Powered by the launch of Tomorrow Health’s Clinical Rules Engine, this innovation aims to streamline today’s fragmented DME ecosystem, giving payers the ability to manage the shift of more care to the home. It also is a first step in the company’s long-term plan to automate the entire spectrum of home healthcare services payment within its platform, spanning tens of thousands of healthcare payment (HCPCS) codes.
More than a third of home-discharged patients transition to higher cost settings over the course of a year. Conflicting requirements for home medical orders between the prescriber and the health plan can lead to delays, or in more severe cases, hospital re-admissions. Even the most well-intentioned physicians, nurses or case managers can struggle with over 100 page health plan documents, or variability in how individual insurance plans approach different types of medical equipment approval.
“High-touch management of care transitions from hospital to home or post-acute care to home requires that we simplify and digitize the process, improving care transitions and providing payers, care teams and all parties with up-to-the-minute visibility into care status,” says Vijay Kedar, co-founder and CEO, Tomorrow Health. “Fully automating one of the most cumbersome and technical parts of the home healthcare coding process is a big step forward for drifting down readmissions and restoring lower-cost home settings as patients’ primary place of care.”
Care providers using Tomorrow Health to order medical equipment for their patient populations can now take advantage of new HCPCS code automation features. Clinicians are now guided through a 1-5 question dynamically rendered digital smart form, fully customized to a patient’s participating health insurance plan. Upon form completion, the order is immediately routed to the home-based care supplier best suited for the patient’s needs. In total, Tomorrow Health cuts a traditionally one to two week process to five days or less for most orders, with half delivered in two days, ensuring patients get the home-based care they need, when they need it. The new feature is currently in active rollout with referring care providers.
“Tomorrow Health makes documentation and order fulfillment much easier, which helps us submit claims and receive payment more timely,” says Shawna Morton, vice president of Contracts at Rotech Healthcare. “Reducing reimbursement complexity is a huge step forward in ensuring patients get the equipment they need when they need it the most.