The partnership brings together complementary pieces to build high-performing networks, giving insurers a degree of visibility that does not exist elsewhere in the market today. The joint solution integrates HealthCorum’s scores and metrics, which identify the high-performing providers in a given region, into the Zelis enterprise Network360® platform where health plans can build, evaluate, and deliver networks based on complex, ever-changing business requirements, including advanced quality scores.
“Whether it’s designing for a new market or improving outcomes for existing products, the right network is essential for effectively managing costs and improving quality,” said R. Andrew Eckert, Zelis CEO. “We’re excited to partner with HealthCorum to make provider-level analysis actionable, enabling insurers to view individual practice patterns and better predict how providers will perform.”
For healthcare organizations, the timing couldn’t be better. Wasteful health spending continues to run rampant in the U.S. with $760 billion to $935 billion lost annually according to JAMA: The Journal of the American Medical Association. As such, the shift to value-based care continues to pick up steam, and with it comes a need to better understand how providers will perform in at-risk arrangements. Even those in traditional fee-for-service models need to optimize outcomes per dollars spent and avoid unnecessary spending. Organizations must have the ability to survey the provider landscape and see how different personnel choices may impact overall network value.
“Just as a doctor diagnoses a patient, healthcare organizations should be diagnosing their provider networks,” said U.N. Amighi, President of HealthCorum. “We deliver transparent and actionable insights to help assess individual providers’ strengths and weaknesses, which can then be leveraged in the Zelis Network360® solution. It’s a match made in data-heaven.”
Zelis clients can adjust networks in real-time, integrating competitive and cost analysis to gain instant feedback on network viability before going to market. In addition, Zelis clients can gain access to HealthCorum’s AI-powered provider analytics. This technology delivers a host of capabilities including care quality identification, referral pattern analysis and conflict of interest detection. These insights combined provide ample opportunities to increase network efficiencies across the board.
As the leading payments company in healthcare, we price, pay and explain healthcare for payers, providers, and healthcare consumers. Zelis was founded on a belief there is a better way to determine the cost of a healthcare claim, manage payment-related data, and make the payment because more affordable and transparent care is good for all of us. We partner with more than 700 payers, including the top-5 national health plans, Blues plans, regional health plans, TPAs and self-insured employers, 1.5 million providers and millions of members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and an integrated pre-payment through payments platform to manage the complete payment process. For more information about Zelis, visit us at www.zelis.com and connect with us on LinkedIn.
HealthCorum, a Boston-based health data analytics company, is uniquely focused on identifying unnecessary care, optimizing referral patterns, and reducing wasteful spending. HealthCorum’s proprietary technologies combined with its AI-powered algorithms help to save money for healthcare organizations and take the complexity out of provider network optimization, offering a holistic view of provider efficiency and value-driven practice patterns. Work is done collaboratively with clients to accomplish their goals, achieve better outcomes, and reduce low-value care delivery. Visit www.healthcorum.com to learn more about our technologies and methodology.