Healthcare Payer Solutions
We partner with payers to help them successfully navigate market trends, such as the rise of consumerism and value-based care, using our broad suite of solutions to address their strategic and operational priorities.
We help payers improve information sharing for better care coordination, risk analysis, and provider network management. We assist with decision support and clinical review, and provide a more comprehensive view of each member, population, and network.
Learn more about our clinical solutions
Our portfolio equips payers to better manage utilization and unit cost, as well as fraud, waste, and abuse. Our payment and data network solutions help health plans optimize provider networks, streamline payment efficiency, improve payment accuracy and revenue performance, and facilitate value-based care and payments.
Learn more about our financial solutions
Our comprehensive set of consumer-facing tools and services spans the consumer journey, from enrollment through billing to ongoing health management, to help payers better engage with members.
Learn more about our engagement solutions
Our solutions power payer consumer engagement initiatives:
Our consumer engagement platform helps more than 20 million consumers
Our quality solutions and care management services help payers comprehensively improve quality programs:
More than $60 million annual payer savings via large physician group closing quality gaps with our quality performance solution EMR Risk Advisor
Our solutions equip payers to manage utilization, unit cost, and fraud, waste, and abuse:
80% of outlier providers exhibit better billing behavior through our payment accuracy solution Coding Advisor
Our risk adjustment solutions help payers determine and validate condition data to improve risk scoring and health plan financial performance:
Approximately 3% increase in chart retrieval—averaging ~$1.5M revenue increase for plan
Our solutions can help payers create, optimize, and execute your value-based care and payment strategies:
In a joint venture with BCBS-AZ for shared savings contracts, we achieved about 2 times the provider recruitment goal in first year
Our solutions offer comprehensive payment processing and outsourcing services for key parts of payer operations
We are driving a more than 40% increase in adoption of electronic (ACH) payments, year-over-year
With the Intelligent Healthcare Platform powering our solutions, we're helping our customers tackle some of the biggest challenges in healthcare with increased collaboration, practical innovation, and problem solving at scale.