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3 min read

Strengthening provider-payer collaboration

Proud to be at the Top of the KLAS

I recently attended the KLAS K2 Summit, where I had the privilege of presenting the case study for which we were recognized in the 2023 KLAS Points of Light report. I was honored that among the 20 case studies presented, we were awarded one of three K2 Peak Awards for demonstrating strikingly impactful, scalable payer-provider collaboration. 


This award is especially meaningful to me because it was given based on votes by Summit participants. Individuals and organizations who are actively working to facilitate better payer-provider collaboration—and thus understand the depth and breadth of the problem—see something special in Moxe and the solutions we offer. It’s another validation point that the problem we’ve been solving for all alongbetter, faster, affordable bidirectional data exchange between payers and providersis still incredibly pressing. We know that the right solution can bear prolific fruit. 


Facilitating better collaboration

We can all agree that better collaboration between payers and providers is needed if we are going to successfully move to value-based care.


Better collaboration is needed to cut administrative waste, support clinicians in their efforts to make the best, most-informed care decisions, and generally improve the revenue cycle. 


I am proud of the work that Humana and Duke Health (the health plan and health system featured in our Points of Light 2023 case study) are doing to foster the type of collaboration that enables them to deliver the highest quality, highest value care possible. I am proud of the role that Moxe is playing in enabling collaboration that helps health systems and health plans exceed their goals. 


A Point of Light: Precise, Actionable Data Exchange

Building on their successful implementation of our Chart Retrieval solution, the health system and Humana set out to streamline requests for supplemental data. 


Using Moxe as their bidirectional data exchange platform, they automated the exchange of supplemental data. We pull data from the EHR and consolidate it into a customizable file that includes the clinical and claims data needed to support Humana’s risk adjustment and quality improvement initiatives. Now, Humana automatically receives the data they need in their preferred format on a timely basis without having to ping the provider. They both agree it’s a win-win situation. 


Using Moxe to facilitate better collaboration has supported HEDIS® and risk adjustment efforts, eliminated duplicative work, increased the timeliness and accuracy of patient/member documentation, and more. All of which drives value; and value-based care.


The future: Less asynchronous, more collaborative 

The collaboration between Humana and Duke Health is a “point of light” because it demonstrates what can be accomplished when payers and providers work together with a neutral vendor who has the best interest of both payers and providers at heart. 


From the start, we’ve been committed to delivering the data that payers need, without compromising the data security and privacy that providers must demand. 


We know the future lies in bidirectional data exchange that allows the business of healthcare to rely more on clinical data and less on time-lagged, derivative claims data. (You can read more about our belief in the power of clinical data in my colleague Mike’s recent blog here).


At the KLAS K2 Summit, one of the major themes that I heard was excitement about how increased bidirectional, real time data exchange between payers and providers can transform many aspects of our healthcare system.


People should be excited: We have the technology to start making what people have been talking about for years a reality. Instead of prior authorizations, why can’t they become simply authorizations, powered by real-time provision of data to clinicians at the point of care? Why can’t risk adjustment be more prospective? Why can’t revenue and payment integrity be more of a collaborative, less asynchronous process? 


We’re here to say yes to all of these questions. We can help. 


With the current business and regulatory environments, AI breakthroughs, and an increased focus on using data to make decisions more quickly, now is the time to harness the power of bidirectional data exchange. When we intelligently share the right clinical and administrative data at the right moment and allow for feedback to be returned, amazing things can happen. 


Goals: You’ve got them. We’ll help you reach them.

At the end of the day, payers and providers share the same goals: Good long-term outcomes and healthier patient/member populations. Every provider wants to deliver high quality care, and they want to be recognized for the high quality care that they deliver. Payers want to give credit to providers for the high quality care they deliver, but they are often missing the supporting evidence they need to give that credit, resulting in a lot of back-and-forth and friction between payers and providers. 


Our technology unlocks access to clinical data and delivers it in a way that empowers both providers and payers. We deliver the data that both parties need to more efficiently and effectively do their jobs and focus on what’s most important in their role to achieve the shared objective of fostering healthier populations. 


We’ve been focused on payer-provider collaboration since day one, and we’re thrilled to see so many other collaborative “points of light” emerging as folks increasingly recognize the potential that smarter collaboration has to transform the healthcare landscape. 


If you’re as excited as we are about all the potential that lies in smarter, data-powered collaboration between payers and providers, we’d love to talk with you about how we can help you achieve your goals.