Prevent risk and enhance quality

Identify risk early. Improve outcomes.

Across healthcare, risk and quality are deeply connected—but often managed apart. Hospitals, payers, and providers face pressure to meet rising quality standards, control costs, and deliver safer care. Yet outdated data and manual processes leave teams reacting to risk instead of preventing it.

The growing risk and quality challenge in healthcare

Healthcare organizations face growing clinical and financial risk as care delivery becomes more complex and fragmented, while accountability for outcomes increases under value-based care models.

Despite having vast amounts of data, most organizations lack the analytics needed to accurately stratify risk, identify emerging quality issues, and target interventions before disease or catastrophic health events occur. As a result, quality improvement remains reactive, variation persists, and preventable adverse events and costs continue to rise.

MA risk scores will be 20% higher than fee-for-service, resulting in

in excess spending.

Source: Becker's

Unmanaged chronic conditions account for

of healthcare spending in the U.S.

Source: CDC

Nearly 25% of hospital readmissions are preventable, costing

for the U.S. healthcare system annually.

Source: AHRQ

When analytics aren’t actionable, quality leaders, clinicians, and payers face the same challenge—
too much data, not enough clarity.

Payers

Bear the cost of missed risk adjustment opportunities and lower quality scores

Members and patients

Experience preventable complications, fragmented care, and suboptimal outcomes

Providers

Lack real-time insights to close care gaps or manage chronic conditions

How MedeAnalytics turns risk and quality data into better outcomes

MedeAnalytics empowers healthcare organizations to predict risk, prioritize action, and continuously improve quality—driving measurable outcomes and financial performance. By unifying data across the care continuum, applying advanced analytics, and stratifying risk, payers and providers can focus quality improvement efforts on the patients and processes that have the greatest potential to transition from reactive reporting to proactive improvement.

Our risk and quality solutions empower teams to:

Stratify risk populations using Adjusted Clinical Groups, Episode Treatment Groups, and Hierarchical Condition Categories

Identify high-risk members and patients, predict emerging risks, and enable early intervention

Track and benchmark HEDIS, AHRQ, hospital-acquired conditions, mortality, and readmission metrics to support proactive quality improvement

Streamline risk adjustment and quality reporting across payers and providers to align incentives and drive reimbursement and performance

Optimize quality, risk, and financial outcomes to support value-based care and sustainable performance

“With MedeAnalytics, we can finally see where our risk truly lies and take action before it impacts our patients or our performance.”

- VP of Quality, National Health Plan

The MedeAnalytics advantage for risk and quality improvement

Improving quality starts with understanding risk before it becomes harmful. MedeAnalytics delivers this intelligence through our key value pillars that empower organizations to act with confidence and drive measurable improvement in patient outcomes.

These pillars include:

AI-powered enterprise healthcare data management platform that unifies clinical, claims, financial, and social risk data into a trusted foundation that delivers a comprehensive view of quality and risk
Intelligent analytics deliver use-case–specific insights to improve cost, quality, and revenue
Expert advisors partner with you to address unique business challenges, translate insight into outcomes, and accelerate ROI
Generative AI planning tools, including playbooks, integrate into your workflows to turn insight into action