MedeAnalytics launches new tool to improve operational efficiency for health plans and hospitals

Today MedeAnalytics, a leading provider of healthcare performance management solutions, introduced its new Provider Engagement solution, a dynamic tool that helps improve operational efficiency for health plans and hospitals, and positions health plans to successfully participate in the Affordable Care Act's (ACA) permanent risk adjustment program for qualified health plans' individual and small group members, both inside and outside health insurance exchanges. The solution was introduced at America's Health Insurance Plans (AHIP) Institute 2013 in Las Vegas, Nev.

Powerful Marketplace Advantage 

"By enabling financial and operational transparency, MedeAnalytics' Provider Engagement solution helps improve communication between health plans and providers," said Michelle Sieling, MedeAnalytics' senior director of product marketing. "The solution addresses providers' and health plans' need to have a view into the claims life cycle, risk scores, and management of value-based contracts. Bottom line, it creates a powerful marketplace advantage that sets the foundation for improved operational efficiency and successful participation in the ACA's permanent risk adjustment program." Sieling noted that the solution calculates and predicts the risk score for ACA permanent risk adjustment program populations by using the federally certified risk adjustment methodology or the alternative certified risk adjustment model chosen by a state health insurance exchange and Medicare Advantage.

ACA Risk Adjustment Program Participation: Solution's Core Drivers of Value

• Fully integrated and data-driven provider engagement analytics and reporting solution to support Medicaid, Medicare Advantage and commercial populations
• Ability to monitor, analyze and report HHS-adjusted risk scores
• Standard solution that is highly adaptable, with rapid development cycles that can be tailored to any state-approved model
• Collaboration between the health plan and providers through online analytics and reporting to support provider engagement regarding HHS risk scores, operational transparency, and management of value-based contracts

Provider Engagement Solution Supports Value-Based Contracting
MedeAnalytics' Provider Engagement solution enables payment modeling to support risk-, performance- and administrative-based programs. Provider performance analytics evaluates providers according to their cost, quality and efficiency. Population health management enables the promotion of evidence-based medicine, patient engagement, and care coordination with providers. These analyses enable network management business staff to design narrow networks, assess provider quality and efficiency, design and monitor pay-for-performance initiatives, and support accountable care.