Clinical Document Exchange
Centricity Payer Connect enables secure and near real-time data exchange between payers and providers to help optimize revenue and reduce operational costs for payers and providers serving the Medicare and Medicaid patient population.

Payer Insights
Gaps in Care
Centricity Payer Connect enables payers to share gaps in care information of Medicare/Medicaid and other managed patient populations with provider networks, enabling gaps to be closed in a timely manner and thereby improving the overall health of the population.

This new collaboration solution reduces manual effort of sharing gaps in care information and providing guidance to providers that optimizes revenue performance.

Risk Adjustment
Centricity Payer Connect can help providers identify which problem codes are relevant to ensure that accurate Hierarchical Condition Categories (HCC) are used when submitting claims. Using the correct ICD-10 and HCC codes helps ensure accuracy of reporting and enables payers to receive more accurate payment rates and premiums.

Payers can benefit from particpating in Centricity Payer Connect in the following ways:

Help ensure accurate Risk Adjustment Factors (RAF). For example, one study found that a 10% increase in RAF score can result in a $75 per member per month increase in premium.¹

Help improve and maintain CMS Star ratings for Medicare Advantage plans. One study found that a ½ STAR rating increment can result in an additional $25 per member per month in bonus and rebates from CMS.¹

Help automate the process of gathering information on gaps in care, which in turn lowers the costs associated with managing the health plan.

Centricity™ Payer Connect is intended to help:

• Close chronic condition gaps and gaps in care
• Reduce or eliminate manual chart review
• Reduce operational and care costs
• Improve clinical and financial outcomes

Clinical Document Exchange
Centricity Payer Connect enables secure and near real-time data exchange between payers and providers to optimize revenue and reduce operational cost to both payers and providers serving the Medicare and Medicaid patient population.

Payer Insights
Gaps in Care
Centricity Payer Connect can help providers improve their patients' health by alerting providers of care gaps that need to be addressed in a timely manner. This new collaboration solution reduces the manual effort required to share gaps in care information and provides guidance that optimizes revenue performance.

Risk Adjustment
Providers can recieve information from Payers to provide guidance on which health problems are relevent to specific Hierarchical Condition Codes (HCC). The Risk Adjustment score determines payments and premiums for Medicare Advantage plans, Medicare Shared Savings ACOs, and ACA health plans. Providers benefit through this by using the right ICD-10 and HCC codes, ensuring accuracy of reporting and reimbursement.

Providers can benefit in the following ways:

Automate the process of collecting data to address clinical data requests from payers, saving providers time and resources.

Providers engaged in global capitation arrangements and other at-risk payment and delivery models, can use quality improvements, data accuracy, and cost savings to negotiate contractual rates or quarterly incentives with payers that reflect these positive outcomes. In more traditional fee for service arrangements, addressing gaps in care during patient visits ensures better care and payment for all services provided to and needed by patients.

It's not just payers and providers that stand to benefit from more seamless communication, patients do as well. When information loops are complete, payers and providers can collaborate to close care gaps and monitor quality metrics through system automation, leaving more time and resources for patient care.