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Payers

To succeed in today’s market, payers need smart data, not big data. HealthEC puts the power of smart data in the hands of payers so that they can collaborate with contracted providers to deliver quality, affordable care to members, improve quality measure performance, maximize value-based incentives, and attract and retain members.

HealthEC’s population health platform unifies and streamlines the management of complex healthcare data, providing payers with the information they need to address issues, such as unnecessary cost drivers and quality gaps. Equipped with cutting-edge technology, real-time data and access to HealthEC's KLAS-rated advisory services, payers can also compare performance across providers and assess the effectiveness of plan designs and pricing strategies. Payers gain valuable insights into their business and can easily:

  • Develop risk and performance management strategies based on clinical, financial and quality data as well as population demographics
  • Identify members for targeted care plans based on established clinical guidelines—and engage providers and members in those programs
  • Evaluate plan and provider performance across clinical, financial and operational metrics
  • Detect waste fraud and abuse
  • Generate reports in for quality improvement initiatives and data submission requirements

Medicare Advantage

To earn and maintain the Five-Star ratings that attract business and help fuel growth, Medicare Advantage (MA) plans must deliver the highest quality service to their members. This means improving not only the quality of care delivered, but also health outcomes and the member experience. Without visibility into member population data or a clear understanding of current risk and potential future risk among its members, MA plans lack the insight needed to manage effectively. HealthEC empowers MA plans with comprehensive data that allows them to risk-stratify members and coordinate with contracted providers on tailored care plans that engage and support members. It also allows plans to forecast likely costs of care, which helps to inform plan designs that meet members' evolving needs, such as medication adherence support, chronic disease management, wellness programs and concierge services. HealthEC helps MA plans keep unnecessary costs in check so they can provide sustainable value and tailored services to their members.

Find out how we help you achieve and sustain Five-Star status

Medicaid Managed Care Organizations

As changes to healthcare policy continue to impact the Medicaid market, it’s more important than ever that Medicaid Managed Care Organizations (MCO) have access to reliable population health data. HealthEC provides MCOs with comprehensive beneficiary data and flexible, leading-edge technology needed to meet evolving federal and state requirements while supporting the health and wellbeing of the nation’s most vulnerable populations. Armed with HealthEC’s population health platform, MCOs can easily risk-stratify their members and develop effective strategies to mitigate that risk. HealthEC helps MCOs and Medicaid providers tailor and coordinate care with 360-degree views of their beneficiaries’ needs, including those related to social determinant of health. Working together, MCOs and providers can engage and educate beneficiaries and connect them to the behavioral, clinical, and other support services needed while meeting value-based care goals of improving quality, accessibility and outcomes in the most cost-effective manner.

Learn how we can help your organization support Medicaid beneficiaries.

Self-Insured Employers

Having a healthy workforce means your business can run at peak capacity. Comprehensive and competitive health care benefits let you attract and retain the best talent on the market. But with the rising cost of care, how do employers offer attractive benefits while ensuring that healthcare costs are manageable? HealthEC gives employers and third-party administrators insight into employee healthcare expenses and the tools to manage those costs. Empowered with data, unified on a single, easy-to-use population health platform, employers can risk-stratify their employee pool and prioritize high-cost segments for tailored healthcare interventions. When engaged through interventions targeted at high-cost conditions and supported by a proactive program of preventive care, employees tend to stay healthier and experience fewer high-cost incidents, such as ED visits and hospital stays. This translates into greater satisfaction for them and lower overall costs for your business.

See how you can ensure a healthy workforce while keeping your costs competitive.