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</header> <main id="site-content"> <header class="page-header header-padding header-basic background-midnight-moon "> <div class="container padding-24 padding-md-80 padding-lg-120"> <div class="header-content"> <h2 class="heading-38 heading-md-70 heading-lg-90 header-basic-heading"><h1>Payers & Payviders</h1></h2> <p class="body-20 body-md-24 body-lg-38 text-align-center-md margin-top-16 margin-top-24 margin-top-lg-32"><h3>Create the most accurate and complete member health record with no data left behind</h3> </p> </div> </div> </header> <section> <div class="container"> <div class="post-body"> <h2 class="h2 text-block gradient-block"> <p style="font-weight: 600">Standardize and enrich claims and clinical data with scalable APIs. </p> </h2> <img style="float: right;" decoding="async" src="/wp-content/uploads/2024/08/refine-patient-data.svg" alt="patient data refinement" width="370"> <p><a href="https://careevolution.com/orchestrate/" target="_self" rel="noopener" id="ga-tag-intro-orchestrate">Orchestrate</a> empowers Payers and Payviders to unlock the value of their patient data by:</p> <ul> <li>Automating terminology and code set normalization</li> <li>Standardizing and enriching health records by adding codes to uncoded data</li> <li>Converting file formats to and from multiple formats</li> <li>Deduping documents and creating a standardized output </li> </ul> <p>Teams in IT, data and analytics, artificial intelligence, operations, risk adjustment, HEDIS, compliance and care coordination adopt Orchestrate to:</p> <ul> <li>Lower total cost of data management</li> <li>Increase operational efficiency</li> <li>Focus on patient and member care ‘next best action’</li> <li>Maximize value from the increasingly available patient data</li> </ul> </div> <div class="tabs margin-top-60" data-tabs style="padding-top: 0px"> <div role="tablist" class="tab-list" aria-label="CareEvolution Orchestrate Product Details"> <button role="tab" aria-selected="true" aria-controls="tab1-panel" id="tab1" tabindex="0" class="tab active">For Business Users</button> <button role="tab" aria-selected="false" aria-controls="tab2-panel" id="tab2" tabindex="-1" class="tab">For Developers</button> </div> <div class="tab-panels"> <div id="tab1-panel" role="tab-panel" aria-labelledby="tab1" tabindex="0" class="tab-panel"> <h2 class="heading-26 margin-bottom-16">Business customer success story</h2> <p>One of the nation’s largest health plans faced challenges with costly data integration, duplication and inefficient workflows due to data existing in silos. Scaling required an agile technology foundation capable of supporting a wide range of data-driven use cases. </p> <ul class="term-list"> <li class="term-list-item"> <h3>Their challenges with data integration and utilization included:</h3> <div class="wysiwyg-block body-16 body-md-20 body-lg-24"> <ul> <li>Provider data files tailored for single use cases (ie HEDIS)</li> <li>Variations in integrations, formats, and terminology</li> <li>Redundant data management efforts significantly driving up costs</li> <li>Fragmented interoperability with limited adoption </li> </ul> </div> </li> <li class="term-list-item"> <h3>It was critical for their business to:</h3> <div class="wysiwyg-block body-16 body-md-20 body-lg-24"> <ul> <li>Improve care coordination and patient outcomes, as mandated by CMS and state regulations</li> <li>Renew and secure Medicaid contracts </li> <li>Secure value-based contracts and differentiate on national RFPs</li> <li>Enable provider and member collaboration across all channels</li> </ul> </div> </li> <li class="term-list-item"> <h3>Orchestrate empowered them to scale by providing:</h3> <div class="wysiwyg-block body-16 body-md-20 body-lg-24"> <ul> <li>A single source of truth for longitudinal member views of clinical and financial data</li> <li>Rationalized vendor solutions, reducing costs, fragmentation and waste</li> <li>Real-time clinical data access for more accurate, coordinated member treatment</li> <li>A scalable foundation for future growth, enabling higher productivity at a lower cost </li> </ul> </div> </li> <li class="term-list-item"> <h3>Departments benefiting from Orchestrate include:</h3> <div class="wysiwyg-block body-16 body-md-20 body-lg-24"> <ul> <li>Risk adjustment</li> <li>Quality (HEDIS/STARS)</li> <li>Care Management</li> <li>Analytics/AI/ML</li> <li>Provider Network Operations</li> <li>Member Engagement</li> <li>Benefit Collaboration</li> <li>Clinical Trials</li> </ul> </div> </li> </ul> <p>For this Payer, <a href="https://careevolution.com/orchestrate/" target="_self" rel="noopener" id="ga-tag-bus-case-orchestrate">Orchestrate</a> has consolidated patient records for over 46 million active and 100 million inactive members, integrating data from over 2,800 providers, 240 data sources, and over 7.5 billion claims across various formats. CareEvolution<sup>®</sup> also built a direct member tool for exchanging comprehensive patient records across providers regardless of direct connectivity with the Payer.