A Healthcare Payer’s Future Depends on Vision, Efficiency, and Value.
Investing in Core Claims Administration Processing Systems is about delivering affordable value to subscribers, members, providers, and plan participants.
The revolutionary movement of healthcare reform continues to provide the healthcare payer market with new challenges of: costs and transparency, consumer experience, delivery system transformation, data and analytics, interoperability and consumer data access, next-generation payment models, accessible points of care, and privacy and security.
- Costs and transparency. Implementing strategies and tactics to address growth of medical and pharmaceutical costs and impacts to access and quality of care.
- Consumer experience. Understanding, addressing, and assuring that all consumer interactions and outcomes are easy, convenient, timely, streamlined, and cohesive so that health fits naturally into the “life flow” of every individual’s, families and community’s daily activities.
- Delivery system transformation. Operationalizing and scaling coordination and delivery system transformation of medical and non-medical services via partnerships and collaborations between healthcare and community-based organizations to overcome barriers including social determinants of health to effect better outcomes.
- Data and analytics. Leveraging advanced analytics and new sources of disparate, non-standard, unstructured, highly variable data (history, labs, Rx, sensors, mHealth, IoT, Socioeconomic, geographic, genomic, demographic, lifestyle behaviors) to improve health outcomes, reduce administrative burdens, and support transition from volume to value and facilitate individual/provider/payer effectiveness.
- Interoperability/consumer data access. Integrating and improving the exchange of member, payer, patient, provider data, and workflows to bring value of aggregated data and systems (EHR’s, HIE’s, financial, admin, and clinical data, etc.) on a near real-time and cost-effective basis to all stakeholders equitably.
- Next-generation payment models. Developing and integrating technical and operational infrastructure and programs for a more collaborative and equitable approach to manage costs, sharing risk and enhanced quality outcomes in the transition from volume to value (bundled payment, episodes of care, shared savings, risk-sharing, etc.).
- Accessible points of care. Telehealth, mHealth, wearables, digital devices, retail clinics, home-based care, micro-hospitals; and acceptance of these and other initiatives moving care closer to home and office.
- Healthcare policy. Dealing with repeal/replace/modification of current healthcare policy, regulations, political uncertainty/antagonism and lack of a disciplined regulatory process. Medicare-for-All, single payer, Medicare/Medicaid buy-in, block grants, surprise billing, provider directories, association health plans, and short-term policies, FHIR standards, and other mandates.
- Privacy/security. Staying ahead of cybersecurity threats on the privacy of consumer and other healthcare information to enhance consumer trust in sharing data. Staying current with changing landscape of federal and state privacy laws.
MHC Products Group’s intellicare 2020 Core Claims Administration Processing System state of the art solution, provides you with a enterprise platform to manage these Critical Success Factors
- Flexible Financial Management: The ability to manage the in-flow and out-flow of premiums, reimbursements, and effective electronic financial transactions is critical in a world where every dollar for health care is scrutinized, tracked, and measured. intellicare delivers a 5010 HIPAA gateway, ICD10 readiness, extensive audit control, and flexible reporting, dashboards and analytics for modeling and tracking financial performance.
- Efficient Operational Performance: Designed on continuous process improvement philosophies of the quality movement, intellicare is designed by experienced healthcare payer and vendor professionals who understand the complexities of plan administration, claims processing, contract management, provider relations, and regulatory compliance. An integrated approach to information management along with strong, flexible reporting give intellicare significant value to the payer, the provider network, and the plan participants.
- Creative Member Interaction: Among intellicare unique capabilities is the capacity to retrieve and gather information quickly in order to resolve a provider billing issue, answer a member question, adjudicate a claim, or address a referral or pre-authorization. intellicare gives healthcare payers a powerful solution to keep members engaged, informed, and directed within an effective and highly optimized care process resulting in quality outcomes. It also provides a framework to integrate clinical and administrative information along with workflow driven processes across the payers operational and financial departments.
MHC Products Group’s intellicare Core Claims Administration Processing System Empowers Vision, Creates Efficiency, and Delivers Value for an affordable price.