Payer-Provider Transparency, Powered by MedeAnalytics, Eliminates Administrative Costs from Healthcare

MedeAnalytics, a leading provider of healthcare performance management solutions, reported at HIMSS10 in Atlanta, Ga., that Blue Shield of California’s innovative Partnership in Operational Excellence and Transparency (POET) program, utilizing MedeAnalytics’ Claims Transparency solution, has resulted in significant benefits to both Blue Shield of California (BSC) and their hospital partners.

Juan Davila, Blue Shield of California’s senior vice president of network management, stated, “MedeAnalytics’ Claims Transparency solution provides a web-based analytic portal to consolidate and view claims performance data, providing unprecedented visibility for both BSC and participating hospitals. This sharing of data has built trust, improving our relationships with providers.”

According to Davila, the claims transparency program has resulted in a decrease in the number of claims appeals and disputes. Overall, the length of time a claim is paid once BSC receives it has been reduced from 10 days to eight days. Currently, 98 hospitals participate in the POET program, and BSC continues to focus on growing participation in the program.

Dan Martinez, director of patient financial services for Mission Hospital, a POET program participant, commented, “Mission Hospital has been collaborating with the POET team to work through underlying operational issues in 2009, and we are seeing about a 30 percent decrease in total denials and about a 50 percent decrease in denied dollars for FY 2010. The POET program has helped create an open forum to share performance issues or processes, with each entity committed to using the data to identify root cause issues and share their findings.”

“We applaud Blue Shield of California for the success of their POET initiative, a great example of the power of payer-provider transparency,” said MedeAnalytics Chief Executive Officer Mike Gallagher. “Given the outstanding results of the program and our nation’s critical need to squeeze costs out of the healthcare system, we believe facilitating claims transparency will emerge as a best practice in our industry.”

About MedeAnalytics

Founded in 1994, MedeAnalytics enables healthcare organizations to improve clinical, financial and operational performance through on-demand analytics and client services. For hospitals and health systems, MedeAnalytics provides solutions to address revenue cycle, patient access, clinical operations, staff productivity, regulatory compliance, finance and accounting, and enterprise performance management. For healthcare payers, the company provides solutions for provider network management, medical management and operations. MedeAnalytics delivers business intelligence to over 800 healthcare organizations using a hosted, Software-as-a-Service (SaaS) model, which reduces up-front costs and enables rapid implementation and exceptional time-to-value. For more information, visit www.medeanalytics.com.