Value-based care reimbursement models continue to mature as the healthcare ecosystem strives to lower costs, enhance clinical quality, and improve patient outcomes. CMS continues to drive the transition towards shared risk and accountability through programs like Medicare Advantage, Managed Medicaid, I-SNP, and advanced alternative payment models. Payers offering value-based payment plans must modernize and expand their capabilities to remain competitive in the market and optimize profitability.
It is crucial for payers to modernize their data and technology capabilities to meet the evolving needs of value-based care programs. High-quality data is critical for payers to comply with CMS and NCQA regulations while optimizing performance on STAR ratings, HEDIS quality measures, RAF scoring, and MIPS reporting. Shared risk arrangements also empower payers to more actively share clinical data with providers and allow the use of that data in advanced analytics and care coordination for members. Putting data to work in value-based care initiatives directly impacts financial performance, population health outcomes, member satisfaction, and retention.
The Clearsense Approach
1Clearsense, an all-in-one healthcare data platform, aggregates data from various sources and is powered by the Clearsense Healthcare Data Model. This model offers pre-built integrations and accelerators to rapidly implement connections, mapping, and data quality rules, ensuring data lineage and traceability.
With payer and provider data residing within the common healthcare data model, organizations can determine the source of truth and assign trust rules. Collaborating with organizations, Clearsense establishes granular data access policies and assigns security controls. Accessible data can be seamlessly utilized in 1Clearsense analytics, outgoing integrations, and existing payer applications and use cases through 1Clearsense's bring-your-own-tool (BYOT) capabilities.
How Clearsense Helps
- Act as an all-in-one solution for clinical data aggregation and enforcement of data quality standards in compliance with NCQA’s data aggregator validation (DAV) program.
- A unified data model for aggregation and normalization of ADT messages, CCDs, and other clinical data through HL7, FHIR APIs, and point-to-point connections
- Improve the accuracy of provider attribution to individual members.
- Increase the visibility of member risk, close care gaps, and improve quality measure performance by readily using claims and clinical data in unified analytics.
- Deliver transparent quality measure reporting with source data to empower provider engagement and collaboration on member care management.
- Enable member risk stratification, hierarchical condition categories (HCC), and predictive intervention to identify emerging member risk, empower care coordination, and reduce the risk of RADV-driven recoupments.
- Leverage accurate provider data and aggregated clinical data to produce out-of-the-box STAR Rating analytics targeting opportunities to improve performance.
Why Payers and Payviders Choose Clearsense
Facilitating the seamless and transparent exchange of information between healthcare providers and payers in compliance with NCQA DAV certification.
HL7 and FHIR-enabled platform supporting common healthcare messages and transaction types, including CCD, ADT messages, and claims, following healthcare standards, including USCDI and EDI X12.
Velocity and Agility
Leveraging the Clearsense Healthcare Data Model, 1Clearsense scales to accommodate your organizational growth and rapidly responds to market demands with unmatched velocity.