Our Network Transformation solutions comprise advanced analytic methodologies to conduct multi-dimensional “risk-adjusted” provider analyses – using quality, outcomes, costs, utilization, care/payment variation and coding factors – to pinpoint network/provider inefficiencies. Our platform also offers an ability to model innovative payment models and assess their impact on plan, population and providers prospectively.
Across all lines of business – MA, Medicaid and the HIXs – it is imperative that the most efficient way to drive sustained profitability and growth is to move toward value-based care. Toward that end, reconfiguring provider networks and implementing value-based payment models has been a key strategy for plans across the nation. Through our Provider Enablement solution, we enable payer-provider collaboration by deploying advanced technology, trained/experienced clinical staff and proven business processes. Provider/Network performance is tracked and reported on an ongoing basis to bring superior transparency to all the key stakeholders. Our Network Transformation solutions are EMR ready – with our proprietary EMR-Connectors – to automatically feed insights into EMR systems as well as retrieve the medical records on a near-real time basis.