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How can Payer-Provider Transparency help you?

Create real-time, exception-driven alerts to automatically identify outliers and problem areas

Share detailed analysis across the organization and collaborate online with other users

Drill down to detailed analysis using an interactive, web-based interface to quickly understand root causes

Solutions are hosted by MedeAnalytics and require no hardware or software and limited internal IT support

Compare and target financial and operational performance to internal and external benchmarks

Transparency has become an integral part of healthcare in the United States. Payers, hospitals, physicians and employers all benefit when information is shared in a format that is accessible and easy to understand. For years, each side has worked internally to remove inefficiencies, reduce costs and improve quality outcomes. Despite these efforts, ongoing challenges—including claim disputes, payment discrepancies, authorizations, case management and practice pattern variations—continue to impair payer-provider relations, adding unnecessary friction and costs. With a renewed focus on cost reduction and quality measurement across the entire U.S. healthcare system, the need for improved transparency and collaboration between healthcare payers and providers has become more important than ever before.

MedeAnalytics Transparency Solutions
MedeAnalytics delivers web-based performance management solutions that enable healthcare payers and managed care organizations to aggregate claims, membership, authorization, pharmacy and call center data into a unified analytics portal that drives both internal decision making and collaboration with provider partners. Key performance indicators, dashboards and benchmarking statistics are shared between payers and providers in an interactive web-based application that increases transparency into administrative costs, practice pattern variations and clinical quality initiatives.

Download the BSC Payer-Provider Transparency Case Study

VIDEO

WHCC | April 12, 2010
Payer Solutions for Operational Transparency: An Emerging Platform for Shared Business Analytics and Reporting

Juan Davila, SVP, Network Management
Blue Shield of California

WHCC | April 11, 2010
News from World Health Care Congress

Corporate Research Group with Ken Perez,
SVP, Marketing, MedeAnalytics

RECENT WEBINAR

Payer-Provider Transparency:
How Blue Shield of California
Improved Claims Transparency

Recorded on Tuesday, February 23, 2010

MEDIA COVERAGE

Make more money with payer-provider transparency: A portal-based solution called MedeAnalytics makes claims data easy to access and share and supports custom metrics for Blue Shield California and its partners.

August 31, 2010 | Hospitals & Health Networks

Transparency Program Helps Insurer, Hospitals Find a Rhythm

May 10, 2010 | Hospitals & Health Networks

“An experiment under way in California is proving that hospitals and insurers can work together to improve efficiency and the bottom line. Blue Shield of California and nearly 100 network hospitals for the past year have been engaged in a transparency program that has decreased the number of claims appeals and disputes. Blue Shield's Partnership in Operations Excellence and Transparency Program—or POET—has also resulted in a quicker turnaround time for claims to be paid. Blue Shield now turns around reimbursements on an average of 8.2 days, compared with 10 days prior to POET.”

The Payer Perspective

“The MedeAnalytics platform has allowed us to create transparency and an environment of collaboration with our providers. The development of our Claims Transparency program has facilitated stronger communications, shared performance targets and improved efficiency. The MedeAnalytics solution has helped differentiate Blue Shield of California in the marketplace.”

Kenneth Deng
Director, Network Performance and CPO
Blue Shield of California

The Provider Perspective

“Mission Hospital has been collaborating with the POET team to work through underlying operational issues in 2009, and we are seeing about a 30 percent decrease in total denials and about a 50 percent decrease in denied dollars for FY 2010. The POET program has helped create an open forum to share performance issues or processes, with each entity committed to using the data to identify root cause issues and share their findings.”

Dan Martinez
Director Patient Financial Services
Mission Hospital