Solutions

Price transparency is designed to help consumers become smarter shoppers; however, determining the quality and appropriateness of care provided is one of the most critical parts of becoming a smarter healthcare shopper. Price transparency alone does not address this critical point. It may lead consumers to select care with providers at facilities that exhibit low-value care or even potentially higher-risk outcomes.

Many studies have shown that up to 30% of healthcare costs in the United States are spent on unnecessary tests and procedures. It’s imperative to realize that Price transparency alone does not protect the consumer from shopping for care that may not be needed and could have been avoided. For some people, cost may be the driving indicator when they choose a provider or facility. However, combining cost, quality, and appropriateness of care gives a much better indicator of the highest-value providers in a geographic area and can result in actual savings.

HealthCorum’s out of pocket calculator solution can be leveraged and integrated by mobile apps, vendors and TPAs alike.

HealthCorum ingest claims data from TPAs or TPA’s clients (when available) to enhance Price Transparency data for more accurate and up-to-date rates based on the direct experience of the client’s population.

For Example, we have experience with the following:

• Incorporating normalized price data from BUCAH MRFs for specific geography supplied by our channel partners.
• Normalize small regional health plan/network MRFs that do not usually conform to the CMS standard.
• Price data per procedure in MRFs are typically mapped to EINs, instead of individual provider NPIs, which might result in over subscribing facility’s procedures to each provider. As a part of the normalization efforts, we have developed solutions to address this issue.
• Augment Price Transparency with claims data (when available) to enhance PT data for more accurate and up-to-date rates based on the direct experience of the client’s population.
• Provide an API that delivers price points and quality ratings per provider/health plan (in development).

Referrals are vital in tracking patient flow and communication between primary care and specialty providers, yet these relationships are not always apparent. HealthCorum has developed a proprietary solution to identify referral activity based solely on information contained in insurance claims data. Clients use our referral insight to mitigate potentially harmful cascades of wasteful specialty care spending while minimizing network leakage.

Most physicians have a tremendous work ethic and treat their patients the best way they know, so it’s no surprise when performance improvement conversations become abrasive. Moreover, payers and providers often have access to varying degrees of information. HealthCorum understands the challenges underlining collaboration with providers. As such, we have designed tools, such as HealthCorum Provider Scorecard, that comprehensively convey vital metrics to build trust with the provider.