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HealthEdge Source™ Horizons: Simplifying Value-Based Care Contracts & Reimbursements

Implementing value-based care has become crucial for many payers looking to enhance patient outcomes while managing costs. HealthEdge Source™ makes it easier for health plans to understand the value-based care landscape, streamline payments, and reduce inaccuracies.

Our five-part blog series, HealthEdge Source™ Horizons, highlights how our payment integrity solution helps healthcare payers adapt and scale to meet their organizational goals.

Read the entire series at the links below:

The shift to value-based care (VBC) raises the bar for care standards, establishing a healthcare system where quality and value take precedence. This approach aims to improve patient experiences, health outcomes, and cost efficiency while promoting preventive care.

However, navigating the complexities of a value-based care delivery system presents challenges for health plans.

Simplifying Value-Based Care with Payment Integrity Solutions

Modern payment integrity solutions offer the tools health plans need to thrive in the VBC environment. These solutions go beyond error prevention to ensure accurate reimbursements, optimize resource allocation, and strengthen relationships with providers.

These solutions enable health plans to extend their existing resources and analyze key historical data and coding patterns to identify wasteful practices, such as avoidable readmissions. Early detection enables payers to implement proactive interventions and collaborate with providers to reduce costs and improve patient outcomes through high-quality care delivery.

HealthEdge Source: An Innovative Approach to Simplifying Value-Based Care

The intricacies of value-based care contracts can be challenging for healthcare payers to understand and abide by. HealthEdge Source offers key features that reduce payment complexity for your plan:

  • Always Accurate Pricing: Bi-weekly updates provide up-to-date data for complex contracts, eliminating costly overpayments and underpayments.
  • Streamlined Workflow: A single platform for claims pricing, editing, and configuration simplifies customization and saves time.
  • Seamless Integration: Third-party content synchronizes to the platform, reducing administrative burdens and automating your operations.

In addition, the Source solution offers the flexibility to operate alongside traditional fee-for-service contracts. With customizable terms, a single configuration layer, and shared business rules, Source makes it easier for health plans to manage multiple scenarios.

Supporting All Payment Models: Prospective and Retrospective

No matter how your health plan approaches value-based care, Source has you covered. The solution handles both prospective and retrospective payment models, ensuring accuracy and efficiency in aligning payments with outcomes.

For prospective payment bundles, Source encourages efficiency by ensuring accurate payments for bundled care episodes, incentivizing quality improvement. When it comes to retrospective payment bundles, health plans can reconcile payments based on actual outcomes achieved, motivating providers to deliver high-quality care while controlling costs. This flexibility fosters collaboration and accountability, leading to better patient outcomes. 

Empowering Informed Decision-Making

Health plans must have access to updated intelligence and performance insights to remain flexible and compliant with regulations. HealthEdge Source empowers payers to make more informed strategic decisions with advanced tools like embedded analytics and predictive modeling.

With embedded analytics, centralized data lets you benchmark performance and model different VBC strategies. The modeling tool makes it easy to create multi-dimensional reports and “what-if” scenarios to compare provider claims against various contract terms. Payers gain real-time insights into the potential impact of edits, allowing for proactive decision-making. This data-driven approach ensures you’re making the best choices for your VBC initiatives.

Building Trust and Reducing Provider Abrasion

At the heart of HealthEdge Source lies a commitment to reducing provider abrasion, a common challenge in value-based care adoption. We demonstrate this commitment through:

  • Single Point of Management: Manage contracts, configurations, and payments in one place—eliminating the need to juggle multiple systems and simplifying communication with providers.
  • Transparency Breeds Trust: Real-time data access and clear reporting foster trust between you and your providers. This transparency promotes accountability, drives improvements in care delivery, and ultimately, leads to better patient outcomes.

With HealthEdge Source, you can build strong provider relationships that are key to thriving in the value-based ecosystem.

Holistically Addressing Value-Based Care Requirements

HealthEdge Source delivers a holistic solution that empowers payers to address obstacles throughout the value-based care journey. When using the Source payment integrity platform, health plans can expect access to:

  • Fair & Fast Payments: Eliminate errors and ensure providers receive accurate compensation on time, reducing frustration and fostering collaboration.
  • Smoother Operations: Consolidate multiple sources of payment integrity editing into one platform, minimizing internal resources and simplifying workflows for cost savings.
  • Enhanced Decision-Making: Gain full insights across all payment functions, empowering you to make informed business decisions.
  • Simplified Adjudication: Leverage a single platform for pricing and editing, leading to faster claim processing.
  • Beyond Basic Integrity: Access to a suite of additional solutions like modeling and analytics can root out the causes of key inefficiencies.

Don’t just survive the transition – thrive with a solution that simplifies complexity, ensures accurate reimbursements, and fosters collaboration for a future of quality, patient-centered care.

About the Author

Diana Nguyen is an experienced Product Marketing Manager at HealthEdge, based in Denver, Colorado. With over 2 years at HealthEdge, Diana has held various roles, including Market Research Marketing Manager, Partner & Services Marketing Manager, and Channel Marketing Manager. She currently focuses on driving market awareness and adoption of HealthEdge Source™, the industry-leading payment integrity solution that empowers payers to optimize claims accuracy, minimize errors, and maximize cost savings.

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