The Most Group - AP2

The only solution that supports SCALABLE “What-if” Analysis and Iterative design of Value based reimbursement programs with ZERO impact to existing systems

Pain Areas:

  • VBR Data Management – Health plans are spending millions of dollars and significant calendar time on unsuccessful projects to enhance their legacy system of records for Provider and Membership to support VBR
    • Provider Management and Membership
      • A leading group of health plans has spent over 3 years and millions of dollars to create a provide system of record that has the extensibility to support VBR models. This is still a largely unsuccessful effort
      • Several other health plans are using ancillary excel grids and access databases to augment their provider system of record. These plans carry significant risk of failing audit and compliance measures
      • Another leading health plan maintained all of its VBR contract information in excel grids and access databases. This involved significant delays in contract assignment (which was error prone) and a result delayed payments to providers which in turn resulted in low provider satisfaction scores
  • Compliance / Fraud & Abuse / Payment Transparency & Accuracy – The current health plan processes are largely claims (FFS) driven OR excel grid / access database driven
    • Health plans have highly manual processes for calculating FFV payments. This results in errors and gaps for fraud/abuse.
    • There is minimal support for retroactivity – given the significant number of permutations and combinations of scenarios, which cannot be determined manually – this in turn results in under or over payments and once again leads to fraud / abuse and lower provider satisfaction
  • Customer Service – Health plans don’t have the necessary tools and processes to support provider and member inquiries in the FFV world. Several plans rely on complex job aids and excel driven processes

AP2 addresses the pain areas as follows:

  • VBR Data Management – AP2 enables health plans to extend their existing system of records to support value based reimbursement with exceptional speed to market (less than 6 months)
    • Provider Management – accommodate various new types of providers, affiliations, contracts and rate tables that the existing provider management systems cannot handle OR are too expensive / time consuming to enhance.
    • Membership – accommodate various new types of member attribution, risk scores and product affiliations that existing membership systems cannot handle OR are too expensive / time consuming to enhance
  • Compliance / Fraud & Abuse / Payment Transparency & Accuracy – AP2’s robust payment engine ensures accurate / transparent payments and proactively eliminates fraud & abuse with its robust retroactivity algorithms
  • Customer Service – AP2 enables health plans to augment their customer servicing (Member and Provider) tools to support true Fee for value (FFV) transactions
  • Claims integration – AP2’s optional claims integration provides a feedback loop into the health plan’s claims system to maintain the FFS and FFV transactions in the current payer claims system
Ready to get started with AP2?
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