Case Study
Helping Payors Enable Unified, Patient-Centered Care Through Digital Solutions
Location
United States of America
Type
National Payor
Size
28 Million Members
Background

In today’s fragmented healthcare landscape, payors face a variety of challenges from rising costs and administrative demands, to disconnected data and technological gaps - issues that ultimately impact patients.

A national payor serving more than 28 million members faced many of these challenges prior to partnering with AssureCare. With a clear, strategic focus on unifying their Commercial, Medicare, and Medicaid programs onto a single, integrated infrastructure, the organization aimed to streamline operations, reduce resource strain, and drive greater efficiency - ultimately improving outcomes for the members they serve.

The Challenge

The payor recognized their ultimate need for unification. When data is unified and payors have a 360-degree view of each of their members, they can improve how care is delivered. However, several organizational obstacles stood in the way of this full view including:

  • Consistent manual intervention required in workflows including program enrollment, prior authorizations, and care coordination.
  • An aging, legacy, homegrown solution made of multiple antiquated systems that were no longer compatible or integrated with modern systems.
  • An unmet need for up-to-date, real-time, accurate data the moment the member needs it.
  • Multiple, disparate lines of business and significant customer specific requirements needed to be addressed by a singular SaaS solution.

The payor wanted to establish a single solution capable of consolidating multiple different lines of business, aggregate and normalize data, and improve patient care.

The Solution

AssureCare’s platform implementation unified multiple business lines and outdated platforms into one, cohesive program. Through this partnership, we:

  • Implemented automated and efficient workflows that were configured to the client’s unique requirements.
  • Streamlined authorization workflows and intake automation by leveraging business rules to optimize the care delivery process and increase efficiency.
  • Provide data integration using APIs to gather up-to-date information from multiple sources in real-time for improved decision-making.
  • Provide “next best actions” to care managers by combining evidence-based guidelines and payor’s internal policies.

AssureCare’s unified platform provides a comprehensive view of the payor’s members and allows for the identification of both life-saving and cost-saving opportunities.

Positive Change
  • All utilization management is unified onto one smarter, faster platform, creating more integration and less manual workflows.
  • Data accuracy for end users has improved, preventing loss and minimizing rework.
  • Compliance rules are configurable by state to support the needs of a national payor organization.
Why it Matters

Smarter, unified solutions lead to measurable ROI - the payor realized at least $21M in annualized savings as a result of the partnership.

AssureCare’s suite of solutions uses sophisticated technology to deliver data and integrated workflows. Our modules, which can stand alone or work together in a powerful, unified system, support informed decision-making to improve member outcomes and reduce costs.

https://www.assurecare.com/connect/contact
About Us
AssureCare is a leading provider of integrated population health management software, offering solutions to healthcare and human services organizations, including payors, providers, pharmacies, and government healthcare programs. Headquartered in Cincinnati, Ohio, and part of the Vora Ventures portfolio, AssureCare has been serving the healthcare industry for nearly three decades.

Our flagship platform, MedCompass, automates care management processes, streamlines workflows, and supports informed decision-making to improve patient outcomes and reduce costs. AssureCare offers solutions across the healthcare continuum, including pharmacy support, nutrition management, comprehensive data analytics, and AI innovations.
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