Large California payvider

Harmonized clinical and financial data to empower employers and brokers

Measurable impact

This payvider partnered with MedeAnalytics to deploy an ambitious initiative: its own Analytic Insights program. This project yielded remarkable results:

mos
payback time on solution
$
Rx savings per script for HIV patients
%
reduction in ad-hoc report TAT for analysis/reporting
%
reduction in ad-hoc report TAT for employers/brokers

The story behind the numbers...

The Challenge

This organization had a wealth of data, but it was separated into varying data systems and departments, reducing its flexibility and effectiveness. As a result, they found it quite difficult to:

  • Obtain a single source of truth
  • Drill down into actionable insights and understand cost drivers
  • Keep claims data lag at or below market norm
  • Respond to ad-hoc queries in a timely manner
  • Create custom reports that satisfied clients
  • Make any improvements without deploying a large-scale project

More about this California Payvider:

  • Integrated care and coverage
  • Mission to provide high-quality, affordable healthcare services and to improve the health of members and communities
  • 5 million members
  • 763 hospitals and medical offices
  • 34 effectiveness-of-care measures
  • 9 states offering in-person care
  • 39 million prescriptions delivered to members in 2020
  • 95 million virtual connections between members and care teams in 2020
  • One of the first integrated systems to launch an EMR

The Solution

This payvider had a strong foundation of data-driven principles. As a unique combination of health plan and clinical provider, they wanted to use data to inform and improve patient engagement and care at every level of interaction. By partnering with MedeAnalytics, they hoped to:

Goals

Integrate population health and claims data to understand key drivers & utilization trends

Drive transparency and deepen understanding into the overall health of the population and its impact on cost of care

Enable actionable insights and focus on proactive initiatives instead of reactive responses

Differentiate itself in the healthcare marketplace

Improve reporting ad hoc responsiveness for customers and brokers

Enable meaningful customer conversations on its clinical care approach to be told through data

Deliver superior customer service to capture share of mind and market from competitors

Strategies

MedeAnalytics applied its thorough understanding of this organization's distinct structure, approach and goals to customize their journey and solution. This thoughtful and collaborative partnership included a customizable suite of dashboards and reports, robust data analytics, industry benchmarks and much more.

Using an ambassador network, implementation liaisons, and a mandatory learning series, this organization enjoyed high adoption and yielded remarkable results, including:

By using MedeAnalytics’ compression methodology to integrate its clinical and financial data warehouses:

  • One customer implemented a smoke-free campus policy after seeing cost & utilization analysis of smokers vs. non-smokers
  • Another customer is now able to use cohort analysis on its weight management program to evaluate outcomes and impact

By offering actionable insights on clinical data

  • A mid-size employer was inspired to work with the organization's internal physician partners to deliver on-site education on preventive care and access options
  • A large customer realized dangerously high opioid utilization trends and used the payvider's appropriate prescribing programs with network physicians

Presbyterian is already working on plans to further their predictive and optimization analytics with MedeAnalytics innovative solutions.

"MedeAnalytics is a wonderful partner. They have really helped us be able to take our vision and create a solution that made it reality. It was not always an easy journey, but MedeAnalytics provided the experience and perspectives needed to drive our analytics initiative forward. "

Senior Consultant in National Customer Analytics & Reporting

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