Texas Medical Management (TMM) is revolutionizing the provision of episodic medical care to improve the experience and quality for patients along with savings of both time and money for patients and their employers. At the same time, TMM improves on existing payor contracts so that surgeons, anesthesiologists, and facilities are paid in a fair and timely manner. TMM achieves dramatic results even as the rest of the industry struggles to cut costs — and often ends up bloating them instead.

TMM eliminates significant waste in the medical system by crafting methodical episode management processes in concert with quality surgeons, sourcing surgeon-selected medical devices at the best price, and managing each case closely through a meticulous process.

TMM does this by managing:

• Time. TMM contracts with quality surgeons in each geography, as the hours required to perform a procedure can differ dramatically for an average surgeon as compared to a quality surgeon.
• Steps. From the right facilities to anesthesia, equipment, implants, medication, and more, TMM ensures that the surgeon’s treatment plan is executed well.
• Budget. TMM strategically procures treatment plan components such as implants at reasonable costs from surgeon-selected quality suppliers, saving budget as compared to device company facility pricing.
• Transparency. TMM publishes the pricing for each treatment plan and ensures completeness of the care episode so patients and employers understand all costs upfront, with no surprises. Unlike traditional insurance companies, TMM’s model allows purchasers to compare pricing prior to service and share savings with patients.
• Friction. TMM manages each care episode directly with the patient, providing expert advice and advocacy, helping them understand what to expect, and coordinating imaging, labs, studies, and more so that patients have one point of contact.
• Effort. TMM surgeons define each treatment plan in advance, creating a bundle. Each bundle is a surgeon’s treatment plan to address a specific diagnosis. The bundled price applies to all patients with the same diagnosis.

Note: 95% of all bundles are surgeon and facility specific.

TMM’s sensible, practical yet uncommon approach has reduced surgical costs to patients and employers across a range of procedures — often saving up to 50%. TMM makes money by adding a margin to the combined provider costs.

Achieving dramatic efficiencies requires a rigorous process for each episode of care, intelligent treatment plans designed by top surgeons for each procedure, and the organizational discipline to stick with the process.

As TMM scaled, they knew they needed custom software to ensure:

• Precision. Each diagnosis requires an expert surgical treatment plan, meticulous case coordination, and seamless handoffs from initial surgical consultation to purchaser billing and provider payouts.
• Automation. Every significant event related to the case must be immediately and automatically communicated to stakeholders including the patient, the employer, the surgeon or providers, and the facility.
• Trackability. All information related to each case, whether communicated by email, SMS, phone, or chat needed to be logged and easily accessed by any team members on the case.
• Quality. Any issue or delay impacting a case must be immediately identified and spotlighted to case managers so that Service Level Agreements can be reliably maintained.
• Repeatability. Training for new TMM hires needed to be eased by a more intuitive visual interface that could offer guidance and prevent unintended wrong actions, but without slowing down power users.
• Visibility. TMM leadership needed easy oversight of each department, treatment plan, and case under TMM management.
  

TMM needed an intelligent system to navigate complex cases at scale. To succeed in the face of this significant technology challenge, TMM called on Altus Nova to help define and develop software to best support TMM’s exacting business model.

Altus Nova worked closely with TMM to define pain points and success criteria. Together, we embarked on an extensive mapping of the end-to-end business processes — from a new case inquiry to data collection after a completed procedure — to capture the true current state of TMM operations.

To guide the way to an MVP solution, Altus Nova formulated an execution plan that ultimately delivered the MVP on schedule and on budget, exactly as planned.

Mapping business processes up front aligned the Altus Nova and TMM teams around the complexity of their decision-making, the necessary information and communication points for case management, and the multiple handoffs that must occur seamlessly between team members to facilitate the patient journey.

It also illuminated the unique view of shared information that external parties including surgeons, care navigators, and facilities needed to stay in sync throughout that journey.

Finally, it allowed stakeholders to define the decision-making audit trail, service quality markers, and functionality needed to minimize mistakes and optimize managerial support in the case of difficult situations during a patient journey.

With a clear map of the problem, Altus Nova worked with the TMM team to define a future-state vision for their custom software. We prioritized a list of must-have, should-have, could-have, and won’t-have features with input from all TMM stakeholders. Updated process flows, wireframes, and mock- ups enabled everyone to see how TMM would measure key performance indicators (KPIs) for the project.

Altus Nova worked with TMM to envision a solution that improved experiences for their own internal team as well as for external stakeholders including patients, surgeons or providers, and care navigators at medical facilities.

Altus Nova then made what was previously an abstract process concrete for TMM. Wireframes detailing what case management might look like allowed TMM to specifically envision how they would interact with each other through the software, and inspired them to provide invaluable feedback before development began.

Process management capabilities

• Automation. Enable logic-based decisions regarding which tasks should and should not be required, and when.

Project management capabilities

• Tasks. Each case is a “project” in which phases, tasks, and responsible parties are tracked, and each step is assigned to individuals according to their role.
• Status. A simplified status-tracking view is available to internal case management team members and relevant outside parties like the patient, employer, and surgeon.
• Scheduling. Shared calendars allow key events across cases to be managed both across the caseload and within each case.
• Prioritization. Dashboards organize cases into actionable groups, such as cases with overdue tasks, so level of effort and priority can be readily identified across caseloads.

Case management capabilities

• Tracking. Track all communications, notes, and documents — from labs or imaging to authorization vouchers and patient questionnaires — so team members can easily access them.
• Sharing. Team members are able to share those communications, notes, and documents easily with outside parties relevant to each case.
• Communicating. One-stop email, SMS, phone, and chat templates help staff move faster while still allowing customization and personalization.
• Service. Knowledge bases provide supporting and explanatory information that can be linked for outbound communications as well as searched for customer self-service.

Having solidified solution requirements, Altus Nova helped TMM select a Technology platform that would enable rapid iteration of solution concepts and deliver an end-to-end MVP in less than 4 months. Knowing that planning makes perfect, Altus Nova evaluated 30+ candidate platforms across TMM’s requirements matrix:

With an expert evaluation of vendor websites and documentation, Altus Nova quickly narrowed the list to a dozen or so candidates. Shortlisted organizations were invited to demonstration and feedback sessions, which further narrowed the field to six finalists.

Altus Nova worked with each finalist to gather apples-to-apples proposals focused on TMM’s specific feature list, further narrowing down the options to four finalists. Then, Altus Nova managed the finalists to create custom demos for TMM use cases with vendor-specific implementation estimates.

After a 6-week selection process, Altus Nova scored each vendor based on supported capabilities, implementation time and costs, and licensing costs. This helped the TMM team select Monday.com for the best combination of out-of-the-box features, extensibility to address shortcomings, financial stability and a compelling pricing model for turning TMM’s vision into reality.

Once the Monday.com decision was green-lit, Altus Nova worked closely with the TMM team across a 3.5-month schedule to develop business process workflows, automate workflow business rules, and establish a data analytics solution providing insight and visibility into both patient cases and the team’s performance.

Management dashboards were designed using carefully modeled sample data to ensure realistic views at scale, effective communications, and ease of use for effective decision-making across all parties — patients, surgeons, and care navigators.

TMM can instantly track each patient’s episode of care and seamlessly pass the baton between TMM case coordinators, TMM surgical specialists, and TMM finance as well as external stakeholders such as surgeons and care navigators.

TMM gets an instant 360-degree view of each patient and their progress, including whether tasks in the workflow have taken longer than expected or are in need of assistance.

TMM is able to predefine every detail of the diagnoses they manage — including the price — so there are no surprises for the surgeon, the patient, or the patient’s employer.