Payer Solutions

• Executive Analytics
• Payer-Provider Transparency

• Medical Management Analytics
• Employer Transparency

• Operations Performance Managment
• Provider Network Management Analytics

MedeAnalytics delivers healthcare performance management solutions that improve
financial, operational and clinical outcomes, with compelling return on investment and rapid time-to-value.

Learn more about:

• Client Success
• MedeAnalytics Platform

Transparency has become an integral part of healthcare in the United States. Payers, hospitals, physicians and employers all benefit when information is shared in a format that is accessible and easy to understand. For years, each side has worked internally to remove inefficiencies, reduce costs and improve quality outcomes. Despite these efforts, ongoing challenges—including claim disputes, payment discrepancies, authorizations, case management and practice pattern variations—continue to impair payer-provider relations, adding unnecessary friction and costs. With a renewed focus on cost reduction and quality measurement across the entire U.S. healthcare system, the need for improved transparency and collaboration between healthcare payers and providers has become more important than ever before.

MedeAnalytics Transparency Solutions

MedeAnalytics delivers web-based performance management solutions that enable healthcare payers and managed care organizations to aggregate claims, membership, authorization, pharmacy and call center data into a unified analytics portal that drives both internal decision making and collaboration with provider partners. Key performance indicators, dashboards and benchmarking statistics are shared between payers and providers in an interactive web-based application that increases transparency into administrative costs, practice pattern variations and clinical quality initiatives.

Operations. Operational transparency is key to reducing administrative waste and inefficiency. MedeAnalytics enables payers and providers to share information and collaborate to resolve process bottlenecks, delays, and unnecessary costs in the claims adjudication and operational service areas that drive the majority of administrative costs.

• Track call center performance, volumes and responsiveness
• Insight into claims administration, denials, appeals and turnaround times
• Share member satisfaction scores by provider and facility

Provider Network Management. Improving medical loss ratios and maintaining strong provider relations requires ongoing collaboration and data transparency around practice pattern variations and provider contract performance. MedeAnalytics enables payers and providers to share information and collaborate to track utilization and reimbursement trends, identify practice pattern variations at the facility and provider level to establish potential outliers, and establish meaningful PMPM benchmarks.

• Monitor provider contract performance and reimbursement trends
• Identify practice pattern variations and utilization outliers
• Track member satisfaction scores by provider and facility

Medical Management. The majority of clinical quality and outcomes improvement initiatives require ongoing collaboration and transparency between payers and providers. Disease management, case management and utilization management all represent opportunities for payer organizations to share data and collaborate with providers to ensure quality care and manage risk.

• Compare clinical quality metrics and share outcomes data with providers
• Collaborate on disease management programs and case management initiatives
• Monitor and investigate adherence to evidence-based medicine

The MedeAnalytics Approach to Payer-Provider Transparency

• Suite of clinical, financial and operational solutions for health plan management
• Strategic executive scorecards, personalized dashboards and dynamic analysis
• Healthcare advisory services, data analysis, hospital benchmarking and best practices
• Rapid configuration and ongoing healthcare support services
• Transformation of disparate data silos into a web-based, collaborative intelligence platform
• Software-as-a-Service delivery model requires no hardware, no software and no IT support