Network & Provider
SCIO® offers impact, trending and opportunity analysis for enhanced business, clinical outcomes.
Pricing in the healthcare industry has never been as simple as in manufacturing, where every widget’s market value is based on materials, overhead, distribution and labor.
Medical care, on the other hand, is ruled by irregularities. Fee schedules change. Edits and modifiers are implemented. Provider negotiations drive capricious pricing. Entities charged with reimbursing medical costs must manage a wide range of interconnected variables. Modify one, and the impact might cascade in unintended ways.
SCIO Health Analytics equips clients with the intelligence to monitor a wide range of factors — quantifying the impact of rate changes, identifying trends and outliers, and uncovering opportunities to strengthen provider relationships.
With a combination of actuarial and clinical expertise, SCIO® offers an extensive tool set to ensure optimal business and clinical outcomes:
Contract Modeling
Contract Modeling provides analysis, reporting and recommendations regarding contracts with participating providers to help network teams understand the impact of contract details and achieve better results.
High Trend Provider Analysis
High Trend Provider Analysis enables payers to identify providers driving above-average trends, and provide assistance in slowing or reversing this drift.
Cost Reduction Opportunity Analysis
Cost Reduction Opportunity Analysis empowers network teams with information about significant opportunities to deliver better results—and recommends action to capitalize upon them.
Provider Care Efficiency Measures
New models of care demand updated tools for measuring provider performance. We know the intersection between quality and efficiency is key to delivering care in the most cost-effective manner.
Provider Measures for ACO Management
Offering providers and other ACO stakeholders, the right tools to identify and stratify populations within each category that have controllable costs.
Bundled Payments for Provider Practices and ACOs
Equipping health plan network teams with information they need to uncover opportunities to reduce costs while promoting health and quality care.
