Commercial and ACA Marketplace
Proactively identify cost savings opportunities, strengthen risk adjustment, grow and retain your business, and close care gaps faster.
Disconnected analytics are limiting enterprise performance
Commercial and ACA health plans face mounting pressure to control medical costs, improve quality, strengthen employer and broker relationships, and deliver better member outcomes, all while competing for and retaining members. Yet critical clinical, claims, financial, enrollment, and social risk data remain fragmented across systems and teams, and insights come too late.
The result is delayed decisions, rising cost trends, higher MLR, inconsistent reporting, missed intervention opportunities, member churn, and a fragmented view of enterprise performance.
Make more informed decisions across your enterprise
MedeAnalytics helps Commercial and ACA health plans transform complex data into enterprise decision intelligence that improves financial performance, operational efficiency, and member outcomes.
“We were able to significantly decrease unnecessary utilization for an entire population with MedeAnalytics’ predictive analytics.”
Chief Clinical Officer
Turn disconnected analytics into enterprise performance improvement
MedeAnalytics connects and integrates clinical, claims, financial, administrative, enrollment, and SDOH data into a single enterprise platform. Moving you from retrospective analytics to predictive decision intelligence, preventing at risk members from becoming your highest-cost claimants. Improve financial performance and member outcomes through predictive, AI-driven analytics to:
- Identify cost savings opportunities and reduce MLR
- Improve utilization management and quality outcomes
- Grow and retain your ACA and Commercial business
- Identify high-cost claimants and rising-risk members earlier
- Optimize population health and value-based care performance
- Improve risk adjustment
Unlike analytics-only vendors, MedeAnalytics does not stop at insight
We are purpose-built for healthcare. Our payer enterprise decision intelligence and AI-generated action plans are informed by decades of real-world experience.
- Cross-Domain Enterprise Healthcare Payer Analytics: Break down silos across your organization with a single, trusted source of truth for financial, clinical, and operational performance. Enable proactive insight with predictive analytics for informed decisions aligned across the enterprise.
- Employer Group Performance: Demonstrate defensible value through real-time, actionable analytics and reports, benchmarking, and measurable improvements in cost, utilization, and care outcomes.
- Predictive Intelligence: Move beyond hindsight with AI that not only identifies and predicts, but anticipates high-cost claimants, unnecessary utilization trends, and performance risks, prioritizing opportunities that drive the greatest organizational value.
- Health Data Foundation: Drive intelligent workflows, automation, and action with our AI-powered enterprise health data management platform, Health Fabric™. Unify clinical, claims, financial, and social data into a scalable, AI-powered single source of truth.
- Action and Measurable Improvement: Close the gap between insight and execution through embedded AI, automated workflows, and expert advisory. Accelerate time to value and ensure measurable results are achieved.
Learn more about how your analytics can drive action
Webinar
Disconnected analytics are holding back payer MLR 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. It’s consistently translating insights into action. Watch the webinar
Case Study
California payvider reduces employer and broker reporting turnaround time by 75%
See how a large California payvider unified fragmented clinical and financial data to create a single source of truth and turn insights into action. The organization reduced reporting turnaround times by up to 80%, uncovered meaningful opportunities to improve care and control costs, and achieved payback in just six months. Read the case study
Webinar
AHIP SmartBriefs webinar
Watch this on-demand webinar to learn how leading health plans are using a care management analytics solution to identify care opportunities sooner, collaborate more effectively with providers, and deliver timely interventions that improve outcomes while reducing costs. Watch the webinar
Explore how our payer enterprise decision intelligence improves performance
Strengthen employer group and broker relationships with transparent, data-driven insights and action plans for cost, utilization, population health, and more.
Identify your highest risk member cohorts with integrated claims and SDOH data to improve risk and between-visit support.
Optimize HEDIS, Stars, and value-based care performance, and identify and seamlessly communicate gaps in care with a member’s primary care provider.
Build high-performing provider networks with real-time visibility into member coverage and provider performance.
Understand cost drivers with key insights into Medicaid beneficiary data to improve care outcomes.
Maximize performance across risk adjustment, HEDIS, Stars, and medical costs.