Loading...

Solutions

Technology Use Cases

IMPROVING OUTCOMES AND COSTS THROUGH SMARTER, MORE PERSONALIZED AND MORE PREDICTIVE CARE DECISIONS

OPTIMIZED NETWORKS

Build the right preferred provider networks of physicians and facilities optimized for the predicted needs of individual members within large and complex populations. Ensure network adequacy and optimally select providers to improve outcomes and costs. Intelligently design broad and narrow networks for populations and member groups.

INTELLIGENT NAVIGATION

Help individual members choose between different network providers to identify the specific providers best suited for their individual health conditions and unique needs. Guide precision delivery of care by recommending providers across the care continuum ideally suited for members to make best use of available network provider choices.

EARLY PREVENTION

Identify members within complex populations at a relatively increased risk of adverse outcomes or increased future utilization. Enable selective and targeted early application of personalized care pathways to reduce this risk. Prevent conditions during the early stages when they can be targeted with increased success and lower costs.

EFFECTIVE TREATMENT

Deliver personalized predictions of benefit, harm and adherence for members across different available treatment choices. Guide the most effective value-based use of treatments to improve longitudinal member outcomes. Guide pricing of treatments by predicting the impact of these treatments across members in a covered population.

REDUCED FRAUD & WASTE

Discover complex patterns and characteristic examples of systematic fraud, waste and abuse to correct and prevent inappropriate healthcare utilization. Continuously self-learn emerging categories of fraud, waste and abuse to stay ahead of future challenges and flag loss and sub-optimal use of care resources in real-time.

ENHANCED QUALITY

Perform machine learning-based predictive modeling for deeply-phenotyped and risk-adjusted evaluation of provider outcomes across complex and dynamically-evolving patient populations. Deliver actionable insights into understanding key trends affecting quality, outcomes and total cost of care for insured members.

Bitnami