Medicaid and Public Sector
Improve cost, quality, and population health performance with enterprise decision intelligence for Medicaid populations.
CMS has demonstrated that addressing social needs has resulted in
$200M in net savings
(Source: CMS)
Disconnected analytics delay or prevent better health outcomes
Medicaid organizations face increasing pressure to improve health outcomes, manage rising utilization and costs, address health disparities, and meet evolving regulatory and value-based care requirements, all while operating with limited resources. Yet critical clinical, claims, behavioral health, social risk, and program data remain fragmented across systems, and insights come too late, making it difficult to identify risk early, coordinate interventions, and measure program performance.
The result is delayed decisions, rising cost trends, higher MLR, inconsistent reporting, missed intervention opportunities, member churn, and a fragmented view of enterprise performance.
The opportunity assessment identified five high-impact population cohorts for a Medicaid population, representing up to $25M in validated savings potential. This included up to $6.6M attributable to pregnant women with stacked risks within a sub-population of just 5,000 members. Read the case study.
Turn disconnected analytics into population health improvement
MedeAnalytics connects clinical, claims, behavioral health, financial, administrative, and social risk data into a single enterprise platform that helps Medicaid organizations improve financial stewardship, quality performance, and population health to:
- Reduce unnecessary utilization and total cost of care
- Improve quality, care coordination, and value-based care performance
- Consolidate data platforms and eliminate fragmented reporting
- Address health equity with integrated SDOH insights
- Strengthen program oversight with enterprise-wide performance visibility
- Identify high-cost claimants and rising-risk populations earlier
Unlike analytics-only vendors, MedeAnalytics does not stop at insight
We are purpose-built for healthcare. We unify enterprise healthcare data, generate AI-powered intelligence, and operationalize action. Moving you from retrospective analytics to predictive decision intelligence to help Medicaid organizations improve cost, quality, health equity, and program performance.
- Enterprise Medicaid Analytics: Gain a trusted, enterprise-wide view of member health, utilization, quality, financial performance, behavioral health, and social risk. Break down silos with a single source of truth. Enable proactive insight with predictive analytics for more informed decisions across state agencies, managed care organizations, providers, and community partners.
- Population Health & Social Risk: Integrate clinical, claims, and SDOH data to identify vulnerable populations earlier, understand the drivers of health disparities, and prioritize interventions that improve outcomes while reducing avoidable utilization. Support more effective risk stratification, care coordination, maternal health, behavioral health, and chronic disease management with predictive analytics.
- 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
Case Study
How one health plan identified up to $25M in validated cost savings across five targeted social risk cohorts
The health plan leveraged MedeAnalytics’ Social Risk Insights Measures & Outcomes solution, a unique, integrated methodology that delivers a comprehensive cloud-based infrastructure to identify, stratify, intervene, and demonstrate the value of social risk programs. Read the case study
eBook
Realizing the full potential of social risk data
Payers face increasing pressure to improve outcomes, control total cost of care, and succeed under value-based contracts. This ebook shares a scalable, enterprise-ready framework for identifying and quantifying the financial impacts of social risk interventions before dollars are spent, enabling payer executives to invest with confidence and validate ROI. Read the eBook
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
Understand cost drivers with key insights into Medicaid beneficiary data to improve care outcomes.
Maximize performance across risk adjustment, HEDIS, Stars, and medical cost.
Build high-performing provider networks with real-time visibility into member coverage and provider performance.
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.
Strengthen employer group and broker relationships with transparent, data-driven insights and action plans for cost, utilization, population health, and more.