Provider Engagement

Where Collaboration is a Performance Measure.

Our Provider Engagement solution brings a whole new level of health plan - provider transparency. By giving a critical view into the claims life cycle, provider networks and value-based contracts, health plans can collaborate with providers to identify the root causes of underperformance, and pinpoint what’s driving high-performing partners as well. Not only does that mean fewer appeals and errors, it means greater member satisfaction and more transparent provider relationships.

  • Eliminate administrative waste due to claims errors

  • Profile and tier providers based on risk

  • Implement payment models to support performance-based programs

  • Support the risk adjustment programs as established by the ACA

  • Provides insight into potential "choke points"

  • Aggregation

    Web-based solution facilitates health plan-provider transparency and collaboration by presenting a unified view of all financial and operational data.

  • Interpretation

    Common analysis of data provides critical insight into denials and processing errors, helping eliminate both.

  • Transformation

    Health plans improve provider transparency with providers, optimizing engagement and payment cycles.

Reduce denials and appeals by evaluating their root causes

Reduce denials and appeals by evaluating their root causes

Monitor high-risk patient populations

Monitor high-risk patient populations

Key Performance Indicators

  • Reduction in appeals and denials
  • Paid/claim and discount percentage
  • Provider practice patterns
  • Fewer high-cost one-day stays

What It Offers

  • Live web-based health plan-provider collaboration
  • Real-time performance tracking
  • HHS-adjusted risk score analysis
  • Physician scorecards
  • Supports Medicaid, Medicare Advantage and Commercial populations
  • Access on the iPad

Complementary Solutions

  • Employer Reporting

    Employer Reporting provides collaborative, high-tech health plan cost analysis tools and reporting that inspire more efficient and better-utilized benefits plans. With unprecedented transparency, health plans can aggregate, analyze and share plan-use analytics with employer groups as well as analyze the plan’s total population internally.

  • Medical and Medicaid Management

    Medical & Medicaid Management helps you identify critical patterns and correlations that reveal exactly where to find savings. By pinpointing areas to take strategic action, mitigate catastrophic claims and promote better health, health plan staff gain an improved understanding of cost and quality drivers and at-risk populations—fully equipping them to steer quality, timely care toward their highest cost members.

  • Population Health for Health Plans

    Population Health reveals the clinical opportunities that lead to healthier populations. Integrating claims, clinical and provider data, it enables health plans and providers to collaboratively deliver on the promise of risk- and value-based contracts.

Questions? Talk to one of our experts. Contact us