Case Studies

One of the nation’s largest healthcare systems approached Innovaccer with the goal of improving its care management technology. Its mission is to provide high-quality, cost-effective care to enhance community health. It operates in 19 states and is comprised of 105 hospitals, including four academic medical centers and teaching hospitals; 30 critical access facilities; community health services organizations; accredited nursing colleges; and home health agencies; and other services.

Over the past decade, payers and providers have made significant improvements in the safety, effectiveness, and efficiency of medical care, and the shift to member-centered, value-based care models has only increased the need to deliver high-quality care.

Members are at the core of any health plan. However, the aftermath of COVID-19 poses new challenges for payer organizations when it comes to member enrollment.

Payer compliance deadlines for the CMS Interoperability and Patient Access final rule are fast-approaching. The rule, which CMS hopes will create industry-wide, barrier-free data exchange, will require payers to give patients easier access to their healthcare data as well as implement provider directory APIs that third-party programmers can use to create applications for members. In addition to true data transparency, the rule will help payers leverage data to identify gaps in care, execute timely interventions, and get new insights for population health management.