KLAS “Points of Light” Award Reflects How Moxe Shines at Enhancing Payer-Provider Collaboration
For the fourth year in a row, KLAS K2 Payer/Provider Collaborative, a group focused on reducing friction and facilitating trust, collaboration, and alignment between payers, providers, and HIT vendors, awarded Moxe with a Points of Light Recognition Award. The Points of Light award celebrates the work and partnerships that promote that collaboration and enhance healthcare outcomes.
We’re proud of our team and our partners who were recognized as part of this award: Quartz and Humana, who have a combined over 9 million members; Cotiviti, a third-party requestor organization; and a healthcare organization with over 500 beds who has chosen to remain anonymous (we’ll call them “healthcare organization 8” in this blog). Through ongoing, open dialogue between all stakeholders and a shared commitment to reducing administrative burden in healthcare, we were able to automate the secure Release of Information (ROI) for quality and risk adjustment use cases.
Why a new approach was needed
The two payer organizations involved had an increasing need for precise, timely data from healthcare organization 8 to accurately determine risk scores, meet evolving quality metrics, and maintain CMS reimbursements. Historically, Quartz would do a manual, labor-intensive audit of healthcare organization 8’s EHR, while Humana would call or visit the healthcare organization to get medical records, usually requesting 6,000-8,000 records per year. Both payer organizations relied on external vendors to obtain medical records via mail or fax, which was costly and time consuming.
While the payer organizations found it challenging to get the data when and where they needed to meet risk adjustment and quality program requirements, healthcare organization 8 was also struggling to keep up with the payer organizations’ overwhelming seasonal demand for medical records. Even though they had third-party help, they knew they needed to augment their ROI strategy to support the increase in patient data requests. They also wanted to prioritize data security, patient privacy, and scalability.
At the time of the case study, we processed 10,000 chart requests for healthcare organization 8 and as of May 2025, we have processed a total of over 37,000 chart requests.
Results of the collaboration
At the time of the case study (May – October 2024), we processed 10,000 chart requests for healthcare organization 8. In June 2024 alone, we were able to process 6,000 record requests and alleviate the influx of requests for healthcare organization 8! As of May 2025, we have processed a total of over 37,000 chart requests for healthcare organization 8.
Cotiviti has achieved a turnaround time of less than one business day for over 95% of record requests.
On the payer side, Quartz has seen time savings, improved efficiency, and increased chart access. Humana has realized internal resource savings due to the time savings and improved efficiency the collaboration has afforded.
What the collaboration has taught us
When we reflect on what made this Points of Light-awarded collaboration such a success for all parties involved, a few key things come to mind:
- There was open, ongoing communication across all stakeholders, including privacy and security officers. Ensuring the appropriate stakeholders were involved in the right conversations at the right time helped foster trust between all parties.
- There was a shared commitment to reducing administrative burden: Problem solving becomes much easier when all stakeholders agree on the problem that needs to be solved and believe it’s an important one to tackle!
- There was great attention to technical detail. We ensured accurate information–like provider TIN and member demographics–was provided for the querying network, which allows us to pull precisely the right data for the specific use case. With an eye towards scalability, we implemented a solution that not only helped automate ROI, but also set the stage for enhanced collaboration and greater interoperability.
Where we go from here
As we celebrate the success of this multi-stakeholder collaboration, we also look forward to expanding data delivery via FHIR to more payer organizations. We want to power the exchange of clinical data wherever clinical data is needed because we believe we can do it the most efficiently and cost-effectively, all while safeguarding patient privacy, maintaining the highest level of data security, and delivering high quality clinical data for all payment and operations use cases.
Thank you, KLAS, for recognizing the work our team does to help facilitate more seamless, secure, privacy-centric data exchange between payers and providers. We’re looking forward to hearing about the continued success of our partners!
To read about our award-winning partnership and the solutions the team implemented, access the full case study featured in KLAS’s 2025 Points of Light report below:
