Payers and payment programmes
Healthcare payer solutions that have raised the industry standard
32 states
Our proprietary methodologies for payment, reporting, risk adjustment, or quality measurement are utilised by 32 U.S. states.
When value-based care is executed effectively, it enhances the lives of payers, patients, physicians — even communities. Our innovative solutions and services are trusted by government agencies, health plans, business partners, employers, and providers to help:
- Ensure appropriate reimbursement by categorising high-risk patients and identifying early intervention opportunities.
- Customise data insights for value-based care, reimbursement, and population healthcare management.
- Assist state payers in navigating regulatory changes, classifying patients, and grouping methodologies.
- Aggregate data from multiple sources, compare populations, and calculate the total cost of care to reveal the complete picture.
- Integrate solutions into current workflows to prevent undesirable outcomes.
- Stay current on regulatory and market initiatives like Medicaid and others that impact risk adjustment, payment reform, outcomes incentives, health equity, and more, through our resources.
- Convert mountains of data into action, to reduce costs and optimise reimbursements and other forms of payment.
$42B
Approximately $42 billion in managed care premiums are prospectively risk-adjusted using Solventum™ Clinical Risk Groups (CRGs) Classification System annually, according to a recent New York state study.opens in a new tab
51%
Reduction in potentially preventable complications by utilising Solventum™ Potentially Preventable Complications (PPCs) Classification System, in an assessment from Maryland Health Services.opens in a new tab
Healthcare payer solutions that make the most of your data
Data is important, but the expression is “Knowledge is power.” That’s because what changes the game is what you do with the data. In healthcare, that means turning information into action that saves money, identifies risk, adapts to regulatory changes and improves care quality.
We created population management platforms that aggregate data from various sources, compare populations and calculate the total cost of care so you have the complete picture. Organizations can derive valuable data insights to help reimagine care delivery and deliver sustainable process improvements.
More expert solutions for better healthcare
With the continued move from volume to value, you need to be able to evaluate population health and patient care by providing insights into patient mix, expected reimbursement and quality outcomes.
We offer a comprehensive analysis of health performance across providers and population segments, identifying strategic opportunities to improve value for your top organisational goals.