Today, Certilytics released CORE Grouper, a next-gen clinical episode grouper that applies sophisticated machine learning to the clinical classification process.
CORE Grouper represents a major advancement in episode-of-care-based grouping, optimizing data for analysis and providing unprecedented insight into the clinical and financial attributes of a population for over 450 unique conditions.
The CORE Grouper enables clinical and financial analysts to identify, report, and benchmark cost trends, treatment patterns, condition severity, and health outcomes.
CORE Grouper is built on Certilytics’ proprietary DL&M Pipeline and organizes disparate data sources at the lowest grain into condition- and episode-based groups, allowing analysts and actuaries to review program performance, explain risk, and report on costs and utilization across billions of records.
“Part of what makes CORE unique is how we deal with time,” said SVP & Chief Actuarial Officer Charles Bloss. “For example, if 10 years of claims data was fed to a legacy solution and you asked for a report on 2018, they would only look at 2018. CORE goes further, looking across all available claims history to build insights about the period of analysis.”
Through CORE Report, customers are provided their enriched and grouped data through an episode-based patient-level retrospective population profile, allowing analysts, actuaries, and data scientists to review performance, assess risk, and analyze spend. Output is available to customers through automated delivery to support enterprise reporting efforts, but customers are also offered the flexibility of ad hoc reporting through the CORE User Interface. Analysts, actuaries, and data scientists can use this information to review performance, assess risk, and analyze spend.
CORE Grouper also has an online portal for requesting on-demand reports for specific subpopulations. Like all of the online tools built on the Certilytics Application Platform, the CORE portal supports SSO and white labeling ‘out of the box’ for easy enterprise adoption.