Help Improve Outcomes and Minimize Risk with Veradigm® Payer Insights

Blog Posts  |  31 July 2023

Written by: Cheryl Reifsnyder, PhD

Identifying and addressing gaps in patient care provides a valuable chance to improve patient outcomes, making it a high priority for providers and payers alike. Closing care gaps can help enhance a practice’s quality metrics as well as appropriately minimize risk. However, providers are not always aware of existing gaps. When gap information is not accessible at the point of care, during the provider’s normal clinical workflow for their patients, the potential positive impact on patient care is greatly reduced.

That’s why we’ve developed Veradigm Payer Insights. This dynamic new solution enables payers to deliver gap alerts to providers and their staff, using their electronic health records (EHRs) to reach them directly within their existing clinical workflow. Providers receive the gap information they need to evaluate their patients for potential health issues; payers gain a simple, user-friendly method for delivering gap information to providers when and where it can be used most effectively.

How Veradigm Payer Insights can change patient care

When Veradigm Payer Insights generates alerts for patient potential gaps in care, those alerts are integrated directly into individual patients’ electronic health records. This allows providers and their staff members to address alerts during their existing clinical workflows.

The process begins with Veradigm Payer Insights connecting to a practice’s EHR and pulling all relevant appointment information for each scheduled patient. This data is sent to payers, requesting that they respond with information regarding potential gaps in care for scheduled patients. Payers send back alerts for any identified gaps; providers and their staff are notified of alerts via a visual prompt when they open the associated patient record.

To view the alert, the provider and their staff click the visual prompt from within the patient record. This opens the Veradigm Payer Insights window and displays the alert(s) for that patient. The provider and their staff can review the alert, then provide feedback and supporting documentation from within the EHR as may be clinically appropriate. Their response is automatically communicated to the payer, completing the gap closure.

If needed, the payer can request the patient’s chart for supporting documentation. The chart will be pulled and delivered automatically and securely via Veradigm eChart Courier.

Provider benefits

There is an increasing demand from payers to communicate risk and quality gaps in care to providers. Previously, viewing this type of patient alert required providers and their support staff to proactively log in and out of multiple health plan portals. Depending on the variety of health plans a practice works with, providers and their staff had to manage multiple workflows to access the necessary information.

Veradigm Payer Insights streamlines this process by integrating alerts directly into the existing workflows of both providers and their support staff. As a result, providers and staff no longer have to waste time and energy searching for patient care gaps; instead, potential care gaps can be directly addressed during the existing patient care workflow.

If you want to improve patient outcomes, closing gaps in care is part of the solution. However, the current method for closing care gaps is a manual process that is time-consuming, error-prone, unsecure and can delay patient care. Veradigm Payer Insights can help improve patient outcomes by connecting your practice to an EHR-agnostic architecture as part of a network connecting to over 100 payers.

Creating a seamless avenue of communication about potential gaps in care reduces the pressure practice staff feel from the patients’ payers. Both providers and staff can feel greater confidence that they are meeting their patients’ needs and improving overall patient care.

Payer benefits

Veradigm Payer Insights enables payers to identify and access additional gaps—based on their criteria—using their providers’ EHR data. Payers can then generate alerts containing relevant, patient-specific considerations for the provider and their staff to evaluate, respond to, and potentially address with the patient.

Payers additionally benefit from Veradigm Payer Insights by gaining the ability to deliver potential care gap alerts to their providers directly within their patients’ electronic health records. This eliminates the need for providers and their staff to log into the payer portal to view gap information—a process that can be time-consuming and may or may not align with the relevant patient visits. Veradigm Payer Insights satisfies the provider demand for alerts that are integrated into their existing daily workflow for streamlined, user-friendly access.

Alerts integrated into the provider’s existing workflow are more likely to be seen and addressed when they are of greatest benefit. The result?

  • Potential improved patient outcomes
  • Minimized risk, including those related to Medicare Advantage Risk Adjustment Data Validation (RADV)
  • Enhanced performance on key quality measures, such as HEDIS scores and STAR ratings


Veradigm Payer Insights is available to healthcare providers at no additional cost. Implementation—also available at no additional cost to providers—is straightforward and usually accomplished in less than an hour. It involves activating the Veradigm Payer Insights app through Veradigm Connect, after which Veradigm Payer Insights connects automatically to the practice EHR. Veradigm support staff are available to help at every step of the process.

Want to see this dynamic new solution for yourself? We would be happy to discuss how Veradigm Payer Insights can help improve patient care, improve efficiency for physicians and staff, and strengthen your ability to reach your clinical and financial goals. Contact us today to learn more and schedule a demonstration!

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