The results are in! Discover how our Capitation Adjudication solution helped an independent physician association revamp its strategic approach to Medicaid and Medicare programs and secure greater industry leadership in its mission of value-based care.
An independent physician association (IPA) client faced a challenge connecting and supporting a large, geographically dispersed provider network—comprised of 3,550 physicians and 1,300 Medicare Advantage (MA) providers—with a very diverse patient population. This IPA’s goal was to remain profitable, while improving administrative and care management efficiency in state Medicaid and Medicare programs, and to grow in market share.
To tackle this challenge, the provider implemented Cedar Gate Capitation Adjudication with the care management module, which automated pre-authorizations, referrals, and claims adjudication in 10 languages through secure data transmission. The software also provided tools for care managers to evaluate care options based on health risk and plan design.
The outcome was impressive, as the provider saw a 10% increase in claims processing efficiency, a 12% growth in membership, the addition of two health plans, and a 33% growth in its provider network without adding additional staff.
The provider achieved its strategic objective to grow its market position and improve administrative and care management efficiency through the implementation of the capitation adjudication software with a care management module. The software provided a solution to the unique challenges and delivered significant improvements in efficiency, growth, and profitability.
The provider was so pleased with the results that it was interested in extending the software’s capabilities to support a new Managed Services Organization. The provider also launched an MSSP ACO and is exploring the use of value-based care analytics to gain insights on the new risk-sharing arrangement.
Time to eliminate manual management of capitated payments and fee-for-service components. Engage a user-friendly, all-in-one solution that delivers complete adjudication capabilities for capitation management. This purpose-built suite of tools can administer capitated and fee-for-service payment models with ease—from contract configuration and eligibility management through adjudication and payment.
The right solution for your value-based journey is only a click away. Our modular technology is quickly and easily integrated into current systems and complements existing IT investments so that we can grow with you.