In an industry defined by government program expansions, aging member populations, and rising healthcare costs, successfully managing health outcomes has become increasingly complicated.
We are dedicated to helping you leverage data to optimize outcomes. Through integrated technology and analytic solutions, we help you assess, predict, and manage risk, while personalizing and enhancing care.
How it works:
Our premium population assessment and stratification solution helps your team spend more time working with members and providers, and less time collecting and entering data.
The Johns Hopkins ACG® System, included in our CareAnalyzer® solution, offers a unique approach to measuring morbidity that improves accuracy and fairness in evaluating provider performance, identifying patients at high risk, forecasting healthcare utilization, and setting equitable payment rates.
We offer a comprehensive suite of quality management software and services designed to help you balance the complexities and costs associated with administration, regulatory compliance, and member care management.
Our solution, combining HEDIS methodology with the Johns Hopkins ACG® System, helps you identify member level gaps in care, integrate member risk and resource utilization, and facilitate member/provider communication.
We provide a unique set of experienced consulting services and analytic tools to help you visualize, monitor and manage compliance, set alerts, and make adjustments based on priority impact on star ratings.
We provide single platform member-centric views, discharge planning tools, and transition of care planning and medication reconciliation that minimize hospital readmissions. We facilitate coordinated care across teams and departments optimizing costs and delivering better health outcomes.
We combine access to critical member, benefit, and provider information with a real-time authorization capability to help UM nurses improve first-pass claims acceptance rates, and maintain necessity and benefit compliance.
Improve outcomes with our automated case creation and configurable monitoring tools that can help your members better understand their conditions and engage in care planning and outreach interventions.
Utilize risk-stratified member data to identify the best prospects for targeted, proactive interventions that can improve quality and coordination of member care.
We arm you with the tools you need to proactively evaluate patient risk, identify member-level care gaps, and make targeted care recommendations.
Our innovative analytics deliver valuable insights on physician effectiveness by benchmarking, comparing and ranking providers, and identifying differences in member health across practices. Robust risk profiles help you eliminate inefficiencies within provider networks.
This member-centric solution automatically creates cases and care plans based on risk-stratified population data, helping care teams focus resources on members who are in the greatest need of care. Our comprehensive case, disease, and utilization management solution provides an overall view of a member’s care in a single, integrated platform to improve coordination of care across teams and departments.