Delivering the value-based future today.

Healthcare Payer Solutions

Navigating Cost and Quality: A Balanced Approach

Health plans, insurance companies, managed care organizations, government agencies and, and other payers face an important challenge: driving cost control while also delivering top-quality care and improving health outcomes for their members.

Comprehensive healthcare payer solutions help organizations harness robust data analytics and management systems to streamline operations and reduce unnecessary expenditures.

Risk Adjustment: Mastering the Metrics of Optimized Care

Deliver advanced solutions for risk and quality management

• Assist finance, medical management, managed care, quality management, actuarial, and case management teams in risk analysis and adjustment
• Translate analytics into action with the help of our experience in risk adjustment, quality management, and provider engagement
• Top rated end-to-end Risk Adjustment vendor by KLAS in 2024

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Veradigm ChoiceRx

Transforming Prescription Decisions for Better Patient Outcomes

A fully automated solution that streamlines prescription decisions, helping providers identify low-cost alternatives while reducing patient burden and improving affordability.

• Seamless experience with no extra apps or signups for providers and patients
• Automatically identifies cost-saving alternatives without compromising care, including switches for specialty drugs and generic options
• Up to 10% reduction in pharmacy spend and 26% plan savings on initial analysis*
• 74% provider response rate ensures high engagement in switching to lower-cost therapeutically equivalent medications*
• Continuously updated for improved performance, deeper clinical coverage, and better patient outcomes, including support for 18 classes of specialty drugs

*Veradigm data on file, 2024.

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Comprehensive Submissions

Ensure accuracy and efficiency in data management

• Streamline the submission and reconciliation process for healthcare data, enhancing reliability across reporting and compliance tasks
• Utilize advanced tools and expertise to minimize errors and maximize reimbursement opportunities

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Quality Care: Elevating Standards, Enhancing Lives

Quality Analytics

Drive superior outcomes with healthcare payer data analytics for quality care

• Harness detailed insights to monitor and improve the quality of care delivered across various healthcare settings
• Empower your organization with actionable data to enhance patient outcomes, optimize provider performance, and comply with regulatory standards

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Provider Engagement: Connecting Care to Every Member

Veradigm Payerpath

Future-proof your risk adjustment and claims by bringing them together

• Compiling files from disparate systems into one standard file type through one streamlined connection point.
• Editing and suggesting corrections to transaction providers BEFORE they reach the payer’s adjudication system.
• Identify and hone in on data elements needed for new value-driven models.
• Protect yourself from RADV audits.
• Reduce provider troubleshooting, call time, and volume.
• Support enrollment and roster management.
• Provide intuitive reporting options.

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Veradigm Payer Insights

Improve outcomes for patients and minimize risk appropriately via care gap alerts at the point of care

Veradigm Payer Insights is an innovative solution that allows payers to deliver care gap alerts to their providers within the patient’s electronic health record (EHR). As part of a network of over 100 payers, these alerts include relevant, patient-specific considerations for the provider to evaluate, respond to, and address with the patient.

When practices use Veradigm Payer Insights, it helps payers to:

• Improve outcomes for patients and minimize risk appropriately, including those related to RADV
• Enhance performance on key quality measures like HEDIS scores and STAR ratings
• Satisfy provider demand for alerting that is integrated into their existing daily workflow

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Veradigm Collaborate

Optimize payer-provider interactions in order to choreograph gap closure efforts to be as efficient and effective as possible

Veradigm Collaborate offers solutions to address gaps in care related to a patient’s condition and quality of care, helping provider groups to code correctly and precisely, and to identify patients who require follow-up due to gaps in care or are at high risk.

Streamline payer-provider communications with efficient interactions that complement the provider workflow.

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Robust Healthcare Payer Software Solutions

Veradigm offers a robust healthcare payer platform that integrates advanced healthcare payer software with cutting-edge payer solutions software, designed to streamline operations for health plans and insurance companies.

Veradigm’s solutions apply to various healthcare payer analytics use cases, including risk adjustment, cost management, and quality care improvement, to provide the versatility and depth payers need.

Learn more about our healthcare payer technology solutions today.

Looking to learn more about Payer/Health Plan analytics?

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