Health Plans
Run your business operations and proactively manage the health of your members on a single platform—generating a more complete picture of member health and risk
Administration & Operations
Shrink the footprint of wasteful administrative processes. Track enrollment, manage benefits, authorize services, and pay claims and capitation.
Administration & Operations
details →
Portals
Automate communication with members through global announcements and member specific reminders. Show providers risk scores and tools to resolve care gaps. Employers can view employee coverage status and relevant analytics.
Portals
details →
Medical Management
Utilization management tools automatically assign statuses and track turnaround times. The software manages referral steering, generates letters, and tracks bed days. Network management provides real-time recommendations for finding appropriate providers.
Medical Management
details →
Provider Collaboration and Automation
Automate the exchange of clinical insights, authorizations, and event notifications. Payers have direct opportunities for promoting preventive care – supporting initiatives for healthier, happier members and lower administrative costs.
Provider Collaboration and Automation
details →
Enterprise Analytics
Schedule and deliver actionable clinical and business intelligence to manage member populations. Analyze progress and benchmark performance on operational metrics.
Enterprise Analytics
details →
We’re thrilled about the real-time bidirectional exchange of health information at the point of care. It supports our vision for Corewell Health, which is to make health simple, affordable, equitable, and exceptional. The comprehensive view of patients from the both the provider and payer side of their health history allows us to anticipate their needs better and keep them healthier. With Payer Platform, we’ll be able to exchange information about care management easily, so both the provider and payer stay on the same page, regardless of which group reaches out to the patient.
—Tina Freese Decker, President and CEO of Corewell Health
Providers and Health Plans Connect to Fast Track Prior Authorization, Claims, and Quality Reporting
Using Payer Platform, Mayo Clinic and BCBS MN reduced ADR denials by up to 75%; Baptist Health and Humana automatically exchanged 24,000 charts in one year; and Ochsner Health and Humana completed 53% of prior authorizations instantly.
Read the full article on EpicShare →
Digital Payer-Provider Connections Save Time, Lower Costs
NorthShore implemented Payer Platform to connect with two of its large payers and send clinical documents electronically. This saves time and administrative overhead, reduces medical records requests from payers, and improves care coordination for patients.
Read the full article on EpicShare →
Study: Association Between Personal Health Record Enrollment and Patient Loyalty
Kaiser Permanente Northwest found that members who use MyChart are 2.5x more likely to remain members of its health plan than members who didn’t use MyChart.
Read the full study in the American Journal of Managed Care →Learn more about successes in health plans – and how you can do it too – on EpicShare
Roadmaps
See a high-level view of what Epic can do now, which new features are coming soon, and what the future holds.
Resources
Copyright © 2024 Epic Systems Corporation.