Creating healthcare benefit plans that encourage members to seek services from high-performing providers creates value by reducing costs and improving health outcomes. Designing value-based benefits plans is easier when you have the right tools at your disposal.
Our analytics capabilities help payers, employers, and advisors pinpoint and predict chronic conditions and utilization, and steer members to providers with the right performance attributes. With integrated care management and decision support, plan sponsors and administrators can align care delivery workflows to act-on analytics insights.
For many commercially insured populations, just a handful of conditions account for the majority of spend. Variations in care among providers make it challenging to forecast and control the cost of chronic condition management. When you can easily define episodes of care, it leads to more consistent, efficient, and high-quality care.
Our analytics, care, and payment solutions work together to support all aspects of bundle program design, operation, and optimization. Use our advanced analytics to model custom bundle definitions that account for unique provider and member attributes of a service region.
Episode-based and bundled payment models are proven ways to reduce the high cost of care and minimize variability for common procedures in your member population.
Our tools are designed to help you confidently design bundles. Build in appropriate inclusions, exclusions, trigger codes, pre- and post-timeframe, and stop-loss measures. Set accurate pricing with access to benchmarked data based on geographic region and provider reimbursement averages. Choose from a library of predefined bundles or customize your own based on unique population characteristics. Then use our analytics tools to monitor and optimize your bundles over time.
The benchmarking capabilities of our analytics products give you access to Medicare pricing data, as well as multi-year claims history for 12 million commercially insured members in our proprietary national Healthcare Benchmark Database. With access to this unique benchmarking capability, you can analyze true cost and quality data to understand potential savings. Use it to evaluate the impact of network exclusions such as narrow network design, member steerage, and changes to benefits design.
Forecast performance based on characteristics and performance of members and providers in your region with our self-service contract and bundles program modeling tool. It’s integrated into our value-based care analytics software, and utilizes the same algorithms and AI capabilities so you are empowered to pursue prospective bundles programs and other contracts with prospective provider payments. Select pre-packaged definitions from our curated bundle definition library and deploy them as is, or tweak them to take advantage of the attributes of your service region and market.
Our analytics solutions help you reliably compare actual provider performance with the mean performance of a region. This includes provider-level utilization metrics, and the ability to compare trends with other providers serving the same member group. Pinpoint opportunities to improve care and close care gaps using appropriate value-based care guidelines and embedded quality, episodic, and total cost of care measures.
As your data management solution partner, we have all of the necessary standards, safeguards, and accreditation, including HITRUST certification and a dedicated data security department. With end-to-end technology for any value-based care and payment model, you can add capabilities to pursue new lines of business while keeping all your data in our secure and centralized data lake.
Choosing the right technology can be a daunting task, but our experts are ready to assist.
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.