Medicare/ Medicaid

Payers

 

 

mP

Health plans now have more challenges, under the different value-based care contracts they are required to report, document and share data with providers, while managing their population health. Ensure Data Solutions provides a robust platform for health plans population health needs by managing aspects such as; care gaps, quality measures, clinical documentation, utilization and financial analytics. Healthcare organizations can share visibility of meaningful insight with providers and can create tasks/actions to suggest adjustments to medical records, in need of more complete and appropriate clinical documentation.

How Ensure can help:

  • Operate more efficiently by allowing your provider network to leverage improved workflows. {?}
  • Bidirectional EHR data exchange with providers to improve communication effectiveness, medical records requests distractions and patient’s health.
  • Improve data chart retrieval, to address lack of documentation and recognize missing codes.
  • Facilitate sharing of patient risk stratification to improve health outcomes.
  • Distinguish high performance networks to improve outcomes and care costs.
  • Monitor medication adherence real-time to comply with HEDIS measures.
  • Point to point EHR connection* alerts physicians of care gaps at the point of care.
  • Engage patients via AI-powered Digital Voice Assistant, to change members behaviors, educate and improve compliance with the treatment plans.
  • Stop loss analyzer to develop risk-bearing provider stop loss pricing (ESRD & non-ESRD).

Why Ensure Data Solutions

STARS/QUALITY PROGRAMS

Help predict and close care gaps, improve their CAHPS/HOS survey outcomes, and manage patient safety measures promptly with real time data.

INTEROPERABILITY COLLABORATION

Provide EHR integrations and FHIR interoperability to assertively collaborate on care gaps and other critical clinical information with other providers. Develop and deploy care treatments that enable the highest quality of care and improve outcomes.

STOP LOSS

Enable stop-loss analytics and stop-loss coverage decision-making.  Payer clients can develop their stop-loss pricing.  Provider clients can determine their optimal attachment point/threshold decisions.  Create alerts for provider clients of patients above or near attachment points that are switching carriers.

HIGH PERFORMANCE NETWORK

Compile the necessary data to identify capitation network leakages. Visualize and compare specialists’ cost efficiency performance.  Evaluate referrals issued by network providers.

FINANCIAL OUTCOMES

Key reports that turn data into actionable insights and generate tangible results. Ability to identify high costs, elevated trends and areas of opportunity. Financial trends and projections.