GE Healthcare’s approach to payer provider convergence | GE Healthcare

the strength of the relationship between payers and providers is dependent upon their ability to communicate and share information meet dr. Gerald he's the medical director at Sigma health insurance plan where he's tasked with ensuring that Sigma maintains the right level of care quality to keep its star rating of four and above this rating minx Sigma eligible for bonuses and rebates from the government for its Medicare Advantage plan dr. Gerald is definitely overwhelmed to meet the star ratings metrics he needs to ensure that

Sigma's providers take good care of their patients and close any care gaps they might have unfortunately the care gap information is with dr. Gerald at Sigma and he has to rely on antiquated methods to share this information which does not often reach the doctor's office in time as a result his providers miss opportunities to address care gaps during patient exams which can result in repeat visits to the doctor's office and a lower star rating for Sigma meet Ann

Marie she's vice president of revenue program management at Sigma health plan like dr. Gerald she focuses on Medicare Advantage contracts but her goals are based on revenue implications of health and quality to capture the appropriate revenue based on health and quality from Medicare Advantage contracts and needs to ensure that the doctors treating Sigma's Medicare Advantage patients understand their patients full risk profiles so they can treat them with the right level of care by documenting appropriate care and on the providers

can demonstrate care quality to the government and receive appropriate risk-adjusted payments technically speaking if Ann can help the doctors use the right hierarchical condition code or HCC to portray the patient's risk Sigma can convert it into an RAF score that will determine the monthly payments from the government now meet dr. Steve he's a family doctor who loves helping people especially seniors but dr. Steve doesn't have as much time to spend with patients as he used to because he's stuck in a

never-ending whirlpool of paperwork and chart requests dr. Steve know in order to get paid for his work Sigma is relying on him to deliver high quality care and generate high revenue at a low cost dr. Steve's life would be a lot simpler if dr. Jerrold shared patient gaps and care information and an provided the right HCC to his staff when he needed it all while high-risk patients were in his office dr. Gerald and dr. Steve stop and

wonder why in this digital age they're burdened with more and more manual processes administrative overhead and paperwork the good news is there's a solution it's GE healthcare superhighway GE Healthcare is building a solution that enables dr. Gerald an ant to communicate electronically with dr. Steve in near real-time unlike the current system where sharing it's low and miscommunication is the norm GE healthcare solution is incredibly fast

and simple to use through this superhighway dr. Steve and his staff can receive information in time for them to take action deliver to them at the point of care there is no new paperwork so dr. Steve can now keep dr. Gerald happy by automatically sending him all the clinical information he needs to comply with government reporting needs what's more dr. Gerald now knows when dr. Steve closed the gap in his member care and what level of quality care is delivered to Medicare Advantage member

and what about Ann she is delighted to see an increase in cash flow from higher payments which enables her to spend more time on strategic initiatives GE healthcare superhighway is a secure instant health care information exchange for reducing cost increasing reimbursement and allowing both health plans and providers to focus on better care for us all