A strong relationship with a primary care provider can have a measurable impact on patient outcomes. Many payment models build on this foundational relationship by attributing patients to primary care providers with incentives for cost and quality attainment. Upside and downside risk corridors help primary care providers build confidence in managing greater risk in bundled and capitated payments.
Cedar Gate Analytics can help providers identify cost and quality opportunities within an attributed population, as well as the overall performance of providers in a network. Forecast performance in quality measures and shared savings models with contract modeling capabilities and analysis using historic provider and member data. These insights give your organization a better idea of the work required to achieve performance targets and shared savings. Our analytics tools can also help you identify populations that require attention by using clinical, claims, and other data sources. Once identified, your team can assign appropriate care management programs for unique population needs. Workflow and decision support tools ensure every member of a care team – including medical assistants, nurses, and providers – has the right task or insight, at the right time, for the greatest impact on care quality and outcomes.
Bundled payments package all the services related to an episode of care into a single fixed price. Capture new lines of business that generate value for payers, providers, and patients with tools to strategically define and price bundles according to the characteristics and needs of your region.
Cedar Gate has over 30 years of experience with bundles and helped pioneer the very first bundled payment programs in the United States. This technology was created to model, design, price, administer, and optimize prospective bundle programs. By adding a fully managed bundles program, our team makes it possible for provider networks to establish centers of excellence that are managed and operated on behalf of the organization.
Per-member, per-month (PMPM) capitated payments are a powerful way to control healthcare costs. Organizations administering or participating in capitation arrangements not only need tools capable of managing complex claims, but also deep visibility into the cost and quality opportunities that exist in their population to support better outcomes and mitigate costly utilization.
With three decades of experience and success supporting organizations in capitation agreements, these focused solutions deliver the functionality you need for the complete capitation adjudication process. That includes advanced data management, payment processing, and reimbursement software. These powerful analytics tools share a unified data lake, giving visibility into the flow of funds and profitability. Integrated care and utilization management capabilities align clinical and administrative functions around a person-centric care plan.
Formulating strategies to mitigate clinical and financial risk begins with data-derived insights. At the heart of our value-based care platform is a flexible and scalable data lake. Our dedicated data team helps onboard and refresh applicable data types from hundreds of sources and vendors. The result is a single source of truth with normalized data available to utilize across our integrated platform applications. Centralizing all your value-based data, analytics, care, and payment solutions with one vendor minimizes the chances of errors or duplicate work.
Forecast and visualize performance in APMs to understand and communicate the clinical and financial risk factors that will impact your bottom line. Surface insights related to quality, risk, leakage, and MLR, and spot and correct variations in trends. Automate distribution of reports and insights to network providers and stakeholders across the enterprise, bringing transparency to your goals and performance measurements. Prescriptive and predictive analytics expose new potential diagnoses and utilization patterns for your team to manage proactively. With the ability to view social determinants data, care managers can deliver appropriate and equitable care.
Helping care teams act on analytic insights is a requirement for any alterative payment model. Our care management tools assign members and patients to care pathways that empower care teams and providers to address treatment opportunities and close priority care gaps. Highlight potential record discrepancies and support evidence-based decision making with integrated clinical guidelines applied to EHR and payer data. Incorporate condition and care gap dashboards in the EHR to surface insights for providers within their traditional workflows.
Administering and adjudicating bundles and capitation claims is a nuanced process that most leading core administrative processing systems don’t support very well. This puts the burden and risk of creating manual workarounds on clinical and administrative teams. Our payment technologies were designed specifically for APMs, with proprietary technology to manage multiple provider contracts under a single ID, package and price claims, and process payments and reimbursements. With support from our Bundles Division, you can access comprehensive bundled payment services, including program design, management, and claims administration.
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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.