ACO REACH and other CMS models challenge participants to manage risk in more equitable and evidence-based ways. This includes risk-adjusted capitation payments and health equity plans, and requires a complete suite of data, analytics, care, and payment technologies to succeed.
Our extensive data onboarding experience and deep relationships with hundreds of data vendors, including CMS, gives you the confidence that all relevant data is usable for the people, processes and technology across your ACO enterprise.
Advanced predictive and prescriptive analytics can help you better understand disparities and pinpoint HCC insights. Integrated care management and decision support functionality helps coordinate teams to proactively manage utilization and chronic conditions, and can help reduce variations in care. Our comprehensive capitation payment technology covers all aspects of claims adjudication.
Empowering primary care practices to proactively manage chronic conditions is a proven value-based care strategy. CMS reimburses providers who offer these important services.
Automatically enroll eligible patients in pre-configured care pathways in our Care Management application. Guide interdisciplinary care teams with tasks, questionnaires, and time tracking using important evidence-based insights and decision support. This task-based approach ensures that teams address and appropriately document all requirements.
Medicare Advantage is an important business line for payers. But changing demographics and member preferences – paired with a disruptive regulatory environment impacting rates, risk adjustment, star rating, and Part D plans – means payers need innovative technologies that helps organize clinical and administrative team around the needs and experiences of the member.
With data at the foundation of our platform, your claims, provider network EHR, and SDoH feeds are available for interdisciplinary teams across your enterprise. Surface MLR, HCC, and other population insights for decision makers to understand, and for care management and practice teams to act on. Efficiently adjudicate capitated claims in MA plans with tools that simplify even the most complex and nuanced alternative payment models.
Making Care Primary is designed to appeal to providers and medical groups that are not ready to participate in an accountable care organization (ACO). If you are one of these groups, you can benefit from focused and intuitive enabling technology with modular components that you can activate or adjust as needs change.
Our value-based care platform offers end-to-end capabilities, with integrated solutions connected through a common data lake. But our applications are also modular. That means your provider group can turn on specific functionality that aligns with your current needs and your existing ecosystem, enabling use cases in any of the three tracks of the MCP model.
PACE is an important model for managing the comprehensive needs of elderly patients that qualify for nursing home placement but prefer to remain in the community. Its rigorous care standards and patient-centric approach helps keep aging populations independent. Acute and chronic care management services meet participants wherever they are located.
Cedar Gate’s clinically-oriented care management and decision support tools integrate seamlessly with analytics. Generate cohorts by applying evidence-based, quality, and risk score methodologies to your data feeds, including EHR, claims, and SDoH. These insights become actionable in task- and time-based pathways with organized work lists for each team member. Our Capitation administration tools support the complete adjudication process, including integrated utilization and letters management.
Managing transitions of care is an important tenant of value-based care. These critical transitions are when patients are more likely to fall through the cracks, resulting in complications and costly hospital readmissions.
Our care management technology can automatically place discharged patients into care pathways that support care team activities and provide documentation through the entire care transition period.
In ACOs, provider networks often work out of multiple disparate EHRs. Our experienced data team can work hundreds of data vendors, sources, and types to normalize and make valuable patient or member data available throughout the applications on our platform. We can also share data with other point solutions in your technology ecosystem. Experience the seamless transition between information, insights, action, and administration when you combine our analytics, care, and payment technologies. Everyone in your organization, from business analysts and actuaries to care managers, providers, claims processors, and finance teams, can act on the same data.
CMS’ value-based models support and incentivize the progression towards greater clinical and financial risk sharing. Participants with the technology and skill to take on the most risk are often rewarded with the greatest financial upside. Our analytics uses historical information about your providers and beneficiary population to forecast performance according to the parameters of any risk-based contract. Identify cost and quality levers and model performance based on different measure attainment levels. When combined with our integrated care and payment tools, organizations can act on insights to proactively control risk.
When clinical and administrative teams act collaboratively on insights derived from a common data source, managing organizations can better align care delivery with the clinical and financial goals of the enterprise. Our care management tools assign cohorts to care pathways that support the coordinated actions of interdisciplinary teams to manage care, utilization, and outreach. Assign tasks according to professional license in organizations with multiple team members to ensure efficient and appropriate resource use and top-of-license care. Predefined program flows, with integrated tasks, time tracking, and communication tools reduce variations in care.
Alternative payment models like capitation and bundled payments require unique administrative steps, leading to a more complex adjudication process. Our bundles and capitation payment technology delivers streamlined capabilities for organizations that need to administer even the most complicated payment models. Reconcile expected versus actual payments, and analyze funds flow with integration between our payment and analytics technologies. Keep track of ever-changing attributed members with advanced and customizable reporting capabilities to ensure accurate payments.
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.