HealthCorum offers a suite of solutions to help risk-bearing organizations and their patients achieve better outcomes while reducing the delivery of low-value care

Transparency Hub

The picture is clear – combined price and quality transparency solutions lead to better financial and clinical outcomes. HealthCorum’s Transparency Hub delivers comprehensive provider quality and appropriateness scores alongside price transparency data to be displayed in any provider search tool or directory. HealthCorum’s partners leverage this powerful solution to improve the provider selection process and optimize referral decisions.

HealthCorum’s Transparency Hub offers a variety of functionality, including:

Achieve Price Transparency Compliance

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As of January 2023, employers must now provide employees with an online shopping tool featuring 500 shoppable services and highlighting personalized out-of-pocket cost information for covered healthcare items and services.  HealthCorum can help you achieve the Price Transparency Compliance.

Process Regional MRFs & Claims Data

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As a market-leading middleware for healthcare price transparency solutions, HealthCorum has the know-how and experience in parsing and normalizing machine-readable files (MRF) from small to mid-size entities and provides the results through various delivery methods, including flat files or APIs.

Surface High-Value Providers

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HealthCorum benchmarks provider practice patterns and scores them based on how they compare to other similar providers in the same healthcare environment.

HealthCorum applies a combination of evidence-based clinical guidelines, clinical review, analysis of unwarranted variation, and specialty-specific definitions of low-value care to develop the risk-adjusted, population-based metrics that define its Value Score. Each provider is assigned to a peer group of similar providers based on their specialty, an analysis of their medical and pharmacy claims data, and their Hospital Referral Region (HRR). Metrics are calculated for each provider, then scored and ranked based on how they compare to their peers.

The level of transparent and accurate details provided through HealthCorum’s data, down to specialty and sub-specialty, sets the stage for better decision-making.

Match Selected Procedures to Provider Experience

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HealthCorum has nationwide scores for individual providers and facilities. The users can also search and sort providers who perform a specified procedure more within a certain geography or network. Our API returns the treatment count for a provider on a given procedure like Cataract surgery, Coronary artery bypass, Hip replacement surgery, etc.

Deliver Provider Quality & Appropriateness Scores

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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.

Calculate Out-of-Pocket Cost

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

Seamless Data Integration & Delivery

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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).

Network Optimization

HealthCorum scores and underlying insights help risk-bearing organizations optimize their provider networks by identifying the highest-value providers across every major specialty nationwide. Payers use HealthCorum’s s provider benchmarks and practice pattern analysis to create strategies that put the highest performing providers at the center of networks. They can design products, organize clinical programs, and coordinate sales and marketing efforts. The result: Payers can reduce their medical expenditures significantly, while patients receive “the right care at the right cost”.

Our reports and data can be accessed via API, SFTP or our executive Dashboards, for use cases such as:

Create, Optimize & Expand Networks

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HealthCorum helps you create new high-value provider networks, optimize and expand existing networks by identifying high-value providers and facilities nationwide. You can view data on all available providers and discover opportunities to reduce wasteful spending while maintaining high-quality care for members.

Gain Market Intelligence

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HealthCorum curates comprehensive market strategy reports, enabling stakeholders to match the appropriate risk arrangements based on provider practice patterns, population characteristics, and sociodemographic factors in a specific geography. Highlights include utilization and cost of procedures/drugs, chronic condition prevalence, population health factors, social determinants of health, and patient flow through the care continuum. HealthCorum’s Market Intelligence report is a comprehensive view of a market explicitly built for clients based on their scope. At-risk entities and their consultants utilize these reports to understand better the opportunity and risks associated with a market for expansion or repositioning.

Identify & Effectively Manage Referrals

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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.

Scorecards for Provider Collaboration

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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.

Data Analytics Services

Our team of data scientists have decades of experience in health data analytics, understands the challenges you face, and will help you develop data analytics solutions.

  • Private and publicly held healthcare companies rely on HealthCorum with their transformation to value-based care and adoption of price transparency solutions.
  • HealthCorum analyzes local market dynamics such as demographics, social determinants of health, typical patient health challenges, insurance coverage, independent versus employed physicians, and physician or hospital engagement.
  • Our healthcare analytics services will help you drive sustainable results with actionable insights and interventions.