Solutions for Payers

For payer organizations seeking to bridge the information gap between provider networks and the health plan, our analytics, care management, and core administration applications leverage a unified data lake and a collaborative care management platform. We support a collaborative approach to value-based care with more informed decision making about treatment options and reducing the total cost of care by eliminating unnecessary interventions.

Payers

The Platform for Payer-Provider Collaboration. Our payer solutions draw from single, unified data lake. Claims, Clinical, and SDoH data are combined, normalized, enhanced and made available to business and clinical teams for informed, collaborative decision-making. A composable technology architecture means our platform and applications can be adapted to compliment your current analytics, care management, or capitation administration solutions.

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A Customer-First Commitment. We’ve been named Best in KLAS for Population Health for the last three of five years. Cedar Gate is bringing the same commitment to customer success in value-based care to our health plan clients. From contracting to project planning, from strategy to implementation and the realization of program objectives, our Client Success Team is your partner every step of the way.

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Reaching for the Future. We are innovators — challenging, but not disrupting the status quo. Our technology platform is the realization of a forward-looking strategy that has yielded a complete and composable technology architecture. The technical excellence of the software and the expertise of our people is creating a new standard in the industry — supporting payers and providers collaborating in the pursuit of a value-based care future.

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ALIGN PROVIDER ACTIVITIES WITH FINANCIAL OBJECTIVES

To remain profitable and competitive in a value-based care environment, health plans are establishing relationships with provider organizations. To enable this new reality, payers must focus on applications that are designed for payer provider partnerships. Our unified care management, care coordination, and enterprise data management solutions deploy analytics insights directly into the workflow. This helps ensure that provider activities are aligned between disparate teams and support the clinical and financial objectives of the health plan.

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AUTOMATED & SELF-SERVICE CLAIMS ADJUDICATION

Health plans managing alternative payment models are burdened with legacy enterprise systems that lack focused support for value-based care use cases. Cedar Gate’s capitation administration applications deliver the right features to tackle capitated and quality oriented fee-for-service arrangements, with the ability to extend functionality as needed. They feature self-service tools that increase the efficiency of financial managers by automating pre-authorizations, claims adjudication, and payment reconciliation.

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Access Robust Administration Features

Payers demand a breadth of high-quality functions that help them drive efficiency across multiple dimensions. We offer a comprehensive data interchange and adjudication functions that are modular. They can be turned on as needed, helping maintain affordable entry and operational costs.

Take Advantage Of A Self Service Tool Set

Complex and inflexible administrative systems can require consulting arrangements to establish and update data connections. Our solution empower clients with self-service interface and electronic data interchange capabilities, ensuring the right information is accessible for administrators and shared within the partner ecosystem.

Reconcile Payments

Unpredictable and inaccurate collections create financial challenges for the organization, including overreliance on lines of credit. Our capitation claims administration solution verifies that organizations are receiving correct payments by reconciling actual payments with expected payments on a member/month basis.

Automate Repetitive Tasks

Processes such as authorizations and referrals are time and resource intensive. Our capitation administration application determines eligibility. Auto-adjudication tables approve or deny authorizations and auto-generate the required correspondence.

ANALYTICS FOR PAYER PROVIDER PARTNERSHIPS

Payer organizations engaged in value-based care are forging deeper relationships with high-performance provider groups and healthcare delivery organizations. Aligning data and analytics capabilities across the enterprise and the partner ecosystem will reduce variation, generate cohesion, and power a coordinated approach to new care delivery and reimbursement models. Our analytics applications empower actuaries and clinical teams to design and optimize value-based care contracts across the spectrum of advanced payment models.

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Achieve Strategic Objectives

Differentiation from the competition with more effective value-based care offerings is an increasingly important objective for payers because it can help grow membership. Our analytics offerings can fulfil strategic value-based care goals and initiatives with tools that enable both payer and provider organizations to work in concert to design, build, and optimize contract terms in any advanced alternative payment model.

Build Trust With Providers

Provider partnerships represent a pathway to success in value-based care programs, and helping providers trust the data is crucial. Our analytics tools allow payers to give providers the ability to share and drill down into their own data with a focused view of areas of improvement. This functionality extends self-service root cause analysis to providers and support productive and transparent relations.

Test-Drive Contract Parameters

In value-based care payment models, it’s important for payers to be proactive, not reactive. We offer workflow tools that models and saves contract parameters, centralizing a job that is currently performed by multiple employees. Users also have the flexibility to manually tweak measures and put proposed parameters through a structured review process.

Create Situational Analyses

It’s important for payers to be able to incorporate local knowledge into how data is analyzed, and insights are identified. We enable users to define what is actionable based on relationships and regional dynamics. The insights can be tailored and displayed in customized dashboards and configured in a way that allows provider partners to have more trust in the insights.

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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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EXPLORE SOLUTIONS

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. Learn more today!

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