Our Medicare Advantage Post-Acute eXchange delivers the industry’s first claims-based intelligence on current SNF-MA reimbursement, outcomes & value-proposition.
Under the Medicare fee-for-service program, you can determine what every facility’s rate structure is based on their county. Under managed care, individual facilities have little idea how they are doing relative to their peer group – often none at all. These data limitations foster a challenging environment for the provider when negotiating with the plans. We refer to this as “information failure” or more specifically “asymmetric information” – an economic principle that exists when one participant (the plans) in an exchange knows more than the other (the providers). Our goal is to shift the knowledge edge, and negotiating leverage, back to where it belongs: to the skilled nursing facility provider.
MAPAX analyzes current MA claims and compiles insights related to utilization, revenue, lost reimbursement opportunities, compliance risks, quality data and value proposition. This information is critical to aid with contracting, rate negotiation and case management. The data can be filtered by region – down to the County level – and is adjusted by acuity with the ability to drill-in to a specific insurance plan. The goal is to empower facilities to quantify programs they do well — from a clinical, financial and patient satisfaction standpoint — with the contextual data to promote their capabilities we can change health care from a market where supply drives to demand to one where quality drives demand.