The Healthcare Performance Improvement Platform
Identify, prioritize, and act on the highest ROI opportunities.
We don’t just provide analytics.
We power prioritized cost and quality improvement across your enterprise.
Unify your data. Identify, predict, and prioritize what matters most.
Identify earlier. Predict intelligently. Act confidently.
Reduce admin cost
Eliminate wasted effort and spend across fragmented reporting, manual analysis, reactive and inefficient process, and redundant systems and vendors —redirecting resources to the highest-value priorities.
Improve MLR, HEDIS, Stars, and ROI
Identify, predict, and prioritize the highest-value opportunities across cost and quality—then take action to drive measurable performance improvement.
Increase financial predictability
Reduce variability across cost, quality, and risk—including predicting high-cost claimants and unnecessary utilization—enabling confident financial decisions.
Improve financial and quality results across all lines of business
Unify your data. Identify, predict, and prioritize what matters most. Act earlier and faster.
Cross-domain enterprise analytics:
Actionable insights from across LOBs include cost, utilization, quality and risk, network performance, enrollment and SDOH
Predict and prioritize intelligently:
AI-driven solutions identify, predict and prioritize cost, quality, and risk opportunities to improve performance
Operationalized improvement:
Achieve improved performance with Agentic AI, Managed Action™, automated playbooks, and Strategic Advisors
Employer group performance:
Increase client value, broker confidence, and health outcomes with transparent, interactive, customized analytics and reporting
Health data foundation:
AI-powered platform build on Health Fabric™ unifies data and drives intelligent workflows, automation, and action
Analytics alone don’t improve performance
Most healthcare organizations have more data than ever with no shortage of dashboards. Yet performance still lags. Why? Insight alone isn’t enough. What’s missing is prioritized action and measurable results.
Disconnected incomplete data and analytics, point AI solutions, and fragmented workflows often:
- Identify problems—but don’t prioritize impact by value
- Generate insights—but don’t translate into action
- Add complexity—instead of making it manageable
The result:
- Missed opportunities
- Slower execution
- Lack of ROI
- Underperformance across cost, quality, and risk —especially in value-based and risk-bearing models where performance directly impacts financial outcomes.
We help payers and risk-bearing organizations improve performance
Employer group performance
Equip account and sales teams with transparent, defensible performance insights that demonstrate value to employer groups and brokers—improving retention, strengthening relationships, and supporting growth.
MLR & admin cost
Pinpoint the true drivers of medical cost and margin performance across your population—down to condition, cohort, provider, and site of care. Quantify impact, align teams around the highest-value opportunities, and execute targeted initiatives that measurably improve MLR and admin cost.
Stars & HEDIS
Continuously identify and prioritize member-level gaps in care, align outreach and care management resources, and track intervention effectiveness—ensuring quality improvements translate into higher Stars ratings and financial performance.
Utilization & specialty spend
Surface avoidable utilization across inpatient, outpatient, and pharmacy, predict high-cost events before they occur, and intervene with precision—reducing unnecessary utilization and controlling specialty drug spend.
Network performance
Evaluate provider performance across cost, quality, and utilization, identify variation and outliers, and optimize network design, contracting, and care navigation strategies to improve value and reduce cost.
Value-based performance
Operationalize value-based contracts with clear performance visibility, aligned incentives, and continuous monitoring—ensuring both payer and provider performance improves against cost, quality, and risk targets.
Learn more about how your analytics can drive action
Too many vendors, too little alignment: The challenge holding health plans back
Health plans don’t have a data problem. They have an action problem. Information from multiple domains, including claims, medical management, finance, network operations, quality, social risk, and customer experience, is spread across dozens of systems and vendors. This data is often isolated in separate environments, requiring your teams to piece together information from multiple sources just to understand what’s…
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Becker’s Payer Issues Webinar: Disconnected analytics are holding back payer MLR performance
The growing pressure on payer performance Healthcare organizations have more data than ever before yet achieving meaningful performance improvement has never been more difficult. Rising costs, specialty drug spend, and Medicare Advantage challenges are putting increased pressure on payer leaders to improve medical loss ratio (MLR) and overall margin performance. The solution isn’t more insights.…
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MedeAnalytics brings actionable insights to the Becker’s Spring Payer Issues Roundtable
The healthcare industry has reached a pivotal moment. Rising medical costs, tightening margins, increasing regulatory pressure, and the continued shift toward value-based care are forcing payers to rethink how they manage performance across the enterprise. Meanwhile, expectations for improved care quality, better member experience, and operational efficiency continue to grow. These challenges will be front…
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