Treat members as consumers. Collaborate with providers.
Be more agile.
Demand for transparency and interoperability are reshaping the business of healthcare.
The payer market is shifting from employers to consumers. You must collaborate with providers to identify new markets, improve service value and reduce costs. Trends in Consumer-Directed Health Plans (CDHP), lifetime medical IDs and payer-based health records (PBHR) requires alignment of information across multiple moving parts including applications, people and processes.
Optimizing information about members, providers and claims both within and across organization boundaries requires more than integration or aggregation. It requires rapid transition to a member and provider-centric strategy to transform your business - from contract to enrollment to claims reimbursement – both inside and outside your four walls.
Initiate has the experience and solutions to guide that transition.
Initiate® Payer Data Management is a proven foundation for delivering value to payer organizations. This solution leverages technology and best practices to:
- Provide member-centric services. Treat members as customers with transparent access to claim history and procedure costs to enable informed decisions about their healthcare.
- Leverage information across boundaries. Create an interoperable platform for sharing member and provider data across healthcare delivery organizations.
- Optimize provider relations. Improve communications and support pay-for-performance incentives by leveraging relationships across providers, contracts and claims.
- Detect fraudulent activity. Create a consolidated view across credentialing, contracting and member management to expose trends in fraudulent claims.
- Respond dynamically to a changing marketplace. Enable analytics against an accurate complete set of member information to make more informed business decisions.
- Transform service levels. Reduce the number of inquiry calls from providers and members to locate status or process of claim though transparency across parties.
- Reduce costs and increase efficiencies. Streamline claims processing and member enrollments, reducing the time spent tracking down information residing in disparate systems.
- Support multiple priorities with a single solution. Implement a single platform as a foundation for all member and provider initiatives to support data management, data stewardship and workflow.
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