Evaluating the success of healthcare transparency platform, seeQer, across healthcare sectors
Introducing seeQer
seeQer is a technology platform designed for everyone involved in healthcare. It provides a comprehensive view of patients’ benefits, coverage, plan type, and adminstrative requirements, all in real time.
The platform has been developed to meet healthcare’s changing needs.
careviso started in the laboratory diagnostic space by performing prior auths on behalf of the ordering physician.
Over time, the company identified needs in the market that would benefit from an end-to-end transparency platform.
Due to legislation such as the No Surprises Act and the growing specialty pharmaceutical market, careviso has expanded into further areas of healthcare.
This case study compiles use cases of seeQer across three healthcare sectors:
- Physician Office
- Pharmaceutical Patient Support Services
- Diagnostic Laboratory
seeQer in the Physician Office: Reducing Manual Processes for Providers
The Case
careviso worked closely with a large physician group that phone calls to health plans.
The physician group habitually called health plans to verify patient insurance, out-of-pocket cost, and other administrative requirements.
In parallel to the calls, seeQer performed its own process and the two separate results were compared to one another and evaluated based on accuracy.
The goal was to reduce manual phone calls for the customer while maintaining accuracy.
20% of patients, seeQer had a higher deductible vs. the claim.
70% of patients, seeQer data matched the claims data.
10% of patients, seeQer had a lower deductible vs. the claim.
The Results
careviso demonstrated that the seeQer platform is able to accurately predict what a patient will be billed in real time.
When compared to real claims data, the success rate of the careviso platform was identical to the physician group performing the manual phone calls.
seeQer was able to replicate the answer that the client staff received on the phone from health plans when inquiring about patient responsibility. Thus, the client was able to reduce the time they spent calling payors.
90% of patients received a bill that was lower or matched the seeQer estimate.
seeQer for Patient Support Services (PSS): Speeding Time to Therapy for Patients
The Case
careviso engaged in a pilot with a PSS provider who was struggling to navigate complex medical benefits.
With many specialty medications covered under patients’ medical benefits rather than pharmacy benefits, verifying cost, coverage, and administrative requirements is challenging for PSS providers.
As the specialty pharmaceutical industry grows, technology solutions are starting to become a necessity.
The goal of this pilot was to test the efficacy and capabilities of seeQer’s electronic medical benefits (eMed BV) algorithm.
The Results
The findings indicated that seeQer is highly effective in verifying complex patient medical benefits.
From the pilot, careviso and the PSS provider found that seeQer brings unprecedented success in verifying medical benefits for specialty pharmacy.
seeQer was able to pull either a full or partial result for the vast majority of cases. A full result includes benefit financial details, PA requirements, network status, and elibility status.
With careviso’s eMed BV solution, the PSS provider streamlined their operations, speeding time to therapy.
As a result of the successful pilot, seeQer is fully implemented with the PSS provider.
72% > 80% eMed BV tool improved full result success rate over pilot.
80% of patients, seeQer delivered full medical eBV results.
95% of patients, seeQer delivered partial medical eBV results.
seeQer in the Diagnostic Laboratory: Providing Detailed Insights to Labs
The Case
careviso collaborated with a national dignostic laboratory who was interested in the real-time data seeQer offers.
Many diagnostic laboratories struggle getting reimbursed for their services. Patients are often notified of the cost of testing after the service has been rendered.
The lab was looking for an efficient way to verify patient insurance information, provide patients with estimated out-of-pocket costs, and check if a prior auth was needed.
The goal of this collaboration was to save the lab time they spent chasing down payments.
The Results
The data highlights that seeQer offers timely and accurate insights and estimates for diagnostic laboratory testing.
For close to 75% of cases, seeQer was able to verify patient insurance, generate a patient out-of-pocket cost or identify prior auth requirements, respectively.
careviso has implemented improvements in information validity, max out-of-pocket estimates, and benefits pulls, that have raised the product’s success to 80% across the board.
These updates allow labs to have even more success with seeQer and continue to capture revenue.
76% of cases, seeQer verified patient insurance info.
73% of cases, seeQer generated patient financial estimate
72% of cases, seeQer identified a prior auth was required.
Summary
seeQer has proven success across the healthcare industry.
The platform has been expertly designed and updated to meet the complex and everchanging needs of healthcare professionals.
- For physician offices and health systems, seeQer reduces manual processes, allowing providers to keep administrative work under control and focus their time on patient care.
- For patient support services (PSS), seeQer helps navigate complex medical benefits for specialty pharmaceuticals, allowing PSS providers to break down treatment access barriers for patients.
- For diagnostic laboratories, seeQer providers real-time insights and estimates prior to testing, allowing labs to more easily capture revenue for services and improve their operations.
seeQer is revolutionizing the antiquated healthcare landscape. Partner with us to build a brighter future for healthcare providers, services providers, health plans, and most importantly: patients.
