Enabling Payer-Provider Transparency and Collaboration Through Healthcare Analytics

Every population health or quality initiative shares a similar goal – better care at lower costs.

Clinigence Health’s healthcare analytics solutions help payers and providers improve the quality and cost-effectiveness of care, enhance population health management, and measure provider performance.

Patient Metrics

Healthcare organizations are focused on creating a more personalized and valuable experience for their patients with the goals of increasing satisfaction, reducing costs, and improving outcomes.

To do this effectively, your organization needs a holistic view of what is happening at the patient level, from existing medical care needs to predictive indicators of future needs.

The Clinigence Health Patient Metrics solution provides a holistic view of an individual patient to:

Quality Improvement

Hospitalizations account for nearly one-third of the 3 trillion dollars spent on healthcare in the United States. While the majority of hospitalizations are necessary and appropriate, a substantial number are comprised of readmissions. These readmissions are costly, potentially harmful, and often avoidable.

Provide your clinical and quality teams with the intelligence required to identify and act on opportunities for improvements around coordination and transitions between care settings. Collaborate and share critical information with your providers to help patients achieve better outcomes.

The Clinigence Health Quality Improvement solutions provide actionable intelligence around:

Cost & Utilization

Healthcare organizations must understand trends within their population to better manage current costs and utilization as well as to predict future utilization of resources. 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.

Predict & Mitigate Risk

It’s no surprise that patients with complex health needs account for a large share of healthcare spending. Quickly identifying and engaging health needs is a requisite for success, but it can be challenging. Predictive analytics enables care teams to accurately identify high-risk patients and determine the appropriate level of care and engagement needed moving forward.

Give your care and quality management teams the internationally accepted Johns Hopkins ACG model to efficiently and effectively stratify and target high-risk patients to improve quality and lower costs.

Clinigence Health’s Predictive Analytics solutions enable care and quality teams to:

Custom Analytics & Reporting

Just as the populations and types of patients vary from organization to organization, so do the needs of the stakeholders that are managing those populations.

Give your finance, care, quality, and population health management teams tools that provide them the flexibility to create custom analytics and reporting to best meet the needs of the organization and the population it serves.

Clinigence Health configures our solutions to allow for custom analytics and reporting with the ability to:

Monitor & Report Quality Measures

Clinigence Health leverages real-time clinical (EHR) data to allow you to see how your organization is performing as compared to relevant benchmarks. You can use this information to see what areas offer the best opportunity to improve your organization’s quality score.

Clinigence Health’s Monitor & Report Quality solutions include interactive dashboards and reports to identify and prioritize quality initiatives, quickly act on areas that need improvement, and take advantage of the best opportunities to improve quality ratings.

Clinigence Health is ONC certified and has successfully reported CMS PQRS and MIPS results for hundreds of healthcare organizations since 2014.

ONC CEHRT – Costs and Limitations

Cures Act Real World Test Plan

Cures Act Real World Test Results (coming in 2023)

Population Health Management

Today’s Healthcare world requires effective population health management to drive higher quality of care at lower costs. The ability to engage patients that might have adverse events and/or a high likelihood of hospital admission is paramount. Prospective identification and earlier engagement of patients reduce the cost of care and support higher quality outcomes.

Give your care management teams access to a holistic view of a population or individual patient with the ability to drill down by cost, provider, disease, risk, and age to identify clinical drivers of cost and quality. They can also utilize our integrated predictive model to anticipate and intervene in situations before an adverse event occurs.

The Clinigence Health Population Health Analytics solutions enable care and quality teams to:

Provider Network Optimization

Measuring provider performance has become a major focus for all healthcare organizations trying to address over-utilization, referrals, and network leakage. Improved transparency between payers and providers is critical to the creation and sustainability of an efficient and effective high-performance network.

Enable your care and quality teams with actionable intelligence to uncover opportunities around cost savings, utilization management, and provider performance.

The Clinigence Health Provider Network Optimization solutions enable care and quality teams to:

Commercial CQMs & Gaps in Care

Organizations are leveraging clinical quality measures (CQMs) and gaps in care to monitor and manage performance to improve quality of care.

Allow your clinical and quality management teams to proactively engage providers and members in a meaningful way by identifying and acting on preventive measures and gaps in care.

Clinigence Health supports Commercial CQMs within our Clinical Quality Platform to enable organizations to track quality performance across their commercial lines of business, including the ability to: