The West Coast Healthcare Provider partnered with Synegen to create a fully customized web application that enhances visibility and streamlines member care coordination within the Street Medicine Program. The platform was designed to be user-friendly, enabling providers in the field to quickly access essential member information while providing their team with a comprehensive view of member care, ensuring better coordination and support across various touchpoints.

Comprehensive, Compliant Health Data Management for Better Care Coordination

The platform prioritizes the secure management of member health data, including Protected Health Information (PHI), in full compliance with HIPAA regulations across multiple providers and data sources. It consolidates critical member information, such as demographics, appointments, and authorizations, into a unified system, providing a comprehensive 360-degree view of each member’s care. By centralizing this data, staff can efficiently track member progress and ensure that no critical details are overlooked. 

Authorized providers can securely access relevant data, including PHI and information from external referrals and multiple healthcare providers, ensuring an accurate, real-time view of each member’s health journey. This centralized approach ensures the team has the full context needed to coordinate effective care and make timely decisions.

Efficient Referral Management to Improve Care Accessibility

Another critical platform component is its ability to manage external referrals for unhoused individuals requiring healthcare services. A referral management tool within the platform efficiently handles referral information and streamlines the intake process. By providing an easy-to-use tool to manage and track referrals in real-time, the system reduces referral leakage and eliminates delays in the intake process. As a result, members access critical services without unnecessary wait times, ensuring they get the care they need when they need it.

Timely Follow-Up for Recently Discharged Members Ensures Continuity of Care

The platform tracks members who have recently been discharged from the hospital, ensuring they receive timely follow-up care. When a member is discharged, the system notifies providers to reach out and verify that the member is receiving the necessary post-discharge services and support. This proactive follow-up helps prevent readmissions and ensures that members continue their recovery with the proper care, improving long-term health outcomes and stabilizing their housing situation.

Enhanced Reporting and Visibility for Proactive Care Management

Capturing and aggregating data from multiple sources in real-time is a significant challenge for any organization, particularly when delivering care to a geographically diverse, unhoused population. The platform addresses this challenge by consolidating data from multiple touchpoints, such as enrollment, service participation, and authorization status, into one centralized location.

Additional reporting and visibility capabilities ensure that no member falls through the cracks, especially regarding timely care. The platform tracks when a member has not been seen by a medical provider in the past seven days and automatically generates a notification, prompting providers to follow up and ensure the member’s needs are addressed. This proactive approach enables providers to quickly re-engage members who may have missed an appointment or require additional support, ensuring continuous care and reducing the risk of health or housing instability. It also allows the provider to mitigate any emerging patterns of gaps in timely care.

The platform’s aggregation of member authorization data ensures that no member loses access to critical healthcare or housing assistance due to administrative oversights. By tracking authorization statuses and alerting providers to expiring authorizations, the system empowers providers to stay on top of these crucial requirements. This proactive approach eliminates the risk of disruptions in care, ensuring that members maintain continuous access to the services they need without delays, ultimately supporting their ongoing health and housing stability.

Additionally, the platform includes a heat map that visually displays the geographic distribution of members and services. This tool provides valuable insights into areas with higher concentrations of members in need and underserved regions, allowing the team to better allocate resources and improve outreach efforts.