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
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.
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.
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.
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.
PMPY average savings, with 97.2 average quality score1
million in medical saving generated, $14.71 savings PMPM2
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
Need support for
- Compliance Reporter Learn more about a robust reporting and workflow-management tool for payers who want to streamline and increase their HEDIS quality measurement and reporting activities. Learn more
- Prometheus Analytics Discover a solution that allows payers and providers to measure, define, and fulfill their value and cost to drive improvements across the healthcare system. Learn more
- HealthQx Learn about a value-based payments analytics platform for payers who want to use episodic claims grouping to help improve the performance of their reimbursement programs. Learn more
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