SCIO Health Analytics is a leading provider of cost and quality-improvement analytics solutions for healthcare payers and providers. With an extensive roster of clients that serve more than 70 million patients and plan members, SCIO Health Analytics provides results-driven health analytics and data mining, member engagement and care effectiveness, payment integrity and audit programs, and business process optimization solutions to reduce administrative costs, eliminate payment errors, increase member engagement and measurably improve outcomes and quality.
With expertise spanning clinical and administrative operations, SCIO Health Analytics offers a unique combination of software and services to help healthcare organizations positively impact Administrative Loss Ratios (ALR) and Medical Loss Ratios (MLR). Drawing upon an expert and experienced team of clinical, actuarial, legal and analytical resources, SCIO Health Analytics offers clients flexible delivery models.
SCIO Health Analytics delivers knowledge, business intelligence and value through data & analytics. SCIO®, means "to know" or "understand" in Latin. Hence, most of our products and services are prefixed with SCIO®. The word SCIO® concretes the foundation of our Corporation and plays a vital role in SCIO Health Analytics' brand identity.
We provide broad healthcare and insurance industry services in the nature of providing the analysis, collection, maintenance and reporting of plans and claims. In conjunction with our many products and services, we provide a variety of online software tools and programs for the healthcare and insurance industries to assist with the analysis, collection, implementation, maintenance and reporting of plans and claims.
MY SOCRATES® Subrogation
MY SOCRATES® is our proprietary subrogation technology platform that efficiently imports, filters, identifies, reviews, tracks and processes a large volume of subrogation cases. The application is specific to health payer subrogation processes, and combines Data Mining, Workflow Management, and Business Rules Management in a single system.
Seamless workflow: MY SOCRATES® provides a seamless subrogation process built around five phases—Import and Identification, Investigation, Case Management, Recovery, and Credit. A purpose-built application, it easily integrates IT infrastructure, subrogation department and existing mail room facilities.
Customized data mining: MY SOCRATES® is programmed with sophisticated data mining tools and predictive modeling logic that allow it to identify and filter claims with a potential for subrogation with greater accuracy than standard tools. MY SOCRATES® has a built-in importer that converts multiple formats of claims data to a standard format, in addition to accommodating customizable filter codes and client-specific dollar threshold limits. These features help overcome numerous hurdles and delays in the identification process, allowing users to avoid potential issues that might otherwise cause them to miss valuable cases as when employing manual identification.
Automated tracking: MY SOCRATES® Subrogation creates a completely paperless environment. It tags member/attorney/third-party responses with specific barcodes and helps the user to reduce the time required to attach incoming documents to respective cases/claims. This substantially reduces potential errors due to absent key responses or documents.
Powerful reporting: The reporting capabilities built into MY SOCRATES® help users obtain accurate information on a real-time basis. The application is pre-programmed with more than 24 best practice reports enabling users to analyze the progress of subrogation and identify potential areas for improvement.
MY COB® helps plans manage the recovery of incorrect payments more effectively, while also developing comprehensive databases to reduce the incident of payment of future claims where COB was possible.
MY COB® Identification and Case Management Platform
- Automates all components of COB processing
- Imports, filters and scrubs claims
- Targets prioritized list of potential COB claims
- Determines the primary payer, order of benefits for each member, sequence for payment and precise refund due
- Updates member information frequently to prevent future COB payments
- Manages member communications
- Features a configurable link to the health plan eligibility database for updating member COB information
- Helps manage member outreach
- Provides advanced workflow for managing case from start to finish, including components for compliance and audit purposes
- With an advanced rules engine that derives logic from regulatory state-specific NAIC, CMS standards and Medicaid guidelines, health plans can update member information more
SCIOVantage™ Data Integration
Integrates a wide range of data types and sources at various levels of complexity into our robust technology platform. Subsequently, we aggregate, clean, and map them to a standard and uniform structure.
SCIOVantage™ Patient Profile
Creates a patient-centric database of disparate source data and integrate it into an easily accessible electronic health record. The Patient Profile is the foundation of our powerful technology suite.
Within the Patient Profile platform, the following power-user definition managers are available:
- Clinical Conditions Manger
- Clinical Facts Manager
- Clinical Measures
- Indications Manager
SCIOVantage ID & Strat—a series of models powered by the Patient Profile that can identify, stratify and forecast member behavior
SCIOrisk –a proprietary tool to help clients rank and prioritize members based on predicted risk
SCIOgap—models to help clients manage clinical quality and drive outreach in areas ranging from operational management and P4P to risk stratification and STARS
SCIOsegmentation—a segmentation schema that allows clients to view and profile risk across four dimensions to support new product development, message management, etc.
SCIOVantage™ Opportunity Analysis
SCIOVantage Opportunity Analysis enables suppliers of care management programs to better understand opportunities within a select population, ensure proper program pricing, estimate appropriate staffing levels, and provide employer- and plan-specific cost/benefit estimates and reporting. In other words, giving plan sponsors the answers and results they demand.
SCIOVantage™ Financial Modeling platform provides clients with a consistent enterprise methodology to answer the business questions surrounding value—such as financial modeling of outcomes and/or comparative effectiveness of therapeutics, interventions, medical devices and biologics.
SCIOVantage™ Consumer Engagement
SCIOVantage Workflow is a cost-effective system designed to support employers, health plan payers and care management companies to administer the complex process of identifying and segmenting individuals to be targeted for care management programs.
Just In Time Wellness® Alerts is a member engagement alert engine to drive change in compliance by utilizing unique communication methods and key content around health risk. The SCIOVantage™ rules engine and Patient Profile identify key member alerts related to gaps in care and preventative screenings, high cost or utilization trends, unhealthy self-reported choices, lab results, and health risk to educate members on why closing gaps and modifying behavior is important.
SCIOVantage™ Value Based Benefit Design model provides actionable data to help plans and their customers identify the highest opportunity for health improvements and cost avoidance through the use of plan designs and incentives/disincentives.
SCIOVantage™ Reporting Modules
Member Analytics provides the ability to drill down on specific members to illustrate cost and utilization distributions, medical and drug event timelines, prospective financial risk score, and other demographic variables—including how they impact overall health status. This functionality likewise creates a unique cohort of members based on select conditions, measures, health alerts, gaps, risk scores or demographics defined within the system, subsequently exporting these lists to drive reporting and member engagement.
Employer Group Reporting (ERG) enables users to modify, drill down and export a detailed set of reports specific to employer-based customers using the Patient Profile as their foundation. This module includes 16 pre-defined and standard reports reflecting enrollment and demographics, condition prevalence, health risk, medication adherence and test compliance, as well as financial and clinical trends. Users also gain the ability to drill down on all figures to both member and claim level for further ad hoc analysis. The module focuses on a robust and user-flexible design that facilitates customized reporting specific to various business needs. Report templates can be saved and executed as needed, with export functionality into multiple formats.
Outcomes Reporting delivers credible results on the effectiveness of a variety of programs.
This module is pre-configured with robust methodologies for savings and other industry standard components, and is clinically validated through the adoption of industry/internal standards including Care Continuum Alliance guidelines for medical cost savings.