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Core Services

Monocle prides itself on providing a comprehensive set of Core Services that promote the very highest level of healthcare Analytics , Price/Quality Transparency and Referral Optimization on the market. Because we are independently owned and provide quality data from over 300 data-points we are the only Cost Plus Quality solution capable of delivering objective metrics instead of subjective user experiences.


With no third party influence for our rating system. We are loyal to no one but our mission. To help match patients to optimal providers on a diagnosis specific basis, provide referral optimization for both episodic procedures and chronic illnesses and a value map of the best low cost high quality in-network providers. All with the intent of optimizing price and quality for routine and complex care and assisting our clients in creating brand loyalty with a personalized in-network experience.

ANALYTICS

Monocle uses its analytics to optimize the value of its other services.  We analyze client internal data and multiple external data sources to support many other synergistic services. Our analytics are second-to-none. We use statistical models rendering a 97% accuracy rate for rankings within one percentile and no one else can claim that.  Monocle owns the patent on its tools and methods.  As a result, Monocle was named Intel Innovation Award winner in 2012. Since this achievement, we’ve identified many other applications for our analytic capabilities allowing us to provide the various turnkey solutions described here. Go to the "Reports" tab to learn more about our analytics capabilities and see a small sample of the reports we generate that support our robust product suite.


We can quantify the savings from each of our products to the dollar -  Not “inflation-adjusted” or other "hocus pocus" but dollar for dollar, year over year.

Case Study

pRICE & qUALITY tRANSPARENCY

Monocle is unique in that it provides transparency in four ways:

  1. Pure price transparency for more than 600 episodic procedures for every US provider.  We reveal the actual paid prices to each provider.
  2. Price efficiency rankings by provider for treating every condition and primary/secondary/tertiary diagnosis.  This is particularly useful for selecting the most efficient provider for treating patients with multiple chronic illnesses (which is two-thirds to three-fourths of all health costs, btw).  Monocle aggregates all costs over a longitudinal period on a provider- and diagnosis-specific basis so now we can tell you which doctor scores in the 90th percentile in price efficiency (less costly than 90% of his peers)
  3. Quality transparency rankings for every physician, hospital and ambulatory surgery center on a diagnosis-specific basis.  Monocle uses dozens of credible, independent sources of quality data to score and rank every provider by percentile for every diagnosis.
  4. Value transparency for every provider.  By combining price and quality transparency, Monocle reveals which provider, say, is ranked in the 90th percentile for both price and quality for a 45 year old male with Type 1 Diabetes, CHF and COPD.  That’s quantified value.


And in the spirit of transparency, we provide full supporting documentation.  And we don’t sell “Honor Roll” or “Best of” certificates.  We will never be a provider advertising or fee for referring patients model.  No “black box” here.

Case Study

Referral Optimization

With Monocle’s Price & Quality Transparency solution, users make informed decisions based on their own unique set of circumstances.  Ultimately, Monocle allows users to determine optimal providers for treating their specific diagnosis at an affordable price. 


For more information, go to:

Case Study
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Additional High-Value Services

In addition to providing our core products, Monocle provides a host of products and services that complement one another and bring additional value.

Proactive Patient Engagement/Concierge

Early and ongoing patient engagement is the key to treatment compliance and referral optimization.  Initially Monocle assesses, segments and assigns each member to the appropriate patient engagement program based on health segment.  Then the appropriate program proactively engages members to provide support in every possible way (referral optimization, remote patient monitoring, appointment assistance, customized care plans, unified communications, etc).  Monocle then monitors members for new diagnoses to determine if changes in medical management/patient engagement programs are warranted.    . 

Complex Chronic Care Management

CCM or Complex Chronic patients are the highest cost patients with six or more chronic diagnoses who require intense proactive care coordination to ensure patient engagement for reduced costs and better quality of life.  Identifying and engaging these patients is a result of Monocle’s Analytics and Proactive Patient Engagement/Concierge service. Our care management efforts rely on flexible care plans, the best in unified communications and activities that are patient-centered and powered by Monocle.

Telemedicine, RPM & Unified Communications

Unified communications is the key required to effectively execute Monocle’s proactive patient engagement/concierge function.  Unified Communications is broadly defined to include: telemedicine, remote patient monitoring, medication adherence, customized care plans, appointments, patient reminders, facilitating communication between providers and patients and many other care management tools.  


There is a lot of information out there and most of it is uncoordinated.  Lack of coordinating information is a glaring omission contributing to lack of compliance, redundancy, waste and medical errors.  We fix that.  While others have “call centers” waiting for calls, Monocle takes the initiative to make the right things happen. 


Our state-of-the art unified communications technology has over 19 million users world-wide. We are capable of providing communication services between patients and providers and providers to providers allowing for a a continuity of care across the continuum of care to be realized. We provide fully integrated remote patient monitoring with flexible care plans to assist physicians and patients in patient-centered care designed for and by the patient. 


