Medical and Medicaid Management
Identify the patterns that reveal savings.
Medical & Medicaid Management helps you identify critical patterns and correlations that reveal exactly where to find savings. By pinpointing areas to take strategic action, mitigate catastrophic claims and promote better health, health plan staff gain an improved understanding of cost and quality drivers and at-risk populations—fully equipping them to steer quality, timely care toward their highest cost members.
Identify high-risk members for care mangement
Gain greater insight into populations with chronic conditions
Measure utilization across various service categories
Track enterprise-level performance
Share performance metrics organization-wide
Medical and pharmacy claims, membership, authorization and provider data provide a complete, interconnected view of organizational performance—from strategic healthcare economic issues to specific care management opportunities.
Predictive analytics identify opportunities for intervention and prevention.
Share insight with plan staff and providers to organize, prioritize and target care, lowering both risk and cost.
Key Performance Indicators
- Total Healthcare PMPM
- 30-Day All-Cause Readmission Rate
- ACE or ARB Medication Possession Ratio
- Average Risk
- Ambulatory-Sensitive Admission Spend
- Dual Eligible Enrollment
- Potentially Avoidable ER Utilization by Asthmatics
- Well Child Visits 3-6
- Non-Maternity Readmission Rate
What It Offers
- Executive dashboards
- Quick dive into claim-level data
- 90-day implementation
- Flexible metrics and definitions that match your organization
- Refresh data nearly instantaneously
- Access on the iPad
Employer Reporting provides collaborative, modern health care analysis and reporting that increases employer retention, reduces strain on internal reporting staff, and improves client satisfaction. Employer Reporting integrates with MedeAnalytics’ full enterprise suite.
Our Provider Engagement solution brings a whole new level of health plan - provider transparency. By giving a critical view into the claims life cycle, provider networks and value-based contracts, health plans can collaborate with providers to identify the root causes of underperformance, and pinpoint what’s driving high-performing partners as well. Not only does that mean fewer appeals and errors, it means greater member satisfaction and more transparent provider relationships.