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Health plans and other payers are confronting a growing need to manage risk more effectively and obtain greater value for every healthcare dollar. Our resources and proven experience help payers coordinate with providers and employers to find the right balance of risk and outcome-based value.

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Capabilities Payers Need for Value-Based Care Contracts

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Performance Analytics

Conduct prospective and retrospective analysis of adjudicated claims data by facility, provider, payer, procedure, and disease state. Identify actionable opportunities to reduce costs and improve performance in value-based contracts.

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Business Intelligence

Analyze healthcare data from both a clinical and financial perspective. Access industry standard reports, designed both for the casual user and the power user, that focus on utilization and cost for areas including location of service, diagnoses, procedures, providers, and drugs.

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Administrative Service

Outsource prospective or retrospective bundled payment programs to Cedar Gate. We will take-over the entire management process from start to finish, including network development, payer contracting, provider credentialing, contract design, performance reporting, and payment distribution.

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Care Management

Leverage a care management platform designed specifically for clinicians and healthcare professionals that assist health plan members and their families. Oversee care management activities that focused on wellness, disease management, case management, and utilization management, all from a single integrated platform.  In addition, a provider portal offers an integrated pathway to request service and pharmacy authorizations, and to review historical member information. Engage members through a dedicated health portal that supports personalized care gap notifications, health goals, health risk assessments, and incentive management.

End-to-End Solutions

Health Plans

Our technology enables government, commercial and private health plans to design, build, deploy, and analyze clinical and financial performance for defined populations. Health plans utilizing our platform are better prepared to respond to population health dynamics, to moderate their risk profile, while sustaining high-quality customer service.

Our solutions make operating all aspects of managed care services simple for Independent Physician Associations (IPAs), TPAs, health plans, and PACE clients. With a single, powerful platform, you can manage all providers and members across multiple companies, lines of business, and contracts. The system will scale with your business as it grows, enabling you to manage hundreds of customers, and millions of members.

Our integrated solution creates a centralized core administrative platform for auto-adjudication and workflow, comprehensive benefit administration, client-specific drill-down and analytics to drive a high value full-service offering.

Serving

payers

Payers

Manage risk more effectively and obtain greater value for every healthcare dollar.

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providers

Providers

Act on emerging opportunities to transform operations and improve financial performance.

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employers

Employers / ASOs

Recognize high-value innovation opportunities in healthcare with our help.

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Discover More

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Case Study

A Large National Payer Looking to Reduce Costs and Improve Provider Performance in Value-Based Arrangements

A large commercial payer with multiple clinically integrated networks engaged Cedar Gate to identify targeted opportunities…

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Press Releases

Cedar Gate Technologies Adds Appropriate Care Measures to its Value-based Care Analytics System

Developed by Dr. Martin Makary, the appropriate care measures identify clinical variations at the physician-level…

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Press Releases

Cedar Gate Technologies Named in Gartner’s Hype Cycle for U.S. Healthcare Payers, 2020

Cedar Gate Technologies Named in Gartner’s Hype Cycle for U.S. Healthcare Payers, 2020

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Client Press Releases

Cedar Gate Technologies Announces Partnership to Expand Value-based Care Programs for 650,000 People in Kansas City.

Cedar Gate’s analytic and bundled payment systems support payer-provider collaboration, so patients have greater access to affordable, quality care.

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SOLUTIONS

Cedar Gate’s enterprise performance management analytics and administration platforms reduce risk, enhance financial performance, and improve patient outcomes for healthcare organizations across the value-based care continuum.

Enterprise Data Management

Capture, organize, and utilize all valuable data sets securely and easily.

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Empower your team with timely information to take action and reach performance goals.

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Transform the way you report on your business with these intelligent tool sets.

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Support medical management activities across the care continuum.

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Manage patients effectively from chronic conditions to transitions of care.

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Administer retrospective and prospective bundled payment arrangements with clinical excellence.

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Operate multiple lines of business with claims and benefits administration, eligibility, capitation reconciliation, financial management and more.

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Extend your effectiveness with managed, professional, or advisory services.

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