Health Plans and Payers

Veradigm Provider Engagement Solutions

Engage Providers Respectfully and Efficiently for More Effective Gap Closures

With the transition from a fee-for-service to a value-based care model, healthcare providers (HCPs) are being reimbursed based upon the quality of patient care, rather than the quantity of care provided. This type of reimbursement depends upon their patients’ conditions being accurately coded; and accurate coding often depends on identifying risk and quality gaps.

Identifying gaps is only half the battle, though: closing them requires the active cooperation of the patient’s healthcare team. To maximize that cooperation, you need an approach that minimizes provider abrasion and alert fatigue. Veradigm Provider Engagement Solutions (formerly Collabor8) is one of a suite of solutions created to optimize payer-provider interactions in order to choreograph gap closure efforts to be as efficient and effective as possible.

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

  • Communicate more efficiently with providers via consolidated alerts for risk adjustment, quality, and pharmacy opportunities
  • Customize prioritization algorithms to deliver only the highest confidence level alerts
  • Configure multiple types of content for provider notifications with the maximum flexibility in types of alerts available
  • Enable Providers to close gaps and upload supporting documentation via a secure, self-service web portal—allowing faster gap closures and saving the expense of later Medical Record Review (MRR)
  • Reduce provider burden by minimizing workflow disruption and eliminating wasteful encounters

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Identify the Best Opportunities for Engagement

Veradigm Provider Engagement Solutions connects member-level risk adjustment and quality data at the provider and group level. These connections enable you to identify the specific providers or groups presenting the best opportunities for engagement, allowing you to use your outreach dollars most effectively.

  • Evaluate and benchmark provider groups and individual providers using the Veradigm Provider Engagement Solutions dashboard and scorecards, by variables ranging from case mix and clinical performance to coding efficacy and diagnostic capture rates, to identify those in need of education and/or engagement
  • Consolidate data from multiple risk adjustment and quality sources and aggregate into single-member alerts, one alert per member to minimize provider burden
  • Utilize confidence-based analytics to prioritize education outreach and targeting

Easy-Access Health Plan-Facing Output File and Dashboards

Analyze, prioritize, and benchmark data via the intuitive and easy-to-use health plan-facing dashboards. Veradigm Provider Engagement Solutions’ health plan-facing dashboards include metrics for opportunities for pharmacy, quality, and risk adjustment, including:

  • Output files
  • Provider opportunities
  • Member lists
  • Member clinical profiles
  • Provider report cards
  • Provider Alert program tracking

Dashboards with combined risk, quality, and pharmacy metrics assist you in identifying groups, providers, and members with the greatest overall impact—enabling you to determine your optimal focus priority. This assists you with reducing provider burden and minimizing wasteful encounters.

Dashboards also provide side-by-side views of opportunities across products to assist you in identifying practice-specific patterns, such as a group practice that exhibits poor abstracting and coding.

In addition, both telephone-based and web-based support ensures customer support services are available to help you make the most of all Veradigm Provider Engagement Solutions’ features.

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Deliver Value to Your Provider Network

When trying to communicate with providers, payers are competing for physicians’ time. Today’s physicians struggle to balance the demands of patient loads, administrative tasks, EHR use, and more. A new study reveals that physicians spend an average of over 16 minutes per patient visit in their EHRs, time that adds up to a significant portion of their day. For some specialties, that number is even higher.1

Veradigm Provider Engagement Solutions helps you better engage providers by streamlining payer-provider communications. It makes interactions more efficient with integrated alerts from all Pulse8 products. Veradigm Provider Engagement Solutions is also designed to integrate into multiple different workflows to minimize provider workflow disruption and offers Single Sign-On access from the existing provider portal.

Perhaps most importantly, Veradigm Provider Engagement Solutions encourages provider collaboration and engagement by delivering value to providers at multiple levels:

  • Improve patient quality of care and help providers close gaps: Notify providers about potential quality gaps with consolidated alerts
  • Facilitate communications: Between providers and health plan to assess, address, and close open gaps
  • Secure electronic document transfer: Easy to use alert upload functionality with document delivery
  • Close education gaps: Provide easily accessible, on-demand educational materials that reinforce providers’ critical role in Quality and Risk Adjustment programs
  • Support continuing education: For practice coding staff with easy access to American Academy of Professional Coders (AAPC) CEU-approved webinars

Veradigm Provider Engagement Solutions education program provides access to live webinars every month, attended by hundreds of clinicians and provider office staff. Educational opportunities also include 13 AAPC CEU-approved webinars contributing toward various certifications for practice coding staff.

Veradigm Provider Engagement Solutions’ combination of dashboards, alerts, educational opportunities, and other features together fuel a strategy that improves gap closure and reinforces the provider’s efforts in the face-to-face patient visit.

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References:

  1. Overhage JM, McCallie D. Physician Time Spent Using the Electronic Health Record During Outpatient Encounters. Annals of Internal Medicine®. February 4, 2020;172(3):169-174. doi:https://doi.org/10.7326/M18-3684.

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