Delivering savings through deep data and machine learning

Proprietary data management systems designed and architected for automation, scalability, and transparency in the data life cycle for provider, member, services, cost, claims and incentives.

Comprehensive Data Warehouses and Data Marts

Our Provider Warehouse is rooted in a comprehensive service taxonomy to define the mappings for service codes to services/service groups and supports service and cost for professionals and facilities. Our Member Warehouse supports member eligibility, claims, search transactions, incentives and is built for reporting, personalization, recommendations, analytics and business intelligence.

Complete with Data Marts for the publishing of new provider and member data sets, these tools enable our best-in-class data science team to work with data science professionals within our client organizations to predict and present value-based activities to members within our shopping and engagement platforms and services.

Data management for segmentation and optimization

We offer data analytics, management, and reporting to provide accurate information and actionable insights that optimize performance and deliver savings. Data is segmented into defined groups that enable targeted activity events to drive member engagement and personalization.

SmartMatching, Dynamic Incentives & ROI Verification

Using enhanced matching algorithms and machine learning, the CareSelect Data Science system significantly increases our ability to match the providers from the consumers shopping experience to the Consumers claim. This enables the measurement of key performance indicators, the payment of incentives and the identification of soft savings. This, mixed with a dynamic incentives framework that supports both cash and non-cash incentives, enables a strong and verified ROI in every instance it is used together.

Consulting for Extensibility & Configuration

Some clients have established data science practices while others are just getting underway. We offer consulting services to help in either case. We partner with full teams to build more data bridges for richer insights and work as a team to help others stand up insights and BI capability.

We are experienced with a number of challenging data-driven problems including:

  1. Selecting Best-Value, Best-Outcome Providers
  2. Steering Consumers to Best-Value Providers
  3. Predicting Future Care Pathways
  4. Intervening in the Care Journey to Influence Future Pathways

Prediction and recommendation through
engagement and business intelligence

Our 360-degree member engagement program helps drive consumer awareness, education, activation and shopping to get members to the right care at the right time. By understanding the most important behaviors our clients want to drive, we can predict and recommend procedures, providers, and other services to consumers through our CareSelect and SmartShopper platforms to keep them healthy, prevent more expensive courses of treatment from delayed care, as well as close gaps in care. Our predictive modeling capabilities help:

Anticipate Shopping Events

Understand authorized member data to predict what they might need next and present those options in the right channel at the right moment to remove friction from effective care selection.

Develop Shopping & Clinical Care Pathways

Using machine learning and predictive analytics, discover shopping and clinical care pathways so they can be optimized to achieve clinical and financial outcomes.

Encourage Shopping by Enabling Outreach

Members shop when they have a moment of need and the options are easily available. Predicting both the need and the channel helps drive conversion be eliminating friction in care selection.

Identifying Targeted Providers

Support the care journey by mapping quality & cost data to member preferences and claims history. Doing so helps members connect to the right provider for them and their unique care need.

Add New Clinical Pathways by Condition

These evidence-based road maps assist in reducing clinical practice variations. Extend and optimize evidence-based health management practices by identifying clinical pathways in member experience data sets.

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Get a closer look at our data science capabilities and how they can support your measurable member and patient engagement strategies.