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Payers and payment programs

Empowering you to manage cost, understand risk and measure quality in your network

Improve quality and efficiency. Reduce unnecessary services. Minimize costs. You really can do it all — we've got you covered.

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Healthcare payer solutions that have raised the industry standard

32 states

32 states use our proprietary methodologies for payment, reporting, risk adjustment or quality measurement

When value-based care is done right, it elevates the lives of payers, patients, physicians — even communities. Our innovative solutions and services are trusted by government agencies, health plans, business partners, employers and providers to help:

  • Ensure appropriate reimbursement by categorizing high-risk patients and identifying early intervention opportunities.
  • Customize data insights for value-based care, reimbursement and population healthcare management.
  • Assist state payers in navigating regulatory changes, classifying patients and grouping methodologies.
  • Aggregate data from multiple sources, compare populations and calculate the total cost of care to reveal the complete picture.
  • Integrate solutions into current workflows to prevent undesirable outcomes.
  • Keep current on regulatory and market initiatives like Medicaid and others that impact risk adjustment, payment reform, outcomes incentives, health equity and more, through our resources.
  • Convert mountains of data into action, to reduce costs and optimize reimbursements and other forms of payment.

Egyptian Health: Strengthening care coordination for at-risk kids

On a mission to improve quality and reduce costs, Illinois’ Egyptian Health Department set out to screen 11,000 Medicaid and/or CHIP recipients via phone and in-person interviews — but soon found this method didn’t capture the full story. But with Clinical Risk Groups (CRGs), the organization was able to validate complexities, meet Alternate Payment Method (APM) performance measures and uncover risk profiles that would otherwise go under the radar and identify at-risk clients.

Read the surprising study
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$42B

Approximately $42 billion in managed care premiums prospectively risk-adjusted using 3M™ Clinical Risk Groups (CRGs) annually, in a recent New York state study.

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51%

Reduction in potentially preventable complications by utilizing 3M™ Potentially Preventable Complication (PPC) Grouping Software, in an assessment from Maryland Health Services.

Healthcare payer solutions that make the most of your data

Data is important, but the expression is “Knowledge is power.” That’s because what changes the game is what you do with the data. In healthcare, that means turning information into action that saves money, identifies risk, adapts to regulatory changes and improves care quality.

We created population management platforms that aggregate data from various sources, compare populations and calculate the total cost of care so you have the complete picture. Organizations can derive valuable data insights to help reimagine care delivery and deliver sustainable process improvements.

More expert solutions for better healthcare

With the continued move from volume to value, you need to be able to evaluate population health and patient care by providing insights into patient mix, expected reimbursement and quality outcomes.

We offer a comprehensive analysis of health performance across providers and population segments, identifying strategic opportunities to improve value for your top organizational goals.

Solutions to understand the complexity of your populations and take action

Spend an hour, discover invaluable information and insights about performance improvement through a variety of innovative grouper applications, bundled program analytics and more.

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