Advantages of PAYVIDERs: Success Strategies

The healthcare industry is changing rapidly, and it’s opening opportunities for PAYVIDERs. CMS studies show that the revenue from Medicare Advantage (MA) plans has significantly grown from $69 billion in 2007 to $187 billion in 2016— that’s three times more than the initial year! By 2019, this number is expected to increase by a hefty 1.86 percent. 

Primarily for PAYVIDERs, the growing demand for MA plans is an opportunity they shouldn’t miss. After all, PAYVIDERs are in the market of providing Managed Medicaid and MA plans to the public.

There are roughly 300 PAYVIDERs in the market, and they cover at least 50 percent of all MA plans, according to an 3M article. This means that PAYVIDERs have a lot to gain from covering MA plans alone. But before we talk about the opportunities of PAYVIDERs, let’s talk about what they are and how they started.

PAYVIDERs is a term used to describe organizations that cover both payer and provider responsibilities. For example, payer organizations that acquire healthcare providers can become PAYVIDERs. The main catch is that running this type of operation requires a lot of resources that only large entities like hospitals can generally accommodate.

The Benefits of a PAYVIDERs Model

Evolving to a PAYVIDER model can help organizations solve the following problems that challenge the healthcare system:

• Market shift towards a more value-based care
• Care coordination between provider networks and payer organizations
• Overall demands of population health management

Put simply, PAYVIDERs have the data and know-how from both provider and payer perspectives. This means that, with proper management, PAYVIDERs can increase overall productivity by bridging the gap between a payer and provider workflows.

Growing Market Opportunities of PAYVIDERs

When it comes to health plans, people often go after the ones with the best value for money. And with limited out-of-pocket costs, affordable premium plans, dental services, vision coverage, and other programs, it’s easy to assume why the demand for MA plans are expected to grow.

This market trend is perfect for PAYVIDERs because they can save on expenses by focusing on providing MA plans to the public. Aside from the growing market population, PAYVIDERs can also increase revenue by keeping the cost of premiums at a minimum. The real challenge, however, lies in applying strategies that can make all these opportunities possible.

Strategies to Overcome Challenges and Ensure PAYVIDERs Success

With so much going on, PAYVIDER organizations need to make sure that they’re putting their resources to good use. After all, you can save more when you focus your efforts on things that matter most. Primarily for PAYVIDERs, they need to make sure that their goals are set to reduce costs and improve outcomes.

In addition to increasing savings, organizations also need to make sure that the following goals are established:

• Mitigate financial risks through effective risk management strategies
• Ensure gradually increase in profit margin
• Provide quality services for members and incentives for providers
• Retain existing members and enhance their loyalty
• Enhance your operational capabilities through an advanced management system

By prioritizing these key points, PAYVIDERs can ultimately increase their productivity and avoid unnecessary expenses which ultimately allows them to reduce premiums for MA plans. If done correctly, these goals can ensure that your organization can make the most of the upcoming demand for MA plans in the near future.

How QuickCap 7 Can Help You Achieve Your PAYVIDER Goals

Setting goals is easier said than done. But with the right tools, putting your plans into action can be smoother than you think. QuickCap 7 (QC7) is a management platform that’s specifically designed to handle the complexities of payer-organization workflows.

Whether it’s storing your crucial payer and provider information or managing your daily workflows, QC7 has all the features you need to succeed. Check out some of the ways that you can use QC7 to support your strategies for a successful PAYVIDER business.

1. Invest in Advanced Management Technology

When it comes to understanding the process of health plans as a whole, PAYVIDERs have the most advantage. This is because they have the essential data from payers and providers that, when used correctly, can ultimately streamline their entire operations.

However, having all large sums of data and managing diverse payer and provider processes also equates to an overwhelming workload for an organization. To put yourself at an advantage, all you need to do is invest in an advanced management platform that allows you to simplify your data management and processes.

QC7 has the following features that can help you manage your entire PAYVIDER operation more effectively:

• Gather and store all your essential business data in one centralized platform
• Utilize flexible electronic data interchange (EDI) features for easy data transactions
• Fully configure MA plans and pricing details to accurately account for risk adjustments, revenue earnings, incurred expenses, and bonus fees

2. Enhance Population Health Management and Risk Management Plans

Having a platform that allows for quick clinical data exchange can mean more complete analytics. With QC7, you can easily gather essential information and review high-risk patient populations. You also have more features that can help you do the following:

• Oversee high-risk patients through a dedicated case management module where you can coordinate with care teams, assign goals, and assess patient productivity
• Utilize extensive built-in report features and data visualization tools to easily analyze trends, predictions, and actionable information
• Ultimately reduce the health-plan-related expenses and control the prices of your premium

3. Utilize Advanced Communication Tools

If you want to build membership retention, you need to enhance your means of communication—patient records and provider notes aren’t going to cut it. By using an in-house communication platform, you can improve your provider and member communication like never before.

Here are some of the communication features that you can utilize with QC7:

• Store member and eligibility information in your system to make them accessible for your staff
• Complete notes and comments features for reviewers and utilization management staff
• Configure different announcements and alerts for specific users and organizations
• Use built-in communication features to send internal emails, chat messages, voice calls, triage notes, report tickets, and more
• Send out essential documents to providers and organizations through different channels like fax and emails

4. Reinforce Your Staff and Optimize Your Workflow

There is an undeniable information advantage that PAYVIDERs have against health plan providers. For instance, the collective data from payers and providers alone is enough to keep your organization growing.

With a comprehensive management platform like QC7, you can make the most out of your information advantage. In fact, with all its administrative and management features, you can ensure your data are put to good use—no information goes to waste.

Here are the top advantages of using QC7 to optimize your overall workflow:

• Accelerate your processes with advanced automation configurations for authorization, referrals, and claims adjudication
• Ensure your staff has the right guidelines through easily accessible integrated care guidelines, documentation storage, code guides, and more
• Take advantage of your business and clinical data and gather detailed reports for stakeholders
• Customize your dashboards, contracting, eligibility, payment pricing, and EDI preferences to suit your organizational needs

Final Thoughts

With all things considered, PAYVIDERs have all the data and resources needed to take advantage of the growing MA market. All that’s left to do is to ensure that your organization has the right tools to effectively utilize your essential business data.

When you have QuickCap 7, you can easily analyze the revenue data from payers and clinical data from providers side by side. With this, you educate your teams, iron out all the gaps between your network, and ultimately create smoother, more accurate workflows.

QC7 can help you harness overall businesses and clinical data to create a wider view of all your assets. Imagine a more comprehensive workflow with easier coordination between stakeholders. Put simply, you have better insight and more control over everything that revolves around your PAYVIDER ecosystem.