Payers

Improve cost and quality performance with enterprise healthcare payer analytics

$30B+

annually is lost due to a lack of data interoperability in the U.S. healthcare system. (Source: MDPI)

Healthcare outcomes have never mattered more and achieving exceptional financial, quality, and operational performance has never been harder.

Disconnected data and payer analytics delays insights and action.

Payers face unprecedented challenges: massive volumes of disconnected data, siloed systems and functions, rising costs, medical loss ratio (MLR) strain, and expectations to deliver outcomes that put people first. This complexity contributes to higher member costs, suboptimal experience and quality measures, and dissatisfied employer groups and brokers.

“We were able to significantly decrease unnecessary utilization for an entire population with MedeAnalytics’ predictive analytics.”

Chief Clinical Officer

Turn disconnected analytics into predictive analytics that drive outcomes healthcare payers care about most.

Connect and integrate clinical, claims, financial, administrative, and social determinants of health (SDOH) data in one trusted platform to:

Improve utilization management, quality, and administrative cost performance
Reduce member cost trend through more appropriate and timely interventions
Increase employer group experience, retention, and value
Increase impact of population health, social risk, value-based care, member experience, and quality measures

medeanalytics-payers-twenty-percent-of-healthcare-leaders-trust-the-data-they-rely-on-for-clinical-and-business-decisions

Only 20%

of healthcare leaders trust the data they rely on for clinical and business decisions. (Source: HHMGlobal)

medeanalytics-payers-analytics-and-AI-generated-action-plans-are-informed-by-decades-of-real-world-experience

Unlike analytics-only vendors, MedeAnalytics does not stop at insight.

We are purpose-built for healthcare. Our payer analytics and AI-generated action plans are informed by decades of real-world experience.

Cross-Domain Enterprise Healthcare Payer Analytics: Get actionable, integrated insights across cost, utilization, quality and risk, network performance, enrollment, and SDOH. Break down silos across your organization with a single, trusted source of truth for financial, clinical, and operational performance. Enable faster, more informed decisions aligned across the enterprise.

Employer Group Performance: Increase client value, broker confidence, and health outcomes with transparent, interactive, customized analytics and reporting. Demonstrate defensible value through real-time, actionable analytics and reports, benchmarking, and measurable improvements in cost, utilization, and care outcomes.

Predictive Intelligence: Detect, predict, and prioritize cost, quality, and risk opportunities to maximize enterprise performance with AI-driven predictive analytics. Move beyond hindsight with AI that not only identifies and predicts, but also anticipates high-cost claimants, unnecessary utilization trends, and performance risks to prioritize opportunities that offer the greatest organizational value.

Health Data Foundation: Drive intelligent workflows, automation, and action with an AI-powered enterprise platform built on Health Fabric™. Unify clinical, claims, financial, and social data into a scalable, AI-powered foundation. Eliminate fragmentation and enable faster, more reliable insights and action.

Action and Measurable Improvement: Achieve sustainable performance with agentic AI, next-best-action workflows, AI-driven playbooks, and Strategic Advisors. 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.

MedeAnalytics enterprise analytics solutions power measurable performance improvement at scale across every line of business, including self-funded (ASO) models.

Commercial

Reduce cost trend across your entire member population with earlier care interventions. Improve client retention and margin performance by delivering transparent reporting and demonstrating measurable value to employer groups.

Medicare Advantage (MA)

Maximize performance across risk adjustment, HEDIS, Stars, and medical cost by identifying high-value opportunities, closing gaps in care, and ensuring targeted actions are executed to improve MLR and revenue.

Medicare (Fee-for-Services/Traditional)

Support performance in Medicare populations by identifying high-risk members, managing utilization, and improving care coordination to reduce cost while improving outcomes across aging populations.

Medicaid

Manage complex, high-variability populations by addressing social risk factors, reducing avoidable utilization, and improving access and quality while maintaining cost efficiency and compliance.

Individual/Affordable Care Act (ACA)

Stabilize performance in a volatile risk pool by predicting high-cost members, managing utilization, and optimizing risk and network strategies to improve financial predictability and margin.

medeanalytics-payers-enterprise-payer-analytics-solutions-power-measurable-performance-improvement-at-scale

Learn more about how your analytics can drive action

Large California payvider harmonized clinical and financial data to empower employers and brokers

This organization had a wealth of data, but it was separated into varying data systems and departments, reducing its flexibility and effectiveness. They partnered with MedeAnalytics to deploy an ambitious initiative: its own Analytic Insights program. The project yielded remarkable results, including reducing ad-hoc report turnaround time for employers and brokers by 75%. Learn more

Becker’s Payer Issues 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 MLR and overall margin performance. The solution isn’t more insights. It’s consistently translating insights into action. Learn more

In-home care payvider reduced hospitalizations among high-risk populations with predictive analytics

An in-home care payvider came to MedeAnalytics to help address vulnerable populations, reduce hospitalizations for target groups, and segment population groups for effective care management. MedeAnalytics’ Population Health solution enabled this client to stratify risk and to assess cost and utilization patterns in the population to identify appropriate areas for intervention. Learn more