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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 configurable, drill-down dashboards 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)