Value Based Care Managed Services

HealthEC facilitates an organization’s transition from fee-for-service to value-based care models by providing the infrastructure, resources and strategic guidance to improve patient outcomes and reduce costs.

Recognizing the enormous opportunities clients have to optimize their population health management strategy, HealthEC also provides consulting services. We offer a full portfolio of solutions to help clients manage their provider network, health plan contracts, analytics, and performance of the value-based business – while proactively improving population health through care coordination, disease management and patient education.

Whether providers require assistance managing 5,000 or 5 millions lives, our robust consulting and managed services capabilities produce measurable clinical and financial outcomes, and support the following risk-based programs:

  • Bundled payments
  • Capitation
  • Commercial exchanges
  • Health plan partnerships
  • Medicaid
  • Medicare Advantage
  • Medicare Shared Savings Programs (MSSP)
  • Provider-sponsored health plans

Comprehensive Population Health Management Technology Platform

HealthEC offers a comprehensive, KLAS-recognized population health management solution. The suite integrates all electronic patient data (any system, any setting of care, and in any format) and applies sophisticated analytics to identify provider-specific patterns and guide patient care interventions. Our platform helps customers coordinate care and maximize incentive payments by identifying and managing high-risk and chronically-ill patients, and addressing gaps in care. Sophisticated care models simplify clinical workflow, engage patients, and optimize performance to support quality measure reporting.

Consulting Services

HealthEC’s value-based care consulting services address critical operational issues while leveraging opportunities throughout the enterprise. Our subject matter experts help healthcare leaders drive process change, align teams, engage providers, standardize care models, and define success metrics and measurements.

Armed with performance data and innovative population health management strategies, HealthEC helps organizations articulate their value proposition to health plans. Further, by creating an environment that supports contract negotiations with payers, organizations are empowered to define strengths, describe current performance against benchmarks, recognize opportunities for improvement, and evaluate the potential impact of shared savings and risk-based terms.

HealthEC can also help providers join Advanced Alternate Payment Model (APM) CMS programs such as the Oncology Care Model (OCM), Comprehensive Primary Care Plus (CPC+) and Million Hearts.

Clinical Care Management

HealthEC can provide staff augmentation or full outsourcing to seamlessly coordinate case management, disease management, utilization, and health and wellness activities. Our solutions promote efficient workflow by stratifying patient risk and prioritizing workflow activities.

Supported by HealthEC, care teams (patient navigators, health educators, social workers and/or pharmacists) collaborate with physicians to conduct patient outreach, gather detailed assessment data, manage individualized care plans, close care gaps, coordinate access to resources, and facilitate care transitions.

HealthEC can also facilitate care management strategies, including:

  • Designing and implementing effective, efficient population health management programs
  • Assisting with medical decision making for high-risk patient groups
  • Recommending cost reduction and quality improvement initiatives to the management team
  • Developing clinical care policies and procedures
  • Implementing practice transformation initiatives to improve throughput, eliminate redundancy, and engage employees
  • Coordinating physician engagement for practice transformation programs
  • Serving as liaison to medical directors

Administrative Services

HealthEC provides full administrative services to support organizations in their value-based care journey, including:

  • Network expansion and clinician recruitment based on the geographic distribution of current and target membership, as well as member-to-provider ratios
  • Quality reporting for all programs, such as the Healthcare Effectiveness Data and Information Set (HEDIS), MSSP, Merit-Based Incentive Payment System / Medicare Access and CHIP Reauthorization Act of 2015 (MIPS/MACRA), State-based Health Homes programs, Prevention Quality Indicators (PQI), Accountable Care Organizations (ACOs), etc.
  • Performance improvement management to identify workflow adjustments and positively impact care delivery objectives
  • Education programs to support clinical transformation efforts
  • Contract management to ensure compliance, oversight and completion of appropriate documentation
  • Financial management to coordinate budgets, revenue cycle and billing
  • Distribution of shared savings based upon performance at the National Provider Identifier (NPI) level

Proven Results

Confident in our ability to deliver results, HealthEC will assume risk in exchange for an interest in savings, based on performance.

HealthEC has produced measurable clinical and financial results for ACOs/CINs/IPAs across the nation, as well as commercial, Medicare and Medicaid payers, including:

  • Up to a $500 reduction in per beneficiary per year (PBPY) costs
  • 14.7% reduction in hospital admissions
  • 10% decrease in 30-day readmissions
  • 6.25% decrease in inpatient costs
  • 8.3% reduction in ER visits
  • 29.3% decrease in skilled nursing facility bed days
  • 10% reduction in duplicate and unnecessary tests
HealthEC supports value-based care programs with comprehensive managed services that:
  • Improve clinical outcomes
  • Decrease healthcare delivery costs
  • Enhance patient satisfaction
  • Increase clinician satisfaction
  • Improve an organization’s ability to secure additional risk-based contracts