As the health care industry transitions from fee-for-service reimbursement to value-based reimbursement, your health plan must re-imagine its traditional relationship with health care providers. Payer-provider collaboration is the cornerstone of that new relationship. Our suite of provider engagement solutions is designed to align providers with your health plan's clinical and financial goals to produce the best outcomes for your enrollees.
Our robust technology solutions and services help you to mine your wealth of provider cost and quality data and extract actionable insights on the value your contracting providers are delivering. The data-driven insights can enable you to profile provider performance and identify outliers, conduct pay-for-performance modeling and adjudication and engage in pharmacy formulary compliance tracking and intervention. By transparently sharing your insights, you can motivate providers to adjust their behaviors toward your plan goals. Using our technologies and services, you also can automate the utilization management process with providers: sharing InterQual evidence-based clinical guidelines; agreeing to exceptions to utilization management rules; and setting up collaborative workflows to make clinical and coverage decisions as efficient as possible.
Your health plan wants the most effective treatment options at the lowest possible cost for members. Your contracting providers want the best clinical outcomes for their patients and fair and reasonable payment for their services. Through our solutions, your health plan will build relationships with providers that produce desired outcomes for both parties in a more collaborative, value-based, connected delivery system. With our product and insurance specialists, health plans can also coordinate care and supplies for members and place orders for those supplies.