Healthtech solutions
DELIVERING BUSINESS CONFIGURABLE SOLUTIONS
Our team of seasoned consultants is dedicated to guiding national and regional health plans through complex challenges, facilitating the implementation of straightforward and effective solutions.
Our consultants prioritize collaboration and innovative thinking, working alongside you as a cohesive team. We bridge the gap between business and IT with proven industry expertise, delivering scalable, business-driven technology and process solutions. Our approach harnesses emerging technologies to optimize operations, enhance patient outcomes, and improve overall experiences.
Payer services we offer
Utilization management
Ensuring the appropriate and efficient use of medically necessary healthcare resources, services, and treatments while optimizing administrative processes and costs.
Our comprehensive approach with custom healthcare payer solutions enables health plans to enhance operations and have fiscal oversight of their members’ services.
Automation of benefit discovery
Automation of benefit discovery
Automate and auto-populate the database of members to efficiently retrieve relevant information and details across various systems, eliminating manual data retrieval and streamlining the process for customer advocates and their teams.
Clinical decision support systems
Clinical decision support systems
A decision engine that analyzes and determines the auto-approval or need for further review of service requests, expediting the decision-making process and addressing potential data gaps upfront to optimize efficiency and minimize the involvement of high-cost resources.
Role-based visualization
Role-based visualization
Within our healthcare payer solutions, our solution aggregates data and access control, allowing users to access specific data sets that pertain to their role, thereby increasing the accuracy of decision-making.
AI in auth process
AI in auth process
Artificial intelligence presents a natural fit where outdated human decisions can be automated through ML models trained on established criteria. This scalable and agile approach reduces administrative costs and optimizes workflow to improve member satisfaction.
Care management
Delivering patient-centered quality care by leveraging data insights to ensure that patients/members receive appropriate and timely care to prevent their healthcare costs from escalating.
Our comprehensive solution manages and determines the most suitable next steps, personalizing care delivery, cost containment, and enhancing patient outcomes throughout the healthcare journey.
Characterization
Characterization
Utilizing valuable insights from large amounts of data to assist healthcare professionals in timely intervention and personalized care, improving efficiency, and enhancing communication to prevent further complications.
Case management solutions
Case management solutions
Our case management solutions prioritize health conditions and streamline patient routing, eliminating the need to outsource specialized services. We coordinate efforts, guide decision-making, and integrate seamlessly with payer enrollment for a more efficient healthcare management process.
AI in predictive risk stratification
AI in predictive risk stratification
Leveraging the power of AI to generate risk scores and recommend timely intervention and prioritize resources to improve patient engagement, reduce unnecessary utilization, and improve outcomes.
Delivering innovative & future-ready healthcare experiences.
Claims matching
Enabling claims matching by integrating authorization and claims data to ensure accurate payments. This guarantees healthcare organizations are accurately paying for the services they authorized.
Our comprehensive healthcare payer solutions perform checks and balances to validate claims, bridging the gap between utilization management and claims systems.
Simplification process
Simplification process
Automating claims processing by streamlining workflows and creating configurable exception handling based on the organization’s unique needs. This increases the efficiency of adjudicating claims by only showing relevant information.
Personalize dashboards
Personalize dashboards
Provide custom screens for financial services unit to identify and address pending claims, enhancing decision-making efficiency.
Data manipulation/data processing
Data manipulation/data processing
Validating claim data against utilization management systems/authorization systems for accuracy and consistency, eliminating manual effort and human error.
Clinical decision support
Automating clinical decision-making processes to provide agile capabilities to clinicians in specialty chronic condition management, like Oncology, Diabetes, etc. Eliminating the complexity and challenges associated with rules engine configuration by creating a single and reliable source of truth for medical necessity.
The clinical decision support system as a consolidated source ensures data consistency and accuracy across any healthcare organization, streamlining and simplifying the authorization process at scale.
Authorization and regimen management
Authorization and regimen management
Facilitating authorization processes to manage multiple regimens and approval criteria across diverse health plans, ensuring accuracy and variation evaluation prior to making a decision.
Lifecycle tool
Lifecycle tool
Enabling initial shell authorization with collected data and running it against member benefit eligibility and other decision factors.
Decision engine tool
Decision engine tool
Streamlining the workflow process for regimens approval by cross-checking them against pre-approved criteria of each health plan, considering traditional treatment plans, drug approvals, and alternatives prior to automating a decision.
Auditable/review component tool
Auditable/review component tool
Oversight of workflow to validate regimen variations during the authorization process. The tool provided a mechanism for auditing changes and their impact across the organization.
Payer case studies
Healthtech
Claims management
Developed a pre-authorization-to-claims matching solution to streamline the processes for commercial, Medicare, and Medicaid plans. Our solution lowered costs and improved customer satisfaction for the payer's clients.
Healthtech
Care management
Launched a care management product for employers, individuals, families, and Medicare/Medicaid plans, and managed the clinical components of planning, execution, and operational readiness, ensuring a successful go-live and stabilization.
Healthcare
Utilization management
Delivered a custom utilization management solution for Medicare and Medicaid programs, seamlessly migrating users across multiple sites without disrupting customer service.
Healthtech
Change management
Implemented a strategic change management program, migrating 2,500+ clinical staff across multiple sites. The solution serves as a blueprint for future processes and technology updates.
Awards & recognitions
Payer insights
Healthtech
Next Gen Prior Authorization - streamlining with automated decision support
Discover how automated decision support is transforming the prior authorization process, and see how 10Pearls Health emerges as a strategic partner in healthtech, revolutionizing prior authorization services for improved efficiency and patient outcomes.
Healthtech
Caregiver support – gaps, opportunities, and emerging models
Critical issues in caregiver support within Medicare Advantage, Traditional Medicare, and Medicaid are examined, identifying emerging care models that improve outcomes and member engagement.
Healthtech
Harnessing AI & analytics as a force for good - HLTH 2023
HLTH 2023 Conference – Harnessing AI & Analytics as a Force for Good. Amir Azarbad, Managing Director, 10Pearls Healthcare was joined on this panel discussion by Ainsley MacLean, MD, Chief Medical Information Officer, Kaiser Permanente and Eugene Sayan, Founder and CEO, Softheon.
Healthtech
The power of digital engagement tools for medicare payers
Revolutionizing payer engagement, enhancing member satisfaction, and improving health outcomes through the delivery of quality healthcare services in the digital age.
Healthtech
Comprehensive clinical snapshot
Unified source of truth for population health management - leveraging cutting-edge technology to advance clinical innovations, transform operations, improve patient outcomes, and reimagine patient experiences.
Healthtech
10Pearls bringing digital & global expertise to healthtech
Revolutionizing healthcare through innovative digital solutions that adheres to stringent security standards, ensuring the protection of patient privacy.