</p> </div> <div id="tab2-panel" role="tab-panel" aria-labelledby="tab2" tabindex="-1" class="tab-panel" hidden> <div class="post-body"> <h2 class="heading-26 margin-bottom-16">Developer customer success story</h2> <p>The development team at a large payvider faced a host of data integration challenges, including:</p> <ul> <li>Fragmented and inconsistent patient records with variations in formats and across systems</li> <li>Uncoded data was often hidden in notes and free text</li> <li>Unresolved data ingestion errors and format incompatibilities</li> <li>Large data gaps in member health records</li> <li>Lack of an aggregated clinical and claims data model to support a needed “360 degree view” UI</li> </ul> <p>Their development team was able to quickly solve these challenges using CareEvolution’s Orchestrate instead of restructuring internal architecture or adding additional enterprise software. By implementing <a href="https://careevolution.com/orchestrate/" target="_self" rel="noopener" id="ga-tag-dev-case-orchestrate">Orchestrate</a> they were able to:</p> <ul> <li>Standardize member data from various sources, converting formats like CDA, HL7, and X12 into FHIR resources to create a consolidated health record for each member</li> <li>Match patient identities across all inbound data using privacy preserving record linkage (PPRL)</li> <li>Standardize and classify codes and concepts and resolve uncoded data</li> <li>Compute advanced derived data elements such as an HCC Risk Adjustment Profiles using more complete datasets</li> </ul> <p>By quickly and easily implementing Orchestrate, the payvider created a unified patient record and delivered actionable insights to care teams for its 175,000 members.</p> </div> </div> <div style="padding: 30px; 0px; 30px; 0px;"><img decoding="async" src="/wp-content/uploads/2024/12/Orch-Tech4.svg" alt="Orchestrate technology flowchart" width="100%" class="aligncenter size-full wp-image-14722" /></div> </div> </div> </div> </section> <section class="section section-resource-list padding-48 padding-md-120 padding-lg-160 background-alpine-overlook "> <div class="container"> <div class="row resource-list-row"> <div class="col-xs-4 col-md-6 grid-row-gap-48"> <div class="card-resource"> <h2 class="heading-32 heading-md-42 heading-lg-56">Curate and enrich member health datasets</h2> <div class="text-block body-16 body-lg-26 margin-top-16 margin-top-md-24 margin-top-md-32"> <p>Learn how payers and payviders use the Orchestrate APIs to create a single patient record</p> </div> <a href="https://careevolution.com/post/unlocking-value-from-diverse-patient-data-sources/" target="" class="btn btn-secondary btn-mobile margin-top-24 margin-top-md-32">Learn more</a> </div> </div> <div class="col-xs-4 col-md-6 grid-row-gap-48"> <div class="card-resource"> <h2 class="heading-32 heading-md-42 heading-lg-56">Build HCC Risk Adjustment Profiles (RAPs)</h2> <div class="text-block body-16 body-lg-26 margin-top-16 margin-top-md-24 margin-top-md-32"> <p>Learn how to build HCC Risk Adjustment Profiles (RAPs) with more complete data</p> </div> <a href="https://careevolution.com/post/why-risk-adjustment-teams-should-be-upgrading-to-api-technology/" target="" class="btn btn-secondary btn-mobile margin-top-24 margin-top-md-32">Learn more</a> </div> </div> </div> </div> </section> <section class="convert-custom-bordered-list-unlock padding-60 padding-md-120 padding-lg-160 background-early-bird"> <div class="container"> <div class="row grid-row-gap-16"> <div class="col-xs-4 col-md-6"> <h2 class="heading-26 heading-md-38 heading-lg-56" style="padding-bottom:20px;">Unlock the full potential of your clinical datasets with Orchestrate.</h2> <p>The Orchestrate APIs liberate, aggregate, standardize, enrich, and transform data to power patient-centric use cases.</p> <a href="https://rosetta.careevolution.com/register" target="_blank" class="btn btn-primary margin-top-32 display-md-inline-flex" rel="noopener" id="ga-tag-cta-bottom-sandbox">Start building</a> </div> <div class="col-xs-4 col-md-6"> <ul class="bordered-list"> <li class="bordered-list-item"> <a href="/orchestrate/terminology" id="ga-tag-cta-bottom-terminology"> <div class="wysiwyg-block body-16 body-md-20 body-lg-24"> <h4 class="heading-26 heading-md-32 heading-lg-38 margin-bottom-8 margin-bottom-md-0"> Terminology API</h4> <p>Standardize & classify healthcare codes and concepts</p> </div> <span class="icon-arrow-circle-right"></span> </a> </li> <li class="bordered-list-item"> <a href="/orchestrate/convert" id="ga-tag-cta-bottom-convert"> <div class="wysiwyg-block body-16 body-md-20 body-lg-24"> <h4 class="heading-26 heading-md-32 heading-lg-38 margin-bottom-8 margin-bottom-md-0"> Convert API</h4> <p>Enrich & transform patient data to optimize your workflow</p> </div> <span class="icon-arrow-circle-right"></span> </a> </li> <li class="bordered-list-item"> <a href="/orchestrate/insight" id="ga-tag-cta-bottom-insight"> <div class="wysiwyg-block body-16 body-md-20 body-lg-24"> <h4 class="heading-26 heading-md-32 heading-lg-38 margin-bottom-8 margin-bottom-md-0"> Insight API</h4> <p>Compute hierarchical condition category (HCC) risk adjustment profiles</p> </div> <span class="icon-arrow-circle-right"></span> </a> </li> <li class="bordered-list-item"> <a href="/orchestrate/identity" id="ga-tag-cta-bottom-identity"> <div class="wysiwyg-block body-16 body-md-20 body-lg-24"> <h4 class="heading-26 heading-md-32 heading-lg-38 margin-bottom-8 margin-bottom-md-0"> Identity API</h4> <p>Privacy-preserving record linking across data sources and use cases</p> </div> <span class="icon-arrow-circle-right"></span> </a> </li> <li class="bordered-list-item"> <a href="/orchestrate/identity-lite" id="ga-tag-cta-bottom-idenity-lite"> <div class="wysiwyg-block body-16 body-md-20 body-lg-24"> <h4 class="heading-26 heading-md-32 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