TEAM of Care

Actions Speak Louder Than Words… And Results Speak for Themselves

For over a decade, TEAM of Care has been delivering industry leading results for hospitals, health systems, medical practices, and Accountable Care Organizations (ACOs) participating in value-based care.  In fact, our customers have produced over $200 million in savings and value-based care revenue across Medicare Shared Savings Programs (MSSP), Dual-Eligible Special Needs Programs (D-SNP), Medicaid Whole Person Care, and commercial ACOs sponsored by several of the largest health plans in the country.  How? We have deployed dozens of workflows, assuring great TEAM-Work in support of care coordination, quality improvement, quality measurement, program compliance, and risk-adjustment.

TEAM of Care works with you to design and deploy workflows to address your most pressing needs.  Operational efficiency is the opposite of “burnout.”  Operational performance that reduces waste increases margins that are straining hospitals and health systems.  Value-Based Care contracts that depend on TEAM-Work, from preventative care, to chronic condition management, to hospitalization, through post-acute recovery, all benefit from better task distribution and follow-up.

TEAM-Work uses EHR and other healthcare data to automate workflows.  TEAM members access TEAM-Work through their EHR or a web-browser.  Power users track their tasks in the application, but many receive and complete tasks only when prompted in their EHR or when they receive action assignments by email or other internal communication systems.

  • Care Coordination
    • Hospital and ED Arrival
    • Transitions of Care
    • Post-Acute Follow-Up
    • High-Touch Care
    • Chronic Condition Management
    • Patient Goal Management
    • Referral Management
  • Quality Metric Management
    • Medicare Shared Savings Program
    • Commercial ACOs
    • Dual-Eligible Special Needs Program
  • Whole Person Care (Medicaid)
    • Program Enrollment
    • Social Determinants of Health (SDOH) capture
    • Case Management
  • Risk Adjustment Factor (RAF) Management
    • Hierarchical Condition Category (HCC) risk review
    • HCC Re-Capture

Impact on TEAM Members

The workflow coordination system reduces the burden on the doctors, nurses, and ancillary care providers to orchestrate and manage the essential and supplemental activities that typically need to occur before, after, and between direct care steps.

Benefits are not limited to the clinical TEAM.  Administrative workflow improvements and efficiencies may create the best business case for your organization.  Learn how TEAM of Care creates exceptional and tangible benefits and ROI for management, administrators, and IT staff.

  • Stop burning out doctors, nurses, and all of the many extended individuals who contribute to care delivery. 
  • Care coordinators may be accessing TEAM of Care throughout the day to address specific patient populations and care programs.
  • Most physicians and nurses only access TEAM of Care through their EHR when prompted by the system regarding a specific workflow.  Because the EHR and workflow coordination system are integrated, the EHR data triggers workflows with patient context without having to leave your system.
  • External providers, ancillary care services, and community service organizations receive assigned actions by email (and other communication systems) that direct them to one specific action items, which automatically opens for them to review and complete in a web-browser.
  • Les “ings” per hour.  Scheduling, coding, billing, documenting, finding missing charts, looking for results, confirming completed activities…. 

  • These are the “ings” that take more time, more energy, and more frustration than they should.

  • Administrative TEAM members are more efficient and more effective with automated workflows that are easy to access and easy to complete.

  • Executives set strategic goals for the healthcare organization.  These typically include clinical, financial, and competitive objectives that support the mission.  Managers need to define the tactics and demonstrate measurable performance that support those objectives.  TEAM of Care is uniquely designed to track what work has been done and whether it is making an impact.

  • Take the burden off the IT staff to create magical solutions. 

  • EHRs and the dozens of clinical applications needed to effectively care for patients and run a healthcare organization are not built to generate and manage workflow task assignment and status. 

  • Designing and coding the EHR to perform any of these functions takes a lot of work, costs a lot of money, often depends on vendor priorities and roadmaps, and typically takes a long time to go from concept to operational deployment.  In the end, the result won’t provide the usability or operational insights end users will initially demand or identify soon after deployment. 

Benefits to the TEAM

TEAM of Care works across the widest possible definition and variety of provider organizations: Hospitals, health systems, Accountable Care Organizations (ACOs), medical practices, specialty care practices, clinics, community organizations, home care, and post-acute care services.

  • Reduce hospitalization and readmissions for patients with structured chronic condition programs, post-discharge protocols, and post-acute follow up.
  • Reduce cost of care with proactive chronic condition programs and collaboration between primary care, specialists, post-acute care, and home health activities.
  • Improve risk-adjustment payments through active HCC re-capture processes.
  • Increase quality of care and reduce costs through proactive care gap closure protocols.
  • Reduce cost of care and improve quality of care through top-of-license task assignment.
  • Consistent, reliable process flows eliminate waste – wasted time, wasted energy, wasted resources.  The highest quality, most efficient, and most effective care also reduces costs.
  • Workflow automation reduces time and energy spent doing what technology is made for.  Well-designed, technology-enabled workflows provide everyone on the TEAM with clear expectations, direction, and visibility for TEAM-Work.
  • Clear understanding of work: yours and others
  • Shared view of work for better coordination and TEAM-Work
  • Reduce burnout
  • Respond quickly to clinical and business opportunities
  • Increase the value of HIT data
  • Reduce the development burden on the IT staff
  • Reduce the dependency on vendor priorities and resource availability
  • Visibility to process and metrics enables management and staff to evaluate what is working and what is not
  • TEAMs have great confidence where to add, delete, or change a process or resources for better performance
  • Consistent training and deployment
  • Peer group support

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