Overview / Enroll Now!

With the accelerating shift to value-based care and as a result of not being able to engage fully with CMS payment, data and quality initiatives, both payers and providers are missing out on capturing bonuses, rebates and payment for patient services. In fact, it's estimated that through 2015 the industry saw $4B in missed quality-related payments and $22B in lost revenue due to inaccurate premium setting.

By improving collaboration between payers and providers, GE Healthcare can help providers deliver better care while receiving accurate payment for services needed and provided, while payers can be more confident that they are realizing the best care for their beneficiaries and return on their payments.


1. GE Healthcare analysis of data from Centers for Medicare and Medicaid Services 2016

Centricity Practice Solution EMR and Centricity EMR customers can enroll in Payer Provider Connect today at no cost*. Once your organization is enrolled, we'll set up the ability to share specific information from your Centricity Practice Solution or Centricity EMR system with participating payers.

To learn more about enrolling, please contact us today.

ENROLL NOW!


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Payers

Payer Provider Connect enables secure and near real-time data exchange between payers and providers to help optimize revenue and reduce operational costs for payers and providers serving the Medicare and Medicaid patient population.

Gaps in Care
Payer Provider Connect enables payers to share gaps in care information of Medicare/Medicaid and other managed patient populations with provider networks, enabling gaps to be closed in a timely manner and thereby improving the overall health of the population.

This new collaboration solution reduces manual effort of sharing gaps in care information and providing guidance to providers that optimizes revenue performance.

Risk Adjustment
Payer Provider Connect can help providers identify which problem codes are relevant to ensure that accurate Hierarchical Condition Categories (HCC) are used when submitting claims. Using the correct ICD-10 and HCC codes helps ensure accuracy of reporting and enables payers to receive more accurate payment rates and premiums.

Payers can benefit from particpating in Payer Provider Connect in the following ways:

  • Help ensure accurate Risk Adjustment Factors (RAF). For example, one study found that a 10% increase in RAF score can result in $75 per member per month increase in premium.1

  • Help improve and maintain CMS Star ratings for Medicare Advantage plans. One study found that a ½ STAR rating increment can result in an additional $25 per member per month in bonus and rebates from CMS.2

  • Help automate the process of gathering information on gaps in care, which in turn lowers the costs associated with managing the health plan.


1 GE sponsored Navigant blinded primary research study 2015
2 GE sponsored Navigant blinded primary research study 2015

Providers

Payer Provider Connect enables secure and near real-time data exchange between payers and providers to optimize revenue and reduce operational cost to both and payers and providers serving Medicare and Medicaid patient population. 

Gaps in Care
Payer Provider Connect can help providers improve their patients' health by alerting providers of care gaps the need to be addressed in a timely manner. This new collaboration solution reduces the manual effort required to share gaps in care information and provides guidance that optimizes revenue performance.

Risk Adjustment
Providers can recieve information from Payers to to provide guidance on which health problems are relevent to specific Hierarchical Condition Codes (HCC). The Risk Adjustment score determines payments and premiums for Medicare Advantage plans, Medicare Shared Savings ACOs, and ACA health plans. Providers benefit through this by using the right ICD-10 and HCC codes, ensuring accuracy of reporting and reimbursement.

Providers can benefit in the following ways:

  • Automate the process of collecting data to address to clinical data requests from payers, thus saving providers time and resources.

  • Providers engaged in global capitation arrangements and other at-risk payment and delivery models, can use quality improvements, data accuracy, and cost savings to negotiate contractual rates or quarterly incentives with payers that reflect these positive outcomes. In more traditional fee for service arrangements, addressing gaps in care during patient visits ensures better care and payment for all services provided to and needed by patients.

Patients

It's not just payers and providers that stand to benefit from more seamless communication, patients do as well. When information loops are complete, payers and providers can collaborate to close care gaps and monitor quality metrics through system automation, leaving more time and resources for patient care.

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Payers:

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GE Healthcare EMR and Practice Management clients: 

Enroll in Payer Provider Connect at no cost today!

Upcoming Events

AHIP’S National Conferences on Medicare, Medicaid & Duals
October 23 – 27, 2016  
Washington, D.C.

MGMA 2016 Annual Conference
October 30 - November 2, 2016
San Francisco, CA

HFMA 10th Annual Thought Leadership Retreat
October 20-21, 2016
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WEDI-Con 2016: A Capital Priority
November 7 - 9, 2016
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May 16-19, 2017
Boston, MA