NaviNet’s suite of Value-Based Network Applications meets the rapid demands of payer provider collaboration.

Value-Based Network Applications deliver the critical clinical information necessary to succeed in the post reform era of healthcare. With changing reimbursement contracts and value-based metrics and incentives becoming more common, NaviNet Open’s Value-Based Network Applications provide a set of solutions to help both health plans and providers work together to achieve shared goals.

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Take a closer look at our Value-Based Network Applications

Document Exchange Advanced Referrals

Empowering Payers and Providers towards Value-Based Care

Enable payer-provider collaboration to achieve shared goals around quality and value-based contract performance

Optimize outcomes by integrating clinical information within existing provider workflows

Equip providers with timely decision support to drive high-quality, cost-effective care

"Payer-provider collaboration is essential to innovation and growth. The NaviNet Open communications network helps to enable data transparency between payers and providers, which builds trust and prevents potential disputes over performance. That trust is further bolstered as patient outcomes begin to improve, leading to additional pay-for-performance revenue for the hospitals and practices."

- VICE PRESIDENT OF PROVIDER NETWORK OPERATIONS, QUALCARE

The Insiders Guide to Payer-Provider Collaboration

NaviNet Open Value-Based Network Applications are configurable, scalable and flexible, helping payers and providers quickly meet changes in the evolving healthcare landscape so you can improve care, patient satisfaction and lower costs.

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Clinical Document Exchange:

NaviNet Open Clinical Document Exchange provides health plans with a robust capability to deliver both in-context and asynchronous clinical information, and to interact with providers in real-time workflows in a bi-directional manner. Many types of clinical documents can be delivered with tangible benefits for value-based programs and improved patient care and outcomes.  Clinical Document Exchange on NaviNet Open replaces the use of fax, the postal service and secure FTP, methods that are too expensive, untimely, poorly adopted or all three.

NaviNet Open features the infrastructure and delivery capability to move clinical documents of many types between health plans and their providers, and back again, in a bi-directional manner.  Use case examples include:

Application

Value Delivered

Patient Clinical Summary
360⁰ View / ↑Pt Safety
Care Considerations
↑HEDIS / STARS, ↓Costs of Generic Medications
Program Enrollment
↓Costs / ↑Enrollment Yield
Work List Tasks ↑Care Plan Adherence
Admits/Discharges ↑Care Coordination / ↓Preventable Readmits
Practice Performance
↑Incentive Alignment



The solution enables the delivery of timely information relating to a specific member’s condition, clinical care need, or proactive step directly to the provider office in real time for immediate action. Confirmation that action has been taken place occurs with the round trip of the edited document. NaviNet Open Clinical Document Exchange includes the ability to send a clinical document with patient-precision. When conducting an eligibility check on a patient, the event listening capabilities can determine if there is a document for the patient and deliver it, in context, to the user. This capability provides a decided advantage for health plans as value-based and risk-sharing contracts are put into place.

Advanced Referrals and Authorizations:

NaviNet Advanced Referrals will include provider to provider and provider to payer communication and episode of care coordination tools. This application will enable the referring provider, servicing provider and health plan to all share visibility into the patient encounter and follow up communications, as well as support the sharing of clinical documentation.  Providers can reduce out of network costs and refer within specific in network tiers. As providers move to contracts tied to Value Based Reimbursement, the cost savings associated with effective provider steerage (including Servicing Provider Cost Information) is an important asset.