Case Study: Community Health Options
Leveraging next-generation technology to optimize operationsand delight members and providers.
Transforming Healthcare Operations
Community Health Options (CHO), a provider-owned and community-based payer, has successfully transformed its operational processes through next-generation technology to meet the diverse demands of its stakeholders. With a mission to offer meaningful, affordable health benefits and promote wellness, CHO has meticulously built its infrastructure from the ground up. This includes in-house management of claims, utilization, medical, and care management.
Adopting Innovative Technology
Upon its inception in 2011 and under the Affordable Care Act’s co-op program, CHO had 18 months to become operational. This rapid timeline necessitated reliance on third-party vendors. However, in mid-2015, CHO re-evaluated its partnerships, internalizing many processes to improve efficiency and integration. Central to this transformation was adopting HealthEdge's HealthRules Payer platform for claims administration, enabling seamless integration, real-time data access, and robust reporting capabilities.
This strategic move allowed CHO to maintain a 99% average member satisfaction rate and retain 91% of its groups. By leveraging HealthRules Payer, CHO exemplifies how a payer transforms operational processes to enhance service delivery, achieve high member satisfaction, and remain competitive in today's market. Learn more about how CHO is setting new standards in healthcare with innovative technology and expert curation.
