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 management
Track enterprise-level performance
Gain greater insight into populations with chronic conditions
Share performance metrics organization-wide
Measure utilization across various service categories
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
Data SheetMedicaid Management
Case StudyBlue Shield of California Improves Provider Engagement
Data SheetEmployer Reporting
Data SheetPopulation Health for Health Plans
Data SheetProvider Engagement
WebinarTransforming Medical Management
Employer Reporting provides collaborative, high-tech tools and reporting that inspire more efficient and better-utilized benefits plans. With unprecedented transparency, health plans can aggregate, analyze and share plan-use analytics with employer groups as well as analyze the plan’s total population internally.
Our Provider Engagement solution brings a whole new level of transparency to the relationship between health plans and providers. 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.