The Calm Before the Storm

Frankie works at a Management Service Organization (MSO), based in New York. The MSO recently expanded its operations across multiple states by acquiring local practices and practice groups. Frankie and their team were in charge of organizing all these practices under a single umbrella to negotiate with health plans and facilitate better management.

The association with the MSO would reduce administrative work for the individual practices, and improve care delivery. The practices managed by Frankie were excited to have a single point of communication with external entities. Frankie and their team would also manage compliance overview on contracts and clinical operations.

The Storm

Frankie was quick to notice a few challenges in working with the practices they had taken over

  1. All individual practices were equipped with Hospital Management Systems (HMS), Electronic Health Records (EHRs), and separate connections with Health Plans. Frankie was concerned about how the siloed data would fit into the MSO’s workflows.
  2. The practices had long-term relationships with their patients, suppliers, and care givers. This meant that patients, providers, and suppliers were comfortable with the existing systems and workflows. Clubbing all these practices under a single platform would certainly be problematic as these parties, across facilities, would have trouble working with a new system.
  3. Since every system had its own workflows, hierarchical level of information, and historical storage mechanism, physicians would take ages to find correlations between clinical data from EHR and claim data from health plans.

There were a couple of bottlenecks holding Frankie and their team from building a unified solution. They were as follows.

Frankie knew coming up with a custom healthcare software solution to address their present challenges was not something that they could manage with their existing resources. They were not just looking to optimize operations and revenue streams; they also needed a solution to aggregate all the day-to-day activities and monitor them from a central location.

They went on to look for experts that offered healthcare software development services. After a good amount of research, Frankie was sure about picking Nalashaa as their solution partner. And thus, Frankie and their team’s way crossed Nalashaa's.

Fighting the Storm

As soon as Nalashaa started interactions and discussions with Frankie and their team, they knew that modifying the current ecosystem was not an ideal solution to the challenges. The solution lay outside the existing operations, and they just had to find it. It was important to Frankie and their team that the solution was aligned with patient-provider encounters, diagnosis, procedures, insurance details, etc. with the need of physicians. Only then would the physicians be able to make better clinical decisions.

The healthcare software development team at Nalashaa was up for the challenge. With a little help from Frankie and their team, the team identified and assessed all business flows that were required to successfully complete day-to-day operations.

Business flows that were required to successfully complete day-to-day operations:

Patient Scheduling
Incentives management based on patient’s risk score
Care gap identification & closure
Improvement in performance measure rating

Braving the Storm

The custom healthcare solution was designed as a focal point to carry out all the above-mentioned operations and acted as a guide for all information the physicians required.

Claims, care plan, and risk score information was extracted from health plan portals via Excels. For clinical, encounter, and patient information, the data was extracted from the EHRs of multiple practices.
Transformation logics were defined and applied to data coming from all these various sources to create a Golden Record for each entity - members, claims, and providers. Data no longer sat in siloed systems.

Nalashaa came up with a solution, using this Golden Record, which would favor the practices and Frankie’s team. All practices under Frankie’s team were given access to this solution, from where they could carry out their day-to-day operations effortlessly thanks to easy data access and an intuitive UI. The solution also helped Frankie and their team monitor activities, manage compliance, contracts, and clinical operations.

The Provider Portal

A provider portal was also developed and implemented, as Frankie wanted to smoothen the provider’s workload to ensure care delivery was faster and effective. Providers would have access to a 360-degree view of a patient’s health status.

The provider could view clinical information from EHR and claims information from health plans, all on a single screen. Nalashaa also equipped the portal to identify and recommend the next set of actions to close care gaps.

The provider portal led to significant improvement in a provider’s decision-making as they did not have to spend time juggling between various systems to get a clearer picture of a patient’s current and historical clinical information.

To help Frankie and their team assess a provider, the portal could keep an eye on key performance indicators (KPIs) to measure a provider’s performance.

And then the Sun came up

The custom healthcare software development team at Nalashaa utilized all the tools and technologies below to come up with the perfect solution for Frankie and their team.


decrease in average patient’s risk score as providers had access to all current and historical data.


reduction in operational costs by bringing all operations under a single umbrella.


increase in revenue as a result of reduced operational costs and streamlined administrative efforts.

Increase in CSAT Score both from Patients and Payers.

The Winds that Swept Away the Storm

The custom healthcare software development team at Nalashaa utilized all the tools and technologies below to come up with the perfect solution for Frankie and their team.

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