McKesson rolls out tool to help insurers manage value-based pricing
The new tool also clarifies the calculation behind the prices insurers pay healthcare providers.
Newton, Massachusetts-based McKesson Health Solutions on Tuesday rolled out a new rate pricing tool that it says will help insurers automate, execute and scale complex mixes of value-based and fee-for-service reimbursement strategies.
The news comes as more health plans move from broad networks and straightforward reimbursement approaches to narrow networks and value-based payments.
The McKesson Reimbursement Manager 3.0 automates network pricing strategies yet gives flexibility for health plans to configure their own payment methodologies, the company claims.
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It helps payers determine the contract amount based on claim and non-claim related data elements, products and programs, as well as service lines and groups, McKesson said.
This enhancement can help improve a plan's ability to innovate around risk-based payment arrangements.
The new tool also clarifies the calculation behind the prices insurers pay healthcare providers, while giving insurers information they can use in their payment audits to ensure claims are being paid correctly.
"We've spent a lot of time with customers at leading health plans to understand their challenges and what they need to overcome them," said Michael Flanagan, VP of Reimbursement Solutions at McKesson Health Solutions. "At the end of the day, it comes down to understanding the elements of transitioning from fee-for-service to value-based approaches for reimbursement, and the daunting complexity of that transition."
Twitter: @SusanJMorse
