Risk Manager

A scalable healthcare business analytics solution and streamlined workflows that deliver actionable intelligence to support payment reform programs.

What’s Included in Risk Manager

  • ACG risk and PROMETHEUS engines

    • Stratifies and identifies populations
    • Identifies risk drivers to help drive better patient care
    • Supports commercial, Medicare, and Medicaid populations
    • Helps determine likelihood of hospitalization
  • Cost and utilization analysis

    • ED visits, including average cost, frequent visitors, and low acuity
    • Inpatient stays, including average cost, readmits, and in vs. out of network
    • Outpatient imaging
    • Office visits
  • QRE NCQA-certified HEDIS engine

    • Measures quality compliance and gaps in care
    • Multiple measure sets (HEDIS, ACO, IHA)
    • Multiple measure runs, including enrollment, time period, and user-entered data
    • Patient-detail reporting and physician profiling
    • Letter generation for outreach
  • Prometheus episode of care analytics

    • Leverage clinically validated episode definitions
    • Target providers with compelling data
    • Optimize your network design
    • Track referral patterns
    • Compare physician performance

Transform datato support payment reform

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Ingest data once to repurpose for multiple insights

Minimize your overhead by providing one data stream. Our healthcare business analytics solution executes a multitude of analytical engines against this data, including risk, cost, utilization, quality, and episode engines to support risk-based contracts.

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Easily use analytics to find areas for opportunity

Utilize our healthcare business analytics platform to find the “needle in a haystack.” Discover actionable opportunities to bend the cost curve by utilizing high-level aggregation and at-a-glance guided analytics.

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Use intelligence to accelerate behavior change

Help modify behaviors by combining scope and depth to provide actionable insights, from the big picture (across the network) to specific provider performance to individual patients who need outreach.

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Powerful dashboards to drive informed decisions

Empower multiple types of users to accomplish their goal of finding actionable opportunities by offering a wide range of tools to help them accomplish their goals. Our healthcare business analytics can be used by medical directors, practice managers, providers, care coordinators, and analysts. Each group benefits from the dashboards, fixed reports, custom visualizations, three-dimensional report builders, and other advanced features.

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PMPY average savings, with 97.2 average quality score1

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million in medical saving generated, $14.71 savings PMPM2

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fewer readmissions and 4% fewer ED visits3

1Achieved by three ACOs participating in MSSP

2,3 Regional health plan using Risk Manager to drive total cost of care

Our outcomes

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