KLAS: 6 Vendors That Aim to Resolve Payer-Provider Friction

Six technology vendors were highlighted for their abilities to address one of the six main points of friction between payers and providers that leading healthcare organizations strive to address, according to a KLAS report that is part of the KLAS Payer/Provider Initiative.

KLAS launched the Payer/Provider Initiative to identify points of friction between payers and providers and to highlight strong collaboration case studies.

The six payer-provider challenges that leading healthcare organizations tackled were prior authorization, value-based care, payer-provider interoperability, denials, credentialing, and patient billing.

The top three types of technologies that leading healthcare collaborators used were prior authorization automation, healthcare data analytics and population health management tools, and provider-payer interoperability and clinical data exchange technologies.

KLAS shared six case studies about vendors that sought to address the needs of payers or both payers and providers related to one of the top six challenges. Moxe's case study is shared below: 

Moxe

Moxe worked with an anonymous payer organization, an anonymous healthcare organization, and Novant Health to reduce waste and provider abrasion during chart retrieval.

The organizations automated the chart-retrieval process using an API-first process and standardized the data format. The provider retained the power to set up release restrictions.

As a result, payer return on investment improved as did member satisfaction. There was less manual work involved in chart retrieval—fewer phone calls, faxes, and follow-ups. Access to care improved and staff assignments in the provider organizations stabilized. 

The partners recommended that payers who plan to leverage this solution group chart-retrieval processes under a single department. Also, partners may need to incorporate cybersecurity and privacy entities in the process.

The full article and details on other case studies can be found on Health Payer Intelligence.