Jiva, our integrated care management solution transforms traditional episodic-based care management into proactive and collaborative population healthcare management through electronic health record (EHR) enabled careplans, point of care tools, decision support, and user-configurable workflows for care management. Portal services connect stakeholders for a collaborative process.
This web-based care management application is built using AJAX based-web technology. Jiva's modular design allows companies to easily configure and selectively deploy modules. Jiva is HIPAA and ICD-10CM/PCS compliant.
Jiva revolutionizes care management by delivering:- An integrated real time rules-driven workflow application that promotes transparency between Utilization Management, Care Management and Disease Management functions.
- Embedded clinical analytics to stratify the population risk, identify gaps in care, and deliver personalized care plans.
- Integrated workflow for health, wellness and lifestyle support programs complemented by content from health risk assessments and clinical protocols and business rules.
- Capabilities for multi-channel communications that can deliver personal health records, patient decision aids, health management tools, clinical content for health education, and decision support tools at the point of care.
- The ability to exchange data with external systems, consolidate information across disparate data sources and present this information through web services to physicians, members and care managers.
Jiva's care management platform integrates workflows across the care management continuum, automates workflows intelligently based on client business rules, enables identification, stratification and engagement of patients and high risk members, and facilitates multi-channel communication and collaboration between members, providers and stakeholders.
Our platform supports group or individual processes for the Private sector and Medicaid and Medicare specific workflows for the Public Sector. Jiva's Sentinel Rules Engine (SRE) goes beyond automating individual workflows to automating business processes across the entire care management continuum. This is performed in real time. The SRE also simplifies the configuration and maintenance of these business rules through an intuitive user interface that enables clients to either modify pre-packaged rules or create rules specific to their requirements.
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Jiva's care analytics focuses on providing relevant clinical intelligence that is actionable and integrated into the care management business rules and processes. Our solution analyzes medical and pharmacy claims, medications, lab and diagnostic data, health risk assessments, and electronic medical record (EMR) clinical data from disparate data sources. The solution identifies and stratifies high risk members, those with chronic conditions and gaps in care. Jiva takes this clinical intelligence and makes it actionable by applying additional client criteria and automating actions such as sending alerts, generating referrals or generating interventions to address these care management opportunities. Our solution also works with third party predictive modeling applications.
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The Advanced ACE within Jiva focuses on collecting meaningful information from members, providers and other stakeholders, analyzing this information and driving workflow activities. Advanced ACE is used to configure content such as clinical protocols, health risk assessments, questionnaires and surveys. This content is then presented to members, providers or other stakeholders electronically or through other means to gather responses. Jiva analyzes these responses to drive pre-determined actions based on client specific clinical or business rules.
- (For example, a health risk assessment can be configured to gather information on a member's dietary habits and presented through the member portal. Once this assessment is completed, it is combined with existing information on the member to determine the potential risk of developing a chronic condition. Business rules are then applied to this information to create an actionable item such as a referral to a weight loss program or contact by a case manager for nutrition counseling.)
- (Another example is a physician satisfaction survey. Here, the survey can be presented online to the physician through the provider portal. Business rules are automatically applied to the responses generating specific actions such as a thank you letter or a personal phone call requesting additional information.)
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Jiva has clinical protocols for the major disease conditions built and maintained to industry standards. These protocols go beyond typical assessments by enabling clients to auto-generate care plans and drive activities based on responses. Clients can use these protocols as is or build upon these protocols or create new protocols as needed
Jiva offers several rules packages such as Auto Approval, Productivity, Clinical Disease Identification, and Gaps in Care that run on the Sentinel Rules Engine and enables clients to address specific business, clinical and regulatory requirements. These rules run in real-time enabling clients to respond immediately to problems and opportunities
- (For example, the Auto Approval package has several rules for auto approval of authorization requests such as rules for approval based on diagnosis or procedure codes which run in real time. Regardless of how the authorization is submitted,
i.e. by portal, phone or fax, an immediate response can be generated.) - (For example, the Productivity package has several rules for improving the productivity of the organization such as an HRA being generated and included in the welcome kit for a new member, auto-generating an approval letter when a service is authorized, auto-scheduling report generation and auto-scheduling batch faxes.)
- (For example, the Disease Identification package has several rules for identifying members with one or more of the major chronic conditions. As soon as a member is identified, multiple activities or interventions can be generated according to the severity of the condition,)
- (For example, the Gaps in Care package has several rules for identifying potential gaps or missed opportunities in the care given to a member such as prescriptions not refilled or immunizations not completed. This will result in automatic alert, appointment request or notification to the care manager, physician or member to address this gap.)
Jiva provides a comprehensive set of capabilities that enable members, providers and care managers to communicate through multiple means of communication i.e. phone, mail, fax, email and portal based on their preferences.
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The Data Exchange Services include standardized interfaces with a diverse set of external systems including medical and pharmacy claims, lab and diagnostics, predictive modeling, decision support tools such as Interqual and Milliman Care Guidelines, fax and Google Maps. Jiva can exchange referral information via Web, Fax and EDI.
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Jiva's secure portal services enable clients to involve members, physicians and other stakeholders in the care management based on their goals
Provider
Providers can login to the portal and get a 360 degree view of the member's EHR, check eligibility across multiple payers, request and receive approvals of a referral or admission, view and collaborate with the care manager and member on care plans, access decision support tools, submit appeals or grievances, complete surveys or questionnaires and run patient reports.
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Member
The member can login to the portal and get a comprehensive view of their profile, collaborate with the care manager and physician(s) on the care plan, complete assessments and surveys, access relevant educational material, receive alerts and notifications, and submit an appeal or grievance.
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Employer
Our clients can enable employers and other customers to obtain relevant information on their members. Employers can login to the portal to run reports on their member populations and submit referrals for care management.
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