With this highly integrated patient-centered technologies, we are able to facilitate and track a variety of activities including appointments, transportation, referrals and engagement with the patient's entire community of providers. With the support of the entire health care team and the patient's community, we actively track the patient's progress using clinical pathways and evidenced-based medicine as our guide.  

Disability Migration to Medicare SSI

Disability Migration is probably the most valuable and yet ignored opportunity to reduce health plan sponsors’ and members’ costs.  Due to our initial analytics phase, we identify those members who have a high probability of being deemed eligible for Medicare SSI Disability. There is a high denial rate and the overwhelming cause is lack of documentation by the member.  


We identify the member, prepare the documentation and marshal the member through the process to increase the approval rate. Why is this important?  Members who qualify pay no premiums and no out-of-pocket costs and if their provider accepts Medicare, which 99% do, they don’t need to change providers. In addition, they receive a monthly disability payment (supplemental security income, aka SSI) in addition to any other income.  


For health plan sponsors, they avoid the cost of coverage of a high cost member now, in the future, and in the past. Once someone is deemed Medicare SSI Disabled, the Medicare program reimburses the plan sponsor for the past 12 months claims’ costs.  The average cost of a Medicare SSI Disabled patient is $300 K.  Assume you have a 50 year old with 12 chronic illnesses who qualifies. In this situation, the plan sponsor will incur $300 K for 17 years until the member qualifies for Medicare (assume 67 as qualifying age). With our assistance, the plan sponsor avoids 17 years of future cost and recoups one year in past cost. That’s 18 years of savings of $5.4 million (without inflation) per qualified member.

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Pharmacy Audit and Recoupment

PBM contracts are extremely complex, and rarely monitored. The drugs are tiered based on the Average Wholesale Price (AWP). Do you know the AWP prices change daily – just like commodity markets – but the PBMs rarely update the price to you? Monocle applies proprietary software to find those gaps in pricing and helps plan sponsors recoup those funds. We do this on a contingency basis. Give us the data and we’ll start helping you recoup your money. And we’ve NEVER failed to deliver a recoupment check. 

Provider Directory Maintenance

Monocle’s constantly updates multiple external data sources for its provider quality scoring and ranking modules. This combined data yields more accurate and timely provider directory info than the traditional expensive manual approach of “smiling and dialing”; contacting each provider via phone twice a year and therefore continuing human error and failing to correct errors for up to six months.  


Monocle does this much less expensively and accurately because of our unique database reconciliation processes. Our electronic provider directory service is constantly updated by matching multiple provider databases to identify potential errors and probabilities of accuracy. In addition, Monocle provides a more robust profile of each provider’s capabilities and sub-specialties/target markets.


Regulators love to audit provider directories for errors and levy fines of, say $50 per day per error. Doesn’t sound like much but, when pro-rated over time, it’s massive! Monocle is much more accurate and less costly. With Monocle, it cost you less to get more accurate, robust and timely information and avoid the fines that regulators can levy. 

Fraud, Waste & Abuse

The FBI estimates 30% of all health care costs are due to fraud, waste and abuse.  Since Monocle’s core service measures provider efficiency, we identify those providers who have excessive costs on a diagnosis-specific basis.  And abnormally excessive costs usually indicate providers more likely involved in fraud, waste, and abuse.  Because we identify likely suspects, we support laser-targeted audits with comparative evidence.

Pre-Authorization

Everyone hates the Pre-Auth process. It’s costly, contentious and has questionable ROI.  Providers incur costs of “administrivia”; patients incur delays in care; payers incur costs of denials which are overwhelmingly overturned on appeal; plan sponsors incur costs of a process with highly questionable savings. 


So how does Monocle address this? By using its provider price transparency, price efficiency and quality rankings. Monocle identifies which providers should be fully exempt, partially exempt or non-exempt from pre-auth on a diagnosis-specific basis. After all, why would you apply pre-auth to a provider consistently scoring above the 67th percentile in efficiency and quality? It’s a costly waste of time. 


By targeting only those providers with sub-par scores on a diagnosis-specific basis, Monocle ensures that high performing providers are rewarded and sub performing providers change treatment protocols to achieve high scores and pre-auth exemptions. 

Automated Clinical Guidelines

As mentioned earlier, OPTIMIZATION should be the health care industry mantra. We hear the term “best practices” far more often in a theoretical sense than real world cases.  As shown in the exhibit (scatter chart), Monocle reveals rankings on price efficiency and quality on a provider and diagnosis-specific basis begging the question: how did they do that?


When Monocle identifies high performing providers, it documents their treatment protocols and offers that documentation to other providers so they can improve their cost and quality.  And this further supports the Pre-Auth process to show providers how to deliver better quality at lower cost.


For a demonstration of this principle see the following:

Quality & Efficiency Scatter Plot Exhibit

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