provider has ordered a test or procedure and would like to follow up on its results.
In an outpatient setting, a staff member or clinician is preparing for a patient encounter, and trying to understand the patient’s complex medical history and recent tests and procedures.