Unlike legacy systems, Next-Gen CAPS like those offered by HealthEdge integrate seamlessly with third-party applications, offering more interoperable data and workflows across payer or third-party applications.
What are Next-Gen CAPS?
Unlike legacy systems, Next-Gen CAPS like those offered by HealthEdge:
● Integrate seamlessly with third-party applications, offering more interoperable data and workflows across payer or third-party applications
● Enable all users to see real-time data
● Enable flexible delivery methods including value-based contracts
● Are customized for each health plan and department including interfaces
● Allow all team members to access, edit and configure data independently, without IT support
● Effortlessly merge new and complex product lines
What Benefits do Next Gen CAPS Offer Over Previous Legacy Systems?
Comprehensively, these new features allow for:
● Lower transaction costs, freeing capital for innovation
● Improved data access including real-time data and transaction processing
● Streamlined operations that support agile regulation updates
● Greater customization in business models such as enabling value-based payments
● Higher security and more utilization of economies of scale
● Decreased reliance on IT or expensive professional services to update regulations
Why Will Next Gen CAPS Be Widely Adopted Within The Next Two Years?
There are a number of market influences making Next Gen CAPS like HealthEdge a must-have technology for payors in the coming months. These include:
- Payers diversifying their business models to include complex care delivery and retail vertical integrations
- More policy exceptions and innovations in areas like medical necessity and provider network alignment
- Regulatory mandates requiring payers to improve timeliness and transparency of administrative processes.
Why are Next-Gen CAPS Solutions Not Standard Technology Now?
The major reasons why Next-Gen CAPS systems have not already been widely adopted are:
- Conflicting payer business priorities
- Risk aversion
- Solution costs
- End-to-end implementation requirements, including replicating legacy processes
- Difficulty with configurability
How to Start Implementing Next-Gen CAPS At Your Health Plan?
When you are selecting a vendor for your Next-Gen CAPS system there are a number of important things to consider.
You should place greater importance on strategic CAPS capabilities versus those that are commodity.
Your teams should analyze whether licensed applications, Saas or business process outsourcing solutions for each CAPS capability are the best.
As well, health plans should make sure considered vendors have:
- New versions of CAPS as greenfield
- Good previous track record with your company to date
- Modular CAPS components for phased implementation
- Configurable interfaces
- Significant proof of concept in your primary market
Read the rest of the Gartner Hype Cycle report to learn more about Next-Gen CAPS like HealthEdge’s HealthRules Payor.
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