Case Study: Highmark WholeCare - Evolving Technology Solutions for Better Outcomes

Highmark Medicaid's Technology Solutions for Better Outcomes

Highmark Medicaid, a combination of Highmark Wholecare and Highmark Health Options of Delaware, is at the forefront of delivering a digital health plan designed to enhance adaptability, efficiency, and transparency in servicing members and providers. By leveraging advanced technology solutions, Highmark Medicaid aims to deliver a remarkable health experience that would be unattainable without a digital framework.

Key Highlights:

Adaptability and Transparency:

• Highmark Medicaid focuses on providing adaptable solutions that cater to the evolving needs of both members and providers.
• The digital health plan ensures transparent interactions, crucial for fostering trust and satisfaction among stakeholders.

Agility in Compliance:

• The necessity for agility has never been higher due to the complex and timely implementation of new federal programs and state-issued mandates.
• Highmark Medicaid’s agile approach guarantees the right solutions are provided, meeting regulatory demands efficiently.

Operational Excellence:

• The use of HealthEdge's capabilities has enabled Highmark Wholecare to significantly increase auto-adjudication rates.
• This advancement reduces transaction costs and enhances payment accuracy, ultimately providing a superior experience for providers.

Speed and Flexibility:

• Speed of configuration and flexibility to meet regulatory changes are pivotal benefits offered by HealthEdge.
• The time saved in configuring systems for new products and benefits allows resources to be reallocated to new initiatives within the Medicaid space, ensuring readiness to react swiftly to federal and state directives.

Seamless Integration:

• Highmark Medicaid anticipates tremendous value from the integration of households payer and guiding care, aiming for improved payment accuracy and reduced instances of over- or underpayment.
• This seamless integration is expected to enhance operational efficiency significantly by 2023.

Growth and Expansion:

• Time-to-market is essential for executing growth strategies. Highmark Medicaid's ability to quickly configure and launch new products and benefits ensures it meets the requirements of new markets efficiently.
• The robust capabilities of HealthEdge facilitate seamless IT and business operations integration, extending services to new members and markets effectively.

Highmark Medicaid's commitment to leveraging technology solutions for better outcomes is evident in its proactive approach to enhancing adaptability, efficiency, and transparency. By integrating advanced AI and digital tools, Highmark Medicaid is poised to redefine the healthcare experience for its members and providers, ensuring compliance, operational excellence, and sustainable growth.

For more information on how technology can revolutionize healthcare outcomes, visit our website and explore the range of services we offer.