The Most Group - AP2

Advanced Payment Platform (AP2) is a Value-based Reimbursement platform which combines existing Analytics capability with a powerful Reimbursement Engine that complements existing claims based payments.

The AP2 Analytics engine analyzes the health plan / TPAs membership, member data (behavioral, familial and biometrics), provider and claims data to provide data driven insights into suitable value based reimbursement programs that would work for the member, provider population.

AP2 enables health plans / TPAs to:

  • Administer pay4performance, shared risk, partial cap and full cap payment programs for various services and chronic conditions
  • Incorporate Incentive payments based on provider performance, PCMH care coordination fees, admin fees
  • Create innovative chronic condition (such as diabetes) based payment programs

Why you need AP2?

  • Build data-driven Value Based Reimbursement strategy
  • Exceptional Speed to Market (< 6 months) and Flexibility for new and emerging Value Based Reimbursement programs
  • Source system agnostic platform
  • SaaS model enables low cost of entry
  • Robust retroactivity engine for correcting payments as source data evolves
  • Integration to existing financial systems and processes
  • Measure success and improve the Value Based Reimbursement program on an ongoing basis using the AP2 Analytics Engine

Our Approach

Design

Existing Analytics capability enables data driven design of value based reimbursement programs using member, provider, and claims data.

Implement

AP2 Payment Reimbursement Engine administers the programs efficiently. Exceptional speed to market and ease of maintenance. Predictive modeling enables upfront data driven result projections for both health plan and providers

Measure

Existing Analytics capability measures success of the reimbursement program on an ongoing basis.

IDC Technology Spotlight

Value-Based Reimbursement Requires Modular, End-to-End, Transparent Solutions for Payers

Click Here to request full study

In value-based reimbursement (VBR) models, there are more rewards for better outcomes and more assumption of risk for providers. The expectation is that these models will prompt providers to follow up with their patients, coordinate care with other providers, and determine the need for procedures. These reimbursement models require healthcare payers to have better access to data and more agile tools than they currently possess. Value-based models will emerge and change, requiring payers to have comprehensive, flexible, and open systems to meet the transparency that the market demands. Concurrently, payers will need to merge clinical data and claims data to provide the necessary information for accurate payment, with flexibility, auditability, and traceability being the measures of success. This Technology Spotlight examines value-based reimbursement functions and how value-based reimbursement engines can be analyzed. This paper also discusses how solutions such as The Most Group’s Advanced Payment Platform (AP2) can allow payers to enable transparency and flexibility as payment models merge and transform in this strategically important area of change.

The Most Group’s Advanced Payment Platform (AP2) is a value-based reimbursement platform. It combines the payer’s analytics capability with a powerful reimbursement engine that complements existing claims-based FFS payments. AP2 is a modular solution that can be implemented in a phased manner per payer readiness. It is suitable for all lines of business, including commercial and government programs.

AP2 is complementary to another product from The Most Group, eBenefitSync, a SaaS-based benefit plan management (product configuration) system that enables a payer to have a single source of truth for products and a streamlined workflow to bring products to market quickly with reliability. Value-based reimbursement methodologies will challenge the product design process, and with this complementary product in its arsenal, The Most Group is showing its commitment to flexibility and transparency end to end.

Ready to get started with AP2?
Join the Gold Sponsors at 2017 TAHP Managed Conference and Trade Show, October 23 – 25, 2017  at Marriott Marquis in Houston, TX.  Booth 309Read more