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Health Plans
Healthcare analytics improve
care management and ensure
payment integrity.
Health plans — perhaps more than other industry stakeholder — is challenged to find new solutions to age-old problems.
And they’re succeeding with the support of advanced healthcare analytics to facilitate superior clinical outcomes and ongoing payment integrity.
SCIO Health Analytics provides innovative solutions that enable health plans to:
- Improve care management efforts by more accurately segmenting members
- Demonstrate solid ROI with decision analytics and data reporting tools
- Respond to emerging healthcare trends and new products to meet members’ diverse needs
- Ensure payment integrity by reimbursing claims more accurately
- Apply intuitive investigation and recovery techniques to uncover and manage third party liability
- Analyze claims data to develop utilization, clinical outcomes and other vital metrics
Our suite of solutions:
Care & Risk Management
Delivering healthcare analytics tools and expertise to help improve member identification, facilitate program design and execution, enhance population health, and produce defensible ROI.
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Payment Integrity
Helping health payers control costs associated with third party liability, and incorrectly billed or overpaid health claims — to reduce overall health claim expenditures.
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Consumer & Employer
Providing actionable data to help plans and their customers identify the best opportunity for improved health and clinical outcomes, and achieve cost avoidance through the use of value based benefit designs and incentives/disincentives.
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Network & Provider
Analyzing the impact of changes in provider contracts, identifying high-trend providers, and delivering reports and recommendations to help network teams uncover opportunities for improving provider relationships and delivering better results.
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