Payers

Implicit in the move towards value-based reimbursement, is the alignment of financial incentives between payer, employer and providers. This also creates an opportunity for payers to synchronize and align analytics and reporting between provider partners and employer clients. Fully dynamic dashboards with advanced visualization functional and mirror image reporting delivers an enterprise wide solution that will engage all key parties and lower plan-wide administrative cost.


Engagement

The transition to value-based arrangements introduces an opportunity for health plans to collaborate with clinicians and change the discussion away from fee schedule negotiations and towards quality improvement and program efficiency. We provide the tools to actively engage physicians in this process. Our complete suite of analytic services can also be deployed through the health plan, to the ACO in order to further enhance their chances of success. This represents a true market differentiator, which has proved successful in solidifying a number of arrangements.

  • Actively engage ACO physician leaders and foster an environment of collaboration.
  • Provide analytic insight targeting immediate ACO saving opportunities
  • Empower and improve internal ACO analytic skill sets
  • Improve ACO ability to improve quality reduce gaps in care

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Population Health

Inherent price variations for specific services can be identified at the local market level. By understanding these differentials, employers can design benefits that encourage efficiency. 

  • Identify provider price differentials to promote transparency and empower members
  • Track provider volume to assess value of bundled payment and case rate options.
  • Report price differentials by place of service to flag savings options
  • Measure center of excellence utilization by disease category to identify alternate reimbursement opportunities.

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Cost Drivers

Gain big-picture insight and collaborate with ACO partners in population health “Triple Aim” initiatives

  • Manage multiple population health initiatives
  • Track cost savings, utilization trends, and pmpm targets
  • Evaluate physician productivity against cost and quality benchmarks
  • Share and monitor success metrics with ACO partners

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Group Reporting

The transition to value will have a significant impact upon the employer market. This shift provides an immediate opportunity for payers to articulate the value of these programs, and engage employers.  

  • Redefine employer reporting to focus upon financial value and quality.
  • Create an “Educated Consumer” culture for employers by introducing referencing pricing, and bundled payments options that direct employees towards high savings opportunities.
  • Identify drivers of monthly variances to proactively address employer questions.
  • Empower health plan client service representatives with the information to flag unusual items, anticipate employer queries, and add meaningful value to the customer relationship. 

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Care Management

The value of your health plan’s care management efforts can be utilized to encourage and support ACO initiatives, or add additional value to the administrative services provided to large self-insured groups. The High Line Health analytic platform helps target the use of resources, estimate potential savings at the plan, ACO and employer level.

  • Develop chronic condition flags to focus care management initiatives
  • Provide health plan medical managers with advanced visual longitudinal view of high cost, high utilizing patients.
  • Deploy advanced predictive models to focus outreach opportunities and estimate potential savings.
  • Array plan wide performance statistics to identify best practices within ACO’s 

 


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Risk Mitigation

The successful transition to population health will require ACO partners that have gained success in managing risk based arrangements. This is an important opportunity for health plans to foster collaboration with ACO’s by utilizing their extensive experience in this area. We assist the health plan identify and separate risk that is uncontrollable by the healthcare providers. We also provide advanced prospective risk modeling for the early identification of potential high cost claims that may be favorable impacted by early case management.

  • Develop plan wide and ACO specific risk stratification reporting 
  • Differentiate between clinical risk and insurance risk in order to minimize inappropriate ACO exposure
  • Provide reporting to support internal stop-loss insurance programs.
  • Custom reporting for the early identification of potential catastrophic claims.

 


Payer Tour

The High Line Health suite of analytic services can be utilized internally, deployed to ACO partners. It can also be provided to large employer groups seeking to replace traditional employer reporting in order to assess and track change.