Platform makes payment & interoperability convenient

To make value-based reimbursement really work, the people must acquire interoperability at scale across payer, contributor and vendor lines, claims Amy Larsson, vice president of clinical claims management at payer vendor McKesson Health Solutions. In a latest initiative, the company has inaugurated payment & interoperability management platform, known as the Intelligence Hub.

Today, the health network sustains to be mired in an atmosphere of siloed information systems, which Larsson herself experienced previous year after suffering a herniated disk. She required searching an orthopedic specialist and known as her primary care physician and got a referral, but choosing an MRI and getting authorization was all implemented manually or by phone. The electronic records of the PCP and specialist weren’t connected and so neither had complete health records for Larsson. When she required another suggestion in another delivery system, she had to take her MRI records to the visit.

The Intelligence Hub or payment & interoperability management platform is created to make it convenient for contributors, payers and third-party vendors to link their systems across networks to electronically authorize and schedule treatment, offer clinicians demographic and specialty data about other physicians in the network, and observe the contractual obligations between contributors and payers to automatically and precisely pay claims in accordance with the contract terms that each contributor has made with his or her insurers, Larsson elaborated.

For instance, an insurer could automatically be notified that a member is getting a knee replacement, in accordance to McKesson. As claims arrive, they would be electronically parsed, processed and paid as part of a bundled payment management. If a sufferer goes to a lab for pre-admission tests, the insurer could automatically know it’s not paying for the labs deployed on fee-for-service, as the labs are the proposed part of the bundle.

“Over time, as payers accept the Intelligence Hub or payment & interoperability management, physicians will initiate to see administrative duties reduce,” she analyzes. “In summary, the aim is to take administrative waste out of the network for contributors and payers through automation, enabling higher quality, more effective care and improved results.”

Now, McKesson Health Solutions is discussing with insurers about ways to educate vendors and contributors on the latest service.