Business customer success story

One of the nation’s largest health plans faced challenges with costly data integration, duplication and inefficient workflows due to data existing in silos. Scaling required an agile technology foundation capable of supporting a wide range of data-driven use cases.

• Their challenges with data integration and utilization included:

  • Provider data files tailored for single use cases (ie HEDIS)
  • Variations in integrations, formats, and terminology
  • Redundant data management efforts significantly driving up costs
  • Fragmented interoperability with limited adoption

• It was critical for their business to:

  • Improve care coordination and patient outcomes, as mandated by CMS and state regulations
  • Renew and secure Medicaid contracts
  • Secure value-based contracts and differentiate on national RFPs
  • Enable provider and member collaboration across all channels

• Orchestrate empowered them to scale by providing:

  • A single source of truth for longitudinal member views of clinical and financial data
  • Rationalized vendor solutions, reducing costs, fragmentation and waste
  • Real-time clinical data access for more accurate, coordinated member treatment
  • A scalable foundation for future growth, enabling higher productivity at a lower cost

• Departments benefiting from Orchestrate include:

  • Risk adjustment
  • Quality (HEDIS/STARS)
  • Care Management
  • Analytics/AI/ML
  • Provider Network Operations
  • Member Engagement
  • Benefit Collaboration
  • Clinical Trials

For this Payer, Orchestrate has consolidated patient records for over 46 million active and 100 million inactive members, integrating data from over 2,800 providers, 240 data sources, and over 7.5 billion claims across various formats. CareEvolution^® also built a direct member tool for exchanging comprehensive patient records across providers regardless of direct connectivity with the Payer.