Enterprise Analytics & Data Services

Caremetrics offers cutting-edge clinical and financial business intelligence tools, analytics and services that are designed to meet the regulatory and business challenges of coordinating care for complex consumers. Our tools specifically meet the contractual and compliance requirements facing Medicaid, MLTC/MLTSS, Medicare Advantage SNP, dual eligibles MMP plans, global payment models, QHPs and the new generation of government-sponsored and subsidized plans.

We offer a one-stop-shopping General Contractor approach for supporting enterprise care management, revenue management, and ongoing reporting, benchmarking and dashboards.

Analytics and Data Services designed for “High Touch” Models of Care

Today’s commercial off-the-shelf healthcare business intelligence tools regularly fall short in handling the highly unique practical requirements of managing care for complex, government-sponsored populations.

Caremetrics fills this gap.

We help our clients create a longitudinal, 360-degree view of each consumer, aggregating information from many sources—including clinical information, functional skill assessments, care plan notes, laboratory values, and EHR/EMR data, in addition to traditional health risk assessments and claims data—to generate population segmentation models and personalized interventions that fully support the required “high-touch” Model of Care.

Custom Analytics and Data Utility Services.

Caremetrics provides a customizable & scalable database platform for rapid deployment and integration of both standard and custom data sources.

Our data cleansing and standardization service captures multiple conventional and unconventional data sources on a weekly/monthly basis, maps these to a common data schema, applies industry best-practice and third-party risk models, and exports actionable and measurable 360-degree insight in a form that allows seamless integration within our clients’ native workflow applications and processes.

Typical solutions we provide include:

  • Population micro-segmentation
  • Personalized interventions
  • Quality improvement
  • Value-based and Pay-for-Quality contracts
  • Surveillance of emerging risk
  • Prospective risk adjustment accuracy
  • Efficacy and outcomes
  • Medical cost control & UM strategies
  • Performance benchmarking and dashboards
  • Data quality audit and improvement
  • Encounter reporting
  • Audit, compliance & recovery