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Webinar: Leveraging Clinical Expertise and Compliance Support to Serve Your Most Vulnerable Members

Leveraging Compliance Support to Serve Your Most Vulnerable Members

Key Highlights

1. Introduction and Housekeeping

  • This webinar complies with ACAP antitrust guidelines, which can be viewed on our website.
  • The session will be recorded and available along with the slide deck on the event showcase.
  • Participants can ask questions at any time using the Q&A feature in Zoom.

2. Meet Our Presenters

  • Sarah Anderson - Director of Clinical Operations at HealthEdge with nearly 15 years of experience in healthcare IT.
  • Amy Bannister - Director of Clinical Operations, celebrating 20 years in health IT, and over six years with HealthEdge.
  • Amy Smith - Senior Director of Business Intelligence for The Guiding Application, with over 20 years of experience in healthcare analytics and implementations.

3. HealthEdge's Mission and Vision

  • Mission: To drive digital transformation in healthcare through transaction automation and real-time business and clinical engagement among healthcare payers, providers, and members.
  • Vision: Innovating a world where healthcare can focus on people, supported by a comprehensive suite of digital products.

4. HealthEdge Solutions

  • HealthRules Payer: Core claims administrative processing platform with 99% accuracy in auto-adjudication, adaptable to regulatory shifts, and enabling value-based reimbursement models.
  • Source: Payment integrity solution encompassing first-pass edits, pricing bundling, and contract modeling, ensuring seamless transaction control.
  • GuidingCare: Comprehensive care management solution supporting patient-centered care, including modules for case management, disease management, utilization management, and more.
  • Wellframe: Digital member engagement tool modernizing services like care management and advocacy through continuous two-way support.

5. Serving Medicaid and Medicare Members

  • HealthEdge's GuidingCare platform is used nationwide to streamline care management workflows and promote engagement for millions of members.
  • Supporting nearly 10 million ACAP members, including Medicaid plans in 35 states, 29 SNP plans, and 14 MLTSS plans.
  • Providing mission-critical workflow solutions by aggregating data from various sources to ensure comprehensive member care.

6. Future Outlook

  • Despite a projected decrease in Medicaid members in 2024, Medicaid and Medicare are expected to grow in the coming years.
  • HealthEdge remains vigilant in managing the complexities of these growing populations, empowering customers to effectively compete and stay resilient in an evolving healthcare landscape.

To learn more about how HealthEdge can help your organization leverage clinical expertise and compliance support to serve your most vulnerable members, visit our website and connect with us today.