Policy That Computes
Harmonizing evidence, care, and reimbursement with digitally native policy that responds in milliseconds
The development and administration of health plan clinical policy is often slow, manual, and error-prone. Concert has engineered a ground-up approach to develop digitally native policy that is structured for machine readability and maintained as a living data asset vetted by hundreds of clinical experts. These policies are deployed from the cloud to integrate into any clinical or reimbursement workflow.
What’s inside the whitepaper:
- The Five Requirements for Computable Policy: An overview of the industry standards (Evidence-based, Transparent, and Intuitive) and the digital requirements (Interoperable and Instantly Responsive) necessary for automation.
- Systematic Curation of Source Content: An inventory of inputs including clinical guidelines, primary scientific literature, market information, and legal/regulatory factors, all used to ensure coverage positions remain consistent with current evidence and practice.
- API & Workflow Integration: A detailed look at how machine-readable criteria delivered via API supports automation in the EHR, prior authorization, and pre-payment claim editing.
- Access to Concert Policies: A link to the Concert Reference Policy Viewer, which anyone can access with a free account here.
For access to “Policy That Computes,” please complete the form on this page.