Optimizing Home Care

Recently healthcare has begun shifting care out of the traditional settings, and back into the home and community.

“The home has been, I don’t want to say ignored from a healthcare standpoint, but there has not been as much invested in home care and post-acute care,” Dant shared.

myNEXUS is changing that with an outcome-focused, value-based model that extends beyond the scope of a typical benefit manager to help optimize health resources in the home and the community.

“We’re not just paying claims, we’re working with the provider to make sure that the member is getting the care that’s appropriate and necessary to get back on their feet, to become independent in their home and to go back out into the community,” Dant explained.

With this model, myNEXUS is shifting the mindset from volume of care to the quality of care. As value-based care is becoming more prevalent in the healthcare industry, myNEXUS is helping providers to focus on the outcome, not just the bottom line, Dant said.

“Through our advanced technology, clinical expertise and high performing providers, we have created an integrated approach to caring for people in their home and community.

Everyone that works at myNEXUS has that foundation and clinical background. They’ve worked with patients directly, they’ve done value-based care, they’ve worked with health plans, they’ve owned health agencies,” Dant said.

This sets myNEXUS apart from traditional TPAs, because it integrates clinical, technological, and financial aspects of healthcare in a revolutionary way.

How Salesforce Makes Transformation Possible

When Dant started working at myNEXUS, he saw a need for technology that could help the company fulfill its mission. As a smaller company needing a customizable system to help manage a quickly growing Network of Providers, myNEXUS decided that Salesforce was the perfect fit.

Through Salesforce, myNEXUS has gained efficiencies alleviating 50% of the administrative functions involved with building and managing a Provider Network, allowing the team to focus on development efforts and expand its Provider network to over 40 states in less than two years.

But perhaps the biggest impact came from Salesforce’s ability to help transfer data in real time.

“By transferring our data in real time to different systems internally — which were formerly done by transferring files back and forth — we were able to save over a year’s time, about 100 working days across the spectrum through our data transfer,” Dant said. “Getting that kind of time and resources back to do meaningful work is pretty significant.”

Fostering Interoperability

Dant recognizes that interoperability has become a buzzword in the healthcare industry, but he doesn’t want that to detract from its importance. He sees interoperability as the key component that can connect value-based and outcomes-based care.

“It’s not just a talking point; it’s so pivotal to making sure that you are achieving outcomes,” he said. “Because it’s really all about making sure that the patient is becoming independent and being able to go back home, getting that outcome that they need and not ending up back in the hospital.”

myNEXUS is solving for this by working to connect Hospital EMRs to Home Care EMRs, and authorizations to payments. Each of the integrations has one common goal, to make data sharing “seamless” instead of complicated or difficult, Dant said.

“There’s a lot of data out there, it’s just all in different systems. Being able to connect that, just from an industry standpoint, would be a total gamechanger, and it’d help everybody, not just people in care.”

Subscribe to How I Transformed This wherever you get your podcasts, and be sure to sign up for our quarterly email newsletter to stay up to date on Virsys12’s latest transformational work.