HealthTeam Advantage Partners with nirvanaHealth to Implement First-Ever Integrated Payer and PBM Platform to Automate Entire Payer and PBM Operations
SOUTHBOROUGH, Mass.–(BUSINESS WIRE)–nirvanaHealth (formerly RxAdvance) and HealthTeam Advantage (“HTA”) announce their partnership, with HTA integrating both nirvanaHealth’s comprehensive Medicare Advantage and PBM enterprise solution. These solutions run on Aria, nirvanaHealth’s integrated cloud-native robotic process automation (RPA) Payer & PBM platform. Based in Greensboro, North Carolina, HTA is a five-star rated Medicare plan that offers Medicare Advantage plans to eligible Medicare beneficiaries and is expected to go live with nirvanaHealth for this year’s Annual Enrollment Period (AEP). fall. HTA will migrate to the Aria platform and will also use nirvanaHealth for PBM and Payer business services.
NirvanaHealth’s comprehensive Medicare Advantage and PBM enterprise solutions include its Aria platform, which runs on AWS and leverages RPA, machine learning (ML), and artificial intelligence (AI). Aria is the first integrated Payer & PBM platform. nirvanaHealth’s Aria platform will be the backbone of all Payer and PBM operations for HTA, helping to recognize significant savings and improve plan improvements for their members. Aria brings a 360° view of the patient to every care provider across the continuum of care, including point-of-sale and point-of-care. “We’ve never seen anything quite like Aria. With this revolutionary platform, we can recognize significant SG&A cost savings that will then enable more premium dollars to be used for our members’ overall healthcare needs. “, said Brendan Hodges, President and CEO of HTA. “We are excited to deliver improvements in the quality of care and an enjoyable experience for our members.”
Aria deploys a digital workforce to automate and manage all health plan and PBM operations, including sales, marketing, claims, administrative, financial, clinical, medical, usage functions , care management, quality assessment and contracting and risk management. compliance. Plans can then allocate their human capital to activities with higher tactile value, such as member health care experience, social determinants of health, welfare plans, and benefit management functions. care. “Even these necessary highly tactile operations are made smarter with artificial intelligence (AI) and machine learning (ML),” says Ravi Ika, CEO and Founder of nirvanaHealth.
nirvanaHealth’s Medicare Advantage solution includes Payer Business Services, which leverages Aria to simplify end-to-end Medicare Advantage operations for any health plan in a compliant manner. “Both MA and HTA plans can be managed at low SG&A costs when fully implemented. Aria eliminates the need to use multiple vendors and platforms, increasing operational efficiency,” adds Ika. Using the Aria platform, Medicare Advantage plans can creatively allocate and manage risk with partners, such as APNs and MSOs, and Aria can help improve quality scores by sharing actionable insights directly into healthcare provider workflows. This includes gaps in care, continuity of care, and fine-tuning of risk,” said John Sculley, president of nirvanaHealth and former CEO of Apple.
Likewise, nirvanaHealth’s comprehensive enterprise PBM solution includes comprehensive PBM services in addition to the capabilities of the Aria PBM platform. HTA will go live on the Aria platform with nirvanaHealth as a full-service PBM with a competitive 100% pass-through network and discount contracts. This solution reinvents the pharmacy benefit management ecosystem to reduce overall pharmacy costs, converts specialty drug management from purchasing and billing to value and outcome-based management, and integrates pharmaceutical care to eliminate avoidable medical costs. “HTA will be the first Payer in the country to integrate Payer and PBM,” concludes Ika. “We are thrilled to partner with HTA and demonstrate how one platform is all you need to run Payer and PBM.”
nirvanaHealth is an innovative provider of Payer and Pharmacy Benefits Management (PBM) platforms that leverages its robotic process automation (RPA) cloud platforms to manage integrated medical, pharmaceutical and behavioral services that reduce administrative costs, global medical and pharmaceutical products and improve overall quality. nirvanaHealth offers the industry’s first integrated one-stop cloud Payer and PBM platform. nirvanaHealth is the pioneer of healthcare automation by uniquely combining deep healthcare domain expertise with a proven track record of building platforms to deploy RPA using cloud architecture native in the Pay and PBM sectors.
About the HealthTeam benefit
Care N’ Care Insurance Company of North Carolina, Inc. (CNC-NC) dba HealthTeam Advantage (HTA) is a health insurance plan founded in 2016 in Greensboro, NC HTA offers Medicare Advantage plans to eligible Medicare beneficiaries in certain counties in North Carolina and is committed to the health and well-being of its members and communities. HTA offers medical and pharmaceutical, dental, vision and hearing services, as well as personalized customer service. Learn more at HealthTeamAdvantage.com