Healthcare technology offers payors, providers and care teams ever more advanced administrative and operational solutions. By supporting patient-centered care through clinically informed technology, healthcare organizations can deliver efficient, effective, and integrated care and best practices toward a common goal.

How Clinical Technology Helps Payers

Physician-informed technology supported by clinical data enables access to evidence-based treatment protocols. Drive better patient outcomes by minimizing unnecessary expense and non-essential treatments or procedures. A nonessential treatment given to a patient can lead to poor quality of care, not to mention side effects and unnecessary outcomes, including toxicities. The ability to capture clinical findings, make diagnoses, and quickly align with the most effective evidence-based guidelines across mountains of available data dramatically increases efficiency for the provider. It also brings patients to what is most important, better health and appropriate treatment.

Here’s how technology can enable greater efficiencies across the health care continuum:

Eliminate costly and confusing benefit options

Technology solutions that offer collaboration between payers and suppliers allow different entities to share and increase operational efficiency by automating manual processes and eliminating redundancy to save time and operational costs. Collaborative technology enables vital administrative, clinical, and population health management information to be quickly shared for two-way exchange of information between payer and provider networks. For example, payers can better manage costs through streamlined authorization workflows that facilitate accelerated assistance based on evidence-based practices.

Consolidate disparate data and health management

Through collaborative systems that combine technology and healthcare clinical expertise, providers and payors are better able to bring together disparate data points while enabling better workflow between providers, payors, caregivers and patients.

A key benefit of clinically informed technology is a streamlined prior authorization process and care plan. As medical policy guidelines and standards increase in complexity, this process can be burdensome for payors, providers and patients. When these solutions are designed by professionals with first-hand experience in submitting and facilitating pre-approvals, their expertise is invaluable in streamlining applications for real-time clinical, financial and administrative document exchange, building trust among payers and suppliers.

More accessible collaboration

When enrollment verification and insurance coverage information is provided in real-time, it’s easier for provider offices to ensure they have access to detailed information about copayments, deductibles, and benefits.

Systems that combine technology with clinical healthcare expertise also provide tools for providers and payers to help manage reimbursements. Health plans can provide providers access to the most up-to-date authorizations and historical clinical information with the integration of electronic medical records (EMR). These capabilities enable primary care physicians and specialists to guide patients and healthcare professionals to the best quality providers and optimal care plan at the most cost-effective cost.

Reduce fragmentation in care

This collaboration between technology and clinical expertise emphasizes improving patient outcomes and satisfaction levels, while reducing total health care costs by reducing fragmentation within the system. The more clinical knowledge is integrated with technology designed to respond to the dynamics of real-world healthcare, the faster providers can move through different aspects and stages of care.

Ultimately, payers and providers benefit from increased operational efficiency, streamlined communications, cost savings, and reduced administrative complexity. The fewer challenges, redundancies, and misdirections for the patient, the better the experience toward a healthy outcome.

Payers can adopt comprehensive solutions to ensure their members receive the best healthcare options in an evolving healthcare system. Solutions that eliminate error-prone manual processes and bring cohesion to the physician and payer dynamics represent the next evolution in healthcare.

Clarice Holmes, R.N is Sr. Director, Clinical Knowledge Management, NantHealth.

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