Health Outcomes Optimization Key Offerings

Behaviorally-Based Interventions

Utilize risk-stratified member data to identify the best prospects for targeted, proactive interventions that can improve quality and coordination of member care.

Population Assessment and Stratification

Our premium population assessment and stratification solution helps your team spend more time working with members and providers, and less time collecting and entering data.

Johns Hopkins ACG® System

The Johns Hopkins ACG® System, included in our CareAnalyzer® solution, offers a unique approach to measuring morbidity that improves accuracy and fairness in evaluating provider performance, identifying patients at high risk, forecasting healthcare utilization, and setting equitable payment rates.

Utilization Management

We combine access to critical member, benefit, and provider information with a real-time authorization capability helps UM nurses improve first-pass claims acceptance rate, and maintain necessity and benefit compliance.

Disease Management

Improve outcomes with our automated case creation and configurable monitoring tools that can help your members better understand their conditions and engage in care planning and outreach interventions.

Case Management

We provide single platform member-centric views, discharge planning tools, and transition of care planning and medication reconciliation that minimize hospital readmissions. We facilitate coordinated care across teams and departments optimizing costs and delivering better health outcomes.

Quality Management

We offer a comprehensive suite of quality management software and services designed to help you balance the complexities and costs associated with administration, regulatory compliance, and member care management.

HEDIS Management

Our solution, combining HEDIS methodology with the Johns Hopkins ACG® System, helps you identify member level gaps in care, integrate member risk and resource utilization, and facilitate member/provider communication.

CMS Star Ratings

We provide a unique set of experienced consulting services and analytic tools to help you visualize, monitor and manage compliance, set alerts, and make adjustments based on priority impact on star ratings.

Care Gaps

We arm you with the tools you need to proactively evaluate patient risk, identify member-level care gaps, and make targeted care recommendations.

Provider Effectiveness

Our innovative analytics deliver valuable insights on physician effectiveness by benchmarking, comparing and ranking providers, and identifying differences in member health across practices. Robust risk profiles help you eliminate inefficiencies within provider networks.




Featured Insights
  • Payers and Providers as Allies
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  • Medicare Part D: A Unique Approach to Quality and Compliance
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  • HEDIS® in 2018 Vendor Checklist
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  • Looking Forward to the 2018 HEDIS® Season
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