Health Outcomes Optimization

Data-driven programs for healthier outcomes

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:

  • Predictive models help stratify and better target interventions.
  • We identify care gaps to help you achieve higher quality ratings.
  • Our insights help improve your provider performance.

Population Assessment and Stratification

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.

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Johns Hopkins ACG® System

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.

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Quality Management

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.

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HEDIS 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.

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CMS Star Ratings

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.

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Case Management

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.

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Utilization Management

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.

Disease Management

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.

Behaviorally-Based Interventions

Utilize risk-stratified member data to identify the best prospects for targeted, proactive interventions that can improve quality and coordination of member care.

Care Gaps

We arm you with the tools you need to proactively evaluate patient risk, identify member-level care gaps, and make targeted care recommendations.

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Provider Effectiveness

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.

Automated Contact Tracing & Case Management

With our Automated Contact Tracing program, you get access to the benefits of AWD without having to purchase the entire enterprise platform, which is critical in matters of public health. Our program delivers the right combination of automation, integration and orchestration so you can scale a successful contact tracing program easily and economically.

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