Payers & Managed Care Organizations

Manage Costs and Risk

With P-CIS, payers and MCOs can offer efficiency tools to providers in exchange for unified networks of care. Real-time pre-authorization and level of care approval ensures that providers can deliver care when patients and clients need it.​

System-wide monitoring of population risks, services, and costs in real-time so that payers, MCOs, and providers can work together for resources to adjust to changing population needs.

Business professionals at work

Payers/MCOs Establish a Centralized Care Network

With P-CIS, Health Plans offer real-time pre-authorization through assessment rule algorithms while monitoring patient/client approvals for care intensity in real-time. P-CIS can seamlessly integrate with all providers’ existing electronic records so that providers connect directly with Payers/MCOs, but providers maintain consistency of their current electronic system and control of what is shared. P-CIS acts as a third-party “data escrow” account allowing all parties to give and receive the information they need in real-time.

With P-CIS, Payers/MCOs can operate from this command center to oversee the entire care network. They can have real-time transparency into the changing needs of the service populations, evaluate the ongoing appropriateness of the care determination algorithm rules and system logic, see the impact of provider’s services on populations and subpopulations, and can adjust the flow of assignment into services. Payers and MCOs can make simple and easy modifications to settings to fine-tune the efficiency of the care system – from the centralized Person-Centered Intelligence Solution (P-CIS).

Highlighted Features

Interoperability: P-CIS integrates with all EMR/EHR and automates tasks for providers

Automation: Providers experience reduced time on documentation

Pre-Authorization and Level of Care: Payers/MCOs can interoperate with provider EMR/EHR to automate pre-authorization and level of care determination in real time, without disrupting provider workflow

Insights: Real-time visibility into member outcomes, value-based care metrics, HEDIS measures, & costs of care, by care model

Next Best Actions: Notifications of best actions based on successful care pathways of similar patients

Care Circles: Co-serve patients with partner organizations work off the same care plan in real time

Reporting: Providers choose what to report, maintain control of data, and opt-out at any time with the flip of a switch

The Benefit

Members experience increased access to needed services more quickly

Provider staff receive instantaneous feedback for member authorizations for service

Members don’t have to repeat their story to the “assessor” and then again to the provider staff because assessment data can be shared in real-time

Members improve quicker because they will receive better matched services sooner

Members engage in the right level of care

Provider staff see evidence of the positive impact they are making on members and experience increased sense of accomplishment and less burnout

Provider staff spend less time on documentation

Transitions to higher and lower levels of care happen efficiently in real-time

Co-served members feel the safety of a cohesive care system

Cost of care reduce

Member outcomes improve

Payers/MCOs have visibility into drivers that improve outcomes and reduce costs

Payers/MCOs have data-supported evidence to show a healthier happier population

Provider staff spend less time hunting down member information

Stories of Success

"Opeeka’s technology platform, P-CIS, almost completely eliminated my phone support for staff because we are now communicating through the platform in lightning speed."

 I wanted to be the agency that not only provided life changing caregiving but actively helped maintain the members quality of life in the home. To do that, I needed to leverage technology that not only allowed me to create customized care plans but also to provide care teams the ability to review progress or decline over time. For Emblem, success is when we can be a small part of making someone’s quality of life better and help tell their story over time. Additionally, adding to that quality of life also means being able to communicate with a clients care circle with ease. Knowing that we can drive care immediately to our clients through our documentation is a huge win for us. 

Opeeka’s technology platform, P-CIS, almost completely eliminated my phone support for staff because we are now communicating through the platform in lightning speed. We can drive more information to health plan Case Management who then can utilize that information for monthly/quarterly review. We can easily drive information to emergency settings for acute needs with a simple click of a button. Information is power, Opeeka can help people get better care faster and drive down risk when providers know about who they are treating. Home Care in the past has been overlooked as an information hub due to our inability to disseminate information with ease, but now with Opeeka we are considered a HUB. 

Home Care walks alongside clients for long periods of time, P-CIS allows us to aggregate information in a way that helps us deliver better care. Allows us to view gaps and where we can focus our care effort. P-CIS allowed us the ability to capture, create, and tell the story of each of our clients. We can now arm health plan case management, providers, and other verticals involved in a patients journey with valuable information. 

We have the privilege of telling our clients story through the powerful data science that plays behind the scenes in P-CIS. We have the honor of humanizing a client who would otherwise be considered a medical record number. If that was not enough, we can even ingest forms, progress notes, and supervisory forms that Case Managers or healthcare providers utilize during client monitoring events. That bi-directional communication brings a client’s whole story full circle and frankly that does not exist in our environment today. With P-CIS we are single handedly creating an information circle around every client in every setting during every possible event where care is needed. Opeeka used science to bring humanity back to every client care setting.

-Lindsey Kroll, Executive Director, Emblem Home Care