The need for cost and utilization trends and drivers has never been more critical as the industry shifts to value-based models. Healthcare organizations need to understand trends within their population to manage current costs and utilization as well as predict future utilization. The ultimate goal is to drive more effective care coordination and transitions in care to deliver the right care, for the right reason, at the right time, at the right cost, in the right place.
Give your finance, care, quality, population health, network, and utilization management teams tools to evaluate the effectiveness of various programs.
QualMetrix provides Cost and Utilization solutions to enable your team to:
- Evaluate the health and compliance of members/patients to determine care management and disease management program development and effectiveness
- Use analytics and predictive values to influence premium and rate decisions
- Focus strategies to reduce hospitalizations where appropriate
- Optimize provider networks by identifying high-performing hospitals and providers
- Analyze and evaluate behavioral patterns of providers and identify outliers