Reports enable AI-inspired predictive analytics of clinician and network performance
LOUISVILLE, Ky., and MINNEAPOLIS, Minn., August 20, 2019 – Certilytics, Inc. today announced the release of Aspects Reports – Provider Insights V1.0, enabling AI-powered comparisons and predictions of various risk-adjusted cost and quality of care metrics for primary and specialty care providers practicing within provider health systems or health plan configured networks.
Provider Insights V1.0 generates analytic metrics for comparing providers, eliminating current legacy product restrictions to access and compiling data from various historical reporting systems that undermine consistent, valid and actionable comparative analysis, especially when applying risk-adjusted features. Provider Insights V1.0 incorporates Certilytics’ sophisticated predictive analytics that are primarily driven by the groundbreaking BrainstormTM AI deep learning platform. This new offering delivers a robust, transparent view of network-level performance that stratifies clinical practice features and specific providers based on the unit cost to treat comparatively similar services—information critical for risk-bearing entities such as health plans, Accountable Care Organizations (ACOs), provider health systems, and Medicare and Medicaid managed care programs.
“By deploying superior predictive analytics, customers can better identify and reward high-performing providers, enabling the design of high value networks,” said Charles Bloss, Certilytics’ Chief Actuarial Officer. Mr. Bloss pointed out that high value networks effectively must make the best possible decisions regarding the ability of specific providers to consistently deliver the best outcomes at specific price points. “Importantly, Provider Insights V1.0 operates on the most advanced and flexible IT technologies that support data ingestion, processing and reporting on a daily, weekly, monthly, quarterly and annual basis – 100% determined by individual customer needs,” he said.
“Provider Insights enables providers, hospitals, and communities to improve services and outcomes for patients through bench-marking to determine the best comparative performers in a network in terms of quality of care, cost and billings,” said Vijay Srinivasan, Certilytics’ Chief Clinical Officer. “It drives patients toward the most efficient providers with the best health outcomes.”
Further, with legislation around transparency in healthcare costs currently making its way through Congress, Provider Insights healthcare cost transparency analytics and reports can help lower overall costs, as well as help clinicians identify low-cost AI-generated “care pathways” to enhance patient outcomes, reduce exposure to costly billing audits and medical cost management oversight.
Additionally, Provider Insights can be used to:
- measure the quality and cost implications of Primary Care Provider referrals to specialists
- assist ACOs in finding the right balance of specialists-to-care for patients with chronic conditions
- empower employer groups and brokers to design high value networks, evaluating network design, construction, and the cost-of-care for enrollees
- create tiered co-pay products that guide patients to quality, low-cost providers
- support provider contracting efforts, whether renegotiating fee-for-service rates, evaluating the status of value-based contracts or identifying median in-network rates for non-par provider reimbursement disputes, including “surprise medical bills”
- identify and financially forecast opportunities in a network where alternative reimbursement arrangements will generate the best ROI
- support independent organizations, policymakers, researchers and stakeholders with fair and unbiased bench-marking reports
Provider Insights is part of Certilytics’ Aspects solution suite, which also includes data visualization through Dashboards, patient-level risk profiles through Forecasts, and a comprehensive set of Reports to help with stop-loss underwriting, pharmacy management, and opportunity analysis.
For more information about Provider Insights, please reach out to us at contact@certilytics.com.
About Certilytics, Inc.
Certilytics, Inc. provides sophisticated predictive analytics solutions to major healthcare organizations by integrating financial, clinical, and behavioral insights. Customers use the solutions to price and mitigate risk with precision and confidence, creating unique value for data scientists, actuaries, developers, physicians, nurses, and patients. Our clients see the future through data using our advanced technologies, including the BrainstormTM AI deep learning platform, our library of predictive models, and the CORE next-generation clinical episode grouper.
Our Healthcare Predictive Data Analytics IT Technology Platform is adopted via remote hosted deployment or onsite within each customer’s IT infrastructure, and is configured using the latest Hadoop and open-source technologies to ensure scaling. Certilytics is a closely held private company that was launched through an innovative product development and partnering arrangement with two national healthcare organizations. Certilytics is headquartered in Louisville, Ky., with a national footprint of employees and customers.