Commercial Health Plans

Data interoperability and transparency ensures effective collaboration with providers, and quality and value for members. For commercial health plans to succeed, they require quality data processes to drive clinical best practices and evidence-based medicine, efficient care coordination and preventive services, and cost-management principles.

Providing Critical Insight into Performance and Risk

HealthEC aggregates and centralizes nearly 100% of all electronic information on a single platform, and applies decision support analytics to the data to help commercial health plans:

  • Analyze quality by physician, practice and organization
  • Examine service effectiveness and cost across providers
  • Identify risk and stratify the member population
  • Provide decision support tools to manage disease
  • Oversee the care of high-cost high-risk members
  • Engage and empower members in their own care

Simplifying HEDIS Reporting

Commercial health plans also face challenges with Healthcare Effectiveness Data and Information Set (HEDIS) reporting to the National Quality Foundation (NQF), including burdensome administrative tasks, inadequate reporting of scores by providers, and low preventive screening rates among provider networks.

HealthEC improves HEDIS reporting in the following ways:

  1. Submitting HEDIS measures on behalf of providers to commercial health plans
  2. Validating HEDIS measures for commercial health plans and eliminating up to 50% of data-confirmation costs
  3. Creating a population health registry
  4. Providing population health management tools to effectively engage consumers
  5. Informing the creation of financial incentives for providers during contracting discussions
  6. Delivering cost transparency

Collaborating with Providers to Manage Risk and Quality

Commercial health plan leaders looking to collaborate with provider networks and develop innovative reimbursement contracts can count on HealthEC for assistance. Our subject matter experts provide advisory services to help commercial health plans negotiate financial risk and quality performance metrics, and ensure that clinical decision support tools are adopted to inform cost-effective service decisions.

 

Advisory Services

Data and expertise to negotiate performance metrics and risk with providers

Population Health

Consumer engagement to improve health and wellness

Performance Reporting

Simplified HEDIS measure management and transparency

BECAUSE
RESULTS MATTER
HealthEC supports health plans in driving quality and value:
  • Augment data access and analytics efforts
  • Improve HEDIS reporting
  • Engage consumers in self-care and prevention
  • Inform the development of new provider contracts and terms
  • Drive greater member affinity