As we all know, the healthcare environment is always evolving. Healthcare payors must adapt to changes, while considering their own distinct needs and goals. And they are often running against the clock. That’s where Claritev can step in and help. We tailor healthcare cost management solutions to fit a client’s unique situation.
We can do this, in part, because of our focus on the following three key areas:
- Customization: We tailor our services and shape them into the best solution for a payor.
- Flexibility: Our experts are the best in the business. We encourage innovation and collaboration, and we give our people tools to help them do this, so they are always looking for ways to help payors.
- Speed to market: We’ve been around long enough to know how to get a solution quickly off the ground.
Customization: No cookie cutter solutions
No two organizations are alike. Each healthcare payor has specific cost containment goals. A cookie-cutter solution just won’t cut it. That’s why we customize each solution specific to each client. The right solution may be a tailored stand-alone solution, or it may be a configuration of multiple services.
- Payment integrity services: Our unique approach to waste and abuse goes beyond typical editing processes. We combine automation with expert clinical review to identify issues before payment. Working with more than 300 million code combinations, we can help payors improve payment accuracy. Plus, we can customize the program to complement an existing program, while ensuring minimal provider abrasion.
- Network-based services: We are contracted with more than a million healthcare providers, making it possible for an organization to tailor access that aligns its network strategy. We can build a custom network, extend an existing network, blend access to fill a gap, and tailor other unique designs.
- Analytics-based services: Using our breadth and depth of data, we customize solutions that balance out-of-network costs with member satisfaction. These cost management services can be arranged or combined to ensure your organization can shift this balance in an ever-changing environment.
Flexibility: Always agile, innovative and insightful
Claritev has the resources and experience that come with being a large, established company. But we also have an entrepreneurial mindset. We encourage innovation at all levels, and we share our insights with each other using the latest tools, technology and resources. This gives us the ability to be nimble and to identify new saving opportunities for our clients.
Collaboration in Action
Collaboration starts on day one. To develop a customized cost-management solution, we assemble an account team to partner with the client. This team works with our data analysis experts to analyze the payor existing program. Working together, we leverage our technology and expertise to develop a deep insight into the client’s situation. Then, we create a solution that aligns with the payor’s cost-saving goals.
And the collaboration doesn’t end there. Armed with data and technology, our expert team provides ongoing evaluation and refinement to ensure the client is always meeting and exceeding goals.
Speed to Market: Solutions that are quickly up and running
As we know all too well, the healthcare landscape is always evolving. From market changes to member demands and government regulations, healthcare payors are constantly tackling multiple challenges. Cost-containment solutions need to ready to go — quickly and efficiently.
We can accomplish solutions quickly for many reasons. We’ve been around the block, so we know the business and have achieved operational efficiencies. We have good relationships and can get the job done. This agility touches every service we offer. Take a look how it benefits those looking for network-based solutions:
- Strength in numbers: With more than one million contracted providers, a payor already has a deep pool to work from. Using analytic tools, our experts, can identify the providers who will add the most value to a payor’s network.
- High standards: Our contracted providers are credentialed using guidelines that meet or exceed NCQA requirements. By leveraging these contracted providers, Claritev can secure contracts quickly, efficiently and cost effectively.
- Long-lasting relationships: We’ve been building strong provider relationships for 40 years. We know what providers want and can convey the benefits of participating in a particular network. Providers know how we work and what they can expect from us.
KH036 06/05/20
