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ClaimSphere® Clinical+ is Cognizant’s digital initiative to help healthcare organizations shift from volume-based, provider-centric systems to patient-centric, health-focused systems. This product uses evidence-based clinical processes at points of care to support national interoperability standards that promote value-based programs and better patient outcomes. By helping align payer and provider value-based contracts with quality improvement initiatives, healthcare organizations will improve outcomes and maximize revenue.
ClaimSphere Clinical+ assigns accountable ownership of quality measures to providers, empowering providers with real-time, actionable insights on patient-level gaps in care. It can be configured for various value-based programs, such as Healthcare Effectiveness Data and Information Set (HEDIS®), P4P and STAR, and scaled up for MIPS and APMs.
Healthcare organizations can easily convert acquired clinical data to pseudo claims that can be consumed by a payer administrative system. Using ClaimSphere Clinical+ providers get actionable clinical intelligence at the point of care by combining clinical and claims data. These features go a long way toward enabling payer-provider convergence.
The ability to track provider performance metrics and supplemental clinical data in real time allows healthcare organizations to more accurately evaluate various provider networks. The system also enables organizations to prioritize care gaps based on quality impact and develop performance benchmarks based on peer comparison analytics.
ClaimSphere Clinical+ helps organizations collect and analyze medical records from providers quickly and efficiently. This allows closer monitoring of care gaps to improve efficiencies. To drive faster care gap closure, ClaimSphere Clinical+ then charts the results of evidence-based, performance-driven provider incentive programs.
Prebuilt workflows for care gaps assignment, abstraction and review are designed to ensure accurate data collection. Multiple documents can be uploaded and accessed simultanously to quickly capture relevant information for medical records.
"HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)."