Medical Groups Leverage the PLEXIS Platform for Accountable Care
“Payer-provider collaboration is real—and it’s reaching a new inflection point, around the opportunity for payers and providers to work together with data, for real results” –Mark Hagland, Healthcare Informatics, 2014
When it comes to patient-centric care, medical groups nationwide are leading the transition into the new era of accountable care. Collaboration between payers and providers is at an all-time high as they leverage new tools for population health management (PHM). PLEXIS provides the modern toolset to enable data-centered collaboration, electronic health record (EHR) integrations for clinical support, coordinated care, cost containment, and more.
PLEXIS provides the right tools and technology for medical groups, enabling you to:
Enhance provider networks: PLEXIS’ unified platform streamlines workflows for provider engagement. PLEXIS automates support for network management for multiple reimbursement arrangements allowing you to enhance collaboration with providers and members.
Lower utilization rates and close care gaps with coordinated care: PLEXIS can integrate care management, UM/UR, and disease management to enable powerful, preventative, outcome-based wellness. We include capabilities for medical management negotiations, data-driven utilization review, wellness services, and monitoring/management of high-dollar claims.
Create significant savings: PLEXIS enables effective medical cost reduction through advanced PPO repricing, Medicare Advantage repricing, claim negotiations, and maximum network discounts (primary, wrap, and supplemental).
Simplify electronic workflows: PLEXIS’ powerful EDI hub delivers enterprise-wide efficiencies with end-to-end workflows for claims, encounter data, and more. Extensible functionality empowers payers to implement an enterprise data warehouse to track key performance metrics.
Automate capitation (PMPM) processing including retroactive adjustments.
Connect and communicate: PLEXIS’ real-time portals connect you to members, providers, and all essential stakeholders. With PLEXIS’ self-service healthcare portal, members securely access eligibility, provider information, ID cards, claims history, and other configurable data fields – all from their computer, tablet, or smartphone.
Meet cost containment objectives: PLEXIS automates complex benefit calculations to drive high auto-adjudication rates and minimize the risk of paying incorrect claims. Payers recover significant savings and reduce utilization by leveraging PLEXIS’ real-time alerts, automatic audits, health risk assessments (HRAs), responsive reporting, and more.
Enhance automation and efficiencies: PLEXIS empowers efficient fraud, waste, and abuse (FWA) detection, automated claim editing, and automated calculations + processing of network fees.
Rapidly respond to critical conditions: Payers keep costs from spiraling out of control through early identification of outliers and critical health issues. PLEXIS can integrate powerful business intelligence + business analytics (BI/BA) to deliver actionable insights.
Enhance transparency for evolving compliance requirements: Accelerate growth while minimizing risk through end-to-end transparency and centralized premium and claim data. PLEXIS provides holistic visibility for compliance requirements.