Technology & Infrastructure, Analytics and Reporting

Transitioning to a value-based care environment requires plans and providers to modernize technology infrastructure, gain expertise in compliance, payment models, and system configuration, as well as re-engineer operational processes to minimize their risk and optimize performance. In whichever stage you are in your transition, work with us to leverage technology, analytics, and reporting to build your VBC models; measure and prove value to meet guidelines like HEDIS and Quality measures; and leverage predictive analytics to segment populations in order to understand intervention opportunities, identify areas of cost savings for your organizations and members, and deliver better health outcomes.

  • CareAnalyzer®  – Proactively evaluate patient risk and select members who will benefit most from care management leveraging the industry-leading, comprehensive predictive modeling capabilities of The Johns Hopkins ACG® System, which provides care managers with risk-stratified data identifying high-risk members for early intervention and improving the overall coordination of care. CareAnalyzer’s unique analytic approach also combines elements of regulatory reporting, provider network evaluation, and risk adjustment – all in a single, integrated system.
  • Total cost of care – Evaluate without bias your total healthcare spend with our Total Cost of Care (TCOC) module available within CareAnalyzer. Get visibility into both risk-adjusted cost and resource-use efficiency, using interactive dashboards to quickly guide you to root cause of results. Metrics are displayed as a set of indices, allowing peer results to be shared transparently without exposing competitive information. TCOC leverages a methodology endorsed by the National Quality Forum (NQF) allowing for unbiased comparisons of both risk-adjusted cost and resource-use efficiency across different entities such as provider organizations, employer groups, and health plans.
  • The Johns Hopkins ACG® System – Gain access to the most widely used population-based, case-mix system and apply your in-house expertise to improve accuracy and fairness in evaluating provider performance, identify patients at high risk, forecast healthcare utilization, and set equitable payment rates.
  • Real-Time Benefit – Provide prescribers member-specific benefit information for a prescribed drug at the point of care. Real-Time Benefit provides members with drug cost transparency, eliminating sticker shock at the pharmacy and increasing the chances they will fill the prescription and adhere to the medication regimen. 
  • Prior Authorization (PA) – Control drug spend and help ensure that the right members have access to the right medications with PA. Our customizable approach supports all channels of PA – including electronic prior authorization (ePA) at the point of care – to help eliminate manual and labor-intensive processes allowing for improved quality and better outcomes.
  • ePrescribing – Reduce prescription errors and improve patient safety by accurately, securely delivering prescriptions to pharmacies from the point of care. e-Prescribing is the foundation for ePA and RTB. When combined, these tools help optimize the potential for positive outcomes, clinically and financially.
  • Provider Pricing – Automatically and accurately price claims across all business lines, regardless of detail or complexity of provider contracts. Full forecast modeling supports iterative contract negotiations by business staff without the need for IT support – allowing business users to easily configure, model, forecast costs, and test contract terms and rates to support iterative negotiations.
  • Medical Drug Management (MDM) - Get deep insights into medical pharmacy utilization and spend, uncovering opportunities to reduce specialty medication costs and risks. Our MDM solution integrates medical claims data to help you identify therapeutic alternatives, improve contract performance evaluation, and mitigate the risk of fraud, waste and abuse. It also aligns medical and pharmacy benefits to help improve compliance and effectively manage revenue.
  • RxNova – Choose the benefits solutions you need, the control you have over program design and edits, and the sophisticated reporting and analytics to inform your organization’s strategy and profitability with our RxNova pharmacy benefits management platform. RxNova combines our robust claims processing technology, proven to reliably adjudicate increasingly complex pharmacy claims, with our configurable managed care applications, Next-generation analytic and data visualization tools provide near real-time insights to help you drive the best possible clinical, financial, and operational outcomes for your members and organization. 

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