With the increasing emergence of fee-for-value payment structures, healthcare payers are grappling with many parallel challenges to those of healthcare providers. Vast amounts of data about their members exist, but until now, have remained disconnected and massively under-utilized from the standpoint of potential to streamline workflows, match resource utilization to patient needs appropriately, and ultimately optimize health.

Achieving value is the central tenet behind the new payment structures. Payers and providers share the incentive of revenue optimization by way of shared savings made possible by positive outcomes at lower cost. When hospitalizations, readmissions, ER visits and other resource consumption can be prevented as a function of effective care management, costs are contained while necessary services are delivered in a coordinated, timely, and appropriate fashion.

The transition away from fee-for-service has proved challenging for myriad reasons. The BettrAi platform exemplifies this complex capability that makes fee-for-value possible. Instead of reliance on a mix of paper-based and IT mainframes to access data, the comprehensive consolidated source of data needed to measure, monitor, and manage member health status and healthcare system performance is now accessible, transparent, and seamlessly shared between provider and payer. Claims and reimbursement processes are streamlined and optimized.

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