Payers

For payers trying to navigate the challenges of healthcare reform and ongoing changes in reimbursement models, ICA delivers multiple benefits as a strategic technology partner.

Manage high-cost members: SmartAlerts automates the identification of high-risk patients, then notifies a payer’s case management team immediately. For example, instead of waiting 2-3 weeks until claims are processed to be informed about ED visits (which typically do not require any pre-authorization), payers now engage with patients either in the hospital or immediately after discharge.

Increase in-network utilization: SmartAlerts also provides almost immediate notifications of patient encounters from a broad network, so payers can quickly engage and re-direct patients to in-network services.

Improve Data Quality and Time Efficiencies: In a pilot program designed to test the effectiveness of Direct messaging, ICA’s CareAlign Connect achieved the following results for a national health plan:

• 30% reduction in the time required to abstract data.

• 85 percent and 91 percent of the medical records received from the two pilot locations were transferred through direct messaging.