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HealthRules® Payer Horizons: Uncomplicate Value-Based Reimbursement

At HealthEdge®, when we think about value-based care, we think about it in two main parts: provider pricing and contracting, and member care delivery. It’s critical that your Core Administrative Processing System (CAPS) is adaptable to your health plan’s changing needs and can integrate with your existing ecosystem to streamline value-based care delivery and payment processing. In our five-part blog series, HealthRules® Payer Horizons, we showcase how our CAPS solution can help your health plan make the most of value-based reimbursements.

Read the entire series at the links below:

Streamline configurations and improve member satisfaction

The pivot to value-based care is not just a trend; it’s a significant shift necessitated by the urgent need to improve healthcare outcomes and patient experiences. The HealthRules® Payer solution suite can help simplify and streamline the transition.

1. Future-proof your plan with AI-enabled, cloud-based software

The move towards AI-enabled and cloud-based solutions represents a bold step away from traditional legacy systems that don’t always have the flexibility payers need to adjust to the healthcare market. This technological evolution enables health plans to adapt quickly to industry changes and regulatory requirements while also offering a scalable and reliable platform. HealthRules® Payer, with its intuitive design and cloud infrastructure, ensures health plans remain future-proof and ready to tackle challenges head-on.

2. Improve user understanding with the HealthRules Language

One of the most daunting aspects of integrating new technologies into your healthcare operations is the learning curve associated with adoption. The HealthRules Language, with its patented, English-like healthcare-specific vocabulary, addresses this challenge head-on. It democratizes the use of the application, making it accessible not just to IT professionals but also to business analysts, claims examiners, and customer service representatives. This universal understanding ensures seamless communication and operation across all departments, a critical component in delivering cohesive value-based care.

3. Quickly configure new benefit plans and contract arrangements

In the realm of value-based care, flexibility and speed are crucial. Health plans need to rapidly configure new benefit plans and adjust contract arrangements to stay competitive and responsive to market needs. The HealthRules Payer’s core administrative processing system and care management workflow solutions empower organizations to do just that. They enable the quick rollout of new products and benefits without the need for custom code or duplication of effort. This strength lies in the HealthRules Language’s ability to transparently define and manage complex configurations with ease.

4. Share actionable data with stakeholders

Value-based reimbursement models thrive on actionable data. The ability to share this data with stakeholders — from providers to members — ensures that everyone involved in the care continuum is informed and engaged. HealthRules Payer, through prospective payment integrity and enhanced member experience features, delivers precise and timely data. Consequently, health plans can make informed decisions, track performance against key performance metrics, and identify areas for improvement with unprecedented precision.

5. Realize value-based reimbursement & improved customer satisfaction

Ultimately, the goal of transitioning to value-based care reimbursement models is twofold: to enhance patient care and to achieve financial sustainability. With HealthRules Payer, health plans are witnessing real, measurable success in these areas. The platform boasts up to 96% billing accuracy even for claims incorporating complex value-based agreements. This accuracy not only mitigates financial risk but also improves customer satisfaction by delivering clear, understandable billing and benefits information.

The constant shifts in the healthcare industry demand innovative solutions, and HealthRules Payer is facilitating a smooth transition to value-based care reimbursement. Its unique blend of AI-enabled efficiency, the HealthRules Language, and configuration capabilities makes it an indispensable tool for health plan leaders aiming to excel in the healthcare market. By adopting HealthRules Payer, payers can ensure better outcomes for their members and set new standards in healthcare delivery.

Do you want to know more about how your health plan can drive quality performance and hit key benchmarks?

Read our brochure, “Health Plans With Home & Host Capabilities Are Market Leaders” to learn more about HealthRules Payer supports health plans with capabilities like support compliance, claims automation, and rapid implementation.