Provider Intelligence
Provider Intelligence
The Provider Intelligence solution enables health plans to insightfully reduce provider operational costs and increase the speed of network initiatives. Through the use of a configurable, drill-down dashboard, health plans can transform dormant provider data into actionable insights. The core focus areas include: recruiting, network analytics, workforce performance, credentialing, contracting, reimbursement and selection audit.
Business Challenges
- Cost reduction and process maturity impeded by limited analytic insight
- Executive and managerial provider management visibility is limited due to historical process analysis
- Increased SLA management risk due to limited root-cause analysis for process bottlenecks
- Fragmented data impedes trend and forecast capabilities
- Difficulty modeling the impact of new provider initiatives due to limited provider data analysis
Key Features
- Increased productivity through rapid resolution of process bottlenecks and workload balancing
- Rapid and multi-dimensional provider profiles, demographics, geography, specialty, quality, etc.
- Flexible provider segmentation: products, networks, efficacy score, accepting patient types, etc.
- Comprehensive network profile analysis: access, provider mix, quality, performance, etc.
- Increased transparency of clinical program efficacy through performance management analytics
- Configurable target operations: feed monitoring, transaction statistics, event data, selection, etc.
- Analytics for provider contract inventory management, standards adherence and clause distribution
Key Benefits
- Administration cost reduction through process improvement
- Increased staff performance and efficiency through increased visibility
- Accurate regulatory compliance and reporting
- Increased accuracy of trending and forecasting
- Increased speed to market of initiatives (e.g., new networks/products, care and payment models)
Solution(s)
