The most beneficial innovator to payers and providers: Opala

The Silicon Review

The team was born from a payer. Opala was started from a large regional payer in the Pacific Northwest, and the founders have decades of experience working with health plans. The team also has first-hand experience with cutting edge technology and software that drives real results. That's why the team is uniquely equipped to understand the clients’ business and the challenges the clients face. Today the team is 65 employees strong and committed to connecting data across the entire healthcare system. But it started with a payer.

Opala stands as a beacon of innovation in the healthcare landscape, drawing upon a reservoir of deep-rooted expertise to cultivate symbiotic relationships between health plans and healthcare providers. Nestled in the vibrant city of Seattle, Opala emerges as a brainchild conceived by stakeholders from both sides of the healthcare spectrum, driven by a singular purpose: to transmute raw data into a tapestry of efficiencies and illuminating insights.

At its core, Opala's raison d'être revolves around a noble mission: to meticulously gather, standardize, and amalgamate healthcare data, meticulously weaving together disparate strands to form a cohesive and comprehensive portrait of patient health. Each datum meticulously curated, each piece of information carefully standardized, Opala tirelessly endeavors to construct a mosaic that accurately reflects the intricacies of each patient's journey through the healthcare system.

However, beyond the realm of mere mission statements lies Opala's grand vision, a beacon guiding its endeavors toward a future where it stands as the paragon of trustworthiness in the realm of patient insights. With an unwavering commitment to excellence, Opala aspires to become the cornerstone upon which the edifice of modern healthcare is built, heralding a paradigm shift that promises to revolutionize the very essence of healthcare delivery.

Exquisite service the company provides its clients

Risk adjustment for payers: Some of the clients’ customers have pre-existing conditions the clients don't know about yet. Others aren't coded correctly, or they aren't getting the care they need. Manage that risk and gain a clearer view of the clients’ risk profile with clean, accurate data. The clients will better understand the clients’ risk, improve the accuracy of RAF scores to maximize reimbursements, and improve patient outcomes.

Clinical data integration: Combine the clients’ claims data with clinical data for rich insights. Automate the flow of information from provider EHRs to provide a more complete member view to power workflows, eliminate redundant costs of chart retrieval and disparate data silos.

HEDIS & Quality reporting: Maximize HEDIS scores and MA Star ratings with timely and complete clinical data. Identify care gaps and quality measure performance across providers. Inform timely and appropriate care interventions leading to reduced medical costs and improved patient outcomes.

Interoperability mandates: Ensure compliance with federal and state mandates, including Prior Authorization Burden Reduction, Patient Access API, Provider Directory API, Provider Access API, Payer-to-Payer Exchange, and Formulary API.

Supercharge the data: There are more than a few economic headwinds these days. Focus on initiatives that grow revenue, reduce administrative waste, and improve patient outcomes with Opala. Capture the most and best data possible. The team will supplement the clients’ current data with clinical data. Data isn't worth much if the clients can't access it. The team delivers reports straight to the clients, or calls them via API. Apply the clients’ own analytics to find care gaps and use the clients’ interventions like UM and case management.

Prior authorization: Identify which denials are overturned and automate providing additional clinical data. Understand which PAs are requested that don't require authorization. Improve care by reducing procedure and treatment delays caused by manual PA approvals.

Risk adjustment for providers: Improve visibility of HCCs across EHRs and claims histories, maximize VBC revenue with accurate coding, and identify opportunities for chronic care support with richer EHR data.

Close care gaps: Identify errors in the clients’ EHRs like care gaps the clients report to payers that show as "closed." Maximize VBC revenue with better quality scores. Quantify and identify patients eligible for preventive care or chronic condition support.

Patient Access API: Opala’s Patient Access API enables third-party app developers to create applications that can be used by patients and healthcare organizations to access meaningful medical data. After a developer registers an application, it can be downloaded from Opala's App Gallery. The Opala API follows the SMART App Launch Framework for the HL7 FHIR Release 4 specification. The Opala API supports HL7 FHIR, DaVinci (PDex), and CARIN for Blue Button^®. Opala’s API provides a robust Master Patient Index, OAuth 2.0 security, a cloud-based data repository, and access to FHIR-based resources.

Meet the leader behind the success of Opala

Ken Chandler, Chief Executive Officer

Ken Chandler is a strategic healthcare leader with over 20 years of experience in health care operations. Prior to Opala, Ken was with Premera Blue Cross, most recently serving as senior vice president of National Accounts. In that role, he was responsible for an $8.9 billion business portfolio representing Premera’s largest, high profile, complex, and sophisticated employer clients. During this time, Chandler also served as Chairman of the Consortium of Health Plans Board of Directors and drove product solutions aimed at improving access to care and health innovations. He also served in a secondary role as CEO of Vivacity, a Premera-owned wellness company. Earlier in his career at Premera, Chandler served as vice president of National Account Operations and vice president of Operations for LifeWise Health Plan of Oregon, a Premera-owned company.