Virtusa Care Cohort Management

Virtusa created the Care Cohort Management solution. Built using Pega, the solution enables payers to identify at-risk groups and efficiently coordinate care plans for their cohorts. Payers can identify the target patient population by running a simple query using a specified criterion such as gender, age range, likelihood of developing a chronic condition, risk scores, etc. The application can integrate with EHRs, a claims database, or consume the result set from a prediction algorithm to gather the necessary identification information.  The solution allows care managers to review the cohort criteria, start a detailed audit trail, add comments, and route to the appropriate care management team for patient outreach. In addition, the solution provides the team with customized patient care guidelines and the option to add additional notes or comments for initial outreach.

Powered by Natural Language Processing (NLP), the solution derives keywords (e.g., hypertension, diabetes, etc.) from the data sources, making patient follow-ups, progress tracking, and care coordination more efficient. The solution’s dashboard provides a cohort-level summary that includes the cohort objective, the number of members identified, members who participated, and a measure of success. Care teams can set goals and targets, identify intervention strategies, address barriers to achieve the care goal, and formulate the appropriate corrective action.

• Basic workflow features: Case management functionality with adjustable phases, guided workflow assistance, integration with various data sources, and case narrative (case lifecycle as a snapshot) are all included.
• Advanced workflow features: The solution upsells HIPAA authorization, multiple procedure codes (HCPCS, CPT), cohort SLAs (configurable by business), and cohort dashboards.
• Business enablement features: Business Managed Configuration Portal, procedure code and diagnosis code configuration, configurable outreaches (one or multiple outreaches), work allocation, and urgency configuration.
• Technology support features: NLP extraction and analysis, extensive cohort audit trails, cohort details (exported as a PDF), and detailed correspondence.