Clinical and Care Management Operations – Services PEAK Matrix® Assessment

Value-based care models have gained significant traction in the market with growing costs of healthcare services and a pronounced gap in the care quality provided under traditional fee-for-service models. Consequently, the Centers for Medicare and Medicaid Services (CMS) plans to drive the adoption of value-based care by transferring all Medicare fee-for-service beneficiaries into a care relationship with accountability for quality and lower total cost of care by 2030. While the pandemic initially drove alternate care delivery models, such as home-based care and virtual care, enterprises are increasingly using them to improve the continuity of care, reduce costs, and drive value for their member/patient base.

However, this push toward value-based care requires further technology investments from both payers and providers for integrated care management and effective utilization management. Providers can fulfill enterprises’ clinical and care management operations requirements by delivering clinical services from cost-effective locations and deploying advanced technology solutions built on a foundation of clinical, claims, and Social Determinants of Health (SDoH) data for personalized care programs and engagement.