Eliminating costly and confusing benefit options

Tech solutions offering payer and provider collaboration enable the different entities to share and increase operational efficiencies by automating manual processes and eliminating redundancy to save operating time and costs. Collaborative technology allows vital administrative, clinical, and population health management information to be shared quickly for bi-directional information exchange between payer and provider networks. For example, payers can better manage costs through streamlined authorization workflows that facilitate expedited care founded on evidence-based practices.

Consolidating disparate data and health management

Through collaborative systems that combine technology and health care clinical expertise, providers and payers are better able to bring together disparate data points while enabling better workflow between providers, payers, caregivers, and patients.

A key benefit offered by clinically informed technology is a simplified prior authorization process and care plan. As medical policy guidelines and standards increase in complexity, this process can be burdensome for payers, providers, and patients. When these solutions are designed by professionals with first-hand experience submitting and facilitating prior authorizations, their expertise is invaluable in streamlining applications to exchange clinical, financial, and administrative documents in real-time, building trust between payers and providers.

More accessible collaboration

When membership verification and insurance coverage information is delivered in real-time, it's easier for provider offices to ensure they have access to detailed copayment, deductible, and benefits information.

Systems that combine technology with clinical health care expertise also provide tools for providers and payers to help manage reimbursement. Health plans can equip providers with access to the most up-to-date authorization and historical clinical information with the integration of electronic medical records (EMRs). These capabilities allow primary care physicians and specialists to guide patients and caregivers to the best quality providers and the optimal care plan at the most affordable cost.

Reducing fragmentation in care

This collaboration between technology and clinical expertise emphasizes improved patient outcomes and levels of satisfaction while simultaneously lowering total health care costs by reducing fragmentation within the system. The more integrated clinical knowledge is with technology designed to respond to real-world health care dynamics, the more quickly providers can move through different facets and stages of care.

Ultimately, payers and providers benefit from increased operational efficiency, streamlined communication, cost savings, and decreased administrative complexities. The fewer the challenges, redundancies, and misdirection for the patient, the better the experience toward a healthy outcome.

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Payers can embrace comprehensive solutions to ensure their members receive the best health care options in a changing health care system. Solutions that eliminate manual, error-prone processes and bring cohesion to clinicians and payer dynamics is the next evolution of health care.

Clarice Holmes, RN is Sr. Director, Clinical Knowledge Management, NantHealth.