Innovative Episode Benefit Plans
Our solutions enable payers to underwrite, sell and administer episode-based insurance products for the commercial and Medicare markets. They encourage greater competition among providers and drive performance measurement and price/quality transparency.
These plan designs create a competitive advantage by controlling costs and more effectively engaging specialists and enrolled members in decisions related to the delivery and consumption of healthcare. To help drive enrollment growth, these competitive new insurance plans achieve the price points of narrow networks without narrowing provider selection at enrollment.
Solutions to Administer Retrospective or Prospective Bundled Payments
Claims Data Management
Establish Target Prices
Provider Bid Packages, Webinars and Coaching
Conduct Reconciliations
Establish and Administer Program Rules
Financial Reporting
Our Payer Software and Content Assets
S O F T W A R E
Episode Benefit Plan Administration
- Claims handling software, including pend,
suspend and assign logic for episode benefit plans - Benefits admin module
- Bundling engines
- Prior authorization tools for discharge to
appropriate setting
Bundled Payment Administration
- Episode Connect portals enable visibility into
patient status, treatment plans and transitions - Cloud-based storage and delivery for easy
deployment and operations - Decision support tools based on machine learning algorithms to stratify patients by level of risk, predict patient assignment to DRGs and the patient’s risk of readmission
C O N T E N T
Episodes
- Episode definitions: 382 proprietary definitions, including 177 procedural and 205 medical bundle definitions
- Episode grouper engines
- Episode pricing methodologies
Contracting
- Physician engagement strategy and content
- Contract Library
Episode Benefit Plans
- Claims adjudication logic
- Regulatory filings for product riders
- Premium rating methodologies