Solutions And Services For The Health Regulatory Authority

Healthcare Policies, Regulation & Intervention

To meet its objectives of making healthcare policies, regulation & control, a government needs real time healthcare information.

For this, a system under the direct control by the government, is required, through which the entire healthcare data is routed to all stake holders in the country or region.

Medicworks Informatics, provides consultancy, services and products to the government healthcare regulatory authority, towards:

- Building a unified health data communication language and protocol, for interoperability.
- Standardizing and centralizing the health data
- Provide unified platform for transactions between the:

• Government
• Patients
• Insurance & Payers
• Licensing Authorities

• Providers
  • Labs
  • Radiology Centers
  • Pharmacies
  • Suppliers
  • Schools
  • Employers
  • Social Institutions

Regulation & Control:

• Bringing more regulation and control on dispensation of healthcare to public.
• Easing the insurance e-claim process by making it faster for patients, providers and payers.
• Monitoring the healthcare system and practices.
• Rolling out policies and decisions faster.
• Delivering government healthcare benefits to the public.
• Providing enormous real time analytical data to the government for taking decisions.

Healthcare Data Analytics

Without interpretation, information is only a vast collection of data. The right healthcare analytics system turns collected data, into actionable information.

As a first step we help in:

• Standardizing healthcare data.
• Build a unified health information communication language and protocol.
• Standardize and centralize the health data.
• Design and set up a data center infrastructure for data communication, storage and analysis.

Finally implement the software system, to organize the above as per the government regulations.

It helps in interpreting information at the macro level and also deep into details of any set of metrics and make high level policy decisions.

It could provide answers to many questions like:

• Who are the high-risk population members?
• How much will it cost for the care of the high-risk members and the population?
• Will my healthcare costs increase next year?
• What are the gaps in care for my member population?
• How can I automate healthcare management so that it is clinically effective but also cost efficient?
• How can I use the information from healthcare analytics to drive operational processes and improvements?

Insurance Management & Streamlining Processes

We provide turnkey solutions to streamline the insurance eClaim processes, for the transparency, easing claims submission and remittance to patients and providers.

It helps in:

• Easing the insurance e-claim process and makes it faster for patients, providers and payers.
• Bringing in quick dispensation of healthcare benefits to the public.
• Monitoring the healthcare system and practices.
• Rolling out policies and decisions faster.
• Providing meaningful real time data for taking decisions.

Implementing Drug Regulation through eRx

We design and implement e-Prescription solutions on regional or national levels.

e-Prescription or eRx allows electronic transfer and sharing of medical prescriptions among different medical entities across the region quickly.

e-Links to the insurance cover at the time of prescribing and has multiple benefits:

• Implement PBM (Pharmacy Benefit Management).
• Minimize mistakes in prescribing and dispensing.
• Monitor drugs utilization automatically.
• Reduce fraud, abuse and waste.
• Reduce drug expenditure costs.
• Information on insurance cover at the Clinic and Pharmacy in real time.
• E- Authorization by Payer (Insurance).
• Reduce patients’ wait time at Clinic/Pharmacy significantly.
• Is confidential and complies with HIPAA.