Health Plan and Payer Solutions

Cost Control Meets Quality Outcomes

Tap Into the Power of Veradigm

Veradigm understands that managed care organizations, pharmacy benefit managers (PBMs), insurance companies, health plans, and other payers need to balance controlling costs with the goal of providing the highest quality of care and optimizing health outcomes for their members.

Solutions from Veradigm can help you:

  • Deliver insights to drive quality outcomes cost-effectively
  • Improve efficiency for you, your providers, and your members through high-speed clinical data exchange
  • Impact point-of-care decision making positively by integrating payer guidance and prior authorization management directly in each healthcare provider’s existing workflow

Clinical Data

eChart CourierTM Streamline medical chart retrieval

  • Save time, cost, and resources by retrieving medical charts electronically
  • Support data collection for Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA) and Centers for Medicare & Medicaid Services (CMS) 5-Star quality reports
  • Send information in a secure format for use by only intended users, in accordance with Health Insurance Portability and Accountability Act (HIPAA) rules

Point-of-care Messaging Communicate gaps-in-care messages electronically

  • Deliver payer messages directly into each provider’s existing workflow such as gaps in care, care plan and care summaries
  • Help improve patient communication and compliance since payer guidance messages are delivered at the point of care
  • Eliminate the need for disconnected forms of payer communications, such as mail, email, or fax

Risk Adjustment Analytics Deliver advanced solutions for risk management

  • Assist finance, medical management, managed care, quality management, and case management teams in risk analysis
  • Translate analytics into action with the help of our experience in risk adjustment, quality management, and provider engagement

For more detail, go to www.pulse8.com/solution/solutions-risk-providers.


eAUTH - ELECTRONIC PRIOR AUTHORIZATION Automate prior authorization

  • Use a fully integrated electronic process for managing the prior authorization process for your medication
  • Increase patient satisfaction, reduce administrative burden, and help to boost patient compliance
  • Improve productivity and reduce wait time dramatically—from days or weeks to just minutes
  • Help get medications to members quickly, without the treatment delays frequently associated with prior authorization

Speak with Veradigm today to request a demonstration or for more information on how we can help you meet your goals

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