by Sanju Pratap, Director of Payer Product Management at Emdeon
Healthcare is experiencing a retail-style transformation. Benefit, health and consumer oriented information are converging and being delivered at the point of care. Because of this, the point of healthcare service has evolved into a very teachable and effective moment- shaping behaviors and influencing outcomes... all of which directly contribute to downstream administrative and medical cost savings for payers.
In a market where efficiencies equate to increases in the bottom line, payers continuously look for additional solutions where they can do more with minimal resources. Emdeon has recently launched a Member Management product category - a suite of solutions designed to greatly reduce downstream administrative and medical costs by leveraging Emdeon’s eligibility-driven solutions and provider reach, payers’ benefit information and the provider workflow to create healthcare efficiencies upstream in the process.
Imagine using one silver bullet, your members’ eligibility & benefit data set, to address multiple market challenges upstream, at the point of service. That’s what payers can do with Member Management! Here are just a few of the key features and benefits:
Eligibility, authorizations, claim status and other related real-time inquiries are often viewed as just another communication requirement for interaction with providers. But by leveraging that information and workflow to enable real-time transactions, payers can use those transactions to also address the evolving pre-care administrative and medical information needs.
• Address multiple challenges with minimal and streamlined development & operational investment
• Improve member care management
• Enhance provider, member and employer group relations by enabling transparency, self service and a reduction in claim denials
• Comply with growing federal & state regulatory compliance – ie: HIPAA, CORE and State regulations
• Increase EDI & auto-adjudication rates
• Reduce waste & cost via proactive coordination of benefits and pre-adjudication services
Emdeon has helped payers ranging in size from 1,000 to several million members leverage Emdeon eligibility-based solutions to achieve HIPAA compliance, improve self-service via increased EDI transactions and web based portals, and increase auto-adjudication rates. These same payers are beginning to leverage existing solutions and operational processes to provide care management, transparency, coordination of benefit solutions and achieve compliance for the growing regulatory requirements.
Emdeon Member Management is a comprehensive approach fueled by the convergence of core healthcare transactions, benefit information management, constituent engagement and care coordination to address as many healthcare challenges as possible upstream in the process by leveraging existing provider, member and payer workflows.
As the marketplace evolves, consumers will be empowered with information to make better decisions regarding how they use and pay for healthcare services. Providers will use clinical data to deliver evidence based care and new tools to effectively manage their business. Payers will use existing proven solutions to support constituent performance-driven solutions to support a healthy population.
To be competitive in such a transformed marketplace, payers will need to remain competitive, achieve more with less, and realize the vision of a healthy population via synergistic solutions.
Emdeon is leveraging existing applications and workflows to address the rising market challenges upstream in the process…thereby greatly reducing downstream administrative & medical cost related challenges. For more information on Emdeon’s Member Management payer solutions, visit www.emdeon.com/membermanagement or contact spratap@emdeon.com.
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