Payer Services
- CareVista, secure cloud-based Platform as a Service, with integrated patient records and end-to-end technology modules
- Population Health Suite with patient identification and targeting using CareSync proprietary logic for revenue maximization and improving quality performance metrics and care gaps
- Value-based contracting design, monitoring and reconciliation
- Population health management intervention program design, implementation and continuous KPI measurement
- Identification of social determinants of health to improve health equity
- Tracking and assessment of quality and performance metrics
- Fraud and abuse evaluation and outlier analysis of claims billing and payments
- Reconciliation and auditing of appropriate capitation premium payments
- Provider profiling with clinical management and treatment guideline compliance evaluations
- Data exchange and integration application tools
- Health outcomes and pharmacoeconomic research and publications
- Clinical criteria development for utilization management and prior authorizations
- PBM contract review and pricing/rebate audits
- Design, training and implementation of care coordination programs with case managers
- Comprehensive population and geographic mapping using medical and drug claims to identify patients and providers for targeted intervention programs
- Technology and vender evaluations and oversight
- Expert RFP/ITN response and reviews
- Regulatory and policy analysis and evaluation
Payers
- Medicaid fee for service and managed care plans
- Medicare fee for service and managed care advantage plans
- Medicare Part D plans
- Employer and commercial plans
- PBMs
- ASOs
- VA and other government payers
- Payment intermediaries
- Insurance companies
- Third party administrators