SOLUTIONS

Member Master

Build a rich member profile with advanced identity management, demographics, and social determinants

Connected patients expect technology to improve access to healthcare and their primary care physicians. Additionally, recent government regulations compel the industry to move to value-based care models that offer high-risk members the kind of intense, personalized care that leads to optimal care outcomes. These forces combined require better management of member data.

With a 360 degree view of members across products and enrollment periods, payers can understand member risk and design health management programs to improve outcomes and lower costs.

Gaine’s Member Master solution offers a flexible data platform to integrate patient information, including claims history, doctor and pharmacy visits, as well as personal demographic information. The Gaine Member Master solution combines every aspect of patient data to support proactive, value-based care that ultimately lowers costs and provides a better patient experience.

With a holistic view of your member’s healthcare experience, you can provide a higher degree of service, value, and personalization. Payers are meeting their tactical cost reduction goals, as well as improving member experience and outcomes using the Gaine platform.

Customize Your Member Master Solution

Member Outreach

Support member outreach programs for STARS, HEDIS, MMP and other quality programs. Capture critical member information at every touch-point and log all interactions.

Population Health Data Store

Ensure that your population health management program has the best possible data by linking member/patient information from internal systems and externally curated databases quickly and easily.

Extended Member Profile

Continually extended the profile of your members to identify risk factors and suitability for health management programs with the Gaine Extended Member profile solution.

Enrollment Management

Simplify the enrollment of members into core administration platforms and other clinical management solutions using the Gaine member enrollment gateway. Create a longitudinal record of members across enrollment periods and products  for maximum efficacy.

Benefits to Members

Personalized Care for Optimal Outcomes

By understanding more about each member, their unique needs, social circumstances and claims history the health plan is able to design personalized care for improved outcomes. This is enabled by the Gaine platform which simplifies the collection and compilation of member related information from any system.

Maximized Care Coordination

Coordinated care programs require that all healthcare participants can easily exchange information about the member/patient. The Gaine platform helps tie together different medical record systems with medical management programs for optimum results.

Improved Access to Healthcare

Managed care providers have proven the immense benefits of pro-active interventions to avoid expensive medical procedures. However, care programs are only as effective as they are accessible. The Gaine platform helps build a comprehensive understanding of each members unique needs and circumstances to support the design of effective provider networks.

Benefits to Payers

Integrate and Track Care Across All Systems

Health plans have invested in multiple systems to manage all aspects of their members medical needs. Gaine enables a health plan to see a complete picture of each member irrespective of the underlying systems in use.

Lower Overall Cost-of-Care

Simple, inexpensive interventions can yield dramatic savings to a health plan and improve member outcomes. However, this is only possible if the payer can accurately identify candidates for these programs – that’s where the Gaine Member Master solution comes in.

Meet Compliance and Wellness Goals

Multiple quality programs exist with the goal of rewarding effective care. Health plans with the Gaine member Master solution enjoy an advantage over their competitors with richer member profiles and more targeted care.

Why Payers Choose Gaine for their Member 360 Solution

Fastest Time to Value

Drastically reduce administrative hours collecting and consolidating data from Providers and contracted groups through our proven exchange process. Within a few week’s time, Gaine is up and running to start saving you time.

 

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Lower Total Cost of Ownership

The cost associated with poor-quality provider data can be crippling. Gaine has the expertise and experience managing provider data for payers and provider groups to eliminate waste and improve the provider experience.

 

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Eliminate Risk Throughout

Our experience and expertise in the healthcare space give us the insight necessary to identify project risks, and the skills to remove these from your roadmap. Tell us about your project! We are sure we can help. Contact us 

 

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Building Your Member Master

Gaine reconciles various disparate member identities into a single view of the individual. The Coperor suite receives raw member and provider information from each of the Payer’s systems then cleanses, de-duplicates, and organizes the data. Coperor then links the master record to clinical records in one or more health Information Exchanges (HIE’s) to complete the picture.

The Coperor Core Services suite supports the creation of a Master Patient Identifier (MPI) which takes the form of a unique key. This key then attaches itself to each touch-point or record and persists throughout all systems, permanently. The process provides Payers with clean, connected, and reliable data where they can track each Member record across their entire ecosystem. 

Select from included or add-on features for a light, enterprise, or custom implementation.

Real-time Services

Enables all core MDM functions through an API for real-time cleansing, matching, merging and mastering from any application or workflow.

Enterprise Sync

A business rules engine with machine learning capabilities to keep all connected systems updated with the enterprise repository based on the preferences and technical specifications of each application.

Notifications Engine

Notifications are posted to a central queue and may be strung together into complex workflows to resolve data problems. Clients may configure a set of notifications from an extensive library and consume these via the Coperor portal or integrate these into their internal applications via the API.

Policy Repository

An online repository that stores your data policy for every data element in the enterprise model in both business and technical terms.

ODS Integration

With the Coperor ODS companies can incorporate transaction data into the business rules driving enterprise synchronization and master data management.

Third-party Gateway

Achieve maximum leverage from third-party reference data without polluting your internal systems with unwanted noise. Our third party gateway gives you complete control over what data is distributed into your internal systems according to your business rules and data policies

Salesforce (SFDC) Toolkit

Integrate all Coperor functions into SalesForce.com via our programming API. Perform live matching, standardization to your policies and issuance of new master ID’s all from your SalesForce application.

Data Stewarding

Leverage our experience team of data stewards with industry experience either to get your through a backlog, or as part of your day to day operational process.

Extended Support

Choose the level of support you need based on response times, dedicated support staff and coverage windows. From Bronze to Platinum support levels available.

GET IN TOUCH

Lets start a conversation and find the right solution to your data management needs

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