Health Plan Claim Analytics

Consolidate all plan claims and clinical data to unlock the details of how and where healthcare dollars are spent.

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Exclusive Platform Features Advanced Claim Analytics, Real-Time Collaboration And More.

Claim analytics provides self-insured employers with the ability to easily unlock the claims data on their healthplan. Our platform consolidates your medical, pharmacy, clinical, and biometric data from your TPA and PBM. We then scrub, normalize, and quality check the data before loading it to your white-labeled portal.

Login at any time to intuitively search all of your claims data, view dashboards, and access our on-demand report library.

Claim Transparency

No longer are employers and their consultants forced to ‘fly blind’ by building cost containment strategies with little to no data to support the effort. Our intuitive dashboards and claim search brings tremendous visibility and provides our clients with the information necessary to create highly targeted programs to control how their healthcare dollars are being spent.

Through linking and optimizing your claims data, you will be able to easily drill down to the data you need.

Actionable Insights

Intuitively access the information you need to assess metrics of your plans such as high volume providers or providers, drugs and conditions that are the most expensive for your population.  Finally, deploy strategies specifically targeted to your healthplan population such as changing plan designs or implementing narrow networks. 

The platform clinical approach is based upon The Asheville Project, which is most independently researched and peer reviewed disease management in existence.

Gaps in Care

When members have missing prevention services or fail to follow the necessary recommended protocols to care for a chronic condition, the platform will flag these missing procedures or drugs. Clients can search missing compliance items on the entire population or on a member by member basis. Each gap in care is categorized to make the information simple to access, use and understand.

Print a personalized health report for members to provide them a road map to improved health.

Validate Effectiveness

After you have built and deployed your healthcare cost containment strategies, it is critical to follow the data to determine if your strategy is being successful.  Through condition level risk scoring and trend analysis reporting you will have the data and validation needed to truly know how your efforts are performing.

Population health investments becomes easier to obtain and maintain when you possess data to measure return on investment.