McKesson Reimbursement Manager 3.0 Automates Complex Network Pricing Strategies to Allow Value-Based Reimbursement to Scale

From McKesson:

McKesson Reimbursement Manager 3.0 Automates Complex Network Pricing Strategies to Allow Value-Based Reimbursement to Scale

November 17, 2015

New tool gives health plans the ability to build and manage rate schedules nimbly and efficiently in an increasingly complex value-based world

NEWTON, Mass., November 17, 2015—Today McKesson Health Solutions debuted McKesson Reimbursement Manager™ 3.0, a next-generation network pricer designed with input from leading health plans and built for an industry in transition. Reimbursement Manager 3.0 deploys new and innovative capabilities to help payers automate, execute, and scale complex mixes of value-based and fee-for-service reimbursement strategies.

Payers are moving from broad networks and straightforward reimbursement approaches to narrow networks and alternative payment arrangements. But this transformation ushers in a dramatic increase in reimbursement complexity. Payers are discovering their current systems can’t price accurately without resorting to expensive customizations and manual workarounds. The result: They can’t bring new products to market fast enough to remain competitive. McKesson Reimbursement Manager 3.0 addresses this by giving payers the flexibility, intelligence, and transparency they need to deploy fast, effective, and efficient payment model innovation.

“We’ve spent a lot of time with customers at leading health plans to understand their challenges and what they need to overcome them,” said Michael Flanagan, VP of Reimbursement Solutions at McKesson Health Solutions. “At the end of the day, it comes down to understanding the elements of transitioning from fee-for-service to value-based approaches for reimbursement, and the daunting complexity of that transition. With McKesson Reimbursement Manager 3.0, we’re giving payers the first next-generation pricer that works intuitively for all the key stakeholders. And that can help assure everyone that claims will be paid as promised in the contract, no matter how complex they might be.”

Indeed, with McKesson Reimbursement Manager 3.0, payers can finally get the flexibility, intelligence, and transparency they need to unleash fast, effective, and efficient payment model innovation:

• FLEXIBILITY and the freedom to innovate
  Traditional pricer platforms are frequently inflexible for a value-based world. They can lock payers into a “canned” reimbursement process due to system limitations. Or they require significant investments in custom development to attain a required level of adaptability. In contrast, McKesson Reimbursement Manager gives payers the flexibility to create and configure their own payment methodologies as fast as they need to, out of the box, based on how they do business.
  
• INTELLIGENCE for smarter, smoother, streamlined pricing
  McKesson Reimbursement Manager helps go beyond the simple calculator model of traditional pricers by helping payers determine the contract amount based on multiple data points and variables, including claim and non-claim related data elements, products and programs, as well as service lines and groups. This enhancement can help improve a plan’s ability to innovate around risk-based payment arrangements.


• TRANSPARENCY that unlocks the pricer “black box”
  With traditional pricers, providers submit a claim and the pricer returns the calculated price. Payers have limited ability to understand the rules and methods that determined the appropriate contract amount. Conversely, McKesson Reimbursement Manager helps clarify how each price was arrived at. Payers can use that information to answer provider questions, such as “Why am I getting paid differently than I was before?” or “How was this payment calculated?” Moreover, payers can use this information in their payment audits to ensure claims are being paid correctly. Now payers can get the access and control they need to compete more effectively in an increasingly value-based world.
  
• INTEGRATION and AUTOMATION to help simplify complex workflowsFor the first time, health plans can automate the entire reimbursement lifecycle, regardless of complexity, by integrating claims systems and data with McKesson Reimbursement Manager. Now, instead of having to custom code claims systems to accommodate more complex contracts and new reimbursement models, payers can use McKesson Reimbursement Manager to “surround” their claims system, help eliminate the need for costly development, and help speed time to market. McKesson Reimbursement Manager also integrates with McKesson ClaimsXten™ and McKesson Provider Manager™ to support alignment of specific payment arrangements, provide advanced claims editing, and help validate payment and reimbursement policies in audits.

For more information on McKesson Health Solutions, please visit our website, hear from our experts at MHSdialogue, and follow us on Twitter at @McKesson_MHS.

Recent McKesson Health Solutions News

• Health Plan of San Joaquin Chooses McKesson for Network Management
• McKesson’s Wukitch to Unlock the Consumer Engagement Conundrum at AHIP’s Institute 2015
• Eight Health Plans Choose McKesson’s Network Management Solutions
• 13 Health Plans Invest in McKesson’s Latest ClaimsXten™ Solution for Accurate and Efficient Reimbursement

About McKesson Corporation

McKesson Corporation, currently ranked 11th on the FORTUNE 500, is a healthcare services and information technology company dedicated to making the business of healthcare run better. McKesson partners with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. McKesson helps its customers improve their financial, operational, and clinical performance with solutions that include pharmaceutical and medical-surgical supply management, healthcare information technology, and business and clinical services. For more information, visit www.mckesson.com.