Cna-guided care for improving clinical outcomes and decreasing total cost of care

Abstract

CNA-guided care, which can improve clinical outcomes at a specific patient level and decrease total cost of care at the population level, has two faces. The first face, the enabling tool, allows a payer to transmit information identifying a health care service under consideration for a patient with a health condition whose health plan benefits cover the service and other payer-selected variables. In response, the payer receives information sufficient to establish that the medical service is an appropriate delivery or level of service allowing the payer to approve payment to a medical care provider for the service. The second face provides for communications that provide information sufficient for a complete medical evaluation and for assigning a CNA to the patient. The patient then can use the assigned CNA to select an optimal care plan and a medical professional based on patient-set criteria within the CNA.