Solutions Overview

Enabling Payer-Provider Transparency and Collaboration through Healthcare Analytics

Every population health or quality initiative shares a similar goal – better care at lower costs. Healthcare analytics play a significant role in helping you identify the most impactful cost, quality and behavioral drivers to achieve effective population health management and provider network optimization.

Share population health analytics with physicians to help them make more informed decisions around personalized, cost-effective care. Help physicians understand their performance and outcomes in comparison to their peers and others like them. Focus initiatives on the populations and individuals who are driving the highest costs.

QualMetrix’s healthcare analytics solutions help payers and providers improve the quality and cost-effectiveness of care, enhance population health management and optimize provider networks. Our solutions bring both payer-multi provider and provider-multi payer views together in a single source to span the continuum of care and provide a complete view of the member.

Our healthcare analytics solutions are delivered in easy-to-use, dynamic, interactive reports, dashboards and visualizations that enable deep drill-down capabilities and powerful filters to help end-users quickly identify and take action on the most impactful and accurate data-driven results.

Rapidly achieve speed to value through QualMetrix’s machine-to-machine (M2M) workflow integration, which allows you to quickly transform massive amount of data into actionable insights.

Key Areas of Focus
  • Cost & Utilization: Manage current costs and utilization as well as predict future utilization
  • Quality Improvement: Identify and act on process and quality improvements (transitions and care coordination between care settings)
  • Predictive Analytics: Stratify and target high-risk members/patients to improve outcomes and lower costs
  • Member Metrics: Access a holistic view of what is happening at the member/patient level from existing medical care needs to predictive indicators of future needs
  • Population Health Management: Drill-down to the physician and member/patient level to identify clinical drivers of cost and quality
  • HEDIS & Gaps in Care: Identify and take action on preventive measures and gaps in care.
  • Key Performance Indicators: Evaluate cost, utilization, quality, pharmacy and prevention KPIs over time.