With healthcare costs continuing to escalate, it is important to know where every healthcare dollar is being spent. In dealing with the risk environment, whether it is Medicare, Medicaid, or Commercial, our clients have the ability to identify risk and cost factors within their patient population simply by reviewing current and historical claims data loaded into our software program. Specifically for Medicare Risk, claims costs and associated ICD10 codes can easily be compared against Hierarchical Code Condition (HCC) scores to determine where patient chart audits may be beneficial.

To participate in Shared Savings Plans, Accountable Care Organizations are faced not only with managing the cost of their assigned beneficiaries' healthcare, but also meeting specific Quality Performance Measures. The ACO Solution uses claim line item detail to determine whether those quality measures have been met.

For employer groups, our comprehensive Data Warehouse application is designed to help Human Resource professionals to more effectively manage the health status of their company's employee population. Through identification of employee health risk and cost factors, our system can highlight a number of health and wellness issues. With this knowledge, companies can more effectively implement proactive measures to manage the health of their employees. Drug costs can also be determined down to the specific prescription enabling our clients to decide if a pharmacy benefit program is warranted or a current program should be modified.

Organizations that can benefit from using the Warehouse include:

  • Individual Physician Offices
  • (ACO) Accountable Care Organizations
  • (MSO) Management Service Organizations
  • (PHO) Physician Hospital Organizations
  • (EPO) Exclusive Provider Organizations
  • (IPA) Independent Physician Association
  • (PPM) Physician Practice Management Companies
  • (PPO) Preferred Provider Organizations
  • (TPA) Third Party Administrators
  • Group Practice Organizations
  • (HMO) Health Maintenance Organizations
  • Managed Indemnity Care Organizations
  • Self Insured Employers